How to deal with a bully patient?

CardiacDork, MSN, RN · Jul 14, 2017

We had a detoxing meth patient who just got out of jail for assault with strangulation and kidnapping. Demons and swastikas everywhere on his body, and outright violent with us.
After he returned to his normal and was healthy enough to move out, he still got a free ride in ICU for multiple WEEKS until they found him a behavioral health placement. Rationale was "they couldn't handle him on the floor or in stepdown." Since when does ICU qualify as the place where it's okay to stick patients too violent for other floors to handle? None of us were very happy about that.
We only gave him to male nurses, and usually only to the male travelers or members of the float pool, and he spent most of his time with us in restraints with a mask on so he couldn't spit in our faces. That's how we dealt with him.

Why is the ICU the place to stick patients the floor deems "too much" to deal with. So somehow I'm more qualified to deal with this rude, disrespectful, bully of a patient? I could be just as stretched as a floor nurse with 5-6 patients when I already have an extremely sick patient circling the drain.

ICUs are dumping grounds for patients with behavioral issues!

I would hope the charge nurses are wisdom when making these assignments, it sucks that a bully attempts to take you AWAY from someone (your other patient) that really needs you.

Same goes for the floor nurses, these patients can be a handful and need to be balanced accordingly.

Overall, as nurses we need to put our foot down. I had a patient once with attention seeking personality type disorder. Maybe BPD?

Idk but this patient would attention seek and pretend and cause scenes and as soon as someone turned an eye would be all good again

catsmeow1972, BSN, RN · Jul 14, 2017

At least in my opinion, travelers are not getting that "couple of dollars extra" for looking good or whatever BS reason. It's because they are uprooting every few months and dropping themselves into a new place with a new typeset of patients and a new documentation system with a new set of coworkers likely in a new town. As best as i have seen, also they don't get the several weeks of orientation that us staff people get. it's more like here's your locker, here's the coffee pot, here's your patients, get to work. That all takes some serious clinical skills.

I've never traveled (toyed with it a few times) but I'm am not too sure it's as financially lucrative as it's made out to be, if you listen to all the advertising. May be cool if you like to get around and see the country but other than that...meh.

Valerieap07 · Jul 14, 2017

Thankfully at my hospital this thought process isn't the norm. Especially in the ICU's. Those pts are reserved for the regular staff, who are assumed to be more capable of dealing with it. We especially wouldn't entrust an agency nurse we don't know to deal with this type of pt.

saskrn · Jul 15, 2017

Because I've been there and done that. When I was an agency nurse, it was the name of the game in 4 out of 5 facilities I was sent in.

I was a traveler for years and never had that experience. Additionally, as a staff nurse we did not treat others this way.

Regardless, treating others the way you described is unprofessional and inexcusable. Just because that was your experience in the past, it doesn't make it right.

Quickbeam, BSN, RN · Jul 15, 2017

As a rehab nurse who got floated to unfamiliar units all the time in my clinical career, I can say this thinking accounts for a lot of my horrible experiences.

catsmeow1972, BSN, RN · Jul 15, 2017

Figure it was only a matter of time before one of my comments bites me in the posterior. i get my patients today and lo and behold, one is this week's designated unit bully. He's thrown things, he's cussed staff out and just been 17 different kinds of a jerk, even to the point of refusing to even speak. Just mumbling and pointing. When I took report, the night nurse didn't even want to go in and do the in-person hand off that we usually do and i can't say as i blame her. He hits his call light, i go in and he does his mumble and point thing. As best as i can interpret his IV hurts. I said Sir, i need you to tell me what is going on so i can help you. I cannot babysit you all day. (Admittedly probably not the best choice of words, but was there anything I could have said that wouldn't tick him off?) He won't let me get to his arm with out nearly climbing into his lap. i manage to disconnect the IV and tell him i will get the IV team in to do a restart. This business goes back and forth a few times and involve him calling his sister/daughter (i never did figure out the relationship) who then called me screaming about how she "was gonna come up there and make you people take care of my father" In my book, that constitutes a threat.

My charge nurse was no help as she said that was part of the job and i was just going to need to learn to take it? uh, nope, not in this century, I don't.

