How to deal with rude & demanding patients/residents?

[Convoy2022_TrumpSupporter]

We got a new admit in our home and he is very needy and demanding. Always using the call bell for stuff like moving the pillow, closing the window, etc... and if you do something not their liking they will have a comment like you did not do it properly or you did a lousy job putting on my Cpap mask on. Constant criticisms.

I spoke with the managers about this because myself and the staff are not going to let this resident abuse/ take advantage of us, all they said was that its their right, and we cannot be rude or tell them that we are attending sicker people. I told them, so you think its okay to take advantage of us? So I wonder what the ministry of labour will have to say about this.

[canoehead, BSN, RN]

It's not their right to abuse the staff. If you get namecalling or swearing I'd say thats your cue to tell him someone will round hourly, and hopefully he'll be in a better mood then.

Hourly rounding might be your saving grace for all the little tweaks he wants, and limit your time to 5-10 minutes. You need to respond to call bells because eventually something important will need immediate attention, but you can say "the CNA will do rounds in xx minutes, and we'll fix that," if its not urgent.

I'd also urge you to give him some settling in time. He may not trust that people will be there when he needs them yet. 

[JKL33]

5 hours ago, DK123 said:

all they said was that its their right

Never understood this terrible response. There are so many things that could be said, by why this?

5 hours ago, DK123 said:

and we cannot be rude

No need to. This is also a terrible way to think about things.

5 hours ago, DK123 said:

or tell them that we are attending sicker people

Depending on circumstances it is appropriate to tell people the general situation IMO, although that opinion is different than anything nurses have ever heard from admin.

 

5 hours ago, DK123 said:

so you think its okay to take advantage of us?

How about thinking of this differently. First, stop taking it personally. Who cares if he makes a comment or undue criticism, such things are about him and not about you. If his comments suggest something needs adjusting (CPAP) then address that in a professional manner. Any other hypercritical rambling - let in go in one ear and out the other.

Try to develop a rapport with this patient--not by inappropriate pandering, but by letting him know through words and actions that you will take good care of him. Be pro-active with his care as suggested above.

Other routes are going to be problematic. It isn't like your supervisor can have the call light removed from his room. Therefore he is going to put it on inappropriately unless the nurses collaborate with him, get a rapport going, and help him see that you're on his side. It is NOT a battle easily won if you just want someone to make him stop. I recommend using therapeutic nursing approaches.

Good luck.

[hppygr8ful, ASN, RN, EMT-I]

I had a patient just like this when I worked in a Nursing home. New admit bilateral Below the kneww amputation and a pain in the donkey's behind. Constantly on the call bell and abrasive as all get out with all staff and even the managers. One day when I was attending to him I struck up a conversation to get him talking about himself. Turns out he loved baseball so we did have something in common as a too love baseball and my dad played semi-pro before he married my mom.  The patient also loved the movie the Sand Lot. So when he was heavy on the call bell I walked in stating "Your killing me smalls!"

We developed a system where he kept a written list of items that he wanted so when we answered the call bell we could address several items at a time. Then tell him, "I will be attending other patient's for the next hour but will check on you after that."

I honestly think he was terrified by his loss of independence and didn't knowhow to express it. 

Hppy

[amoLucia]

Care conference time! And the Soc Wrkr needs to be in on it.

OP - who is the 'ministry of labor'?

[hppygr8ful, ASN, RN, EMT-I]

1 hour ago, amoLucia said:

Care conference time! And the Soc Wrkr needs to be in on it.

OP - who is the 'ministry of labor'?

Sounds like op is from Canada or possibly UK

[amoLucia]

I was guessing so, too.

[PoodleBreath]

This sounds like a lot of nursing home patients I've worked with and I may be missing something but am not quite understanding the level of abuse that would warrant talking to the ministry of labor.

Someone else mentioned that part of this could be about adjusting to a loss of independence, some patients do lash out at whoever is closest to deal with that grief and loss. Some patients are just rude and abusive.

