Auntie Jo’s Advice: How do I care for the VIP?

I work in a hospital that depends on donations for a large part of its funding. Every once in a while, we get a donor in as a patient. These people are given VIP status, which means they get free parking, real silverware with their meals and soft towels, stuff like that. A lot of them take “VIP status” to mean “I can abuse anybody and direct my own care.” What’s a poor nurse to do?

Signed, Frustrated in Fargo

Dear Frustrated,

Auntie Jo read your cri de coeur with a sardonic smile. For most of her career, she has worked for a hospital owned by EnormoGiganto Research and Education, Incorporated, which also depends on handouts—alors!—for a fair portion of its overall operating budget. She, too, has had the noiseless tenor of her way interrupted by those misguided souls who believed that donating a paltry 100 million smackers to EGRE, Inc. would buy them uninterrupted sleep and unpunctured veins, if only they whined loudly enough.

Take heart! Auntie Jo’s motto is: If You’re Sick Enough to Be in the Hospital, You Will Be Treated Like Somebody Who’s in the Hospital (and no amount of chump change will make that go away, sucker!).

Auntie Jo approaches this in a very specific way: the Limited Choices Approach.

Instead of asking, “Do you mind if the laboratory technician, that vixen of venipuncture, that Boadicea of bloodletting, takes a teeny-weeny sample of blood?”, Auntie Jo announces brightly as she walks in the room, “Lab’s here! Right or left arm?”

Instead of asking, “Madame Secretary, I have some pills here. Would you like to take them?”, Auntie Jo announces, “Time for your morning medicines, Mister President! Would you like to take them with milk or water?”

This is a well-known tactic to any parent of a three-year-old. Since most people, especially the rich or privileged, turn into three-year-olds when they’re hospitalized, it crosses over.

Auntie Jo is also fond of what she terms the Celebrities: They’re Just Like Us Approach. Most very rich people are surrounded by sycophants and yes-men. The arrival of someone—like you or (if you are very lucky indeed) like Auntie Jo—who is the slightest bit of a smart-ass makes them brighten up and look alive. You are not afraid or awed by them, no matter how many deals they’ve brokered or innocuous third-world countries they’ve invaded. It’s a refreshing change of pace.

Two noti bene for Auntie Jo’s less perceptive readers: The smart-ass approach should be undertaken with great caution. It should also never reference political views, religious practice or sexual tendencies (even if those tendencies are well known as a result of pending or resolved litigation). What you want is a sort of insouciant, devil-may-care tone, not an all-out debate.

Finally, Auntie Jo recognizes that sometimes the chief difficulty in caring for a patient springs not from that patient, but from the hordes of money- and recognition-seekers in the hospital administration or management who wish to a) pay their respects or b) make things illogically hard for the nurse.

A perfect illustration of this happened just the other day to Auntie Jo herself. Rather than being able to place a lunch order for her patient (who was demented and unsure of even the year, but frankly stuffed to the gills with money and with a very short life expectancy), Auntie Jo had to run a gauntlet of people who thought they could do it better and with more style than she herself could. (Longtime readers will laugh hollowly at the futility of that belief.)

Auntie Jo did what she terms the Timesaving End-Run around the six people who believed, with all their hearts, that it would take all of them to place and deliver a lunch order. She merely called the kitchen, asked to speak to a longtime friend of hers and had lunch delivered in record time as the gauntlet was still working out how best to take the order.

On a more serious note: Remember that you are in ultimate charge of what happens to your patient. If the president, CEO, CFO and COO of your hospital show up while you are bathing your patient, the correct thing to say is, “His Highness is engaged. Please return at 1 p.m.” If a patient consistently refuses such things as scans and blood draws, let the attending physician handle it—he’s paid much more than even Auntie Jo.

Dignity, poise and a particular carriage of the head go a long way in dealing with a VIP.

If all else fails, though, Auntie Jo keeps a special gold-plated mallet in the nurses’ station for tough cases.

This post originally appeared in The Head Nurse blog.