How do you handle narcissist patients?

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I am an experienced nurse and the one thing that I just cant seem to handle is narcissist patients. I dont run into them often, but when I do, I crash and seem to fall for their games. At this one hospital I worked for, we had a program that wouldnt let you see the patient's diet until you answered some basic questions about them. There were maybe 10 including their pharmacy. I didnt have to answer them in detail, like if they had a different pharmacy, it allowed me to mark that their pharmacy had changed and get the details later. So I got a narc who was demanding water and I told her we needed to answer the questions for me to see her diet, but that they would be as quick as I could do them. We got to the pharmacy question and she went off because it was not her pharmacy. I could not calm her down, she was screaming. Luckily someone came into the room and stood beside me (unknown to the patient). In the middle of her fit, she asked for her pain button and I handed it to her. She threw it and as I went to get it, she pinched me. I said OUCH! and dropped her pain button onto her chest and backed up (all seen by my witness). The patient started screaming that I hit her. Luckily, she had not seen the other person in the room who had witnessed the entire thing, so her fake accusations got no where. Security was called and she backed down when she found out there was a witness.

So I have started refusing to care for narcissist patients that go after me. Last week, I had one screaming at me that her meds were "late" because it was 10 minutes after 8 and they were due at 8. When I explained that I had an hour to get them to her, she said I was being rude and called our patient advocate. I sent the charge nurse in and I heard her tell him everything was fine, then she got on the phone asking for our manager and an advocate. She then trashed talked me to several other people on the phone loud enough that several nurses asked me about it. I refused to go back into her room and asked for a different patient. I figured at that point, she was after my license and she was going to TRY to get it all day long and it was only 9am. My manager pulled me aside and said I could be written up for refusing to care for her for the entire shift and I said...so write me up, but I am not going back into her room, change the assignment. They also do this thing where they scream at you to get out, then they call you back into the room for something and its a set up so they can cause more problems.

At this point, my only tool is to refuse to care for them and I know there has to be a better way. I am not talking about the hard to deal with patients, I dont really have an issue with them, but these are the worst of the worst and they are too demanding.

Mr. Murse

403 Posts

Specializes in Critical Care/Vascular Access.

I don't think narcissist is really the right word for the patients you're describing, but I know exactly the kind of patient you're referring to.

Frankly, I think refusing to care for them is wrong and unprofessional. No one, and I mean NO ONE actually likes caring for those kinds of patients. It is almost as self-centered of you to refuse to care for them as their behavior is, because now you're just dumping it on someone else who probably hates it as much as you do.

I'm not saying that to attack you, just to point out that you really need to find a way to deal with these types because they will always be there and you will always come across them no matter where you go unless you get out of direct patient care altogether. No matter what industry you go into you will have people like that as well. There are just people out there who are unaware that anyone else in the world exists, or at least they just don't care.

Learning to deal with all types of people is just part of our job.

mikala3

50 Posts

That is exactly why I asked...there are times when changing nurses just gets another nurse into a bad mood as well. At least we are talking about patients that are few and far between..if I get one a year I feel unlucky. I just havent yet come across a good way to deal with them. Although calling security on the one that said I hit her was a good call, now her bad behavior is documented not only by me and my witness but by security as well.

Libby1987

3,726 Posts

Why are you calling this patient narcissistic?

By your telling it seems you lack experience with behavioral health and unless there is a dx of narcissim I'm wondering where and how you determined this description.

To answer your question, I start with thick professional skin and perspective of who is most vulnerable to whom. (grammar?) And then I avoid making statements that invite rebuttal. I don't say things like I'm not that late, I would say something like I'm sorry, it's frustrating.

mirandaaa

588 Posts

Specializes in PCT, RN.

My mom is a nurse and has dealt with some pretty awful patients and families and her advice has always been to "kill them with kindness". As much as it sucks and as hard as it is, sometimes that's really the best thing to do.

It saves your skin because what are they going to say to get you in trouble? "She was too nice!"? Patients like these are likely to be the ones to try to get you in trouble and they can't as long as you don't give them a reason to. (As a side note, I also think it makes them more angry when their antics aren't working and this makes it a little more humorous to me).

canoehead, BSN, RN

6,890 Posts

Specializes in ER.

I let them live with the cponsequences of their action. It can be more time consuming than just giving in, but then I'm in charge of my day, not them. So she throws the pain button on the floor- it stays there. She starts screaming at me- I leave. If you approach the patient this way you have to be ready to answer every bell, or let everyone on the floor know the limits you are setting.

Specializes in Family Practice.

I think entitled might be a better term? I've had to deal with patients like this back when I worked in the ER. I had a patient try to get me fired because she accused me of tearing the adhesive dressing holding her IV off with "excessive force in order to cause extreme pain" when I was getting ready to discharge her home. She started screaming and hollering, flailing her arms around, blood splattering as I was trying to hold the site with gauze, her husband getting in my face too. She demanded the manager and that's what I did.

