Good-bye, Mrs. Meanjeans

Here's a "world's worst patient" tale....with a twist. Wilma is, quite simply, a terrorist in an elderly woman's body. She is verbally and physically abusive. She calls 50 times a shift, then refuses care "because you took too long to get here". She's paranoid and thinks everyone in the building is out to get her. She loves to pit staff members against each other and cackles evilly when she makes them cry. She eats nurses for breakfast and snacks on CNAs between meals. She is......Mrs. Meanjeans! Nurses Announcements Archive Article

Good-bye, Mrs. Meanjeans

After a few years in this business, we all learn that patient-care supplies are hard to find (and even harder to get administration to pay for), but one thing we never run out of is bad-patient war stories.

Like everyone else, I've got my share of them, although I like to think that my repertoire of good-patient stories is much longer, to say nothing of more enjoyable. I have this strange habit of investing time in my more "challenging" patients right at the beginning of our relationship, which builds trust and saves us both much anxiety and grief later on when things are busier. It also works on almost everyone but the truly miserable and the pathologically angry, and I have met only a handful of these in the entire course of my career.

Unfortunately for everyone who works at the Grace L. Ferguson Airline, Storm Door, and Nursing Home Company, Wilma Bennett's* personality contained both of those characteristics. An eighty-three-year-old widow whose voice still carried the drawl of her native Oklahoma six decades after moving to the West Coast, she was, quite simply, a terrorist in an elderly woman's body: a twisted soul who ate nurses for breakfast and snacked on CNAs between meals, who was just as likely to punch you in the face as look at you, who cussed a blue streak and called the staff names that would make a repo man blush. She enjoyed nothing more than playing staff members against each other, unless it was playing the moderately demented residents against each other and egging on the fights that ensued. And of course, everyone hated her and was ignoring her on purpose, and if you didn't believe it......just ask her!

She'd put on her call light Q 5 minutes and then refuse care "because it took you too (blank) long to get your lazy butts in here". She had 30+ different skin tears on her hands and arms from picking at the parchment skin covering them, and one of her favorite tricks was to pull off the bandages right at dinner time or shift change, then scream at the nurses because we didn't have time to change them then. She weighed over 200 lbs. and was dependent for toileting and incontinence care, but insisted that only one CNA each shift be permitted to work with her, even after the DNS himself told her she had to have two because it wasn't fair to expect the aides to risk a back injury this way. She didn't care; she just wanted what she wanted when she wanted it, and if she didn't get it, she'd hit, kick, scream, curse, spit, and play mind games.

All of this would have been forgivable had Wilma suffered from dementia, as did the majority of our skilled-nursing patients to some degree. But no, she was as sharp upstairs as the average person half her age. She was just meaner than a snake and madder than a wet cat, although at what, we had no idea.

Shortly after her admission, the staff began calling her Mrs. Meanjeans.

I was new to the facility, and not a big fan of subacute units in general as I feel they're too much like the hospital---the patients are very nearly as sick, they take as many meds, and they need as much monitoring---only without the benefit of hospital staffing and resources. So I wasn't looking forward to working on this unit anyway, but I needed the money.....and I figured I could win over Mrs. Meanjeans with the tried-and-true "kill-'em-with-kindness" routine I'd used so successfully in the vast majority of 'difficult' cases.

I figured wrong. She yelled at me just like she did everyone else, accused me of 'neglecting' her, and griped about everything I did, from re-bandaging her fingers multiple times per shift (after she yanked the dressings off) to giving her nighttime pills at 2202 instead of 2200 on the dot. She didn't care that I had twenty other people who needed me, or that shipping the CABG patient back to the hospital for chest pain was a bigger priority than fussing with her pillows for the 900th time that night. While I knew better than to take any of her abuse to heart, it stung to hear "You don't give a damn about me, nobody in this place does" when I'd bent over backward to accommodate her needs (and more than a few of her wishes) at the cost of my lunch or break, or simply time spent with a more appreciative patient.

