How to deal with a bully patient?

babychickens · Jul 26, 2017

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."

Question: How long did it take for you and your fellows to recognize her "games"? Just curious.

dimpledRN · Jul 26, 2017

As a float pool nurse in my hospital I find this incredibly insulting. First off, we don't get paid more and second, without the float pool you'd be forced to work short.

I'm grateful that where I work we have leadership that sticks up for us and doesn't allow the "dump on the float nurses" attitude to prevail.

Szbeylik · Jul 26, 2017

Wow... boy am I glad I don't have to work with you. What an unpleasant, arrogant, nasty attitude you have about your fellow nurses...

I did agency work for a few years to match my custody schedule and be with my kids as much as possible. I think I know you...! You were one of those nurses giggling with your friends watching me struggle with the hardest patients, purposefully not lending a hand or pretending to be busy with your feet on the table, eating a snack or browsing Facebook when I asked you for help.

JayHanig · Jul 27, 2017

i feel horrible because other nurses had to absorb my workload on top of the fact that I have never been fired by a patient before.

You should adjust your attitude about being fired by PITA patients who fire you. It's a gift; one you should encourage in your worst patients. If I had a patient that I could not satisfy no matter what I did, I fired them. The way I did it was mention to them that if they were unsatisfied with my services that they could fire me. It was apparently something that nobody had ever explained to them before. They'd fire me and I would be out of the room like a rocket.

I recognize it wasn't really fair to my fellow nurses but I also recognized I'd been dumped on to have gotten stuck with a very difficult patient for so many days. Let the others take their turn with him.

I had a very manipulative patient for weeks on our unit. He was going back to prison as soon as he was discharged but he was playing the system in such a way that they wouldn't discharge him. (He was there because his spinal cord had been damaged during a surgical procedure... they were trying to prevent the unpreventable lawsuit that was surely next).

In any case, after I'd been ripped a new one by him for supposedly diverting his drugs (believe me, he got every bit I could provide in an attemp to shut him up), I decided two could play the game of manipulation. I told him that he'd already fired every nurse but me (he had) but that if he was still dissatisfied with his nursing care, he could fire the unit. He took the bait and I flew out of there to arrange his transfer to another unit. He stayed there (on the other unit) for about six weeks. I became a hero on my unit, even getting a slap on the back from my nurse manager. Of course, I couldn't walk downstairs for months without a body guard. The other unit found him to be a handful.

That's not the end of his story. I got pulled to his unit and of course they tried to assign him to me. I sorrowfully had to decline, since he'd fired me when we were upstairs.