Quote from Nurse Beth
In working with behavioral health patients:
Remain calm and professional "I'm here to give your meds"
Set boundaries "That is not appropriate- please do not do that again"
Establish rapport "Sounds like you're having a rough evening. Want to talk about it?'
The response you've used so far are not working. Start practicing new responses and build from there. It's not easy but it's rewarding. Best wishes!
My apologies; I should have been more clear.
What do you do after the above that you stated do not work?
This week has been the first time that the above has truly just failed me. I typically have a good rapport with my patients, and I actually enjoy the hell out of my job. If I have an argumentative patient, I've set limits ("please lower your voice; it's disruptive to other patients") and use it to turn it back around to them (i.e. one patient was very angry, started yelling ... turned out she had a difficult probate hearing that morning that she was emotional about).
In the beginning of my shift, I make my rounds so that I check in with everyone ... not just during the heat in the moment interactions. Usually saves a lot of trouble.
But this week ... for example it's like ANYTHING I said made it worse for one patient in particular. She would start off the shift ok ... good rapport established ... and then as the evening went on would become more and more irritable, shouting my name across the nurses station and demanding a PRN that she says she has wanted for 30 minutes but hasn't asked for until just then. She's forgetful, so that doesn't help, but she doesn't want written reminders either. When I calmly explain that she has not asked but that I will get it for her, the (loud) insults begin. And they don't stop even after I give her the med. Or, one day I simply said, "of course, I will get that for you" (omitting the statement that she didn't ask as that didn't go well), same result.
Other nurses on the floor have done either two things in this scenario (so she's exhibiting this behavior to not just me): ignore the insults, or tell her to stop. Telling her to stop insulting them seems to up the ante ("please don't raise your voice at me; I treat you with respect and expect the same respect") doesn't sit well; she starts screaming in the milieu.
If I ask if she wants to talk about it, I get the ramblings of how I'm going to hell, I'm a liar, etc. it's not her, it's everyone else. That's why last evening I just walked away; I was getting way too distracted to safely administer her meds.
I've asked my nurse manager and my former preceptor and they said I'm handling it fine ... mainly because I'm doing the same things they are. It just doesn't feel right.