Dealing with borderline

[Cute_CNA]

Patients with Borderline Personality Disorder are some of the least favored in the hospital I work at. Or at least, so it seems.

Lately, we've been getting these patients who insist at talking at the top of their voices, and constantly blab at the nurses' station window. This happens every frigging day. I hate it!! A couple of the RNs say they don't mind the patients doing this, BUT I MIND!!! I find it very distracting, rude, and honestly, I cannot stand these people. There are times when I just want to yell at them to SHUT UP! Part of the problem is, there are a couple RNs who just allow this to happen, and I'm just not sure what to do. I'm a CNA, so I have little power.

What would make things better is if she didn't talk so loudly. Thing is, sometimes I go to the nurses' station to get away from what is going on so I can get some planning done for activities with the patients, but she's still blabbing away and distracting me.

Does anybody have any advice? Sometimes I feel like things are at a critical high with myself and these borderlines. I feel like I just want to yell at them and tell them that I don't care what their problems are. (I would care and feel some empathy for them if they DIDN'T REHASH THE SAME THINGS OVER AND OVER AND OVER!). I am not the type of person who just brushes people off, but I really cannot stand people who require constant attention, and constantly talk about their problems, and REPEATEDLY talk about the same problems.

What can I do to change their behavior? What can I do to change my attitude? Frankly, I just don't even want to deal with these people. Perhaps that may be part of the problem, but I really don't want to sit there all day wasting my time while they talk for hours at a time.

[IMustBeCrazy]

:chuckle :chuckle :chuckle

Sorry, no room on the unit! But...I may be able to wrangle a trade for a few actively hallucinating pts?! :chuckle

~IMBC

[Cute_CNA, CNA]

:chuckle :chuckle :chuckle

Sorry, no room on the unit! But...I may be able to wrangle a trade for a few actively hallucinating pts?! :chuckle

~IMBC

I would actually prefer actively hallucinating patients!

:selfbonk: :smiley_aa

[kadokin, ASN, RN]

Also speaking of boundaries in relation to new folks considering being a clinician in this field. When the person is discharged, he/she is discharged. Your relationship is terminated. It is not appropriate to call the Borderline, give your home number, your email address, invite them over, or meet at lunch to chat. If you would/do, you do not belong in this field. You are more harm than good.

Amen to that brother (I'm assuming your gender from your avatar picture)! I will never understand the fellow clinicians I see who actually do this. l am an RN working in an inpatient psych. unit. While I don't KNOW of a lot of people meeting pts outside the hospital, many of them will take calls from former pts "just to chat" while they are at work. These are not crisis calls. In my mind, it is the client becoming dependent on the system. They need to be making connections/building relationships OUTSIDE of the clinical setting. I try to gently educate my co-workers that we as a treatment team are there strictly for support of pts on an inpatient basis. It frequently falls on deaf ears. Doesn't help much that 2 of our former charge nurses were the worst offenders. Thankfully, they have retired. Sorry to stray off topic, saw a good chance to rant. In dealing w/BPD pts, there have been some good hints and tips on here already. Chiefly, "Boundaries are your friend" . And in a similar vein, "Don't get sucked into the drama". One noted expert whose seminar I attended explained that for many people w/serious personality d/o's, drama is their only reliable coping mechanism and the more people they can get involved in it, the better they feel. Also, this same expert cautioned us to realize this may truly be a biologically mediated phenomenon, and the client may not even realize or understand the kind of havoc they are creating. This is why they NEED boundaries, gently and respectfully presented, of course. One way I've found to deter the client who loves to "hang" at the nurse's station is to remind them that a lot of sensitive, confidential conversation goes on there and we need to limit the number of people who spend their time@the station in order to preserve EVERYONE'S confidentiality. Hope this helps

[kadokin, ASN, RN]

I was kind of alluding to this in my original post. Part of the problem is, this person is dealt with inconsistently. Some people act like they don't care how she acts. But what about people like me who are not as patient, and not as WILLING to deal with their ridiculous and unreasonable behavior? The people supervising ME act like it's no big deal. If I have less patience, I'm afraid it's going to make me look bad. And the RNs keep rewarding the rude behavior of these people by PAYING ATTENTION TO THEM!!! And I'm thinking, STOP! She's going to think that if she's annoying to me, she'll get attention the same way she got it from you when she was annoying to you!

