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| Three Strikes, and You’re OUT: A Nurse Practitioner Feels Patient Entitlement is Increasing |
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by Kimberly Spering, MSN, FNP-BC - August 26, 2010
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 Provided by Clinician 1
I had a blog made up for this past week.
I went on vacation, so I started a blog about how I was rejuvenated. Then I re-read it and thought, “BORING!” Which is one thing that I strive NOT to do to readers. (smile) So, back to the proverbial drawing board.
Then, as always, “life” got in the way. Busy with work, and my boss being on vacation. The craziness with patients (no surprise there). Trying to swim above the tide while not over-stressing myself. After all, I JUST came back from vacation...I should be relaxed, right?
Well, sure, I was...for the latter part of the vacation week away. It took a few days for me to really relax. We didn’t spend it in a hospital like we had three years ago when my husband had bilateral pulmonary emboli (but misdiagnosed as pneumonia, then re-admitted at home...but I digress). I still thumb my nose at the hospital in New Jersey as we drive by on our way home.
However, what struck me anew this past week was the amount of patient “entitlement.” And pure old nastiness to my staff. I’ve seen this increased in recent months...perhaps the past year or so.
Whatever happened to the old adage, “you get more flies with honey than vinegar?” I would NEVER talk to someone the way some of these people talk to my staff! Perhaps that’s why I’m so amazed when someone is polite...including staff in other medical offices.
A few weeks ago, a new male patient, in his later 40’s, came to our office to meet with the doctor. No care in many years, and a believer in Chinese medicine. He was rude to my front staff, made my MA student cry when she asked if he was there to see Dr. B. or me (“if I wanted to see the G-damn assistant, I’d schedule to see one, NOT the doctor”), and told her that he “had a stock of machine guns and grenades” when asked if there were any guns in the home (a routine question we ask for safety). Rude ALL around. My collaborating physician addressed his behavior to the staff, told him in no uncertain terms that it would not be tolerated, and oh-by-the-way, while he could choose to see HIM for routine care, sick visits would be scheduled with whomever was available – the Dr. or the NP. The patient settled down, admitted he was “nervous about the visit,” and apologized.
Fast forward to Wednesday...he called and complained that the SAMPLES of Avelox he had been given for his cough were no longer helping. He wanted MORE antibiotics called in. I reviewed the doctor’s notes, taking notice that he felt the patient had ALLERGIES more than anything, and sent a triage back to the staff to tell the patient to try Flonase and Claritin. The patient’s response was to scream at my staff, “NO, NO, NO...it is NOT allergies! I DEMAND to speak to your DAMN NP NOW!”
Oh...nothing like hearing THAT to make me decide to make him WAIT...until the end of my late night of patients before calling back.
Those who know me best say that when I am furious, I become exceedingly polite, clipped, and to-the-point...without any soothing words or “frills.” It’s what I call my “drill-sergeant” voice. I called him back, told him that I had received word of his call, but I needed to finish patients before calling him back. I had already reviewed Dr. B.’s note, and I was going by what his directive said. I also did not appreciate his tone with my staff. He didn’t answer my last comment.
“My physician friends told me to try Benadryl, and it didn’t work. That’s how I know it isn’t allergies,” was his response. I felt like saying, “Gee, why didn’t your PHYSICIAN FRIENDS treat this, then?”
Instead, I answered, “Well, now, if the Avelox didn’t work, why would you want to repeat it, for a cost of about $180,” knowing he had a high deductible. He was silent.
“If you REALLY think this requires an antibiotic, why not treat it with one that is generic and specific for the sinuses?” I asked him. “Plus, increase your sinus rinses to twice daily, and go back on your Mucinex. Personally, I would add the Flonase to help open things up as well.”
He agreed, but I also added that if he was not improving, he would need a follow-up visit. Not once did he “give me any lip.” Maybe it was my tone...and he got his antibiotic, whether or not he really needed it (another story, I know). Was I in the mood for more arguing late at night? Not really. Those patients, I’ve learned, won’t change. However, there is now a note in his chart that says, three strikes, and he will be kicked out of the practice. I will not tolerate any more abuse of the staff.
Now that I’ve been in this practice almost two years, I feel that I have enough security to use my leverage to dismiss a patient from the practice. My boss has told me to do so many times in the past, but I never felt I could. This last patient, however, has given me the confidence to stand behind my staff and pull no punches for the next incident. How sad that it actually may come to pass one day…
 Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| sterling sherwood (new london) |
on 30 Apr 2011 at 7:55 pm |
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| I am so tired of seeing nothing but how staff is abused. My Mother was verbally and physically abused while at Samaritan Hospital in Ashland Oh. Would not listen to Her and had treatment done against Her will while She screamed in pain. If I would have had a recorder people would be behind bars. Nobody cares about what a hospital does to patients, they are above reproach. |
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| gogi (Texas) |
on 11 Apr 2011 at 12:28 am |
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I totally agree that patients need safe care and respect. However, when will the American public realize that hospitals are not hotels. Nurses are not maids/butlers. We are not there to fetch, fetch, fetch.