So, as this woman got there and proceeded to stand out in the hall with her arms folded and glare, I kinda freaked out. I'm honestly not sure if she was looking for me or what. i got a bit upset. fast forward, my patients got dispersed to other nurses and i got sent home. i feel horrible because other nurses had to absorb my workload on top of the fact that I have never been fired by a patient before. i actually get along pretty well with my patients, even the known bullies. i suppose the only consolation is that there is lengthy list of staff that refuse to take him. Well, i'm on that list now....

kdkout, BSN, RN · Jul 15, 2017

IMO - I'm not dealing with it nearly as much as the adult floors and it's different where I work - in our case it's parents that are dictating care too much and dont know what they are talking about, (ie they consulted Dr Google)& just want to push their weight around. They're fearful but it comes out as bullying, narcissism, you name it. Staff gets scared of being sued. If you have a manager that has no idea how to deal with this, it can get much worse because too much is tolerated. They should get a "behavior contract." Security should get familiar with the unit when it's broken. Drs dont really deal with it much at all except on rounds- the nurses (RTs, etc) get stuck dealing with it. Lot's of nurses get "fired" but you're happy when you do! But it's totally not fair to the other staff whatsoever.

The patient quickly figures out which nurses have the poorest boundaries and it goes downhill from there.....

Guest862922, LPN, RN · Jul 15, 2017

I would love to work there as an agency nurse â¤ï¸ It is nice to see that this kind of place like yours exist!

Kudos to you and your staff ðŸ’•ðŸ’•ðŸ’•

marylou5 · Jul 15, 2017

Bullies want you to engage..they want an audience. Don't engage! Don't argue.

I resent entitled individuals taking my time from other patients.

I offer the RX/Med. etc. If they refuse..I calmly state why MD ordered it, possible consequence, CYA,

... and that they of course have the right to refuse.

I simply walk away/chart incident/report to Supervisor and MD.

I am too busy to argue/engage with bullying patients, who expect special concessions.

If they touch me, spit, throw things etc making my environment, and theirs, unsafe, I call Security.

It is no longer my problem.

Hospital rules/regs are in place for the safety of everyone.

If bullying is addressed properly the first time, it usually ends or at least becomes manageable.

Violent, uncontrollable bullies should be transferred to a Psych unit....they are not safe in the general population.

We all experience loud, nasty, argumentative, entitled individuals....

Don't engage. Don't bend the rules and jeopardize your license.

Walk away/report/ and go on to the next patient.

I've reserved a special place in H*ll for Charge nurses who abuse Part time/ Agency/ or Travel nurses by always giving them a full load of the most difficult patients...shame on them!

I always call them on it and calmly suggest a modification of an impossible assignment ;-)

Nurse3000 · Jul 15, 2017

Hmm bully patient not really... But probably worst comment I have heard while on the job would have to be an old bloke saying, "a ni*** is still a n****" while looking at me and talking to another patient... Some people

Nurse3000 · Jul 15, 2017

We had a detoxing meth patient who just got out of jail for assault with strangulation and kidnapping. Demons and swastikas everywhere on his body, and outright violent with us.
After he returned to his normal and was healthy enough to move out, he still got a free ride in ICU for multiple WEEKS until they found him a behavioral health placement. Rationale was "they couldn't handle him on the floor or in stepdown." Since when does ICU qualify as the place where it's okay to stick patients too violent for other floors to handle? None of us were very happy about that.
We only gave him to male nurses, and usually only to the male travelers or members of the float pool, and he spent most of his time with us in restraints with a mask on so he couldn't spit in our faces. That's how we dealt with him.

UNLIKE BUTTON. my goodness gracious, he sounded very unwell, to put it nicely... ok catty side coming out to play... It's sounds like Hannibal lecter!! ðŸ˜‚

Val_998, BSN, RN · Jul 15, 2017

I've only gotten fired twice by patients, and they were aggressive, threatening and verbally abusive. Both times my managers were on my side and aware as these patients had been making hell for the other nurses prior to me coming along. I was pissed off by the sheer stupidity that we were stuck dealing with but not bothered by being fired! As far as travelers and floats getting worse assignments, yes, they usually do. I am resource pool now, and will be traveling soon, and know I will get worse assignments. Sometimes when I walk in on the unit and overhear a tidbit about a problem patient, I can just assume they are in my assignment. It can definitely be frustrating but also a good learning experience, if you can handle patients who make your shift a living hell, you can handle anything :)