power struggles

Mandychelle79, ASN, RN · Aug 9, 2013

I think it has to do a lot with YOU not them. I can get our Axis 2 patients to cooperate more than other staff. You approach seems very much like mine. I dont make a HUGE deal out of non safety related issues. And in the scenario you stated I would have said the same thing. Ive said it to patients and been told, well I just threw my shirt in the washer/dryer and going to go get a shower and get dressed after the shower. I just open the shower door for them, or if they are coming from the shower to their room I just tell them if they forget it next time just call out, one of us can get it for them.

Mandychelle79, ASN, RN · Aug 9, 2013

When my staff is acting like that ( and yes I say my staff, Im charge for that shift, I usually work with the same people day after day) I normally just ask them if this is the hill they want to die on. By nature I am someone who sees many shades of gray in every situation, a lot of the staff I work with is very black and white. The black and white thinkers are usually the ones that who end up engaged in a power struggle, because of the my way or the highway attitude vs the patient is part of the team.

Now when I have a safety concern you better believe it is my way or the highway. But for some reason the patients respect that and dont usually make too big of a deal about it.

TerpGal02, ASN · Aug 10, 2013

Over safety stuff, no I don't play games, but the above scenario, I was like, "really? Over a shirt? C'mon guys".

Davey Do · Aug 12, 2013

It seems that some Staff have Little Voices that whisper in their Ears, "C'mon. You need to make those Axis II Patients do what they need to do". According to Eric Berne's Transactual Anaysis (TA) Concept, that Little Voice comes from our Parent Tapes. Parent Tapes stem from our Need to be Responsible.

Applying the TA Concept TerpGal and Mandychelle, you two seem to have a Tendency to listen to your Adult Tapes; the Voices of Logic and Reason. Using Logic and Reason, you Systematically Approach your Axis II Patients and Choose your Battles. Kudos (LIkes) to you!

Some Staff have Difficulties in grasping the Concept that Mentally Ill Patients are going to display Unusual Behavior. Often times, my Peers and Co-Workers will Energetically Identify a Patient's Unusual Behavior and talk about that Behavior as if they were Gossipping. I sometimes say things like, "Gee- these Patients act as though they were Mentally Ill!" A Psychiatrist once told me, "Expect Unexpected Behavior from Mentally Ill Patients. If they typically display Expected Behavior, they're not Mentally Ill".

Personality Disorder Patients are somewhat different, however. Theirs is not a Mental Illness, but Personality Traits that are Behaviors manifested in Relationships. Although there are about ten different specific Personality Disorders, we often refer to a Patient being an "Axis II" in the realm of a Borderline Personality Disorder. Borderlines are difficult to deal with due to the Buttons they can push in us. Their Behavior is often so overly Insidiously Manipulative, they can be very trying Patients to work with.

I doff my Proverbial Hat to both of you for your Clear, Realisteic Perspective in dealing with such Trying Patients.

(Before I sign off, I need to tell you of a Reply I once gave an Axis II Patient. This Patient was requesting that I perform a task and was critiquing my method. The Patient said, "I'm not trying to be a Pain". and I replied, "Oh- you don't have to try." I guess what I said was not the most Therapeutic thing I could have said. However, just saying it decreased my Feeling of Strees.)

New Angel · Aug 13, 2013

This is a hot topic around my office as well....Some say that certain employees have higher propensities for antagonizing pt.'s then others. I try to have the optimist's mindset and hope that noone would ever purposely antagonize a pt..

Firsty, I commend you for not cutting off your coworkers while they work with other patients....It's so important that we have eachothers back in our kind of working environment. I also know how difficult it is to correct coworkers or suggest different interventions/styles.....people can be sensitive. If you feel a coworker is causing an unsafe work environment, then I would bring it up immediately. If it seems that their work behavior just makes life at work more difficult for them, then the best way is to lead by example. I quite appreciate the hard line some of my coworkers use with pt.'s, I see that we all have our own ways of working with clients, and that some staff get along better with some clients more then others. I also have a more, "pick your battles" type of approach....it can be very challenging with BPD clients testing their boundaries.

