7 Tips on How to Handle Difficult Patients

7 Tips on How to Handle Difficult Patients

7 Tips on How to Handle Difficult Patients

Working as a nurse means dealing with different kinds of patients, even the rude ones. You must know how to handle difficult patients to become an extraordinary nurse. 

Why are some patients rude?

Several factors make a patient hard to handle. It could be due to the stress of the illness or the tensions they feel from being inside a hospital. Sometimes, patients can be distressed, angry, scared, demanding, or have unrealistic treatment expectations for their needs. However, some of these behaviors may also be due to their past experiences in terms of medical treatment. 

How to Deal with Difficult Patients

As a nurse, you cannot avoid patients that can test your nerves. However, you can also find ways to deal with them. Here’s how:

Tip 1. Don’t fight fire with fire.

One of the first things you must understand is that patients are sick and need your help, not the other way around. As a healthcare professional, you must try not to respond in anger or reactive behavior; keep your professional face on. A patient’s offense may not originate from when they were at the hospital but perhaps triggered by something that might have happened in their life. Try to be as patient and understanding as you can. Showing respect is still the right thing to do. 

Tip 2. Listen to them.

Sometimes, an angry patient will tell their story once they have calmed down. Showing concern for a patient is one of the best ways to calm someone who is being difficult. When they do, give them undivided attention and listen to what they are talking about. Be sure to collect your thoughts before speaking to them too. Address them by their first name, acknowledge their concern, talk slowly and maintain eye contact when talking to them. Avoid mirroring their words; this could trigger them and may even turn defensive again. 

Tip 3. Take note of your body language.

Sometimes, actions speak louder than words. That said, be mindful of your body language when dealing with a difficult patient. When a patient is angry, they will also find a way to push your buttons. In return, you become mad yourself. It will be easier to deal with a difficult patient if you do your best to remember not to take it personally.  Being mindful about how you react is crucial. It will also help you choose the right words to say, use the tone of your voice, body language, and overall response. 

Tip 4. Acknowledge the situation at hand. 

Learn to acknowledge the situation. Most importantly, recognize how your patient feels. You can start by saying, “I understand how you feel” or “I feel like we have a misunderstanding.” As you do, keep your feelings aside and stay calm. Avoid using negative words that could escalate the situation. 

Tip 5. Setting the boundaries. 

Patients go to the hospital because they need attention, no doubt about that. However, if you keep giving in to their demands, how can you give attention to your other patients? Be clear with your boundaries. Let them know that their abuse is unacceptable. Make sure to set a time limit, say 15 minutes, then tell them you will see them in the next 30. As you continue to practice this with them, they will soon realize that you have a busy schedule and empathize with your situation. 

Tip 6. Provide a Patient’s Satisfaction Survey.

This survey will allow your patients to share any of their concerns. Tell them that you value their feedback seriously. It also prevents them from leaving bad reviews online. 

Tip 7. Stay proactive.

There is no use ignoring the problem. Avoiding a problematic patient won’t work either. So stay proactive, acknowledge your patient’s situation, identify the source of their anger, and be sure to implement steps to de-escalate the problem. The more you understand the case, the better it is for you to handle difficult patients. 

Your Takeaway

There will always be unruly patients wherever you go. They will come to you with various ailments, mood disorders, fears, and other complications. You must also understand that they come from diverse backgrounds and live different lifestyles that you may disagree with. But it is part of the job, after all. As a nurse, stay professional; you were trained in this field, so use your nursing knowledge and abilities to provide them with the quality care they deserve. 

 

 

EP 174: Best Healthcare Coverage For Nurses With Zack Young

EP 174: Best Healthcare Coverage For Nurses With Zack Young

Best Healthcare Coverage For Nurses With Zack Young

Every travel nurse and healthcare professional must find the best healthcare coverage. But did you know that there are different healthcare coverage that you should know of? What’s the difference between healthcare insurance and healthcare coverage?

Health coverage includes preventive medicine, prescription drugs, and ER visits, while health insurance covers your medical services. Now to get a clearer picture, let us welcome our guest for today’s podcast, Zach Young. 

Zach Young is a health advisor helping traveling healthcare workers find affordable coverage! He loves passive income projects and setting up financial freedom. If you want to do the same and learn more about health coverage, join us as we tackle another exciting episode for Cup of Nurses. 

QUESTIONS FOR GUESTS

The questions below are some we’d like to tackle. We always go off-topic, so we don’t expect to hit them all. If you have any ideas, please let us know.

We look forward to our conversation!

  1. Can you tell us a little bit about yourself? 
  • What is a Licensed healthcare advisor? 
  • What made you get into health advising?

2. What does health mean to you? 

3. Why is it so important to have the best health care coverage? 

  • What are some common misconceptions or questions you get asked about health coverage?
  • Speaking for the travel healthcare professionals that don’t have coverage from the hospital, what are our best options?
  • Why should I get health coverage even as a young, healthy 20-year-old?

