How to deal with a bully patient?

  1. Recently we had a patient who was a bully. He got to do things that other patients weren't allowed to do. Many of the nurses were scared of him and just let him be. He basically ruled the floor. So how does your unit deal with these types of patients and how do doctors deal with them?
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  2. 69 Comments

  3. by   remotefuse
    Could you elaborate more? What kinds of hints would he do others were not? Did he threaten you guys with violence?

    I have had one pt that comes to mind. (He also insisted everyone call him pastor) I would offer him whatever medication/treatment was ordered. He would spout off, and I would ask him simply, do you want it, yes or no? If he did not answer, I would just leave the room to avoid his verbal abuse, and would document what happened. He refused assessments, treatments, yet refused to be dischargered until he was ready, like 4 days.
  4. by   remotefuse
    He pretty much just got passed around, sometimes 2-3 nurses a shift because no one wanted to deal with him. I had no problem dealing with him though. It was simply yes or no. No? Okay, see you next time.
  5. by   calivianya
    We had a detoxing meth patient who just got out of jail for assault with strangulation and kidnapping. Demons and swastikas everywhere on his body, and outright violent with us.

    After he returned to his normal and was healthy enough to move out, he still got a free ride in ICU for multiple WEEKS until they found him a behavioral health placement. Rationale was "they couldn't handle him on the floor or in stepdown." Since when does ICU qualify as the place where it's okay to stick patients too violent for other floors to handle? None of us were very happy about that.

    We only gave him to male nurses, and usually only to the male travelers or members of the float pool, and he spent most of his time with us in restraints with a mask on so he couldn't spit in our faces. That's how we dealt with him.
  6. by   Mandychelle79
    Honestly, by nature I'm a snarky individual who can be very blunt and apparently has a deamenor that warns others to not even try. I've had patients and families "warn" me that they were demanding patients and were going to make my night hell. My typical response is I worked in psych for 7 yrs so it takes a lot. That alone (especially those who have been on bu before) usually curbs most behaviors. I also don't get into a power struggle... you don't want scds, fine, here's the possible consequence. I use empathy and tell patients the truth... I don't mind calling your pcp regarding pain, however they gave deferred all pain medications changes to chronic pain service who has not been here to see you yet, has noted this, etc.
  7. by   JKL33
    Quote from DesiDani
    Recently we had a patient who was a bully. He got to do things that other patients weren't allowed to do.
    Unless those allowances were part of a well-thought-out, therapeutic care plan, that was wrong and it's also why he got anywhere with bullying anyone.

    I do as posters above me. Take it or leave it; if you wish to refuse one of your treatments it doesn't affect me in the least; I will not be stressed by it. I present choices with sincerity, proper pleasant tone of voice and good eye contact.

    Many bullies who aim to get their way by intimidation will give up when dealt with...well, about like 2 year olds are dealt with. Pleasant but firm. Physically violent individuals are another matter.
  8. by   chacha82
    I agree with other posters. The biggest mistake was that he was allowed to do things that other patients weren't permitted to - whatever that may be. If you have a mentor nurse on your floor you trust, you can bring up this situation and discuss how to handle it in the future. But don't give him an audience. Go in, offer the meds, offer the interventions, make sure he's safe, etc. Whatever he says, don't respond. Document, notify the doc when you have to, basta. Often bullies are looking to engage, so don't stick around for that.
  9. by   futurebsn92
    Patients from hell makes me happy that I want to go into OR. My patient cant curse me out or spit on me if they are sleeping . But on a serious note I'm more of a no nonsense person. "Oh, you don't want the services I'm offering you? K bye". No one came into nursing to be disrespected and abused. There has been too much sleepiness night, tears, blood and sweat to deal with anyone's crap. I have my own problems and I'm not going to let them become another one.
  10. by   Julius Seizure
    Quote from calivianya
    We had a detoxing meth patient who just got out of jail for assault with strangulation and kidnapping. Demons and swastikas everywhere on his body, and outright violent with us.

    After he returned to his normal and was healthy enough to move out, he still got a free ride in ICU for multiple WEEKS until they found him a behavioral health placement. Rationale was "they couldn't handle him on the floor or in stepdown." Since when does ICU qualify as the place where it's okay to stick patients too violent for other floors to handle? None of us were very happy about that.

    We only gave him to male nurses, and usually only to the male travelers or members of the float pool, and he spent most of his time with us in restraints with a mask on so he couldn't spit in our faces. That's how we dealt with him.
    What was the rationale behind this? I can guess for the male nurses part, but what about for the rest?
  11. by   KatieMI
    Quote from Julius Seizure
    What was the rationale behind this? I can guess for the male nurses part, but what about for the rest?
    Because getting assignments nobody else wants to work with is what travelers, float pool and temp staffing agency RNs are there for. You are not paid more for your beautiful face when you sign up for jobs like that.
    Last edit by KatieMI on Jul 12
  12. by   saskrn
    Quote from calivianya
    We only gave him to male nurses, and usually only to the male travelers or members of the float pool, and he spent most of his time with us in restraints with a mask on so he couldn't spit in our faces. That's how we dealt with him.
    This seems unfair. What did these poor nurses do to deserve him?
  13. by   saskrn
    Quote from KatieMI
    Because getting assignments nobody else wants to work with is what travelers, float pool and temp staffing agency RNs are there for. You are not paid more for your beautiful face when you sign up for jobs like that.
    This is completely inappropriate, unprofessional, biased thinking.

    What makes you think you're better than they are? Unbelievable! smh
  14. by   Here.I.Stand
    Quote from KatieMI
    Because getting assignments nobody else wants to work with is what travelers, float pool and temp staffing agency RNs are there for. You are not paid more for your beautiful face when you sign up for jobs like that.
    I tend to think of them as there to fill staffing holes, thereby preventing mandatory OT and tripling in the ICU, stuff like that.

    Now I can see having them take these pts if all of the regular staff nurses have had their turn(s)... but to consistently dump on floats? I don't agree with that.

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