Mandychelle79, ASN, RN · Aug 13, 2013

Applying the TA Concept TerpGal and Mandychelle, you two seem to have a Tendency to listen to your Adult Tapes; the Voices of Logic and Reason. Using Logic and Reason, you Systematically Approach your Axis II Patients and Choose your Battles. Kudos (LIkes) to you!
I doff my Proverbial Hat to both of you for your Clear, Realisteic Perspective in dealing with such Trying Patients.
(Before I sign off, I need to tell you of a Reply I once gave an Axis II Patient. This Patient was requesting that I perform a task and was critiquing my method. The Patient said, "I'm not trying to be a Pain". and I replied, "Oh- you don't have to try." I guess what I said was not the most Therapeutic thing I could have said. However, just saying it decreased my Feeling of Strees.)

Honestly, I just treat people how I would want to be treated if I was in that situation. Just last night, I was running a med compliance group and we had an influx of new patients over the weekend ( when I left there was 14 friday, there were 24 when I left last night) so the group was mostly made up by patients who didnt know my name, let alone how I am. Some of the first comments I heard " You arent a normal nurse" " Normal nurses dont say things like that ( when I pointed out that Street Value was one of the reasons people dont take their meds) " At the end of the group I was trying to figure out who was in the room, so I could chart, and I asked one pt his name. He didnt want to tell me, I just said, "Fine, I just cant give you credit for being here" he made sure I knew his first and last name after that.

chevyv, BSN, RN · Aug 21, 2013

I cannot tell you how infuriating this type of behavior makes me. I find myself wanting to medicate my staff more than my pts! If they would just shut up the patients would be fine but nooooooo they have to argue and make things horrible. I have to take them aside and remind them that this is a psychiatric facility and we get to leave at the end of our shift. Management is not usually around on my shift so I try to put out these little fires so I don't end up in a huge massive fire! You are so not alone.

HealSpec · Oct 6, 2016

Sorry to necro this thread, but I found it while googling the issue and figured this was better than starting a new one. Out of curiosity, how do you deal with those "little voices"? I usually consider myself a huge proponent of least restrictive environment, but I have a button or two like any person, and I've found that patients refusing care pushes them. The patient might be belligerent about it, jerking away from me or yelling... or they might be perfectly polite, but they're simply not going to take those meds tonight, thank you. It drives me nuts that I even have this button! It feels very un-nurse-like. But each time it happens I find myself trying to cool down afterwards. Obviously I'd never force a patient to do anything, or perform something they'd refused against their will unless it was an emergency (we do very occasionally have emergency orders for things like IM antipsychotics). But from the other side of you guys' discussion, how do you deal with the urge to stay on the hill and fight?

James W. · Oct 7, 2016

Problem solving in psych is important, as is providing therapeutic learning situations,

- for less adept (anxious/pushy) staff & patients alike.

Sadly, psych has always attracted its share of 'Nurse Ratched' control freaks who think

provoking dominance confrontations to assert power, is a substitute for real psych skills.

Ironically, if such staff did a self MMPI , the results could give them self-awareness cues,

- to take to supervision, & IMO, in many cases,

..ought to be done on professional/safety in the workplace grounds..

Too many times such 'incidents' are needlessly ramped up into dramas, & violent ones.

EKUGRAD, BSN, MSN, RN, CNS · Oct 18, 2016

I worked on a forensic adult psych unit with full-time security officers. One of our PD's came out of his room without a shirt. The officer told him to put on a shirt and the patient told him exactly what to do with that idea. The officer responded in kind and if myself and another nurse hadn't gotten between them, they would have gone to full-on blows !

Davey Do · Oct 18, 2016

I have a button or two like any person, and I've found that patients refusing care pushes them.

Good for you, HealSpec! The first step in dealing with any problem is to identify it. This you have done. The second step is to gather data. You are in the process of this by your request of asking others how they deal with having their buttons pushed.

Know your priorities as a Caregiver and choose your battles. Don't take it personally when a Patient refuses care. Patients have the right to refuse care.

I use to think that I was a failure at my job if I couldn't get a Patient to do what they were suppose to do. I thought, "If I cannot get that Patient to do what they're suppose to do, then it must be my fault; it must be because of some sort of shortcoming in me."

Working in Chemical Dependency Treatment gave me an epiphany- an illuminating revelation, if you will. I embraced the concept of what or who I have power over, and what or who I do not.

The Serenity Prayer really says it all.

The best to you on your road to a higher conscious which you are obviously on, HealSpec!