One thing that struck me was that you said the patient had never been on any meds. Dementia and/or untreated mental illness sometimes will manifest itself with the most outrageous inappropriate behaviors I have ever seen. Ask for a patient care meeting with Social Work. Let your thoughts about this patient's behavior be known. Come up with a plan that when this happens, patient is put on a 1:1, pending a bed in inpatient psych. or anything else you can think of that would help this patient within your facilitys' policies. (family member call ins to 1:1 is also a thought). And no, you should not take this personally,(and I know easier said than done) as there's usually a cause for a patient to act out--dementia, mental illness, even a brain tumor or head injury. If the patient is just simply an a**, again, social work and the ombudsman can go a long way in creating some sort of treatment plan for this patient--but I would ask that they rule out any other medical cause first. I would hate to see you lose your job, or get involved in a legal mess, only to have found out that this patient was severely mentally ill and unmedicated, or s/p head injury with significant organic brain damage. Have them involve the family in this process. And if all of this is much more involved than you would like to be, I would call the ombudsman to visit with this patient to get to the root of the issue, and keep your responses to the patient unemotional and to a point--patient is "tantruming" and when patient is winding down, you say "what is it that you need from me right now?" And if they start again, leave area with saying, "when you can be appropriate and you need something, let me know". Even the a** patients lose steam when faced with the fact that you are professional and not emotionally vested in this behavior. Some patients are master manipulators, and find people's weakness' and expose and flaunt them, pushing every button you may have. With that being said, I am also of the thinking that it is doing the patient a dis-service to allow them to continue to embarrassingly act out and untreated. That could be how you approach this with social work--not on a personal level, but that the patient is at risk, and patient is acting in a way that is inappropriate to themselves and others.