4. How has being a licensed healthcare advisor helped you throughout life? What are some things you take away from it that you incorporate into your daily life?

5. You’re big into time. We can see it’s important to you; how do you maximize your time, and how do you do it?

6. You’re into other ventures and want your money to work for you. Do you invest in anything? 

ENDING QUESTIONS

Before we end the show, we have one last question we like to ask all our guests.

If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why?

Connect with Zach through Instagram at @youngz1220 and Facebook page at https://www.facebook.com/zachary.young.549 for more on healthcare insurance coverage!

Want to have that financial freedom? Click on the full episode here. 👇

TIME STAMPS:

00:00 Introduction
01:39 About the Guest
03:04 What is being health
04:36 What is the problem with our current healthcare?
09:36 Where does the expenses coming from?
12:31 What is the best coverage?
14:31 The pros and cons as a health advisor to medical professionals
19:20 What does Pre-authorization mean?
20:49 Why hospital expenses has gone up?
2:29 Things you should be looking at in a health coverage
24:25 What does a Co-pay mean?
28:06 Talking about Universal Care
31:52 Insurance Tax
35:29 What does the future of healthcare looks like?
38:07 What other things that you do?
39:33 Leveraging Time and Money
44:58 The value of time
47:08 The emerging education system
49:51 Wrapping up the episode

5 NCLEX Myths That Are Holding You Back

5 NCLEX Myths That Are Holding You Back

5 NCLEX Myths That Are Holding You Back

Are you planning to take the NCLEX but there are NCLEX myths that are holding you back? If this is the case you are facing right now, this post will help debunk their reasons. Here are the most common NCLEX myths that you’ve probably heard of.

Myths About NCLEX

Myth 1. The length of the NCLEX exams matter.

Many test-takers believe that the more questions you answer, the more likely you are to pass the exams. However, this is not always the case. 

The NCLEX has a maximum of 265 questions [1], and if you get to answer them all, the myth says you’ve failed. On the contrary, reaching only around 75 questions means you’ve passed. 

While this may sound believable, NCLEX does not work that way. The length of the exams has nothing to do with you passing it. Instead, the length of your exam is based on how you are answering the questions. If you have answered correctly, the test presents you with more complex questions. The easier the questions means you have answered incorrectly. Your exam will only stop when the computer has determined your competency level. 

Myth 2. You have to be computer savvy to take the NCLEX.

Even if you don’t have computer skills, you can still take the exams. The test administrator will brief the test-takers on how they can answer the exams on the computer and work through a tutorial. In this tutorial, you are taught how to use the keys and record your answers.

Administrators will also teach you how you can answer test questions that do not require a multiple choice. So, don’t worry; the main thing you need to use during this exam is the space bar and cursor to highlight your answers and lock them. It will be a piece of cake!

Myth 3. NLCEX in other states is easier.

One of the many NCLEX myths that are holding you back is the idea that NCLEX examinations vary from state to state. In case you are planning to take this exam in a different state because it’s “easier”, stop right now!

It is not true though, keep in mind that this exam is a national exam. It means that the one you are taking is the same as other nursing students in other states. NCLEX is used nationwide, so it doesn’t matter where you take it. It is still the same exams wherever you choose to take it. 

Myth 4. The “select all that applies” answer shows that you are doing well in the examination. 

Among NCLEX myths, this one is probably my favorite. According to gossip, the more “select all that applies” or SATA choices given to you mean you are passing the exam. But are you, though? 

Again, this is not true as it could be subjective. Some may have ten SATA answers, while others may have more.  However, the best thing to do is focus on how you answer the examination and not on the types of questions you are getting. Do your best and answer all questions to the best of your ability. 

Myth 5. It will take a long time before you can reapply for an NCLEX exam.

Absolutely not; you have 45 days till you can apply for another NCLEX examination [2]. And this is enough time for you to study for the tests again. If you failed on your first try, the nursing board would send you a CPR or Candidate Performance Report. 

This report will show you which exam areas you should focus on more so you don’t have to repeat the same mistakes. It shows your strengths and weaknesses as well, which helps assess yourself. CPR also breaks down your performance and shows if you are above or below the passing competency level. 

Don’t Let the Myths Take You Down

Now that you know five of the NCLEX myths that are holding you back, go ahead and sign up for the examination. Don’t just believe the myths. Give it a try and see how you do. If you fail, do not worry, you can always try again. You just have to figure out if you are on the right track or not. We hope that our list helped you identify these myths so that you can take the next step towards your RN license, good luck! 

