Dilemma today regarding an undesirable patient

[TazziRN]

We have a frequent flyer that many of us think has undiagnosed Munchausen's. He came in tonight with pain and had injections ordered. He has, in the past, attempted to kiss me, so I refused to medicate him. My coworker refused because he's also exposed himself to many of our staff. We called the house supe, who called the clinic next door (owned by the hospital) and had a male MA come over and medicate him for us. We are at a total loss about this patient; like any other patient he deserves care but because of his history most of us are not comfortable doing anything to him that requires very close.

Thoughts? Opinions? Don't bash us, please. He causes a lot of stress every time he comes in.

[TazziRN, RN]

We would have to wait until he actually tries something again.

[rn/writer, RN]

I talked with my manager today, and she liked the suggestion about coming up with a game plan for all of us to follow. She backed me up about last night, along with my teammate, and she is going to talk with the other managers, social services, risk management, and the PMD to try and get something done. I told her that if it was anything overt, I would have no problem telling him to knock it off, but it's subtle enough that if I were to confront him he could very easily claim to have just been shifting position in bed, etc. It was a relief to hear her say that we have her support, and that she's going to try and help find a workable solution.

When our kids would do things that just "toed the line," our practice was to move the line. In this case, you can do proactive things like cover him with a towel or a sheet and tell him right up front that you won't stand for any funny business. Call him out and stick to your guns. Be very clear about what is and isn't acceptable.

And, as difficult as it may be, try to keep your response matter of fact. NO emotional payoff for this guy.

I'm glad to hear that management will back you on this.