How to deal with a bully patient? - page 5

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... Read More

  1. by   anitalaff
    Quote from CelticGoddess
    We once had a long termer who was a bully. She had a diagnosis of narcissistic personality disorder, and would pit the staff against one another. She also whined, cried, would call the CNO, President of the system, the CMO and whoever else she thought would help her get her way (She called the ombudsmen more than I care to think). Not a single nurse wanted to deal with her for more than 1 shift.

    We ended up writing out a contract: She was given privileges that would be taken away based on her behavior. She was given a list of expectations of her behavior that she agreed to. (Things like not yelling, we would round on her per the policy of the facility and provide for her needs then, no more than 10 minutes per hour was to be spent on her, etc) When she engaged in the negative behaviors, she would lose those privileges.

    She had every right to refuse treatment but she was NOT going to play us. We would provide care but refused to engage in her petty games. Our manager explained (In person and in the contract) that if she started to play games with us, we were allowed to leave, so long as she was safe. She was still difficult but we managed to deal with her until we could get her transferred off our floor. (She was with us for a very long time).

    Sometimes, the only thing you can do is set limits and follow through. And rotate staff so they don't all walk out in a mass exodus.
    I found your comment very helpful. Thanks!
  2. by   sarose611
    As a pool nurse for a chunk of my career, I absolutely resent being told I was there so regular staff could dump annoying patients. Though I found this frequently true, that is NOT what I was there for. I was brought in to improve staff-patient ratios, cover for nurses out sick, on vacation, maternity leave, etc. I frequently worked full time, and even overtime, just like the staff. Putting me in the rotation for a difficult patient was one thing, but not permanently dumping on me. Generally the staff created or enabled the bully. Why torture us with your screwups? I agree with those who said don't engage, if they refuse, explain the consequences and document the behaviour. This approach works well for bully doctors as well.
  3. by   Orion81RN
    Quote from Mandychelle79
    Honestly, by nature I'm a snarky individual who can be very blunt and apparently has a deamenor that warns others to not even try. I've had patients and families "warn" me that they were demanding patients and were going to make my night hell. My typical response is I worked in psych for 7 yrs so it takes a lot. That alone (especially those who have been on bu before) usually curbs most behaviors. I also don't get into a power struggle... you don't want scds, fine, here's the possible consequence. I use empathy and tell patients the truth... I don't mind calling your pcp regarding pain, however they gave deferred all pain medications changes to chronic pain service who has not been here to see you yet, has noted this, etc.
    LOVE LOVE LOVE this!
  4. by   connectchoicecareme
    Most often some nurses want to prevent to be nice and allow bullies to toss them around."Oh he like me".When you have a bully patient it is yes or no.Give him his medication when due,tell him the truth.I will write down the rules on the board.The exact time for the next medication,provide things within his reach make sure that he is safe.Do not tolerate any manipulations.If he becomes violent call code gray.Do not allow yourself to get hurt.Do your hourly rounding on time.Provide the medication on time.Do not talk too much.Don't preach but be professional.
  5. by   GadgetRN71
    Quote from catsmeow1972
    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.
    It depends on the assignment. My first one was a local travel assignment, which was 9 miles from my house. I got paid well over what I had been making as permanent staff in my previous hospital. ( $11 more an hour)

    Second assignment didn't pay as well hourly, but at the end I got $7500 worth of bonuses. I liked the hospital too. That was semi local travel, I worked in Boston and took the train in each day, so I didn't have housing expenses that time either.

    The most recent assignment paid extremely well hourly and local as well, but it was supremely unsafe. Very short staffed and the hospital going through upheaval..I ended up backing out of that contract for those reasons and also my dad was dying of lung cancer.

    Traveling can be awesome but you have to read the contracts carefully and not be afraid to negotiate..remember, these recruiters need you more than you need them.
    Right now I have a permanent job but would consider traveling/agency nursing again.
  6. by   calivianya
    Quote from Julius Seizure
    What was the rationale behind this? I can guess for the male nurses part, but what about for the rest?
    Rationale was none of the rest of us could stand him. He was with us for over a month and we just couldn't do it anymore.
  7. by   NunNurseCat
    It might help to think of the bully patient as an opportunity to practice restraint and self-discipline.

    Avoiding them is a missed chance to learn the valuable skill of "shrugging it off."