 

EP 173: Determining Fluid Status in Patients

EP 173: Determining Fluid Status in Patients

Determining Fluid Status in Patients

Maintaining the correct fluid balance in the body is crucial to the health of our patients. Knowing how to check for fluid status in patients will help determine if they are overhydrated or dehydrated. That said, learning how to determine fluid status in your patients is essential, and you will learn all about it in this post. Assessing a patient’s fluid status is a critical skill you will regularly do as a nurse. It involves evaluating if a patient is hypovolaemic, euvolemic, or hypervolaemic.

Hypovolaemia vs Hypervolaemia 

Hypovolaemia refers to a deficit of fluid in the body. Causes include:

  • Poor fluid intake.
  • Excessive fluid loss (e.g., vomiting, diarrhea, hemorrhage, excessive diuretic therapy).
  • Third, space loss of fluid.

Hypervolaemia refers to an excess of fluid in the body. It is also known as fluid overload. Hypervolaemia is expected in the elderly and those with renal or cardiac failure. It can be caused by excessive fluid intake or inappropriate fluid retention (e.g., heart failure, renal failure). It is also why checking patients’ fluid status is crucial. 

Assessment Findings Determining Fluid Status in Patients

  • Bleeding from any source
  • Vomiting: frequency, volume, presence of blood
  • Stools: frequency, volume, presence of blood
  • Fever and diaphoresis
  • Urine output: color and volume
  • Heart rate
  • Lung sounds
  • Pre-syncope/syncope
  • Mucous membrane – Wet or dry?
  • Skin tugor – skin tenting 
  • Capillary refills <3 seconds
  • Oral intake
  • Daily weight 
  • Fluid restrictions
  • Fluid overloaded symptoms:
    • shortness of breath
    • Orthopnoea
    • paroxysmal nocturnal dyspnea
    • leg swelling

Labs of Fluid Status in Patients

  • Full blood count – May reveal raised hematocrit in hypovolaemia  
  • Urea and Electrolytes – Urea/creatinine will be raised in hypovolaemic patients and those with acute or chronic renal disease. Electrolytes such as sodium may be low in hypervolaemic patients (e.g., dilutional hyponatremia).
  • Urine and Serum osmolality – consider if suspected SIADH or DI. 
  • BNP is a marker of cardiac stretch under the effect of fluid overload.

Passive leg raise

If a patient has a blood pressure cuff, and you want to see if the patient will be fluid responsive, a passive leg raise is easy to check. Passively raise the patient’s legs to at least 45 degrees and check a patient’s blood pressure before and after the leg raise.

You can also lift the foot of the bed and see if there are changes in the blood pressure. This motion acts as a mini fluid bolus because you are forcing the blood to go from the legs into the core. 

Orthostatic 

Orthostatic hypotension, also called postural hypotension, is a form of low blood pressure that happens when standing after sitting or lying down. To check orthostatic:

  1. Have the patient lie down for 5 minutes.
  2. Measure blood pressure and pulse rate.
  3. Have the patient stand.
  4. Repeat blood pressure and pulse rate measurements after standing for 1 and 3 minutes.

A drop of 20 mmHg in the systolic is supportive of hypotension.  

Jugular venous pressure (JVP)

JVP provides an indirect measure of central venous pressure. The Internal jugular vein runs between the medial end of the clavicle and the ear lobe. 

To check this position, see that the patient is in a 45-degree place, turn their head slightly to the left, and assess the vein. 

A raised JVP indicates the presence of venous hypertension/hypervolemia. It can also be indicative of Right-sided heart failure. 

Patients with a Central Venous Pressure (CVP) 

These patients have access to the central venous system and peripheral arterial line. When you have a Central Venous Pressure (CVP), you can measure the patient’s preload. That will directly correlate with the patient’s fluid status. 

A CVP is good for checking where your patient’s fluid level is moving. A normal CVP is between 8 to 12 mmHg. 

Systemic Vascular Resistance (SVR)

If you don’t have a Swan, you can still check and SVR by Non-Invasive Continuous Measurement. SVR is the afterload, the pressure the heart is working against to push blood across the body. A normal SVR is between 900 and 1440 dyn/s. If your SVR is below 900, you will be more dilated vascularly; if above 1500, you will be more clamped down. 

So if you have a patient that needs fluids, you will have someone with a high SVR because the body is clamping down to increase volume to help maintain blood pressure. Maybe your patient is low BP, but the SVR is down, well, that can be a sepsis issue, and we can fix the SVR with vasopressors. 

Swan-Ganz catheterization

Swan-Ganz catheterization is also known as right heart catheterization. The tiny catheter is placed into the right side of the heart and the arteries leading to the lungs. This catheter monitors the heart’s function, blood flow, and pressures in and around the heart. 

