Abuse of a Nurse

Your patient needs a psych eval and probably an anti-depressant. She is unhappy, feels depressed, abandoned by life and is attention seeking. Unfortunately, you are at the end of her gun, so to speak. You need to talk with her physician about her pain control issues as well. And then start setting some limits. If you are terrible worried about "your word vs her word", have another person along with you when you have to interract with her. More than likely all of this is due to the fact that she is old, sick and alone.

p.rabbit

First of all, you must keep in mind that you are not the problem. Once you put that at the forefront of your mind, you will be ready to deal with this person effectively.

First of all, pain in the elderly is a phenomenon that not many nurses, and even fewer physicians are adequately educated to cope with. Myths about 'addiction' and 'respiratory depression' in the light of REAL, DISABLING and PAINFUL medical conditions tend to paralyze health care professionals, leaving the older adult like your resident. I wouldn't be so upset about the cigarette smoking, either.... as an ex-smoker [of 3 years], I can tell you, when you are in pain, or other upset, they can be QUITE comforting.

First of all... since pain is a SUBJECTIVE phenomenon, I would not label this person an 'addict' many surgeries don't resolve in older adults they way they resolve in younger people, recovery times can be profoundly LONGER. It is a myth that older adults do not have as much pain as younger adults...BELIEVE that this woman is in pain, and be her advocate. She is probably nasty to you because she knows she CAN be. You sound to me as if you have been providing compassionate care instead of being judgemental and removed.

My best advice [mind you, it is only advice]....

1. Believe her pain, and advocate on her behalf. Work with her attending M.D. or N.P. to control her pain.

2. Discuss the case with your nursing supervisor and D.O.N., be sure they are aware of ALL of your activities and interactions with this resident.

3. Get your social worker involved. They are often an overlooked ally for the nurse.

4. Try to visit this resident even when she doesn't need anything. This is hard to do I know, because I am sure your just as understaffed as everyone else, but try.

5. Discuss the problem with the resident, ask her WHY she is doing/saying these things.

6. Try to discuss the matter with her daughter, and let the daughter know that you are on her and her mother's side. Many family members appreciate a nurse who goes that extra inch.

7. Be sure that everything is documented and CARE PLANNED. If there is a problem where the Dept. of Health or Ombudsman get involved, they will want to see the resident's care plan.

8. Finally, don't be paranoid about your license, remember the "4-D's" of the successful lawsuit/license disciplinary actions [by Board of Nursing]:

-Duty Owed

-Duty Breached

-Damages

-Direct Cause

[if they cannot successfully pin all 4 on you, the lawsuit/disciplinary action will not float].

In conclusion, if all else fails, ask your DON to be assigned to another unit. Keep your chin up, and believe in yourself, everything will work out well, and you will be a better nurse for it.

You received goodadvice so far and I'll only add a question. How does the other staff interact with this patient? Canthey support your assessments?

Originally posted by skyepayne:

HELP!! I am an LVN in a nursing home and have had a really bad time of it of late! I have a resident who has singled me out and accused me of some very upsetting acts. She is in a wheelchair and also uses a walker. She has had surgery on her back 4 times. In this process of recuperation she has become dependent upon narcotics. Last night at 7 she was given Oxycontin..30 mins later she was given Oxycodone for breakthrough pain..she said it didn't help and wanted an injection.We were instructed to give her 25 mg.Benadryl IM as she had become totally dependent upon Nubain and declared the injection was the only thing that helped her. Thirty minutes after the injection she was requesting Ambien because she couldn't sleep.Ten minutes later she requested Tylenol for pain. The thing is..she gets out of bed after each medication and wheels herself to the patio area to smoke!!!

The problem? Well..on one occassion I went to her room and gave her an injection.I had my hands full of syringe,alcohol prep and closed her door with my foot..the door slammed and she became upset enough to turn me in! She said I am rude and although I apologized she had an incident report made up all of which were lies. She said I told her that I couldn't give her a shot because I had to give some *mexican* a med. What I did say was that *I would bring her med when I finished this NEXT ONE*..She has me turning in so many directions I am afraid for my license which I have had for seven years! Please help!!! She has 2 other residents talking about me now as well and this hurts!

She has her daughter believing that I am a very mean nurse and requested I no longer be her nurse. My DON is aware of this situation but each day this res. adds a new ringer and the saga continues like a bad nightmare. She calls me *baby* and is very sweet to my face until after I give her a medication,once she has what she wants she becomes very hateful to me.What are MY rights as a nurse against a patient who is so abusive to me?

Thanks

Skye

[This message has been edited by skyepayne (edited December 17, 2000).]

I want to thank all of you who answered this message! For an update here is what has happened since I wrote this. I went to work at 2 this afternoon to find that the resident had been to the nurses station on numerous occassions after I went home requesting pain medication. She was given the alloted doses and by 3 a.m. she told the staff that she wanted to call her daughter and be taken to the E.R.(that we weren't doing enough for her) She was obliged and upon finding out that she was to be transported to the E.R. became very calm and was actually polite and pleasant. They admitted her! Her pain management Dr. came by to visit her at the facility and he had NO clue she was admitted into the hospital. He immediately called over there and gave orders to up her doses of Oxycontin and Oxycodone!! He then asked me if I felt she was abusing the drugs. I told him I could not *state* that she was but by her behavior it was possible. He replied *well she's OLD so what is she going to do?*..the woman is 59 years old!I charted every statement he made and closed the chart.I do not know how she is handling the not smoking at this point but I am sure she is getting the attention now that she is seeking. Oh, and one thing I forgot to mention. She has *seizures* and is on Dilantin however not once has anyone observed these seziures with the exception of her family.

Again..Thanks and I will keep you posted!

HELP!! I am an LVN in a nursing home and have had a really bad time of it of late! I have a resident who has singled me out and accused me of some very upsetting acts. She is in a wheelchair and also uses a walker. She has had surgery on her back 4 times. In this process of recuperation she has become dependent upon narcotics. Last night at 7 she was given Oxycontin..30 mins later she was given Oxycodone for breakthrough pain..she said it didn't help and wanted an injection.We were instructed to give her 25 mg.Benadryl IM as she had become totally dependent upon Nubain and declared the injection was the only thing that helped her. Thirty minutes after the injection she was requesting Ambien because she couldn't sleep.Ten minutes later she requested Tylenol for pain. The thing is..she gets out of bed after each medication and wheels herself to the patio area to smoke!!!

The problem? Well..on one occassion I went to her room and gave her an injection.I had my hands full of syringe,alcohol prep and closed her door with my foot..the door slammed and she became upset enough to turn me in! She said I am rude and although I apologized she had an incident report made up all of which were lies. She said I told her that I couldn't give her a shot because I had to give some *mexican* a med. What I did say was that *I would bring her med when I finished this NEXT ONE*..She has me turning in so many directions I am afraid for my license which I have had for seven years! Please help!!! She has 2 other residents talking about me now as well and this hurts!

She has her daughter believing that I am a very mean nurse and requested I no longer be her nurse. My DON is aware of this situation but each day this res. adds a new ringer and the saga continues like a bad nightmare. She calls me *baby* and is very sweet to my face until after I give her a medication,once she has what she wants she becomes very hateful to me.What are MY rights as a nurse against a patient who is so abusive to me?

Thanks

Skye

[This message has been edited by skyepayne (edited December 17, 2000).]