Ever have a patient that "turns" on you?

[dudette10]

Going good, good rapport.

And, then, BAM.

Have no idea what happened. Miscommunication? Misinterpretation? I didn't see it coming...

[carolmaccas66, BSN, RN]

What's 'stink eye'? haven't heard that one, not having worked in peds b4.

[~Mi Vida Loca~RN, ASN, RN]

Just like the evil eye.

[xtxrn, ASN, RN]

It could have had absolutely nothing to do with you- you were just "convenient" to lash out at. If you can't identify a point in the task/treatment that was tense or awkward, I'd go with the idea that they just were overwhelmed in general and don't have the coping skills to deal with it any other way Or it could have reminded them of something else- who knows? Patients come in with all sorts of baggage....just like everybody else- then they're in an environment with a lot of things that are beyond their control, and they can snap... If they don't get over it, a psych consult might not be a bad request- it might not be anything major, but some stressors they can't deal with . ((((dudette)))) Patients are hinky sometimes. :)

[NoFlorenceRN]

I think of patients like I think of Rottweilers...they make good pets, but, don't put your face too close to their mouth.

[misswhitney]

I had a patient who was all nice to me, when I didn't have them the next day, they asked if I could switch, etc. I was in their room and the room across the hall, all day. I specifically asked to not have them the next day, but did not let them know that. They told the doctor that I was rude and that I had not been getting them their pain medicine (oops, did I happen to chart every single time I not only gave one, but your pain before and after *a total of six times in a 12 hour shift), and had not been following the orders the physician had written out (good thing I charted that too; the orders were very time constricting to follow).

[Horseshoe, BSN, RN]

During my critical care internship shortly after graduation, I had a very sweet elderly patient in the ICU. She couldn't have been lovlier. Right before shift change my first day of caring for her (6:30 pm), I hung yet another piggy back (she had many IV medications ordered that day). Right before my eyes, her facial expression changed from sweet and happy to almost evil and suspicious. She accused me of trying to poison her! I couldn't believe it. One of the other nurses in the unit had taken care of her several days prior to my assignment. She said, "Oh, I forgot to tell you-she's a sundowner." Sure enough, every day after that, Ms. Hyde would morph into Dr. Jeckyl at the same time each evening-you could see the change come over her face and she became such a challenge (mostly for the night shift).

It happens.

[xtxrn, ASN, RN]

And who knows what sorts of personality disorders SOME patients have- borderline personality disorder is notorious for flipping the love/hate switch. Any paranoia, histrionics, etc- all are very hard to deal with .

It's always good to self-evaluate when something happens- but sometimes there really isn't anything else you can do....:)

[CareteamRN70]

I have one patient I really have a good relationship with, but this worries me to no end because it kind of puts me in her sights.

This pt is the one that has the DON, the Facility head, the ombudsman, and state on speed dial. She will call from her room to the nurses station to report that her call light has gone unanswered for hours (her biggest complaint is having her cath bag emptied and most times she will hit her light and go back to sleep, the aides empty it, turn off the light and exit).

Every morning after she is hoyer lifted into her scooter she will be up at the facility managers office with a list of complaints. She has asked me to write up aides for not performing duties (which I have seen them do as I enter her room from the shared bathroom to care for her room mate and she doesnt always see me as she berates the aides to no end as they do her care).

She has gooten several aides pulled from her care, and had at least 1 nurse let go because of her accusations.

My concern is right before she goes on the warpath it always seems to be her favorite aide, nurse that gets the full brunt of it.

[Orange Tree]

Unfortunately, it's really not that uncommon. I've found that staying calm, caring and reasonable will snap most of them back into line, but there are some who just stay far out there.

[JRP1120, RN]

