What should I do about the patient from hell?

Nurses Relations

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Good evening everyone. I have a situation at my job and I would like you all to give me some advice. Three weeks ago, I accepted a position as a charge nurse in a skilled nursing facility. Most of the patients are good people, but I have one lady who is verbally abusive and she routinely slanders me.

For example, she has told the care plan coordinater and her psychiatric nurse practictioner that I come into her room every morning, and shoves all of her pills down her throat without telling her what it is. What really happens is, I put each pill, one at a time, on a spoon and place them in her tongue (She has MS and is unable to use most of her limbs, yet her mouth works perfectly fine). This woman also has her medicine memorized, however when she asks I am able to tell her what it is, and why she is taking it.

She also has large wound on her buttocks, which is unstageable, but most likely a stage four. And everytime I change it, she says I am „hurting“ her „like I always do“, and not doing it right. She has called me a lousy nurse. Has made personal insults, which I don’t care to repeat. It’s gotten to the point, where I have a witness with me whenever I have to do something for her.

At this point, I have come to the conclusion that, I am not going to jepordize my license because this horrible shrew of a woman wants to make up stories. I also not going to be insulted everytime I have to give this lady a pill or provide care. I decided that I am going to refuse this patients for the above reason. I refuse to accept the fact that people who are alert and oriented X3 can speak to me anyway they want to.

Has anyone been in a simular situation? If so, what happened? Anyone have any advice? I don’t really want to have to quit my job over this horrid little woman.

Specializes in M/S, Travel Nursing, Pulmonary.
That was a low blow.

You really think so? I didn't think that first time I read it.

IDK, maybe...........good advice put poor tact?

You really think so? I didn't think that first time I read it.

IDK, maybe...........good advice put poor tact?

????

saw nothing wrong or offensive about nurselovejoy's comment.../

nothing at all.

i have to agree that he needs to eval his response to this pt, and consider why he's taking this so personally.

low blow?:confused:

i'm seriously lost on that one.

op, there'd be nothing wrong with approaching psych np for advice.

briefly explain how this pt treats you, and what would she advise in responding or redirecting.

this could serve 2 points:

you really could receive helpful feedback and you indirectly put your complaint on the record.

if i were her, i'd be ticked as hell, if i was losing my autonomy, one function at a time.

leslie

Specializes in Psychiatric.

My advice would be to check her chart and find out why this patient is seeing a Psych NP. That would be a good start on finding why this lady acts the way she does. I've been a Psych nurse for over 5 years and routinely get yelled at and insulted by my patients. You just have to remember, when dealing with mental illness patients, that you will have to ignore most of what she says, do your job, and kill her with kindness. And of course, document, document, document.

Good luck, if she is a borderline, this situation might get slightly better, but will always be there.

When I read the original post to start this thread I felt a slew of emotions come over me. If you read your post again it sounds very insenstive. You are very concerned about your feelings and how this woman makes YOU feel, what about her? I have worked in nursing homes and long term care facilities for many years and have encountered many of these "difficult" patients. My advice to you would be to first figure out why her feelings towards you are bothering you so much, could it be that she is just very unhappy herself and this is how she copes? Also, when I have encountered patients like this in the past and they make a mean or rude comment to me I simply ask them how they would like me to do things. It is important to remain patient and calm and never let your patients see that they have hit a nerve and they are making you feel bad-not only is it not worth it for you to get upset, it only leads to problems. It also sounds like your giving up, refuse to take care of a patient? I don't understand, it is our job as nurses to care for all patients easy or difficult- now I understand there are extenuating circumstances but this just sounds to me like a very sad, sick and difficult patient. Goodluck to you in the future, I challege you to make ammends with this patient and show him/her how compassionate and interested you are in improving the way you care for him/her and how you make them feel. You would never believe how far unrelenting kindness will go no matter how poorly you are treated:D

"I challenge you to make amends with this patient and show.." I challenge YOU to figure out the time I am supposed to have to show all this compassion.

Specializes in Operating Room Nursing.