I haven't finished reading all the replies yet. I will continue to do so. Thanks for the help!

By the way, some of the worst borderlines recently moved off our unit.

:balloons: :biggringi :balloons: HURRAY!!! :bowingpur :smiley_aa :balloons: Thank God, praise the Lord!

I hope you don't take offense, but, are the rns you speak of rewarding rude behavior or attempting to be therapeutic? Just had to ask. I know from experience that some rns really don't handle these pts effectively, but they are obligated to try and be as therapeutic and compassionate as they can be. Maybe your way of setting boundaries w/these pts would be to gently, respectfully refer them to their rn when their behavior is wearing on your nerves. Maybe the rns in question would start to understand the need for boundaries if they had to deal w/them more often. And there is nothing wrong w/asking your co-workers(rns included) to back you up when you are setting the boundaries. Some more food for thought, sometimes giving these pts what they ask for (within reason), when they are in the midst of pitching a fit can head off an escalation of the rude, nasty drama they are creating. If the rns you work w/are worth their salt, they should be able to listen to your requests/suggestions and help you get through your day w/a minimum of stress. Keep those line of communication open! It is perfectly ok to say you have had all you can handle of a particular pt and let someone else step in the breech for you. This is healthy and sensible.:)

[RM23]

The BOrdlerline patient is very challenging to work with. Having worked with borderline patients (and staff) for many many years, I have just a few simple rules. 1. Leave your own baggage at home for if you don't the borderline will push your buttons and you will react. 2. All staff must have the same approach otherwise treatment does not work. Staff must be constant and consistent, to say the least, MUST BE CONSISTENT> 3. I have learned that when staff become upset, irritated, annoyed, angered with the borderline then someone needs to look at their own behavior, etc. Meaning, all staff have baggage, as I stated, that they bring with them to their jobs. Often identification comes into play. ALl this baggage, etc must be left outside the unit doors otherwise your buttons will be pushed. Remember the borderline is a mental health patient who we must remember probably had a terrible upbringing of which contributed to the now behaviors, etc. This person is going to need long term therapy to make a difference and the acute settin gis not going to cure just bandaid. I used to tell my staff.. "if the patient is pushing your buttons, making you angry, upset, etc. ask yourself what is happening that this patient has made me react the way I am? Do I react to schizophrenics or depressed patients the same as I am reacting to the Borderline? Good luck ladies and gentlemen...

[krisssy]

I agree with the last two posters. To me, a pt. with BPD is just another patient with their own diagnosis to be treated therapeuically in the ways we have been taught. We must remember that these are patients, and they are ill, and we are professionals. I totally agree with the poster who said that the RN's may be doing what they think is therapeutic. Cute CNA, I agree that the best thing for you to do is to have a conference with the RNs treating this patient. Find out what their treatment plan is and what you can do do help. I think it is important that you all are being consistent. Also, in my experience, when a BPD patient feels like someone doesn't like them or someone feels annoyed by them, it exacerbates their illness. We all need to remember that they are in the hospital because they are ill and need help. I certainly don't know all the answers as far as what is the best therapeutic treatment, but I do know they need help, and I am there to help them just as much as any other patient with any other diagnosis. As I work and learn in psych,I do try to think what it is in me that makes certain people push my buttons and aggravate me, and I am finding out!!!!! and working on myself so that I can help my patients without getting frazzeled. Cute CNA, I do understand how you feel. You have gotten very good advice here. Hope it helps you.