My husband and I went to the grocery store yesterday. It is a cooperative style store, with mostly local and organic foods. We shopped there when they were just a tiny place with a cult following, now they have grown and matured. There is a great deli there with seating inside and out. They are careful to prepare foods to my allergy needs.

While my husband and I were eating, I happened to notice this older woman at the express checkout lane. She had a full load of groceries in her cart, seemingly oblivious to the resigned sigh and smile the cashier put on his face. At that point, there weren’t any other customers behind her. This changed, however, and soon there was a line of seven people behind her.

Nurses know this woman. They dread her as a patient. She requires everything just so. She moves slowly and deliberately. She doesn’t seem to ever notice the body language of those around her, expressing their frustration and impatience with her apparently excessive needs. This is the patient who requires her bedding to be rearranged repeatedly. She rarely says thank you. She makes you do it over and over until it is the way she wants it. She questions you in detail about minor things that have no real significance to her care or outcome.

The care this type of patient receives is a spectrum. Some nurses take the super sweet angle. They indulge her and do everything they can to make her feel that she is their only patient. Other nurses will avoid this room as much as possible. They get in and get out. They ignore many of the patient’s requests. This sets up the scenario for the patient becoming a call light abuser.

The middle of the spectrum for these patients is to set limits and be consistent. Compassion is always a priority, but it must be tempered with common sense. Being consistent means showing up on time. If the nurse promises to return in half an hour, then that is when that nurse must return. If the nurse is unable, she needs to send another staff member in to explain the delay. It is okay to explain to these patients that you want them to be comfortable, but you have other things to attend to now, and is there anything else they need before you go? Be sure to let them know when you will be returning and what you have planned. This goes a long way toward alleviating their anxieties and showing them that you are paying attention to their needs.

The lady at the store took the entire time we used to eat lunch to checkout. She even continued to need the cashier’s attention after her groceries were loaded into her cart. He tried to help the next customer, but she interrupted him for just “one more thing”. I had to smile. I went up to him after we were done shopping and told him I sympathized. He said that she comes in there on a regular basis, and he never has the heart to tell her that she is using the express lane improperly. I have a feeling that she knows full well what she is doing. She knows that he is not assertive enough to set a limit with her, and therefore, everyone else has to be inconvenienced. This can become a crisis in a hospital setting. The nurse must maintain control and flow of her patient’s needs, prioritizing and putting out fires as she is able. This requires her to be assertive, kind, and consistent.