I can really empathise with the OP here because I've been there. When I worked as a PCA we had a resident with MS who was just atrocious to deal with. She took great pleasure in belittling people every chance she got. I kid you not it would take two and a half hours just to get her out of bed and shower her because she was so demanding. This was costing the facility money because extra staff had to be put on just for her and often other residents missed out.

I tried everything from being kind and listening to her vent to asking her to please be respectful it didn't work. In the end we were told by the DON to simply leave the room when she became abusive and tell her we would come back in 5 minutes and do the same until she stopped abusing the staff. After a while this resident became much easier to deal with.

So to the OP I'm not going to tell you to 'hang up your stethoscope' or to 'go see a counsellor' because I think right now you're facing a learning curve and need some support rather than being judged. I recommend thinking about how you can set boundaries with patients to let them know that you are willing to support them and give them quality nursing care, but will not tolerate abusive behaviour.

Best of luck to you.

Specializes in cardiology/oncology/MICU.

I can really empathise with the OP here because I've been there. When I worked as a PCA we had a resident with MS who was just atrocious to deal with. She took great pleasure in belittling people every chance she got. I kid you not it would take two and a half hours just to get her out of bed and shower her because she was so demanding. This was costing the facility money because extra staff had to be put on just for her and often other residents missed out.

I tried everything from being kind and listening to her vent to asking her to please be respectful it didn't work. In the end we were told by the DON to simply leave the room when she became abusive and tell her we would come back in 5 minutes and do the same until she stopped abusing the staff. After a while this resident became much easier to deal with.

So to the OP I'm not going to tell you to 'hang up your stethoscope' or to 'go see a counsellor' because I think right now you're facing a learning curve and need some support rather than being judged. I recommend thinking about how you can set boundaries with patients to let them know that you are willing to support them and give them quality nursing care, but will not tolerate abusive behaviour.

Best of luck to you.

That is wonderul advice and much more eloquent and appropriate than my recomendation for the old pillow Treatment. :eek:

Just kidding never done that one

Specializes in M/S, Travel Nursing, Pulmonary.

I can really empathise with the OP here because I've been there. When I worked as a PCA we had a resident with MS who was just atrocious to deal with. She took great pleasure in belittling people every chance she got. I kid you not it would take two and a half hours just to get her out of bed and shower her because she was so demanding. This was costing the facility money because extra staff had to be put on just for her and often other residents missed out.

I tried everything from being kind and listening to her vent to asking her to please be respectful it didn't work. In the end we were told by the DON to simply leave the room when she became abusive and tell her we would come back in 5 minutes and do the same until she stopped abusing the staff. After a while this resident became much easier to deal with.

So to the OP I'm not going to tell you to 'hang up your stethoscope' or to 'go see a counsellor' because I think right now you're facing a learning curve and need some support rather than being judged. I recommend thinking about how you can set boundaries with patients to let them know that you are willing to support them and give them quality nursing care, but will not tolerate abusive behaviour.

Best of luck to you.

I was taught this. Leaving the room sends............so many messages that are necessary for a respectful/therapeutic relation. Mind you, its just leaving the room, not ignoring the patient.

I've really learned how to walk away from bad situations in the non-hospital setting because of it. If only I could do this when I was younger.

I was taught this. Leaving the room sends............so many messages that are necessary for a respectful/therapeutic relation. Mind you, its just leaving the room, not ignoring the patient.

I've really learned how to walk away from bad situations in the non-hospital setting because of it. If only I could do this when I was younger.

Amen.

And it also allows you to leave with your dignity intact.

I'm sure I'm not alone when I say I've felt stupid and angry at myself for letting a "hell" pt get to me... and for the that pt to have the satisfaction of seeing it.

Best to walk out sometimes.

I do have to say, refusing the patient will not win you brownie points with the rest of the staff, and might even make your job harder. Psych diagnoses generally, yes, do indicate that the patient is not in their right mind, and therefore tends to show visibly in their behavior. Would it be easier if she was schizo and heard voices? She's got a psych NP, there's gotta be a reason.

Sometimes you just gotta suck it up - not everyone is going to like you. Kill 'em with kindness.

Specializes in Cardiology and ER Nursing.

When I get a patient from hell I usually bring a Catholic Priest in to perform an exorcism. Gotta send that demon back from whence it came.

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