How to deal with a bully patient?

[DesiDani]

Recently we had a patient who was a bully. He got to do things that other patients weren't allowed to do. Many of the nurses were scared of him and just let him be. He basically ruled the floor. So how does your unit deal with these types of patients and how do doctors deal with them?

[msmoe16]

Man, after reading this I am starting to reconsider travel nursing. Especially being a male.

[Val_998, BSN, RN]

Msmoe16, not all places make assignments this way, but it does happen, charge nurses would rather avoid making their own people the dumping ground. However, as I said, it does make you a stronger nurse so I feel they are doing their own nurses a disservice by dividing assignments based on position title. You don't learn new things by staying in your comfort zone. If you want to travel, don't let that be what holds you back. If you are confident in your skills, and are able to stand up for yourself if it's a truly unsafe assignment, then I think you should go for it.

[kennyg572]

Why did u give this pt only to travelers or floats

[kennyg572]

Why only to travelers or floats

[feelix, RN]

Because getting assignments nobody else wants to work with is what travelers, float pool and temp staffing agency RNs are there for. You are not paid more for your beautiful face when you sign up for jobs like that.

Giving difficult assignments to travellers/float pool is a dangerous and unprofessional practice. The only benefit it provides it for the regualar/senior/in the loop staff to dump off their problem on to an unsuspecting stranger.

Imagine someone from OB/Gyn who was floated because of staffing incompetence. You give them the most difficult Med-Surg Assignment. First of all, you really are not aware of their level of competency. Secondly, even if they are competent to perform the job, they are in unfamilar environment and learning their way around. This is asking for a mistake to happen. Our director gave explicit directions not to give difficult patients to PRN staff and floaters for that reason.

[JinnSchlajfertig]

A bully will push as far as you let him/her. I, like many other posters make it clear that I won't take any abuse, am only here to do nursing-related tasks, will limit the time I spend with the person, advocate for a behavioral contract if needed, etc. Things seem to go pretty smooth on my shifts and I work in a men's prison that has more that its share of inappropriate/maladaptive behaviors. Allowing one difficult patient to burn everyone out without providing support to the beleagured nurses is a sign of poor management.

As for the comments about dumping the difficult patients on temp/agency nurses-wow. Do any of them stick around? And yeah, I get more an hour as an agency nurse, but I since I not full time (am in grad school), I don't get medical benes, days off or retirement. How does anyone expect to get the bully to chill out if s/he has temp people floating in and out who don't know his/her tricks, don't have rapport, etc. That kind of thinking gives me the impression that this is not a team effort to take care of the patients. Which increases stress and staff turnover.

[dec2007]

We've had several over the years. At one point we had a lovely elderly lady whose son happened to be a pharmacist at a different facility. He had a slew of "supplements" that he insisted we administer to Mom daily, and somehow got the primary MD to write an order to "given all supplements as requested by patient's son". That was annoying in itself ( and time consuming), but then he began to write her daily TPN orders, which we had to take to the primary provider, who always signed them...no matter what. I finally asked the primary MD why he put up with all this manipulation? He said, " He knows a lot of people, and I'm just tired of fighting it."

It is hard, in this day of " patient satisfaction," that management nearly always backs the most outrageous patient/family demands in the pursuit of those ever-important satisfaction scores!

[Kooky Korky, BSN, RN]

What was the rationale behind this? I can guess for the male nurses part, but what about for the rest?

You're kidding, right?

[Kooky Korky, BSN, RN]

Because getting assignments nobody else wants to work with is what travelers, float pool and temp staffing agency RNs are there for. You are not paid more for your beautiful face when you sign up for jobs like that.

I'm not saying that floaters, temps shouldn't have some tough patients, but your rationale is not helpful to the patients and says exactly how much you hate or envy "the outsiders". Don't expect any mercy for yourself.

I could understand assigning a toughie to an outsider if you regulars plan to help - either hands-on or even just advice/advising. But I'm guessing you and your cronies turn tale and get as far away, just as fast as you can, and your outsiders never see hide nor hair of you again.

Don't forget - a lot of outsiders have no benefits. All they get is the higher hourly pay. So they still deserve to be treated with decency and not envied as much as staff nurses often envy them.

[Kooky Korky, BSN, RN]

It depends on what type of bullying we're talking about. The moment the patient said one swear word at me or yelled at me, I would probably call security. Our security is so on top of this stuff (head of security's wife is an RN at our hospital, so he's really not kidding when he says to call him for even the tiniest thing--like raised voice, swearing at us, etc.). If it's pretty mild bullying, I simply say "its policy and that's what we have to do."

That can be a maddening answer. Do you try genuinely to help the patient understand why it's policy or why absolutely no deviation from policy is ever allowed? Yeah, I know - given them an inch, they'll take a mile.

I think we still need to put ourselves in the patient's shoes.

We had a policy of no snacks given out on night shift. I never saw it in writing, but that was the so-called policy.

But some staff would still give snacks. They'd even share their own food with long-term patients. Most of us did give out a pudding or milk or whatever we had - including staff who scolded others for giving out snacks!

We pretty much figured we didn't want to get beaten up over a PB&J sandwich. It gets very tiring to always swim upstream. I'm just saying that we can sometimes find a way to keep everyone calm and safe. It does make it harder on those staff who do want to adhere strictly to policy.

I figured that the food was going to be thrown out anyway, so what's the difference?

So "Policy" isn't always the best answer.

[JayHanig]

I don't have much patience for that kind of crap. If a patient doesn't want what I'm offering, he doesn't have to have it. If a bad outcome will result, I'll tell him and if he's still obstinate: fine. He's not in my family; he's not one of my friends. At the end of the day I'm going home but he's not. And if he dies during the night, I'll get another patient in the morning to take his place. It's not like I'd miss him.

I also had a reputation for being the fastest person on my unit with a AMA form. If a patient threatened me with going home against medical advice, I practically ran for the form and said, "Sign here. Do you need a taxi?" I never tried to talk them out of it nor did I delay, for fear they'd back out. I also never bothered to mention what the reaction of his insurance company was going to be when they received the bill for his stay in the hospital. That was my own personal "have a happy life" for having to put up with his behavior.

Life is too short to have to suffer *******s. There are plenty of patients who actually want care and will allow you to do your job.

As others have said, the thing to do is document, document, document.

[Kooky Korky, BSN, RN]

I'm not saying that floaters, temps shouldn't have some tough patients, but your rationale is not helpful to the patients and says exactly how much you hate or envy "the outsiders". Don't expect any mercy for yourself.

I could understand assigning a toughie to an outsider if you regulars plan to help - either hands-on or even just advice/advising. But I'm guessing you and your cronies turn tale and get as far away, just as fast as you can, and your outsiders never see hide nor hair of you again.

Don't forget - a lot of outsiders have no benefits. All they get is the higher hourly pay. So they still deserve to be treated with decency and not envied as much as staff nurses often envy them.

That should be "tail".