How to deal with difficult patients as an LPN

[chicharito]

I have a quadriplegic patient who is wheel chair bound. Ive had some difficult patients but this one takes the cake. I need some advice on how to deal with him and not get consumed into his mind games. Like we could be talking normally and then the next minute he wants to argue with me over something dumb like did I close the lid correctly of some tupperware of food I put in the freezer. The list goes on and on. He is manipulative, argumentative, and sometimes even demeaning. He calls us (his nurses) "the help" and he complains about all of us to all of us. I understand he has pretty much lost control over his life since his accident and therefore wants to control us but I need to know how not to let it get to me. Ive been on the verge of tears before and I want to be strong enough to brush it off and continue because I know there's always going to be patients like him. Please advise.

[nursel56]

I worked for a long time with an adult patient that exhibited similar behavior. I had worked in many different capacities as a nurse prior to beginning private duty, most of the time had very positive feedback, so it came as a bit of a shock at first. I took it personally and tried to defend myself at times. What I learned was that both of those reactions, though pretty normal, are counterproductive. I determined that I would find it within myself to deal with it as best I could.

I tried to do a sort of mental pause when I heard the demeaning remarks. I tried to mentally place myself in the patient/client's situation and tried to imagine what it would be like to be dependent on other people for even the simplest things, to have to constantly train new people, to have "strangers" in your home all the time. Honestly, over time this really helped, but it is a process more than a destination.

I feel I grew as a person and a nurse throughout this experience and actually learned to appreciate that I had an intimate window into the life of someone challenged by so many losses. You don't get that in too many other nursing environments. If you can hang in there, and your patient/client begins to trust you and open up their feelings a very positive and therapeutic relationship can happen. Is it always perfect? No. This patient passed away several months ago, and I feel a real peace and sense of accomplishment that I was able to (however imperfectly) enhance their quality of life through some very tough times. Best wishes to you!

[toomuchbaloney]

You have to have impeccible boundaries.

Resist the temptation to take anything the patient says personally. He doesn't know you personally, only professionally. Even then, he knows only what he sees and experiences which is a miniscule portion of who you are in your work.

When he speaks badly to you about other nurses tell him to stop that you are not interested. Do not engage or exchange with him verbally in those rants.

Treat him with respect and dignity. Tell him you expect the same consideration.

[chicharito]

Thanks for the responses but I forgot to mention that my patient is also sue happy. Their is a pending lawsuit with the prior agency and now has complained about a hippa violation by another nurse. He has no regard for other people and he likes to encourage us to do things so later he can turn around and complain that we didn't follow procedure. He also has cameras all over the house. He is so anxious in finding fault that he complained I wasn't using the hoyer lift properly so my supervisor had to come observe me do this after months of caring for this patient. After 3 years working in a clinic now I've decided to do home health. I don't know if this was the right decision. Are all patients at home this nuts?

[caliotter3]

Your last post has enough added info to make it clear you would do well to find another case fast. If you can afford it, leave this case before the agency finds you a new one. A good deal of long term hh clients have "issues". There are some reasonable people on occasion, but those cases are usually already staffed with nurses who have no intention of leaving a good work environment.

[TheCommuter, BSN, RN]

A good deal of long term hh clients have "issues".

Especially the quadriplegic patients. . .

They've lost control over much of their bodies, so many spinal cord injury patients attempt to exert tight control over their environments (and the people who step into their environments).

[JustBeachyNurse, LPN]

A client with law suits pending against another agency, already filed a complaint against another nurse and admits to documenting your every move in search of error or reason to complain is prime reason to get out of dodge. Long term HH/PDN patients have issues, they have strangers in their home and nitpicks to compensate for what they cannot control especially as a quad. It is not typical to try and "catch" or entrap staff as well as constantly file formal complaints.

If the suit against another agency was known, I'm surprised your agency's risk management agreed to take the case. Ask to orient to another client to transition off this case

[caliotter3]

When pending lawsuit status is known by the agency and they actively deny concern to the nurses they have placed on the case, one might want to consider whether or not they want to continue to work for an agency that clearly shows no concern for their employees.

[chicharito]

Well in defense to my supervisor she really stood up for yesterday. She said to hang in there and will find another client. They just have to train new victims.