It may take a while to set up relationships and routines that can carve out some boundaries. That's one of the challenges of nursing. Best not to say you're taking care of sicker people, that just opens the door to a lot of other arguments about your priorities and huffing and puffing about why other people are more important.

Stick to reinforcing boundaries with specific patient behavior, and make it specific to the patient. Set up routines that certain things will be addressed at certain times so that the patient doesn't feel lost in an abyss of uncertainty.

A lot of times when we've had really abusive demanding patients we set up a system that all patient interactions will be done with two staff members until the patient can settle in.

Most important is to get a social worker involved as well.

[amoLucia]

Also the family needs to be clued in. They prob are also on the receiving end of some abusive behaviors. So this might not come as a surprise.

But I have seen these very unhappy, disgruntled and ANGRY pts (and families) start calling the Ombudsman/DOH offices. Their way of lashing out or trying to maintain some type of superior control. Sadly this often serves to antagonize facility staff. So all depts, particularly therapy & dietary need to be incl.

A psych consult is prob indicated for unresolved issues. Best to be proactive.

Staff will need to be understanding & professional. Good recommendations by PPs made.

[Hannahbanana, BSN, MSN]

Another consideration: does this man have COPD or other serious respiratory-related dysfunction? Obesity can contribute to this-- you mentioned CPAP…

Many people think COPDrs are notoriously rude and demanding—“Fix my pillow,” “Move my water closer,” “Push the Kleenex over,” but on further observation experienced clinicians come to discover that these people have a respiratory reserve that is so small that they literally don’t have enough breath to add “Please” or bundle their requests.

They desaturate so fast that pulling their overbed table closer to reach the water pitcher is genuinely hard. This is hard for you, but it’s terrifying for them, and may not ever get any better, and they know it. Helplessness is hard.  How do we nurse someone who has to live like that?  

[amoLucia]

HB - points well made. BTDT on the pt side of that table.

You forgot "angle my phone", "call bell cord looped one time over my Cpap hose", "reacher/grabber thingy RIGHT THERE in bed on my left side".

Sad thing, if folk just fixed me the way I asked, I wouldn't need them for hours. My (and others') responses are LEARNED and acquired patterns of behavioral coping responses. Cognitively, I knew to be as polite as poss, but that's kind of diff when my O2 canula is on the floor. All I wanted was for it to be looped ONE TIME over the side rail. I COULD HAVE easily retrieved it. No bother to you. But nooooooo! You gave me some half-a** reason *& dismissed me.

Any wonder why I might be rude & demeaning!?!? Just look in the mirror, and for many that will show an answer.

[Nightshade1972]

On 11/15/2021 at 9:39 PM, amoLucia said:

HB - points well made. BTDT on the pt side of that table.

You forgot "angle my phone", "call bell cord looped one time over my Cpap hose", "reacher/grabber thingy RIGHT THERE in bed on my left side".

Sad thing, if folk just fixed me the way I asked, I wouldn't need them for hours. My (and others') responses are LEARNED and acquired patterns of behavioral coping responses. Cognitively, I knew to be as polite as poss, but that's kind of diff when my O2 canula is on the floor. All I wanted was for it to be looped ONE TIME over the side rail. I COULD HAVE easily retrieved it. No bother to you. But nooooooo! You gave me some half-a** reason *& dismissed me.

Any wonder why I might be rude & demeaning!?!? Just look in the mirror, and for many that will show an answer.

Years ago, I was a pediatric patient in the neuro ICU, following brain surgery (hydrocephalus).  Some sort of doctor or counselor came into my room to do some cognitive testing.  During the day, my covers had gotten pushed down to my ankles, and I was too weak to reach for them myself.  I was cold.  I politely asked the doctor/counselor if he could pull my covers up over my legs, then I'd be happy to do the testing.  He flatly refused, and was so rude about it that I started to cry.  I realized, even then, it was a power thing for him--"I'm a fully grown adult, you're just a child, *you* don't get to tell *me* what to do!" He did ultimately pull the covers up over my legs, complaining the entire time, even though I'd done everything he asked.