    Remember, their words cannot make you bleed, it's all "water off a ducks back, water off a ducks back!"
  8. by   calivianya
    Quote from Kooky Korky
    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.
    Since I was the first on who mentioned dumping on the travelers - to be fair, when I am charge, I end up spending half the night in everyone else's patients' rooms. In the case of the very difficult patient mentioned earlier, I was there whenever he had to be held down again. It just made it easier to deal with when I was only in there once every two hours instead of every fifteen minutes like the primary nurse.

    I don't let anybody drown. But, I still need a little bit of a break from the difficult ones.

    I will also say - it's not a few extra dollars at my place. We are offering critical pay to the travelers. Based on traveler self-report, some of them are bringing home $1900 a WEEK. One literally makes over $8,000 a month after taxes where I am lucky to take home $2700. It's not an insignificant difference - it's more than threefold staff nurse pay. I realize this is not the norm everywhere, but it is where I work. Higher hourly rate goes for a whole lot when it's like getting paid triple time, all the time. Plus our hospital lets the travelers work overtime if they want to because we're so short, so there is potential for them to take home almost $10k/month after tax if they want to.
  9. by   cyc0sys
    So what you're saying is, as charge nurse, you aren't the one assigning difficult Pts to travellers and male nurses? And the 'higher' traveller pay is not a factor in these assignments ?
  10. by   GypsyRose444
    "We usually only gave him to the (male) travelers and float pool"

    speaking as a nurse who has traveled for years, all I can say is I'm glad I've never worked at a place like that. Mostly I'm treated as one of the staff when it comes to patient assignments. I work just as hard as any other nurse in the floor and offer assistance when I can. Hope I never come to your floor.
  11. by   Julius Seizure
    Quote from billswife
    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 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!
    We had a patient once in the ICU whose parent was a surgeon (different specialty). He acted so entitled...and they just let him. He would demand to know what the consulted physicians said - sorry, I work nights, there's no note in the chart yet, and even if there was, it's probably something I would get in trouble for telling you before the doctor talked to you. So he googled the consulting physicians name, called his office, and demanded to speak with him directly and immediately because he was a doctor himself and "deserves some professional courtesy." He was alternately incredibly rude, or incredibly condescending. It was so irritating that the ICU physicians gave him the special treatment that he thought he deserved.

    Another patient in another ICU that I worked in also had a parent who was (again) a surgeon, this time at a hospital in the same "chain". He would ask things like if there was a physicians parking lot closer than the visitors lot that he could park in. He would come wandering around behind the nurse's station, opening drawers, saying that he was looking for a pen. Um, no! He would use the nurses computer in the patient room to do HIS patient notes....uh I need that computer to document on your kid....we are at my job right now, not yours. He also wasn't interesting in speaking to the nurses at all, except to say, "when will the doctor be here?" I was very happy to see that the physicians at this job set stronger boundaries with him, but it still was frustrating.
  12. by   livelovelaugh22
    And when do you think it's okay to pair up the difficult patient with the RN from the float pool? Although I am just a nursing assistant, I am in the float pool. Some floor NAs are jealous of float NAs (they think our wages are higher, but they're not!) and they insist that we take on their difficult patient assignments. Also, if we're sitting with a violent patient, some floor NAs think it's acceptable to not coordinate break times with us.

    Everyone should work as a team to ensure the continued safety and care of complicated patients. Let's not forget to mention that the safety of staff should always be maintained.
  13. by   connectchoicecareme
    Bully patients should not be given to floaters and travel nurses.Rather they should be rotated among the regular staff of the unit.
    Set limits to bullies do not pamper them.
    Make sure that their needs are spelled out and are met and that they are safe.
    But when they try to manipulate you should resist,if they start yelling or want to become violent,call security.A bully knows that he/she is not realistic but he is trying to test you.
    I had a bully patient.As soon as I walked into his room he yelled "I want to shower,I showered this morning and I want another shower ".
    I replied No,you do not because you have external Fixator on both ankles and I don't want it to get infected.He insisted I called his doctor and the doctor refused to order for another shower.But patient still did not give up.As soon as the Nursing assistant walked into his room, he made same demand.
    The nursing assistant came to me and I told her that he had showered in the previous shift and it is not safe for him to have another shower with the external fixator.
    Another shower might not be good for him.Then he asked for his pain medication and anxiety medication.He was medicated as ordered by the doctor.
    He slept for less than an hour and started calling every five minutes making unrealistic demands "Can you call the kitchen I want pizza,Ice cream, pudding and some popsicles?Also can you call the doctor to increase my dilaudid?