I never raised my voice. I had a poker face. I calmly explained I would get my manager and I walked out of the room. Basically I like to think of them like toddlers who want something. They are going to throw a temper tantrum. Much like a child, if you also get angry, it becomes a positive feedback loop. They get more hysteric and you get more angry. So I just act cool and collected, because that is the professional thing to do.

Borderline personality disorder. It takes a village to provide care.

When they are identified, call a care conference. Everyone needs to be forewarned, and on the same page.

Specializes in SICU, trauma, neuro.

I'm not able to dx personality d/o's, but have dealt with similar. We had one once who would falsely accuse male MDs of sexual battery (she was not well, she also smeared stool into the sores she picked on herself). It immediately became policy that any male entering her room had a female accompany him--for his protection.

I'd consider false accusations immediate grounds for never entering the room alone. Of course you'll have to involve your colleagues--and be willing to be the witness for them, when they are assigned to her.

I wouldn't refuse to care for her, though. Having already taken report, that would be considered abandonment -- which does put your license at risk. Besides, none of us are so special that we shouldn't have to deal with the difficult ones. People like this are generally made one-shift assignments, so everyone shares and nobody is stuck day after day.

As for the other manipulative behaviors, I set clear boundaries. PCA button gets thrown down, I'll give it back with a "fair warning, if you intentionally drop it again, it will stay there. We're both adults and beyond that game." Then clip it to their gown so they can't claim an accidental drop.

Call light use to the point of being disruptive gets a "This is not appropriate. We have critically injured/ill people in our unit and can't We round hourly, and this will be when requests are addressed." And then we have shut off the call light from the deskl

allnurses Guide

hppygr8ful, ASN, RN, EMT-I

4 Articles; 5,049 Posts

Specializes in Psych, Addictions, SOL (Student of Life).
I don't think narcissist is really the right word for the patients you're describing, but I know exactly the kind of patient you're referring to.

Frankly, I think refusing to care for them is wrong and unprofessional. No one, and I mean NO ONE actually likes caring for those kinds of patients. It is almost as self-centered of you to refuse to care for them as their behavior is, because now you're just dumping it on someone else who probably hates it as much as you do.

I'm not saying that to attack you, just to point out that you really need to find a way to deal with these types because they will always be there and you will always come across them no matter where you go unless you get out of direct patient care altogether. No matter what industry you go into you will have people like that as well. There are just people out there who are unaware that anyone else in the world exists, or at least they just don't care.

Learning to deal with all types of people is just part of our job.

Narcissistic Behavior Disorder is a psychiatric medical diagnosis that you as a nurse are unqualified to make. That being said there are many ways to deal with troublesome patients.

First, since you have low frustration tolerance for this type of patient I would suggest you focus your attention on why this is so. Often this goes back to our own history with people who demstrate these traits; Parents, siblings, ex-lovers etc.... Take some CEU classes in how to handle this time of patient and get good at it. No more refusals unless that patient has threatened you with actual physical harm. Ask youself what kind of secondary gain the patient gets from their behavior. Most of these folks are attention seekers and are fully self absorbed - They really don't care about anything other than themselves. A true Narcissist is incapable of thinking outside themselves- so does not have the mental capacity to be "after you license."

When it comes to meds given on time the patient is right.If their meds are due at 8 and it's 8:10 the patient's perception of the meds being late is correct. If a patient tells me this I d my best to make them 1st on my run. Why - if I can keep them moderately happy I will have less behavior to deal with.

Remember you can never have a rational conversation with an irrational person so don't even try. In and out of the room quickly, all business with a smile, no endorsing their behavior. I had a patient who was refusing a straight cath for 3 days and he was so difficult that no nurse would do it or even try. I came in after 4 days off and grabbed the supplies went into the room. The patient saw me and what was in my hands and said "Out of my room you &(*&%" I smiled and said - MR. so and so - I know this procedure is uncomfortable but Dr.Z is not comfortable discharhingyou without knowing your UTI has cleared up. So can we get this done so you can go home?" All delivered with a smile. He agreed and I did the cath and got the sample. He called me several choice names in the process but that's ok - I have a thick skin.

Remeber what they do is all about them and they don't give a hoot about you, your license or the horse you rode in on....

hppy

Horseshoe, BSN, RN

5,879 Posts

At this point, my only tool is to refuse to care for them and I know there has to be a better way. I am not talking about the hard to deal with patients, I dont really have an issue with them, but these are the worst of the worst and they are too demanding.

So you are the special one who gets to refuse patients who are "too demanding" and inflict them on other nurses? Keep that job, seriously. If you came to my facility with that demand, you'd be gone the first time you played that card.

Specializes in PDN; Burn; Phone triage.

You can only see the diet order after you answer a bunch of questions? Wut??? That is irritating me just thinking about it.

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