The hospitals are doing this because Joint Commission will now evaluate hospitals according to patient satisfaction. Well, patients will not be satisfied, no matter if the nursing director puts on some grass and hula hoops for the patient. |
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| frustrated (tennessee) |
on 03 Apr 2011 at 4:56 pm |
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| Well, our clinical director goes down the hall at our hospital everyday and asks our patients "How is your nurse treating you today?" How about that! How would that make you feel and what are your responses? |
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| Nancy (Michigan) |
on 04 Sep 2010 at 11:12 am |
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| You're very fortunate to work for a Dr. who backs you up. The facility I work at is all about Pt. Satisfaction, here it's 3 strikes and YOU'RE out. The pt. and family are never wrong. It's like you stand there naked and no manager will hand you a towel. For 32 yrs.I've loved pt. care but now I'm just trying to bite my tongue for 4 more years. With a bad back and stress related depression I've now become my own pt. |
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| JL (Vancouver, WA) |
on 01 Sep 2010 at 3:28 pm |
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| Mr. Boren, you need to get off your pedestal (is that spelled correctly for you or not?)! Is it so hard for you to realize that Kim is just venting about some of the frustrations in the practice of medicine? It doesn't mean we aren't professionals or don't enjoy medicine. Some of us may find the scenario familiar and relate to it. If you don't then good for you. Move on. Some of us find it helpful and enjoyable to share thoughts and ideas with our colleagues. Apparently you can "easily handle" your patients while the rest of us struggle with our human side through some of ours. |
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| fc (tucson, az) |
on 01 Sep 2010 at 2:02 pm |
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while i agree that there are many, many more entitled patients seen as the years pass along, it is my impression that often it is the younger set, especially young women, whose complaints can be endless and whose tricks beyond mind-numbing. but, naturally, this white female nurse practitioner simply HAD to writed about the awful MALE patient that was seen in her office, even though, apparently not even by her.
further, since it is a QUESTION on our patient questionnaire, why would his answer about guns be considered odd, especially give the lunatic states/state laws that exist in many states that make such a description as his the norm, rather than the exception.
also, even as a long-time nurse practitioner, if this , and you don't indicate knowing one way or the other, had called your office expressly requesting a physician visit, his response, with the exception of swearing isn't so far out.
while they certainly don't earn a great deal of money, it is quite, quite the norm for the nearly 100% FEMALE desk staffers to act utterly annoyed while dealing with patients (including those decades their senior), be rude themselves, be disrespectful, act as if they are on some sort of power trip, e.g. "go sit down.", and engage in any number of behaviors that have over the course of treatmen for a 11/2 year injury, made me on many occasion either retort curtly to them, tell them to speak to me in an appropriate tone, drop the attitude, and opther necessary balancing comments. now, thisbehavior, per my intentional observation, seems to be directed much, much more frequently at male patients of ANY age than at female patiens, and is in itself as vile, if not MORE vile thn what this one MAN (naturally) said.
regarding this man, is it not possivble or even evident hat he has isues which are distressful to him in his life that this behavior are symptomatic of? also, were he an 80 year old woman, would you feel compelled to speak so and want him treated as punatively s you did/do? i higly doubt it.
the nursing world and its allied staff associates are female worlds that just LOVE to act as artivcles about men are written in gossip magaizines. that is, men are jerks, pigs, obnoxious, etc., etc., etc.
you, as a treating clinician, should have the inner stance to better understand the motivations of one who would act as this man did, and delve more therapeutically into it, instead of write a women's magazine article about yet another rotten man.