This same thing happened to me once when I was a PCA. Good rapport with the patient, all going well, etc then BAM! I come in the next day and she's a little icy to me, I ask her if she needs anything, could I do anything else for her, etc (I always asked my patients this after taking their vitals, taking their food tray out of the room, etc...nope, she was fine, don't need anything. I go in the next time to take her vitals and she's not facing me and refuses to have her vitals taken. I ask her if she's ok, she barks rudely she just doesn't want them taken. So I leave the room and go tell her nurse she refused vitals. The nurse goes in there and is talking to her and I hear her getting upset about something. The door is open (mistake #1), when I start to walk by the patient yells, "yeah, YOU little girl, come here". Shocked, I walk in (mistake #2). And she proceeds to start yelling at me about how her toilet had not been cleaned or her bathroom trash not been taken out (she was a walkie-talkie, able-bodied, no brief-wearing, clean herself up kind of patient who was scheduled for discharge on this day). It was the weekend and housekeeping hadn't yet made it up to her room. With the nurse standing there, the pt just lambastes me, yelling at me, I'm apologizing for housekeeping, etc. I'm trying to calmly talk while she's yelling over me, not letting me get a word in edge-wise (mistake#3). Then, she gets IN my face and puts her hand in my face and says, "talk to the hand!". I'm flabbergasted and just speechless at this point. Mind you, the nurse is just standing there, letting her lash out at me, not saying a word. So, in my frustration, I calmly say, "ok, whatever" (mistake #4) and turn around to leave the room. Well THAT got her nurse talking, she immediately jumped on me and tells me to leave the room, that wasn't appropriate, etc. I was so shocked, shaken up by this incident I was almost in tears. Once the dust settled her nurse reprimanded me for saying "ok, whatever". And she did it in a very condescending way, calling me "sweetie" like im some little child, ugh, really? Yeah, granted, it wasn't the best thing for me to say but in the moment I didn't know what else to say, so execute me, I'm human. Looking back, I could've said much worse to her; I was trying to keep my cool in the heat of the moment. So then the nurse supervisor comes up and talks to the patient then proceeds to come and talk to me and SHE yells at me telling me what I said was inexcusable then out of nowhere asks me if I have had a problem taking care of this pt because she was a different ethnicity than me??? HUH?? Where did this come from? Again, I tried to explain the situation to her, told her no, we had good rapport, etc...she's talking over me now telling me "well, the customer is always right!". She walked away from me, leaving my jaw on the floor. Turns out, this nurse sup used to work with this pt, knew her personally, etc. The pt writes up a 4 page complaint (my guess is about the entire stay she had). She's discharged about an hour later, I'm at the nurses station charting, she comes up and asks the secretary to make her copies of her complaint and while she's waiting, stands directly in front of me, staring me down. I of course ignore her. Her kid even told her to not say anything and to calm down. Total intimidation tactics!

Needless to say, I felt like I was thrown way under that bus! I was severely disappointed in her nurse. A) she should have shut her door when she went in to speak with her. B) she should have told the patient she was handling it when the pt so rudely called me into her room-nurse shouldn't have let me walk back in that room (and I shouldn't have walked back into her room, esp with the way she called me in there). I had never before had any complaints on me but had quite the opposite. The DON liked me and my work and I was told by the other nurses not to worry about it, to shrug it off, she was a pt that just wanted to b**** and moan, AND, she was being discharged that day. Oh yeah, housekeeping was called, they came up and cleaned her bathroom and trash and they got a lashing from this pt too the entire time they were in her room). I did email the DON about this but never heard back and I was told she had been made aware of the situation but wasn't worried about me or the pt's complaints (in other words, she saw it for what it was).

I was glad for it to be over but was really hurt by the lack of support from this pt's nurse. She did not have my back and left me out to hang. I wonder if she would've stepped in finally had that pt actually pushed me or shoved me? She stood there and watched the pt get in my face and put her hands in my face, to the point I had to back away from her. Why didn't she step in then? And the nurse sup who knew the pt? I was extremely disappointed in how she handled it-insinuating the race issue when i never have ever had any issues with that kind of thing-just absurd in my view. The other nurses said i couldve said a lot worse and many said they wouldve had a hard time biting their tongue for so long like i did. I learned I'm not always going to please everyone (I already knew this) and also to have my fellow team members backs (PCA, nurse or other) always! Now that I'm a nurse, I know there will be times I will get the crap from pts but I won't let one of my PCA's go through what I did as a PCA. If I'm in the room, I'll find a way to handle it as professionally as possible. Sorry for the long post but had to get that out! :):)

[Horseshoe, BSN, RN]

I have one patient I really have a good relationship with, but this worries me to no end because it kind of puts me in her sights.

This pt is the one that has the DON, the Facility head, the ombudsman, and state on speed dial. She will call from her room to the nurses station to report that her call light has gone unanswered for hours (her biggest complaint is having her cath bag emptied and most times she will hit her light and go back to sleep, the aides empty it, turn off the light and exit).

Every morning after she is hoyer lifted into her scooter she will be up at the facility managers office with a list of complaints. She has asked me to write up aides for not performing duties (which I have seen them do as I enter her room from the shared bathroom to care for her room mate and she doesnt always see me as she berates the aides to no end as they do her care).

She has gooten several aides pulled from her care, and had at least 1 nurse let go because of her accusations.

My concern is right before she goes on the warpath it always seems to be her favorite aide, nurse that gets the full brunt of it.

Document, document, document, and then when you're finished, document.

[loriangel14, RN]

Sometimes it can be manipulation on the patient's part or sometimes it can be sundowners. Sundowning can turn athe sweetest patients into completely off the wall patients. Some are pleasant as long as they are getting what they want.