Handling rude or dishonest patients

[wildlaurel]

I have had a recent spate of plain old rude, manipulative patients. I can ignore rude behavior, but it amazes me when people lie to/about me. For instance, the other day a patient called out for assistance to the BSC. I was charting and a tech immediately got up and went into the patient's room. I came in about 5 minutes later. The patient said, "I've been calling out for 30 minutes and nobody came in here." I had been in and out of the nursing station and in the room next to the patient's during that time and never heard her call out. I asked the secretary about it and she said that was the first time the patient had called out. So, I told the patient that I didn't think she'd called out for 30 minutes and if she had, I certainly hadn't been made aware of it. The patient insisted she had called out for half an hour....and I know she HADN'T!!

I had another patient who would call the hospital operator and say nobody was helping her instead of calling out with her call bell. I noticed several times when I went in the room the patient would be on the phone and say into the phone, "She's here," and hang up. I thought that was weird...The operator finally called our secretary and told her the patient was calling her and when I asked the patient about it she said, "I didn't know how else to get help." I said, "I gave you the call bell and explained how to use it and I've been in and out of this room every half hour. If you need help, calling the operator isn't the way to go."

I just get so frustrated with these patients! It seems as though they're just looking for a way to get staff in trouble or make it seem as though they aren't being cared for.

What do y'all do about patients like this? My fear is that these patients will complain that I didn't take care of them and I'll get in trouble.

[kattycakes]

perfect!:yelclap:

[JeneraterRN]

I think you were thinking of the night I just had! People in the hospital can be miserable and you happen to be the nearest target. Most times I can talk them down, but tonight was an exception. Good luck!

[wildlaurel]

Thank you guys! I did document on it, but I guess my main question was - do you confront the lying? With the patient who said she'd called out for 30 minutes I finally said, "I'm really concerned that you aren't happy with your care and I'm sorry about that because I've tried really hard to take good care of you today." Then she was all, "Oh, you haven't done anything to me, you're a good nurse honey, don't worry about it!" I just get so frustrated with the manipulation and craziness of some folks and it seems like I've had more and more of these patients in the last month! I hope it's just the heat and they'll get better. Of course, I do need to constantly assess my own behavior and make sure I'm not doing something to provoke the complaints - I realize that too!

[judybsn]

Had one of those just last night. I was driven crazy to the max and thought I was losing it till we had a care conference and found out she was doing it to everyone! Personality disorders are difficult to deal with.

[Altra, BSN, RN]

If you have patients that continually state lies, such as they have been calling for ages or no one has checked on them for hours, perhaps a polite reply with, "Ma'am, your statements are concerning me. I was just here ten minutes ago to give you a medication and before I left I asked if you needed anything. It concerns me that you seem to be having trouble remembering these things and keeping track of time. I would like speak to your doctor about getting you a psychiatric evaluation to rule out any problems."

I've done this. In an ICU setting I have also pulled up days of care conference documentation on the computer in the patient room, to *review* with family who state that "you people don't tell us anything".

The results vary, but they are always dramatic.

I also recently took a COW, my radio headset and a stack of charts into a patient's room and pulled up a chair after her repeated complaints of being ignored -- when as charge I had watched her nurse physically enter and exit her room a dozen times in the previous 90 minutes. The patient was indignant - "what are you doing?" Me: "Keeping you company, since you seem to feel that your nurse's attention is not enough." Patient: "Well I don't want someone in here all the time!"

I can deal with neediness exacerbated by fear, anger or dementia ... but manipulation is not OK.

[kathy dean]

I let the rude patient just talk and hear him out,say I am sorry and ask him what I can do to make things better for him,I always ask them what the issue is to validate him or her.Patients that lie or are manipulating just kill me,I take another person in the room wirh me if I know these people are like this from my first meeting so I have someone to back my comments up,as they say in administration, The patient is always right.WRONG!!!!!!!DO NOT sack a nurse or cna inless you have wittnessedthe situaation,these folks could have dementia,alzheimer.s,strokes,or cancer with metastasis that can get you into alot of trouble.Alot of inocent staff have been discharged over false accusations,we must redefine the laws,especially with human rights and elder care.The nurse or other staff is in the way of these patients,who had problems before they came in,ADMINISTRATION MUST STICK UP FOR STAFF.

[NBMom1225]

We are currently dealing with a manipulative patient, and documenting lengthy narrative notes since this patient and their spouse appear to be looking for a lawsuit, the type that are just waiting for a mistake to happen so they can cash in...what bugs me is that, despite the extensive documentation that shows the manipulative behavior, administration just about fell over themselves putting this patient into a private room when the family called patient relations! Oh well, I guess it shows that the hospital really did try to make them happy

[Ruby Vee, BSN]

documentation is your friend. document each time you go in the room and what you did. before you leave, ask the patient, "is there anything else you need?" and then document that you asked and what their response was. if they call out or press the call bell, document why they called and what you did for them. encourage ancillary staff, such as cnas to do the same.

if you have patients that continually state lies, such as they have been calling for ages or no one has checked on them for hours, perhaps a polite reply with, "ma'am, your statements are concerning me. i was just here ten minutes ago to give you a medication and before i left i asked if you needed anything. it concerns me that you seem to be having trouble remembering these things and keeping track of time. i would like speak to your doctor about getting you a psychiatric evaluation to rule out any problems."

​merely "liking" this post is not enough. i had a similar answer, but this one is more polite!

[sauconyrunner]

Agree with all said.

Documentation is important. Crucial as a matter of fact. Now that I do chart reviews, I am constantly surprised at what is and is not documented. Heck, I ended up having to review my own documentation and I was not so thrilled with it.

In addition I do think it is OK to be honest with a patient without being too confrontational...though it depends on the patient.

Things I've said that have worked in the past are,

"Mr. Jones, I was right here with you 10 minutes ago to give you *insert stuff here!*. I know when you need something it sometimes feels like a really long time. Is anything else going on? Are you worried about someone not coming in when you need help?" Sometimes there is some underlying anxiety and things do not go so well with that, it depends on the rapport you develop. I've had patients either get huffy, or break down in tears and tell me how frightened they are about either being left alone, or falling or something. We also seem to see this a lot in patients transferred from the ICU to PCU because they get used to the nurse with 2 patients, as opposed to the nurse with 4.

[SENSUALBLISSINFL, BSN, RN]

"Ma'am, your statements are concerning me. I was just here ten minutes ago to give you a medication and before I left I asked if you needed anything. It concerns me that you seem to be having trouble remembering these things and keeping track of time. I would like speak to your doctor about getting you a psychiatric evaluation to rule out any problems."

Wow I love such statement....hopefully I will remember it if I ever come across such situation.

[MahzieLPN, LPN]

LOVE the psych evaluation remark - perfect for some of those patients! A friend of mine works in ED and his chief complaint is the patients who won't stop using their cellular telephones while he attempts to interview/assess them and begin care as ordered, etc. Unbelievable!!

[wooh, BSN, RN]

We also seem to see this a lot in patients transferred from the ICU to PCU because they get used to the nurse with 2 patients, as opposed to the nurse with 4.

Ugh, ICUitis.