How do you deal with the name calling?

[pixierose]

I have had a long string of bad evenings. I work in psych. Apparently I'm not the only one; those in my new grad residency have had similar experiences on telemetry, ED, med-surg, etc floors. No guidance was given by our residency superior; more a gripe session which is a pity.

Last night I wasn't fast enough apparently with meds for a particular patient; she told me several times that I was going to hell. Ok.

Another patient stated, "you're a terrible nurse! Just get me my damn meds!" when I got to her. Went downhill from there.

Granted, I work psych. One of my patients is detoxing so I just let her ramble the insults, didn't respond, and left.

However, the other one? She is borderline and paranoid, yes. But she just kept going off as I was starting to scan her meds from the WOW no matter what I said (or didn't). How I was a liar, how I was going to hell, and a whole slew of names. I finally had enough; after asking her to please lower her voice the 2nd time (she was beginnning to shout) I placed the meds back in the WOW and stated that she could have them after she stopped shouting rudely at me.

I then walked back to the nurses station. She was extremely angry ... but she did knock it off. Eventually.

After speaking to my classmates, it seems like this happens quite a bit ... psych patient or not (and there have been a lot of psych patients on floors who haven't been medically stable enough to come to us).

So what do you do when the nastiness rolls in as you're providing something like their scheduled 8p meds/prn pain/Ativan med which comes up a ton? I used every therapeutic communicative technique I could think of. Nothing. Ignoring? Nothing. Attempting to validate? Nothing. I wasn't even late with meds. It just seems like some patients are bent on venting their frustrations onto the staff ... and here I am, gritting my teeth and wanting to just walk away. Last night it worked for a certain patient; I just don't know if I did the right thing. It's distracting!

[NightNerd, MSN, RN]

Whomp! I didn't even think about TOS.

[kbrn2002, ADN, RN]

Oh, I'm using my imagination here!

We need a "best of" thread.

Sadly with TOS violations being a given I doubt a best of name calling thread would even be able to be deciphered by readers. Sure sounds like a fun idea though! It'd be a challenge getting the names past TOS, but some can probably be figured out like my personal favorite... the otherwise adorable little old lady who calls me a rooster lollipop at least a few times a day.

[RNNewYork]

I worked in psych as well, and would still be there if it weren't for some physical issues I have. Sometimes we have to "check in" with ourselves to figure out why certain patients are making us bristle. Are we having a bad week? Is our health a bit off? Sleep poor? Maybe there is a staffing issue? I never let any of their "stuff" bother me because I knew the patients were in the hospital because they needed acute care. But we are human and some patients can get under our skin especially those that split staff. If the entire staff is not on board with treatment plans or letting certain patients have privileges and not others (that includes visitors as well). I often found that staff created more problems then the patients did. Do I have stories! It can make for a rough shift or a tough couple of weeks until the difficult patient is discharged. Stay strong and things will turn around. In the end the patients, even the difficult ones, know that you truly care about them as you help them through their difficult times.

[Psychnurse49]

22 yr. psych veteran, 22 yrs. before that in M/S, Tele, ICU, etc. You have every right to walk away, and tell the patient she can have her meds when she/he can act appropriately.

If the patient is in crisis (manic, psychotic, etc.) that's different. If just a BPD, or just not very nice, you have to set boundaries. They are there many times because they have boundary issues. If they are disrupting the milieu, they can be asked to go in their room to calm down.

Just keep it professional, and it sounds like you did. Calm, level voice, non-judgmental, direct. Most of the time they come back and apologize when they figure out they can't push your buttons.

I've been hit, (7 stitches) bit, punched, kicked in the stomach, spit on, knocked down and cracked my hip, but I love my patients, and my job. It's very rewarding when you see them go home and are back to baseline.

[unknownjulie]

I find psych to be a very spiritual type of nursing. I spend time meditating on the way to work, and I pray throughout my shift for protection and guidance. I find people with thought disirders to often be very tuned in spiritually. They respond to the staff being very grounded energywise.

[OlivetheRN, ADN, BSN, RN]

Working in the ER we get patients and family members who are in high stress situations or, more often, are just impolite people who don't understand that their ingrown toenail does not take priority over the person we are doing CPR on in the next room or the person who is doing their best to die on us. Honestly, I treat them as I do the psych patients I work with. Establish boundaries, give them consequences for their actions, and follow through with the consequences.

Im fortunate enough that there is one particular doctor that I work with who if he finds out that a patient or visitor is being abusive towards a staff member will go in the room a set things straight in a hot minute. "This is Olive. She is your nurse, not your verbal or physical punching bag. You will treat her with respect. Is there any part of that that you do not understand or that I need to clarify?" I love that man. Great, great guy to work with.