One night, she pulled this stunt as I was just about ready to explode from the tension of a tough shift during which I'd gotten two admissions, both at dinnertime, and one of whom I promptly had to send back to the hospital when she suffered a massive stroke right before the horrified eyes of her two daughters. I'd also suffered a reaming from another unhappy patient's grandson, who had demanded to know why I didn't just hop over to Walgreens to get some pain medicine instead of waiting for delivery from our 'house' pharmacy: "What kind of place are you running here, lady?!" the kid screamed at me. "Why don't you get off that fat orifice of yours and go get Grampa his pills?"

So when Mrs. Meanjeans started in on me about my many sins of omission that evening, I lost it. I actually yelled back at her. I didn't curse or call her names, of course, but I'd had enough of being bullied for one night, and I let her know it.

"Wilma, I wasn't put here on this planet to be at your beck and call," I spat. "I have bent over backwards to help you and make your stay as comfortable as I can, but I have 20 other people to take care of and sometimes you're NOT number one on my list. You are going to have to understand that, and no, I am not gonna put new bandages on you when I just changed them two hours ago. Quit pulling them off just to annoy me!" And I literally turned on my heel and walked out.

Later, I felt bad about what I'd said, but not bad enough to apologize, and certainly not bad enough to report my outburst to management. I figured that she'd take care of that for me anyway. However, I noticed over the days and weeks that followed that Mrs. Meanjeans tended to be just a wee bit less bombastic with her negative commentary when I was on duty than when another nurse worked that unit and I was on the long-term floor. I also noticed that when the CNAs came to me to blow off steam about her, and then I went in to listen to her side of the story, that she was somewhat less hostile once she'd gotten it off her chest. And one night as I was leaving her room after one such discussion, I even heard her say, ever-so-faintly, "Thank you".

After that, working with her was, comparatively, a piece of cake. On one noc shift, she threw all of the CNAs out of her room while she was on the bedpan, refusing to let them change her or even take the bedpan out from under her, even though she and her bedding were soaked. She demanded to see the nurse; when I showed up, I gave her a chance to choose two of the four CNAs who were on with me that night. I didn't care which two, but she would have two aides working with her, that was non-negotiable. (We needed to cover ourselves.....too many careers have been ruined by false accusations, and Mrs. Meanjeans was such a catastrophe begging to happen.) Once that was made clear to her---and yes, having three people in the room at one time probably helped to persuade her---she stopped fighting it, picked her two aides and even became almost......well........pleasant.

It turned out to be short-lived, but only because she was transferred to another facility a few days after this. During what turned out to be my last evening with her on the unit, she was actually HUMAN for the very first time.....she ate in the dining room, fully dressed and even wearing a flower in her hair. She didn't yell, didn't curse, didn't even use the call light more than a few times. I found myself spending more time with her that evening than usual; this was a restrained, even polite Wilma that we'd never seen before, and when the shift was over, I went in to say good-bye to her and wish her well at her new place. I even reached inside to find the words to say that I truly hoped life would treat her better there, and that she'd finally be able to go back to her home one day soon.

She was sitting there in her wheelchair, drawing pretty, intricate designs with colored markers on a pad of unlined paper, and when she looked up at me, her eyes were wet. Then she said something I'll never forget: "Thank you, Marla. You're a good girl, and you've taken good care of me, even if hardly anyone else did. Come here---I want to give you a kiss and a hug."

Thunderstruck, I bent down to receive the affectionate gestures. She had never called me by name before.

"I love you, honey," said Mrs. Meanjeans.

"I love you too, Wilma," I said, meaning it.

The next afternoon, I came on to find her bed empty, the tension which had gripped the entire building gone, and CNAs and nurses alike doing the happy dance. Two of them ran up to me excitedly to announce the news, then added, "You'll never guess what she said when she left---she told us to give you another kiss and a hug, and to tell you again that she loves you."

Good-bye, Mrs. Not-So-Meanjeans. Wherever you've gone, I hope you'll get good care, and maybe even find a little peace and joy in life someday.......but just in case you don't, your bed in 10-A will be waiting. :redpinkhe

*Names changed for HIPAA purposes

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VivaLasViejas

About VivaLasViejas, ASN, RN

Long Term Care Columnist / Guide

I'm a Registered Nurse and writer who, in better times, has enjoyed a busy and varied career which includes stints as a Med/Surg floor nurse, a director of nursing, a nurse consultant, and an assistant administrator. And when I'm not working as a nurse, I'm writing about nursing right here at allnurses.com and putting together the chapters for a future book about---what else?---nursing.

