Dealing with Difficult Patients

[epicnurse]

Hi all! I'm an LPN with 3.5 years of experience in long-term care settings. I'm not totally new, but I'm still a little green around the edges. Today my question for everyone is about how to deal with difficult patients.

Normally, I work on a long-term wing of a residential facility and deal with your run of the mill older residents - dementia, Alzheimer's, diabetes, hypertension, CVA, CHF, and the lot. For the most part, I've figured out how to work with my residents and their individual behaviors.

However, this facility also has a rehab wing which I float to every other weekend. These patients are much different than the people I normally work with. They are, for the most part, alert and oriented, and they know what's going on with themselves (which is not something I can say for my beloved long-termers). I haven't had much of an issue with this (other than the clock watchers... better not miss a PRN norco...) until recently.

A short-term rehab patient was admitted post heroin overdose, and he is extraordinarily behavioral and demanding. He's a player, he's an attention seeker, a drug seeker, he's a thief (and has been caught red-handed going through staff members' purses and bags if left unattended), and he's doing his level best to get someone fired. He's turned more nurses into the higher-ups for trivial things than I can count. I've only dealt with him for one weekend, and it was HELL. Out of 20 patients I was responsible for, he caused me more stress in two nights than all the other 19 patients put together. And, woe is me, I'll be working on his wing with his patient group this coming up weekend.

I'm so stressed! I'm already dreading going into work on Saturday and Sunday nights. Best case scenario... he'll just sleep through the night, and I'll only have to deal with him in the morning for his 6 am meds. I have a feeling that's not going to happen though, and that I'll be dealing with this man for my entire 8 hour shift. My supervisor is aware of his behaviors and issues, and there'll be another nurse working the opposite group of this wing with me, but I'm still very nervous to go into work and deal with this patient.

My plan right now is to treat him very, very professionally, make sure I don't have any conversations (work related or not) where he could possibly overhear, keep my nursing practice air-tight over the weekend, and rely on my supervisor's opinion for any incidences that may come up. But, to any nurses who've had experience dealing with difficult patients like this one, do you have any advice?

[LTCNS, LPN]

-Document, document, document!

-Don't engage him. Be professional at all times with him. No matter how much he acts like a jacka$$ don't give him the satisfaction of reacting. Don't give him any ammo to use against you.

-Report every jerkish move he makes to your managers and document that you reported it.

[Been there,done that, ASN, RN]

Add borderline to his list of diagnoses. They can be very hard to to handle, unless everyone is on board.

The facility should not be tolerating this manipulative behavior. Call a patient care conference ASAP, so every one is on the same page.

I don't know how desperate your facility is for patients, but theft should be reported to the authorities.

I agree with the Nurse Ratchet demeanor , and document , document , document.

[TheCommuter, BSN, RN]

The previous two posters made excellent suggestions.

I'd also like to add that boundary-setting is of the essence when dealing with manipulative patients. They are not reasonable people; therefore, do not negotiate with them. Yes means yes, no means no, and no shades of gray are permitted. Once you give an inch, they'll take 100 miles.

[NaeLPN]

Yikes! Please pray before and during and after these shifts! I would definitely make sure I document EVERY thing, and have a witness around for any conversations I have to have with him. I would be over the top ivory-white-tower professional and meticulous with my care. NO personal or opinionated conversations with or even remotely around him, strictly work & patient care related conversations only. I would have my poker face on so he wouldn't know if anything bothered me that he said that was offensive. Some manipulative people love to get charged up and start on a new target. Do not engage him. Please be on your P's and Q's and remember this is only a shift. It will end soon, you can and will get through this! Good luck and God bless!

NaeLpn

[Mandi67]

Sad, but this seems to be the norm these days. It is best to take the path of least resistance and DOCUMENT....I always remember this ..."the customer my always be right , but it does not mean you are wrong"