believe me, there are PLENTY of bad-acting females in the medical world, too. manipulative, unendingly complaining, etc. as any provider knows, who is not overlty female-centric, male patients are, as a rule, ten times easier to deal with than the average female patient. |
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| JoAnna (Massachusetts) |
on 01 Sep 2010 at 11:00 am |
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| I was so excited to read this, because I thought it was just me who saw an increase in "entitlement"......In a nutshell, I have been a nurse for 13 years in excellent standing...I am very understanding, educated in my area of practice, and extremely empathetic to my patients. I worked for a non-profit continuation of care facility...there is independent living, assisted living and long term care living on the premises.....The facility caters to very wealthy individuals. I worked on the sub-acute unit. One of my patients was there for a couple of weeks to be monitored fo afib......she made it very clear from day 1 that she didnt want to be there, but instead would rather be in her townhouse which was on the premses.....she was very nasty to the staff and ungreatful of anything anyone did for her. She made it very well known that she was a "large" financial contributor to this non-profit facility, and "paid alot of money" to live there, therefor, the staff should be at her beck and call every second...which we were. One day, this patient put her call light on and asked the assistant to "see the nurse" ( me ) when she got a minute. The assistant knew I was tied up with another patient at the time, and didnt tell me right away....a while later I was told she wanted to see me. To late....the patient came to me at my med cart literally screaming at me in front of visitors, patients and other staff telling me how incompetent and unattentive I am as a nurse. She said, " if you think I'm not reporting this young lady think again and you will not have a job when I'm done with you". I smiled at her holding in my embarassment in front of the onlookers and nicely said to her I will be right there. as I mumbled to myself........guess what...she reported "her wait" to the CEO on monday morniing. Being a facility that is dependent on financial contributions to cater to, what I now refer to as the "entitled" , my job was mysteriously " eliminated"........Human resources response to me was" we are so sorry, but Ms.C. just isnt letting this issue go..............So yes you are right that people are becoming and feeling as thought they are "entitled" to whatever they decide they want in the healthcare setting wheather its simply an immediate response from a nurse or a medication that "they" have determined is what is right for them regardless of the healthcare professionals education and expertise. Thank you for sharing your blog. Sincerely, JoAnna |
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| daschuhow (Branson, Missouri) |
on 31 Aug 2010 at 9:05 pm |
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Kim, I'd ignore the above piece. Most blogs are not written to be published within a journal or to academic standards, thus the need for grammar/ syntax, etc is not necessary because we are talking verbally. No one talks like they write. A blog is a place to share your thoughts with others and I appreciate your candor about your perception of the situation. We all need a place to discuss those issues that take place in our work setting without having to fear repercussions from others. It called a peer to peer supervision. A safe place to bounce off to others about our problems and get feedback if we are out of our scope of practice or to get ideas from others about how to handle a situation.
It is understood that your blog is not shared with the general public. |
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| Shawn Franklin (Dallas, Texas) |
on 31 Aug 2010 at 8:20 pm |
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| First of all, I commend Kim for sticking up for herself and her staff and do not for one moment believe her intentions to be immature. I am an RN in home health and have worked in the hospital for several years. I also know what it is like dealing with demanding patients on a daily basis and will not tolerate rude, abusive patients. Not saying that I am being unproffessional or as you say, immature and inexperienced. For many years health care professionals have been in front of the gun when dealing with the public. Some have been verbally, emotionally, and physically abused. If we, as the front line of health care, continue to ignore this abuse, it says to the public that they can treat us any way they want and get away with it. Kim did not say she had been unprofessional, in fact she did express being assertive, professionally, and not returning the abuse in which she and her staff was forced to endure. Also, her manner of writting this article is very appropriate to me. You should step into the new world and stop criticizing people for the way things are today. So there were fragments or even slang in lamin terms or maybe even misspelled words. The key is the point she is trying to make. If I understood exactly where Kim was coming from, I know you did too. Kim, yeah for speaking out. |
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| C Dever (Amarillo, Tx) |
on 31 Aug 2010 at 5:48 pm |
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| @ Jon...I think that you have too much time on your hands and way too much access to a thesaurus.. |
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| Jon Boren (Santa Fe) |
on 31 Aug 2010 at 1:51 pm |
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The caliber of writing displayed here is appalling. There is nary a complete sentence in the entire "piece" as it were and the syntax is horrific - a function of the modern age, texting and such. I would expect a great deal more from an educated medical professional, particularly one who teaches.
And why tell us that you strive NOT to bore readers? Would that intent not be presumptive for anyone who is writing a public piece regardless of where it is to be viewed? Does anyone really care about your intention? Perhaps you should just NOT bore us versus telling us your intent NOT to bore us.
Hearing about your "boss" and "thumbing your nose" at a hospital as you drove by secondary to a perceived poor experience, your "drill sergeant tone of voice" etc. are things that you write in a journal and keep in your bedside table or perhaps might be reserved for girlfirend chit-chat or the senseless end-of-day blather that one bores a spouse with.
Difficult patients are a part of every practice. Competing with them, patronizing them, approaching them with finger-wagging threats of "three-strikes" and acting like a junior high school hall-monitor reflect a great deal of immaturity and inexperience on your part. I have practiced in a very broad variety of clinic settings over 15 years ranging from HMO Urgent Care to multispecialty integrative clinics and chronic pain management in a very rural, poor, area of the country and have seen every imaginable sort of patient from extremely demanding, wealthy people with sore throats to down-trodden, dirty, edentulous narcotic-dependent pain patients and have only advised one person that I would no longer be able to see him. The rest can generally be easily handled without the kind of histrionics your piece smacks of if you are a modestly gifted communicator and can find a way to become a bit more sophisticated (Greek root + worldly) emotionally. The combination of content (was anything taught here versus some journalistic rant?), tone, and abysmal writing is really quite embarrassing to me - it would be fine on some blog or other but not in association with a trade journal such as Clinician 1. |
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