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Specializes in adult ICU.

This is a really nice story. It is so true that sometimes the most hateful people turn out to be the ones that are in the most emotional pain, but are too afraid to express it.

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There you go, some people would tell you must never say the things to a patient that you said.(not that it is that bad) Heh, but they are ivory tower nurses. Good story, Good story thanks for sharing.

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Specializes in CVICU, Obs/Gyn, Derm, NICU.

This is a familiar story.

We have our regular terrorists passing through our ED who make untrue accusations .... refuse to move themselves for toileting (when they normally mobilise independently) and deliberately create situations for staff to risk backs.... monopolise as many staff members as they can with their outrageous behaviour. Refuse to feed themselves when are able to eat independently and then insist staff have let them starve

Of course they are very obese and it's quite an effort moving them. And of course their family members support their poor behaviour.

I have had one recently and it was all too much. Am seriously thinking of leaving nursing ....this has done it for me.

I do not want to look after these people anymore

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So glad she turned around for you. You know that is all you needed, just a little from her!!!

Viva, have you spent time thinking of this fact too? I am sure we all have. All the sweet grandmas that used to sit and knit, or make cookies, or spend so much time with the grandkids... are now in short supply (Mrs. Meanjeans is not included in this group, LOL). Soon, most little old grandmas will have worked a full career and be hardened like we are. Also, all the WWII vets, who have the grand stories to tell, and really just worked for the simple things in life soon will be gone.

The generation of those with time and respect for "manners" will be gone. So sad for the world. When you think of our image of what little old ladies are like -- that image will be wrong.

And I have to say, of course, that people often forget that old people are just that. If you were a horrible person your whole young life, you have a good chance of remaining so as you age (or worse). Old people can and will screw you over if so inclined if they did same to others when they were young if pathology doesn't make them forget how. And now, with "manners" almost totally gone from society, it's gonna be a free-for-all in LTC. What a scary thought!

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Specializes in LTC, assisted living, med-surg, psych.

That's totally understandable, pedicurn.

I've got to admit, I've thought about leaving nursing more than once after dealing with people like this. But it's not the patients, per se, or even the families, that burn me up.........it's the utter refusal of management to staff up when we have high-acuity patients, or even to set some limits on their behaviors. And what REALLY chaps my hide is the fact that it's always the staff that gets thrown under the bus when the inevitable conflicts arise---it's always their word over ours, and if it ruins a career.....well, that's just too bad.

I've never had this misfortune happen to me personally, but I have seen a good LTC nurse ruined by nothing more than mere allegations from an immensely selfish, neurotic, out-for-all-she-could-get patient. She lost her job and was essentially blackballed from nursing because this 400+lb. brittle diabetic got angry with her for refusing to fetch her a second piece of cake from the kitchen. (The nurse was responsible for over 35 patients.........she didn't have TIME to run to the kitchen, even for the 2-Cal that the skinny ones were prescribed.) As these things go, the story got worse each time the patient told it, and after the state jumped in, the nurse was fired for "failing to respect resident rights" and even reprimanded by the BON. She now works as a cashier at Fred Meyer for a fraction of the wages she earned as a nurse, because no other local facility would hire her and with a husband and kids still in college, she was unable to relocate.

THAT is what I find most disturbing about nursing these days. I can handle the patients---I've learned to let barbed comments and even insults run off my back---but the lack of support from management in most facilities can take the heart right out of even the strongest of us. We can be verbally and physically abused, threatened, even killed, and almost NO ONE in administration will stand up to the abusive patient/family and tell them to stop or face the consequences. And they wonder why nurses are leaving the profession........

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Specializes in CVICU, Obs/Gyn, Derm, NICU.

Totally agree ...management refuse to set proper limits with these patients ....especially if they are old ladies LOL

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Specializes in Plastics. General Surgery. ITU. Oncology.

This sort of case always makes me grateful to be nursing in the UK.

The NHS would throw out a complaint of "Not giving cake to a diabetic" on grounds of the nurse acting in the best interests of the patient. The regulatory body the NMC would, I strongly suspect do the same.