One way to check fluid status on a Swan is by looking at the cardiac index. The index relies on cardiac output and turns cardiac output into a normalized value that accounts for the patient’s body size. A normal Cardiac Index is 2.5 – 4.0L/min/m2

Here’s how you can determine fluid status in your patients correctly. Click here for the full episode 👇

TIMESTAMP:

00:00 Introduction
01:21 Hypovolaemia vs Hypervolaemia
03:36 Assessment findings to determine fluid status
13:28 Passive leg raise
15:13 Orthostatic
17:02 Jugular Venous Pressure
18:06 Central Venous Pressure
24:55 Systemic Vascular Resistance
28:24 Swan-Ganz catheterization
33:07 Wrapping up the episode

5 Things You Need to Look for in Your Travel Nurse Contract

5 Things You Need to Look for in Your Travel Nurse Contract

5 Things You Need to Look for in Your Travel Nurse Contract

Being a travel nurse offers you new and exciting ventures as you get assigned to different locations. But before you get pumped for your assignment, it would help you read your contract first. Here are things you need to look for in your nurse travel contract. 

The Travel Nurse Contract

Before we check the important contents of your contract, let us first know what a travel nurse contract is and make sure you understand every detail it entails [1]. 

By definition, this contract is an agreement between the professional (you), the agency, and the hospital. The agency employs travel healthcare workers like you through this contract. The agency then has an agreement with the vendor sourcing manager that makes contracts with the hospital. In some cases, smaller healthcare facilities can work directly with the agency, but it depends highly on the matter. 

There are a few types of travel nursing contracts that you should know. Among these includes the standard and crisis, where extra nursing staff is needed immediately. The arrangement between the nurse and agency may also serve as the leading tax documentation. It also establishes the obligations and conditions for work and covers essential things like wages, benefits, and others.

Besides the initial arrangement written in the contract, travel nurses can also negotiate specific terms with the hospital during the interview. It could be something like the particular number of days off, night shift wages, floating rules, and so on. The agency will then send an updated supplement to the hospital regarding these specified agreements called confirmation, but only once the nurse accepts the offer for this assignment. 

What to Look Into Your Contract

Before signing your contract, be sure to check that your responsibilities are clearly stated and the staffing responsibilities of the facility. The agency and healthcare facility must be transparent with you. Here’s what you need to look into:

Travel expenses and reimbursements

Take note that the agency almost always pays and reimburses your travel expenses. Many agencies are willing to cover the costs you make when traveling to your assignment, either by driving or traveling by plane. There are three ways that this can happen:

  1. You initially spend money on gas or airplane tickets, and the agency will repay you afterward. 
  2. The agency will pay for the traveling expenses in advance; airplane tickets, train tickets, or gas for your car. 
  3. The agency will pay out an amount over a set period. 

Any reliable agency will lay out these terms to you and ensure that you are provided with what you need. In addition, you must also know how you will be reimbursed if there is a cancellation of the assignment. 

Housing Policy

In some cases, agencies will offer to arrange or provide travel nurses with housing. This is done through an internal system or several housing sites that cater to healthcare professionals on a temporary assignment. You also have the freedom to look for an apartment or housing. But why bother when there is someone who can do that for you? 

So, before you sign a travel nurse contract, be sure to check what your agency is offering you in terms of housing. Make sure to take note of your responsibilities regarding this part too. See if you will pay for it and if yes, are they going to reimburse you after? If the agency is the one to set up the housing, ask what will happen in case your assignment is extended. Be sure to ask essential questions so you are not left with all the responsibilities. 

Sick Pay

Getting sick while on the job cannot be avoided, especially since there is a pandemic. No matter how much you take care of yourself, there will come a time when your immune system weakens and you need rest. In case this happens, see what your contract has to say about it. 

Your agency must be able to state clearly what happens when you get sick while on duty. It should also include the coverage pay in case you are placed in quarantine. 

Policies on Cancellation

Travel nurses are often overlooked by hospitals, and sometimes, their contracts get pulled at the last minute.  In case this happens to you, be sure to know what your agency states in this matter. Are you going to get paid for it? Is the agency willing to find you another assignment? Are they going to reimburse your travel expenses just in case? – knowing all about these will help you get a better position and prepare you for the following steps. 

Health Insurance

Many nurses are covered with health insurance as full-time staff. However, if you work as a travel nurse, are you covered with the same insurance? Of course, being a travel nurse means you are more exposed to risky situations. Therefore agencies will provide you with the health insurance you need. 

Keep in mind that the risk of getting sick on the job (even accidents) is pretty common for all nurses, and travel nurses are no exception. Finding a good agency that can provide you with health insurance is a must, so you don’t have to meet any medical expenses in the future. 

Your Takeaway

Now that you know what things to look for in your travel nurse contract, be sure to note them. Working as a traveling healthcare professional has its perks, but knowing that your agency provides you with protection and security is always ideal. Finding one that can help you with everything you need is something you should always consider.