First time a patient didn't like me

loriangel14, RN · Sep 29, 2012

Don't take it personally, especially coming form a confused patient.Confused patients will not like anyone that stops them from doing what they want. You will have non confused patients not like you either.You will grow a thick skin after a while.

Long Term Care Columnist / Guide · Sep 29, 2012

The first, and most important lesson here is: You can't argue with dementia/delirium. That was not your patient saying those hurtful things and fighting with the staff; that was the disease, and you cannot take any of it personally. She didn't hate you, she lashed out at what you represented to her at that moment in time. This happens all the time in caring for patients with altered mental status, as well as Alzheimer's and psych patients, and you must learn to let it roll off your back. It's not directed at you or your nursing skills!

Another crucial truth is that attempts to re-orient a demented or delirious patient are usually met with increased agitation in the form of combativeness, verbal aggression, and general upset. Think about this for a moment. Most of us, if we found ourselves in an unfamiliar place, surrounded by unfamiliar people who were doing unpleasant things to us, would feel threatened and try to fight. And as far as 'reality orientation' is concerned, wouldn't you rather be in a world where, say, your children were in the next room and your husband was about to walk through the door? That's why confused people so often come unspooled and wind up sedated and/or restrained---in their way, they're trying to show us where their reality is, while we're insisting that ours is the only correct version and PLEASE CALM DOWN, ETHEL, YOU'RE IN THE HOSPITAL!!

But these are lessons that take a great deal of time and patience to learn, and if your heart is in working with the elderly, they will become second nature. :yes:

JessiekRN · Sep 29, 2012

Wow- I'm not sure where to begin with this post. But first of all, where were the primary RN and your clinical instructor in this scenario? What is this hospital's protocol for restraints, and what, or whom, gave you the authority to monitor this patient without what seems like any prior training? You saw it in a "video?" I'm very confused. If this patient was restrained, how was she able to get a phone cord wrapped around her neck? There are many things that are just plain wrong not to mention inconsistent with your post. But I suppose my biggest issue here is that your biggest issue is that the patient "didn't like you". Um. She has dementia, first of all, so obviously nothing she says can be taken personally. You're there, or supposed to be there, to monitor safety and health, not to make a BFF. Sorry to sound harsh. I just don't see how so many things can be wrong- blatantly wrong with this scenario- yet you are concerned with being popular with a patient with obviously altered mental statu

commonsense · Sep 29, 2012

I got stuck with an elderly pt who was having an episode of delirium and was combative. She wasn't "my patient" I just happened to be there and the nurses needed help getting her in a (posey?) restraint to keep her in the bed. Once they restrained her the floor nurses left and I felt obligated to stay in the room since I remembered in our training video that patients in restraints needed to be on 1:1 and no one else was there.
I put on Wheel of Fortune and was trying to distract her with that. She kept asking me to go to the desk and ask for scissors so she could cut the restraints off. Eventually she said "I don't want to be your friend anymore because you won't get me scissors." It was a long time I was in there with her, and she managed to get the telephone and tried to make a call. I had no idea if she actually succeeded in dialing a number, but she started talking "hello operator? they have me tied to the bed and won't let me leave, please send the police." I had no idea what I was supposed to be doing - I didn't want to infringe upon her pt rights to use the phone. Worried that she might have actually dialed 911, I convinced her to give me the phone, saying that I'd tell them where we were and give directions. But as I took the phone, she grabbed the cord and wrapped it around her neck. I got it away from her, wrapped it up and stuffed it in the bottom drawer of a nightstand. Finally a classmate walked by and I told her to get our clinical instructor.
I told her what happened and she got the nurse and they came back with the boxing glove mittens. I had to help hold her arms so they could get them on. After that the patient told me she hated me, never wanted to see me, and that I hurt her. I just kept trying to tell her that she was in the hospital, we were her nurses, we were trying to help her get better, and that she just needed to relax and get some sleep.
I really felt woefully unprepared for this situation and was so hurt to have the patient hate me. Anyone else ever deal with something like this? It's especially disturbing because I feel like my calling is to work with a geriatric population and I know these situations must arise pretty often.

Like you said clovery, the pt. was confused. Don't take it personally, nursing is a profession that requires thick skin, might as well thicken up now while you're in school.

Clovery · Sep 29, 2012

Wow- I'm not sure where to begin with this post. But first of all, where were the primary RN and your clinical instructor in this scenario? What is this hospital's protocol for restraints, and what, or whom, gave you the authority to monitor this patient without what seems like any prior training? You saw it in a "video?" I'm very confused. If this patient was restrained, how was she able to get a phone cord wrapped around her neck? There are many things that are just plain wrong not to mention inconsistent with your post. But I suppose my biggest issue here is that your biggest issue is that the patient "didn't like you". Um. She has dementia, first of all, so obviously nothing she says can be taken personally. You're there, or supposed to be there, to monitor safety and health, not to make a BFF. Sorry to sound harsh. I just don't see how so many things can be wrong- blatantly wrong with this scenario- yet you are concerned with being popular with a patient with obviously altered mental statu

I don't really appreciate the attitude but to clear up what you perceive as inconsistencies...

The primary RN was standing in the doorway of a room and we had just come back from lunch. I was walking by the room and she said "Can you help?" So I did. She and another RN were moving her into a new room and then put a restraint on her that allowed her movement of her arms, but it fixed her upper body to the bed. I believe the nurse called it a "posie" restraint. The nurses were in the middle of change of shift, so they left, asking me to "keep an eye on her". I said okay, and remembered the hospital's training video said something about one to one for restraints, so I took that as "don't leave the room." I didn't know where my instructor was at the time, probably giving meds with another student. There was a phone on the nightstand; they have very long cords. She reached it herself. When I tried to get the phone from her, she put the cord around her neck in an act of frustration. She was also trying to bite herself and the nurses when she was being transferred to the new bed and when the restraints were being applied.

