Handling rude or dishonest patients

[wildlaurel]

I have had a recent spate of plain old rude, manipulative patients. I can ignore rude behavior, but it amazes me when people lie to/about me. For instance, the other day a patient called out for assistance to the BSC. I was charting and a tech immediately got up and went into the patient's room. I came in about 5 minutes later. The patient said, "I've been calling out for 30 minutes and nobody came in here." I had been in and out of the nursing station and in the room next to the patient's during that time and never heard her call out. I asked the secretary about it and she said that was the first time the patient had called out. So, I told the patient that I didn't think she'd called out for 30 minutes and if she had, I certainly hadn't been made aware of it. The patient insisted she had called out for half an hour....and I know she HADN'T!!

I had another patient who would call the hospital operator and say nobody was helping her instead of calling out with her call bell. I noticed several times when I went in the room the patient would be on the phone and say into the phone, "She's here," and hang up. I thought that was weird...The operator finally called our secretary and told her the patient was calling her and when I asked the patient about it she said, "I didn't know how else to get help." I said, "I gave you the call bell and explained how to use it and I've been in and out of this room every half hour. If you need help, calling the operator isn't the way to go."

I just get so frustrated with these patients! It seems as though they're just looking for a way to get staff in trouble or make it seem as though they aren't being cared for.

What do y'all do about patients like this? My fear is that these patients will complain that I didn't take care of them and I'll get in trouble.

[wildlaurel]

Oh, by the way, I'm an ED nurse!

[rnsrgr8t]

I love when patients call and leave messages for us to call them. You can call them multiple times, they don't answer and you leave messages. Then they eventually call back screaming that no one called them back. Love looking in their chart and telling them, yes I called you back this time, this time and this time and left you messages. Just document to cover yourself and do not worry.

[nurseclm]

Don't argue with patients, you will never win. Report the incident to the Charge nurse or Nursing Supervisor so they can become aware of the problem. Are others having this problem? Document, document, document. Just the facts. Incident report may also be necessary.

[MahzieLPN, LPN]

Document, document, document. I know it takes a lot of time, but in case a patient (or family member) chooses to really make your life miserable, you'll have what you need. The documentation work will then be very worthwhile! Good luck; hopefully, the next round of patients will be more reasonable.

[ARCTX85]

I agree with Nurseclm and MahzieLPN- I'm pretty sure that any other nurse/physician/tech that goes in there will pick up on the pt's behavior. Especially when they work with you all the time and know your quality of work. Furthermore, I understand that if you're providing pt education or you're checking in on them, that you have to document the specifics- time, what was asked/needed, etc. It's not like the pt can get into your chart and change their info. I would brief the nurse relieving me at end of shift as to what's going on and just remember to do a "cya" with your charting.

I know I'm only a student, but I would like to say that I'm wanting to eventually get my CEN cert. I was a head trauma pt at Johns Hopkins and thanks to my nurses, I was able to bear the interesting treatment recieved by residents. I'm thankful for what you do and I'm sure that there are 99/100 patients besides the jerk you're dealing with who truly appreciate everything that you're doing for them. Sometimes, if people cannot articulate that to you, know that they may be thinking it. Hell, at one point I was throwing up in a basin but I was thinking about how greatful I was to have my ED RN Geoff helping me out. :^)

[bezany]

With patients like this, it really does no good to argue with them. I can humbly apologize whether I am right or not. I then ask them if there is something that would make their stay easier, remind them of how to get help, and offer comfort measures like a warm blanket. Remember that they are in the ED for whatever reason and I would hope that most of them would rather be anywhere else. We are getting paid to be there. I have been an ED nurse for 21 years and have yet to win an argument with a patient! I agree with documenting a note, for instance: "responded to call bell, patient states waited 30 minutes for response, confirmed call bell was lit less than 1 minute, checked proper functioning of call bell and REinstructed patient on use. care needs attended to and appropriate reassurance provided." Then maybe two more notes 15 minutes apart documenting "checked on patient, no new needs or needs addressed". At the end of the day, the customer/patient is always right because they have the power to complain, but with appropriate documentation and a few extra minutes of care and concern, the complaint may become a compliment!

[Double-Helix, BSN, RN]

Documentation is your friend. Document each time you go in the room and what you did. Before you leave, ask the patient, "Is there anything else you need?" and then document that you asked and what their response was. If they call out or press the call bell, document why they called and what you did for them. Encourage ancillary staff, such as CNAs to do the same.

If you have patients that continually state lies, such as they have been calling for ages or no one has checked on them for hours, perhaps a polite reply with, "Ma'am, your statements are concerning me. I was just here ten minutes ago to give you a medication and before I left I asked if you needed anything. It concerns me that you seem to be having trouble remembering these things and keeping track of time. I would like speak to your doctor about getting you a psychiatric evaluation to rule out any problems."

[GptunaRN]

100% correct. Part of life is dealing with individuals who are unhappy for one reason or another. Be professional, know your stuff, and perform at the highest level you can. Over a nursing career this will all level out.

George

27 year PICU nurse

[Larry77, RN]

Kill them with kindness...if that doesn't work just kill them...LOL...

I do what I can to mend relationships but sometimes you just can't win. Sometimes I feel like I just can't make anyone happy but then just when I'm at the end of my rope, I get a real honest to goodness quality human being that appreciates my hard work...appreciate those! Don't perseverate on the unhappy people :-)

[AWanderingMinstral]

In all likelihood, this sort of behavior speaks to their baseline personality. I don't have the energy to feed into their neuroses. So, I simply behave in a matter-of-fact manner...short, sweet, and to the point...without being rude. Good luck!

[wooh, BSN, RN]

I like Ashley's suggestion. Of course for me, it's usually PARENTS that are lying. Perhaps a suggestion that we get SW involved to refer them to some psychiatric help. This might actually make those situations fun instead of just aggravating. (Why yes, I do have a passive aggressive streak!)