How to deal with a bully patient?

Here.I.Stand, BSN, RN · Jul 13, 2017

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 tend to think of them as there to fill staffing holes, thereby preventing mandatory OT and tripling in the ICU, stuff like that.

Now I can see having them take these pts if all of the regular staff nurses have had their turn(s)... but to consistently dump on floats? I don't agree with that.

CelticGoddess, BSN, RN · Jul 13, 2017

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?

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.

cyc0sys · Jul 13, 2017

I don't tolerate bullying in any form, whether it's my staff, management, patients or laterals. I'd make a beeline to the UM or DONs office and let them know the situation so they could 'address' it (eyes roll). Document things for CYA and then go about business as usual.

Setting the expectation that this behavior will not be tolerated is paramount (think a small team of people and a 'come to Jesus talk' in the room with the bully). If they aren't compliant, like another poster said, I'm not going to lose any sleep. I definitely wouldn't shuck the responsibility off onto a traveler or male nurse because I couldn't step up to the plate and handle things like a professional. That's just another form of avoidance, which leads to ineffective coping skills, and perpetuates bullying. Nurses are supposed to be courageous leaders who set the standard and you can't do that by circumventing the problem.

Purple_roses · Jul 13, 2017

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."

catsmeow1972, BSN, RN · Jul 13, 2017

We did have one recent "long termer" that had a pretty lengthy list of staff that either refused to take her and that she refused to have assigned to her. She was quickly running out of people to have as nurses.

I've usually gotten along with the "bullies" that come along simply because they won't get an audience from me. Don't want whatever therapy I've got due at the moment? okay. fine, see ya next rounding. No you still can't eat. No, I will not give you your narcs early. No, not just this once. I will be happy to disconnect the PCA so you can go out to smoke but it will not be getting reconnected AT ALL. I'm not getting pushed. I won't say it out loud, but there's a voice in my head that says "sorry dude, i like my license more than i like you.

I hate to be that snarky, but i am no one's punching bag, even if they are not feeling well.....not an excuse.

KatieMI, BSN, MSN, RN · Jul 13, 2017

This is completely inappropriate, unprofessional, biased thinking.
What makes you think you're better than they are? Unbelievable! smh

Because I've been there and done that. When I was an agency nurse, it was the name of the game in 4 out of 5 facilities I was sent in.

Julius Seizure · Jul 13, 2017

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.

Because I've been there and done that. When I was an agency nurse, it was the name of the game in 4 out of 5 facilities I was sent in.

At first it sounded like you thought it was right for agency nurses to be dumped on like that. But now that you say you've worked as one, I assume you don't think that is a fair or decent practice. *crossing my fingers*

I'm sure as a former agency nurse, you must know that travelers do NOT get compensated significantly more overall - their pay is just differently structured. And when it comes to difficult patients, their beautiful faces should be treated fairly, in turn with all the regular staff.

KatieMI, BSN, MSN, RN · Jul 14, 2017

At first it sounded like you thought it was right for agency nurses to be dumped on like that. But now that you say you've worked as one, I assume you don't think that is a fair or decent practice. *crossing my fingers*
I'm sure as a former agency nurse, you must know that travelers do NOT get compensated significantly more overall - their pay is just differently structured. And when it comes to difficult patients, their beautiful faces should be treated fairly, in turn with all the regular staff.

I am not for it at all, of course, but in many (not all - but definitely many) places which depend on temporary staff it is just part of the business. It was one rude discovery I'd made very soon after joining agency, and I heard the same from many other agency/travel nurses, so I think it must be facility specific and quite common at that. And, yeah, some so-called "nurses" think that those measly additional $3 - 4/hour at most give them right to treat agency nurses like that.

It was the type of situation which taught me how to say "no" as a nurse - for myself and others. Where I am, I won't hesitate for a second telling charge if I feel an assignment as unfair or unsafe, and for incoming shift it better be changed before incoming shift clocks in.

Purple_roses · Jul 14, 2017

We did have one recent "long termer" that had a pretty lengthy list of staff that either refused to take her and that she refused to have assigned to her. She was quickly running out of people to have as nurses.
I've usually gotten along with the "bullies" that come along simply because they won't get an audience from me. Don't want whatever therapy I've got due at the moment? okay. fine, see ya next rounding. No you still can't eat. No, I will not give you your narcs early. No, not just this once. I will be happy to disconnect the PCA so you can go out to smoke but it will not be getting reconnected AT ALL. I'm not getting pushed. I won't say it out loud, but there's a voice in my head that says "sorry dude, i like my license more than i like you.
I hate to be that snarky, but i am no one's punching bag, even if they are not feeling well.....not an excuse.

Nurses need to have a backbone, and your license and livelihood IS truly more important that a patient getting a narc early or getting a smoke break. Hands down. We aren't servants who do whatever our patients want. And coincidentally, policies in place are usually best for the patient too. That's why they're in place.

chacha82, ADN, BSN · Jul 14, 2017

I am not for it at all, of course, but in many (not all - but definitely many) places which depend on temporary staff it is just part of the business. It was one rude discovery I'd made very soon after joining agency, and I heard the same from many other agency/travel nurses, so I think it must be facility specific and quite common at that. And, yeah, some so-called "nurses" think that those measly additional $3 - 4/hour at most give them right to treat agency nurses like that.
It was the type of situation which taught me how to say "no" as a nurse - for myself and others. Where I am, I won't hesitate for a second telling charge if I feel an assignment as unfair or unsafe, and for incoming shift it better be changed before incoming shift clocks in.

One thing I really like about my floor is that we do not "dump" on travelers or float staff routinely. If we get a nurse four hours into the shift, we can peel off a patient but the charge is careful to make sure it's a decent assignment, so that the float isn't getting the hardest ones from everybody. It is an expectation for all shifts. And they also balance admissions well. I am very lucky to work where I do.

RNGummy40 · Jul 14, 2017

What I find interesting is that you asked how do doctors deal with "bullying," patients. The sad answer from my experience is that they do not deal with these patients. Narcissistic personality disorder is the usual diagnosis I have seen when working with "BULLYS." The lake of empathy and need to control are not dealt with because providers are not around to manage milieu issues. Bullies are always weaker when you have greater numbers, and usually nullifying, in the moment staff splitting, gives you an advantage when managing their behaviors. Good and at times great Doctors, will really listen to a nurse, and focus on maintaining unit safety. One doctor I worked with trusted my assessments, and believed me when I called with an acute situation of a patient attempting to kill staff. The doctor was not hesitant to call the police or discharge the patient due to having a secondary malingering diagnosis. Bullies have always been confronted, provided clear and consistent communication, and empathy has been the focus of their treatment plans. If a bully controls your unit you are handicapped in practice, and jeopardizing other patients treatment plans.

Lhalty · Jul 14, 2017

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