Cases of abusive and difficult patients are dealt with by senior nurses. Sister, Senior Sister or Matron will read them the riot act and the Consultant doctor will be informed. The Consultant will then pull them up on bad behaviour.

The Consultant can refuse further treatment if abusive or non-compliant behaviours persist although they rarely do. These abusive patients are well-known, their behaviours documented and complaints made by them are rarely upheld.

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Specializes in Professional Development Specialist.

In my short career in subacute, I can say these facilities are often the last bastion of patients like this. Not willing/able to go home and too stable for acute care, the nurses are at the mercy of salespeople who only need to fill the beds. I have made high marks in my short career of handling them, although I may not be as well adjusted when I vent here or to my friends at work. But this helped a little to know that even in the worst cases it may be appreciated if not always verbalized. Now send me strength to get through one more week, or even a day!

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Specializes in Professional Development Specialist.
That's totally understandable, pedicurn.

I've got to admit, I've thought about leaving nursing more than once after dealing with people like this. But it's not the patients, per se, or even the families, that burn me up.........it's the utter refusal of management to staff up when we have high-acuity patients, or even to set some limits on their behaviors. And what REALLY chaps my hide is the fact that it's always the staff that gets thrown under the bus when the inevitable conflicts arise---it's always their word over ours, and if it ruins a career.....well, that's just too bad.

I've never had this misfortune happen to me personally, but I have seen a good LTC nurse ruined by nothing more than mere allegations from an immensely selfish, neurotic, out-for-all-she-could-get patient. She lost her job and was essentially blackballed from nursing because this 400+lb. brittle diabetic got angry with her for refusing to fetch her a second piece of cake from the kitchen. (The nurse was responsible for over 35 patients.........she didn't have TIME to run to the kitchen, even for the 2-Cal that the skinny ones were prescribed.) As these things go, the story got worse each time the patient told it, and after the state jumped in, the nurse was fired for "failing to respect resident rights" and even reprimanded by the BON. She now works as a cashier at Fred Meyer for a fraction of the wages she earned as a nurse, because no other local facility would hire her and with a husband and kids still in college, she was unable to relocate.

THAT is what I find most disturbing about nursing these days. I can handle the patients---I've learned to let barbed comments and even insults run off my back---but the lack of support from management in most facilities can take the heart right out of even the strongest of us. We can be verbally and physically abused, threatened, even killed, and almost NO ONE in administration will stand up to the abusive patient/family and tell them to stop or face the consequences. And they wonder why nurses are leaving the profession........

The amazing nurse that precepted me was fired for supposedly using body language that the patient felt was threatening. Having worked with her closely I can say it was more likely the color of her skin than her body language. We were all later inserviced to be aware of our body language. :( She gave MUCH better care than some nurses we had and a million times better than those who have replaced her. But they were only let go after serious (ie-deadly) errors. Sad that questionable reports of poor customer service is more important than poor care!

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Specializes in LTC, assisted living, med-surg, psych.

Ah, don't even get me started on 'customer service'...........I'd like to see every nurse in the country come together and gang-slap the snot out of Messrs. Press and Ganey! :devil:

It's a shame that TPTB seem to believe that common decency and manners are lacking in those of us lower on the food chain, thus we have to be taught, threatened, scripted, and forced to be nice to people. I don't get it. Most folks who weren't raised by wolves know how to treat their fellow travelers on the road of life; certainly we know how to say "Please" and "thank you". (It would be great if patients remembered this a little more often too!) The rest should, and in my experience usually does, come naturally; we don't need a piece of paper telling us how to talk to our patients, and we certainly don't need hospitals and nursing facilities run like the Ritz-Carlton.

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Specializes in ICU, MICU, SICU.

Well....that is a sweet story and everything, but I still hate it. I *HATE* that this is one of the only jobs on the planet where it is acceptable to be treated like crap. If my patients spoke to a cop the way they speak to me, they'd be in jail. Yet I have to sit there and take it?? BULL! I am not an angel, I am not there for you to unload 40+ years of resentment on! I want to do my job (ie. MEDICAL CARE) and be done with it.

Sorry. Bad night :/

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