How to deal with a bully patient?

Nurses General Nursing

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ComeTogether, LPN

1 Article; 2,178 Posts

Specializes in Transitional Nursing.

In my facility (Skilled/long term) bullies are "yes'd" up and down and we basically just placate them until we can get out of the room. If something is against policy, it's against policy and they don't get to do it. If they then complain about it we just have to listen to their complaints and around in a circle it goes.

Sometimes we turn a blind eye on patients breaking policy, it just depends. Generally, though, patients such as you describe end up finding themselves in a new facility.

JayHanig

149 Posts

Specializes in Orthopedics, Med-Surg.

As a permanent float pool nurse, I can tell you definitively I was not there to accept the patients that nobody else wanted. I was there so you wouldn't have to take care of 14 patients each that night because your unit ended up short staffed for whatever reason. I was the little Dutch boy, sent to stick my finger in the dike until the cavalry arrived in the morning. Sticking me with your worst patient was playing with fire:

1) the patient may be beyond my skill level. I was a jack of all trades; master of none (except orthopedics). I knew more about cardiac issues than any other nurse on the floor, until I went to a cardiac unit; then I became the most ignorant and least experienced. Give me that fresh heart transplant in CVRU (actually happened once). Understand that when I'm out of my comfort zone, I nurse reactively. I respond to things that have already happened and don't necessarily see what their regular staff might spot from across the unit. I don't know unit protocols unless somebody takes the time to teach me. So patient outcomes may not be what one might hope. I did my best and you'd better show some gratitude for the effort.

2) You also better believe the nursing office knew which units abused the float pool. How? We'd tell them if they treated us like turds in the punch bowl, too ignorant or too lowly to bother with. I expected some respect because I knew lots more than they did about every other unit in the hospital (with certain exceptions). This didn't make me a nursing god but it didn't make me an idiot either. That same CVRU that I got sent to night after night because they couldn't get one of their own to come into: that's where the morning nurse acted like I bored her when I gave her report... the same report I had gotten at 2300 the night before... where I certainly didn't act bored. Jerks.

Anyway, I made my feelings known to the nursing office and they stopped sending me there. I have no idea which of us was more relieved but I know my relief was significant.

And why did they pay me more than floor staff? Because I had no unit I could call my own. I didn't have a locker; I didn't have supervisors who were capable of what we could do and so weren't really the ones you could go to with the usual stuff nurses speak to their managers about. I had a different boss every night with different expectations. Whether those expectations were reasonable or not varied. That CVRU that had me titrating dopamine drips, drawing my own labs and then treating magnesium deficiencies via a unit protocol: do you suppose they were aware I never passed ACLS? (This was back in the day when it was still possible to do that.)

Bottom line: I was paid more to hold a relatively unfamiliar place in the line next to nurses I hardly knew if at all, with no stake in the unit and the unit in return having no stake in me. Think of it this way: on your own unit, would you accept being pulled to other units every night without some extra compensation?

I agree with the comments from the others about giving that difficult patient to floats and travellers. That mentality really pisses me off. No respect and professionalism toward people who are just there to be part of the team however short of a time it may be. They're not there for you to abuse. They are your peers. Treat them like it.

azrocket

1 Post

We are there to help YOU, prevent You from being mandated, prevent YOU from taking more patients than is reasonably safe. WE ARE NOT there to be abused by YOU or the patients. Eventually WE will no longer come to help YOU. In my opinion, YOUR attitude is a disgrace to the nursing profession.

Specializes in Public health program evaluation.
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!

sarose611

62 Posts

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.

Orion81RN

962 Posts

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!

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.

Specializes in Operating Room.
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.

Specializes in ICU.
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.

NunNurseCat

64 Posts

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!"

Specializes in ICU.
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.

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