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?

[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 ?

[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.

[Julius Seizure]

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!

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.

[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.

[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?

[emergenceRN17, ASN, BSN, RN]

I was thinking the same thing!!!!!!

[djh123]

Well, I don't know WHY we don't have these at work (I'm really, really, joking here), but I tell aides and other nurses that all we need is one of those huge mallets from the old cartoons (before most of your childhoods) where they'd whack each other over the head and would end up on the ground with their tongues hanging out and little stars & birds flying over their heads. That's all we need when patients get out of hand! :^)

[DesiDani]

A nurse told me that a patient actually told her "I know that when make a scene I get what I want"

[DesiDani]

The problem is that one shift will let a bully get away with something and then when the next shift tries to enforce the rules a big stink usually happens. Eventually people just give in

[ManicRN911]

, 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 thinks they are hurting you when they demand that you don't enter their room again, but you feel so relieved despite the ego bruise. I do feel bad for the coworkers that now have to provide care.

[Nightnurselife]

I work in a cvicu, and as soon as the pt doesn't meet icu criteria, I call the Dr for transfer orders. I notice a lot of pts get comfortable in the icu setting with huge rooms and a nurse with a low patient ratio they begin to start thinking they have a personal assistant. When pts are perfectly capable of doing an ADL and they start asking me to hold their cups of water for them to drink out of, i know it's time for them to be on their journey out of the hospital. When a pt is belligerent or tries to bully nurses, I flat out ask them why they are behaving in such an unfavorable way. Sometimes it's their defense mechanism. A lot of times there is something deep seeded that needs to be addressed. Some people are just mean and miserable and want others to be just as mean and miserable. Those are the people I am the cheeriest to. I would never let them know they got the best of me.

[sistasoul]

That is terrible to do to float nurses. No wonder people hate to float. If a person is a float nurse they should probably have an easier assignment as they are not as familiar with the floor and have less of a comfort level.