I try to be nice and pleasant to everyone, until it's time not to be. One of my young co-workers has a tendency to rail (volubly) when there seems to be an over-abundance of career drug seekers in the department. This makes her furious. I keep my mouth shut and vent my frustrations in obscurity. There is nothing I can do about it anyway, so I direct my energy elsewhere.
"She will get into trouble with that mouth, one of these days", observed another co-worker. She has a tendency to mouth off in areas where patients and visitors can hear. She has not yet learned that there is absolutely nothing she can do about it.
Most of the time patients are told by the provider that they can take tylenol or motrin for their pain. The provider will then leave it up to the nurse to get the signature on the discharge instructions, whereupon the patient will be pissed and continue to argue for narcotics. It is not so much education oriented as it is getting through the instructions, getting them to sign, and having them leave. With a minimum of bullshit. This is not always the case.
Me: "I have your instructions and will go over them with you now". The alleged injury was minimal.
Unhappy Patient: "So all I'm getting is Motrin? I explained how bad my pain was, this is bullshit". The patient had not iced, elevated, or taken OTC pain killer in several days.
Me: "Yes, I'm sorry you are not happy with the medication the doctor has prescribed. Perhaps if you use it the suggested three times per day as directed, and be sure to take it with some food so it won't irritate your stomach"
UP: "Motrin is not a medication! I've been taking motrin, it does absolutely nothing for the pain, this is bullshit. There has to be something really wrong for it to be this painful". Patients frequently forget the timeline of their own fiction.
Me: "Yes, I understand. Also, in addition to the Motrin, you should rest it as much as possible and use ice on it 20 minutes at a time. Elevating will help minimize or relieve any swelling, which will also facilitate healing"
UP: (getting louder) "This was a waste of time! Nobody cares about my pain! This is bullshit". The security guard now makes his presence known in a casual manner, but an obvious presence nevertheless.
Me: "Yes, I'm sorry you were not happy with the care, sir. Please follow up with your own provider if the condition does not improve or gets worse after following these instructions. Also, please lower your voice as we have a zero tolerance policy on shouting and cursing. I hope you feel better soon. Please sign here, and this is your copy"
I do not encourage too much discussion. What is the point? I do not egg them on. I do encourage them to complain about their dissatisfaction (in writing) to my boss/administrator/CEO. I stay pleasant and noncommittal. My co-worker frequently makes the mistake of either being defensive or confrontational. This is not a practice that is healthy for anyone.
Often the patient will refuse to sign, frequently accompanied by:
1. Throwing the discharge instructions on the floor and stomping out of the department on the affected, excruciatingly painful ankle.
2. Stomping out of the department after throwing the discharge instructions on the floor, and then stomping back in to demand the name of the treating provider, which was printed on the instructions. I helpfully circled it after retrieving from the trash.
3. Storming out of the department while loudly complaining on the cellphone what bullshit the patient had been subjected to (with the excruciatingly painful elbow) and then having to return to ask for the phone charger he left in the room.
One patient demanded both a new doctor AND an new nurse, as she did not consider the bedside manner up to her standards based on her past innumerable visits. That nurse was not my mouthy co-worker, oddly enough.
I had inexplicably become the week's IV Ninja, having been asked to start a number of difficult ones. Apparently I am more accommodating than Best Paramedic on the Planet who always seems to have 5 (minimum) other tasks to accomplish before he can get to it. I have learned to trade tasks, such as requesting vital signs or medication for one of my patients. This usually works well.
I came out of the 3rd room within 45 minutes after my latest success to, "Did you get it? Did you get the labs?" Yes, and yes.
"But I think that's it", I said. "I am probably out of Hail Mary's for the day, maybe even the week."
"Indeed", said Partner sagely. "Like heartbeats, there are only a finite number of miraculous IV starts. You never know when it will be your last, grasshopper".