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.

[sauconyrunner]

Ugh, ICUitis.

I gotta admit, back int he day I had a horrific accident and spent a very long time in an ICU. I spent about 2 days only in a regular unit before I went home. The first night I was on the regular unit and my nurse had at that time I think 8 patients (like I said back in the day)...I was TOTALLY freaked out. Now, whenever I work with a patient who is going from ICU to PCU or MS, I usually remind them, "OK so you are doing a lot better now and you can do a lot on your own...so when you get to the floor, because you are getting ready to go home, the Nurse is going to have a lot more patients...it might feel like she is not there, but of course he will be there if you need him/her" It seems to help...But of course, a lot of ICU nurses forget that it will seem different to the patient.

[PROUD2BANLPN]

Hi Wildlaural, I'm an LPN of several yrs, LTC, love it! Unfortunetly I have experienced some of your frustrations. My best advice to you is, if you are a good, compassionate, thorough nurse...have a good relationship with your charge nurses, supervisors, ADON & DON. You are creating a reputation with all these folks every shift you work. If you are perceived as such, then when a patient complains excessively or makes false or exaggerated statements, you can then explain the situation to whomever and more times than not, your word will be taken as truth (and tell the truth, it's much easier).

In my experience, there's many facets to patient "attitudes & perceptions". Many feel "entitled" to individual attention & "special" privilege and when we are caring for 40-50 patients in a shift, that is simply not possible. We do owe our residents & patients the best attentive care we can provide, but people are quick to forget that we're on duty and doing our personal best for them. Hang in, talk to your superiors for more advice!

[Esme12, ASN, BSN, RN]

When patients are acting out there is usually a reason for their behavior.....but there is that small proportion that are just crazy.

I will gently confront the behavior and not be confrontational....while I let my charge nurse/supervisor know of the games afoot. "I am feeling you are frustrated. I actually have been in here about every 10 min. But i know when you don't feel good it still may seem like a long time. What can I do to make you feel better/more secure. How about I come every 10 min whether you can or not to see if you are OK" and give them a clock to watch or provide some distraction. I'm a big advocate for TV's in the ED.

Then documentation will be your friend.

[nurse2033, MSN, RN]

I find that old grumpy people were usually young grumpy people. But, from your descriptions I'd say they were more likely not paying attention to anything you said because they were distracted, or having some elderly impairment that prevents them from following directions versus outright lying. But, of course, I wasn't there. I agree that documenting when you respond to calls is to your benefit. Some people are just not that, er, smart and have trouble making sense of the ER. I try not to engage in argument, re-explain (which is wearying) and not take it personally.

[bonbutler]

It never ceases to amaze me, how many of our patients think that they are at the Holiday Inn....in my almost 30 years of service, I have been known to tell them.."this ain't the Holiday Inn, and I am NOT the maid service!" I would never act as a family member as some of these folks act. My mom was a patient for 9 weeks before her death, I would never have used the code to get into ICU, I was never intrusive or demanding. Some of these families come in with attitude! I treat all my patients the same, don't care who they are or were!

[brainkandy87]

I don't tolerate rudeness. I'm here to help them with whatever problem they are having and rudeness is never a c/c, so I don't have to tolerate it like I do someone pooping the bed. I have a very big problem with people that constantly cuss. I cuss. A lot. However, I don't believe in cussing at your nurse or your doctor or in any situation that's not informal with friends. I'd never go see my doctor and say "I can't stop f'ng s***ing! I need some f'ing medicine!" That bothers me. And I tell them if we are going to continue to care for them, they will need to cease cursing immediately and treat the staff respectfully.

As far as dishonesty, I really don't care, unless it's about drugs. I don't care if someone uses drugs and I tell someone, if I suspect drug use, that I don't care if they use, but in order to treat them properly, I need to know. When they say no and the UDOA comes back for meth or opiates or whatever, I'll say something about it. One doc (that I love) will put a note in their chart for the future and tell them that they will not receive any narcotic pain meds in the future from us because they lied about drug use and they will need to seek out a different hospital if they are looking for pain meds.

[itsnowornever, BSN, RN]

Without reading all the replies, chart. Each time you go into the room, chart it. Put everything in that darn computer with the difficult patients and they can complain all they want, they don't have a leg to stand on. I'm sorry you had a rough string of patients.