I told the nurse and my clinical instructor about the phone cord. Eventually security came up and I had to tell them about it too. They did a "suicide sweep" of the room. Security and the nurse had to do some calling around and then the patient was officially put on one to one, and a PCT was assigned to sit in there.

I wasn't looking to make a "BFF" or be "popular". I was just venting about a situation that upset me and looking for some empathy from other nurses/students.

Clovery · Sep 29, 2012

Thanks for the replies, everyone. I know I have to develop a thick skin, and I think I have been.... but it still hurt when the patient said that. I understand it's just the illness talking. I didn't go home and cry about it or anything. I just felt so bad because I know this is someone's mother, sister, aunt, etc. and she was in such distress and there was nothing I could do to help her.

Esme12, ASN, BSN, RN · Sep 30, 2012

Remember that feeling about how much distress and how helpless you felt in the future and this is someones mother, wife, sister, aunt and imagine how the family feels when the patient acts this way.......it might help explain why the family acts/reacts the way they do.

Now.....I realize that, as a student, this has upset you and Yes, you need to develop a think skin for it will not only be a confused patient that may be aggressive and not like you.

I have worked in nursing a long time.....and grant it I work in areas where this kind of behavior occurs from completely "rational" oriented people. There are times they mean every word they say. I have been called everything but blonde and white (my hair color and my race) and then some.

I remember answering a code MANY, MANY years ago and a very nice tiny little old lady, who, obviously had a bad night..... had 4 point restraints on with a "posey" (brand/company name) vest on. She called me into her room, and I never walk past a patient room when someone is calling for help, she proceeded to ask me for a "pair of scissors or perhaps a knife".....to "get free from my captors". When I declined she went on a tirade of profanities that was shocking from one so sweet looking and tiny. She spewed more venom and called me some pretty amazing profane things for a 92 year old. Then calmed down and begged for water....tearfully she begged, so I asked an aide that went be the room is she could have a drink....the aide said yes.....which I gave her......and....she promptly spit in my face and called me more foul degrading names.

I have been beaten with a call light cord by a confused 80 year old lady, that weighed 90 lbs dripping wet, while she screamed for the police be called because we were in her home.....she was in ICU 2nd POD after open heart.

I have had patients that are confused who get the phone and call the police that they are being abused and kept prisoner.....the police call and tell them so an so called and is being abused....PLEASE!!!!!! take the phone away from them.

I have had a perfectly rational commercial airline pilot push me into a wall because he didn't think we were moving fast enough to care for his infant daughter who had a temp (100.1) after vaccinations that day, and he had to make a flight.(he got arrested by the way and never made that flight).

I have had perfectly "rational and oriented" patients who just wanted to die and were very angry that we would not let them kill themselves and that they lived.

I have been choked with my own stethoscope.

It happens.....some of them will actually mean it, but you can't take it to heart. It's like being a parent. You have to say and do things that they may not like or understand (like a baby getting shots and screaming their sweet head off) but it is in their best interest. You are there to be their nurse, a good nurse. Being liked as a good nurse is nice but in doing your job you may not be as popular with some of the patient population. This is not a popularity contest......and that's OK.:hug: You learned a valuable lesson today. There will be patients that you will not be able to help....and yes, it is a totally helpless feeling. But you are the professional in the room and how to best handle these situations will improve over time.

Things we learned today....that confused patients can be unpredictable. That they need to be protected from harm until they are more alert/oriented and/or better able to make good decisions. That patients in restraints need to be 1:1 observed (and yes I have given a video about restraints to many students and staff) and to remove all things from the patients reach that they can use to hurt themselves and you.

That you will not always be able to help someone. :notworthy:

You did good...and grew a little as a nurse today.

Welcome to nursing, well done.:hug:

Esme12, ASN, BSN, RN · Sep 30, 2012

Here is my favourite poem.......

Being a nurse means…

Being a NURSE means…

You will never be bored.

You will always be frustrated.

You will be surrounded by challenges.

So much to do and so little time.

You will carry immense responsibility and very little authority.

You will step into people’s lives and you will make a difference.

Some will bless you. Some will curse you.

You will see people at their worst… and at their best.

You will never cease to be amazed at people’s capacity for love, courage, and endurance.

You will see life begin…and end.

You will experience resounding triumphs And devastating failures.

You will cry a lot. You will laugh a lot.

You will know what it is to be human and to be humane.

-Melodie Chenevert, RN

Clovery · Sep 30, 2012

Esme12 - thanks so much for your sweet and thoughtful reply. It really means a lot to me :inlove:

Esme12, ASN, BSN, RN · Oct 1, 2012

Esme12 - thanks so much for your sweet and thoughtful reply. It really means a lot to me

:hug:...:)

Aurora77 · Oct 1, 2012

I just wanted to add some sympathy. It's hard when your patients get confused and agitated. I work post op and you'd be surprised how many older adults get confused and combative after anesthesia. Once that's out of their system, they're back to normal and alert and oriented. I've been threatened with the police, been yelled at, had people try to bite, scratch, and kick. It's tough, especially because dealing with this is something that can't be fully taught before the situation arises. It's one thing to know in theory that these things happen. It's another to see that sweet little old lady turn into an angry biter.

It sounds like you did good. Next time you'll be better at handling the situation. These things only come with time and experience.