How do you handle narcissist patients?

Mr. Murse · Jul 2, 2015

I don't think narcissist is really the right word for the patients you're describing, but I know exactly the kind of patient you're referring to.

Frankly, I think refusing to care for them is wrong and unprofessional. No one, and I mean NO ONE actually likes caring for those kinds of patients. It is almost as self-centered of you to refuse to care for them as their behavior is, because now you're just dumping it on someone else who probably hates it as much as you do.

I'm not saying that to attack you, just to point out that you really need to find a way to deal with these types because they will always be there and you will always come across them no matter where you go unless you get out of direct patient care altogether. No matter what industry you go into you will have people like that as well. There are just people out there who are unaware that anyone else in the world exists, or at least they just don't care.

Learning to deal with all types of people is just part of our job.

mikala3 · Jul 2, 2015

That is exactly why I asked...there are times when changing nurses just gets another nurse into a bad mood as well. At least we are talking about patients that are few and far between..if I get one a year I feel unlucky. I just havent yet come across a good way to deal with them. Although calling security on the one that said I hit her was a good call, now her bad behavior is documented not only by me and my witness but by security as well.

Libby1987 · Jul 2, 2015

Why are you calling this patient narcissistic?

By your telling it seems you lack experience with behavioral health and unless there is a dx of narcissim I'm wondering where and how you determined this description.

To answer your question, I start with thick professional skin and perspective of who is most vulnerable to whom. (grammar?) And then I avoid making statements that invite rebuttal. I don't say things like I'm not that late, I would say something like I'm sorry, it's frustrating.

mirandaaa · Jul 2, 2015

My mom is a nurse and has dealt with some pretty awful patients and families and her advice has always been to "kill them with kindness". As much as it sucks and as hard as it is, sometimes that's really the best thing to do.

It saves your skin because what are they going to say to get you in trouble? "She was too nice!"? Patients like these are likely to be the ones to try to get you in trouble and they can't as long as you don't give them a reason to. (As a side note, I also think it makes them more angry when their antics aren't working and this makes it a little more humorous to me).

**canoehead, BSN, RN** · Jul 2, 2015

I let them live with the cponsequences of their action. It can be more time consuming than just giving in, but then I'm in charge of my day, not them. So she throws the pain button on the floor- it stays there. She starts screaming at me- I leave. If you approach the patient this way you have to be ready to answer every bell, or let everyone on the floor know the limits you are setting.

blondenurse12, MSN, NP · Jul 2, 2015

I think entitled might be a better term? I've had to deal with patients like this back when I worked in the ER. I had a patient try to get me fired because she accused me of tearing the adhesive dressing holding her IV off with "excessive force in order to cause extreme pain" when I was getting ready to discharge her home. She started screaming and hollering, flailing her arms around, blood splattering as I was trying to hold the site with gauze, her husband getting in my face too. She demanded the manager and that's what I did.

I never raised my voice. I had a poker face. I calmly explained I would get my manager and I walked out of the room. Basically I like to think of them like toddlers who want something. They are going to throw a temper tantrum. Much like a child, if you also get angry, it becomes a positive feedback loop. They get more hysteric and you get more angry. So I just act cool and collected, because that is the professional thing to do.

Been there,done that, ASN, RN · Jul 2, 2015

Borderline personality disorder. It takes a village to provide care.

When they are identified, call a care conference. Everyone needs to be forewarned, and on the same page.

Here.I.Stand, BSN, RN · Jul 2, 2015

I'm not able to dx personality d/o's, but have dealt with similar. We had one once who would falsely accuse male MDs of sexual battery (she was not well, she also smeared stool into the sores she picked on herself). It immediately became policy that any male entering her room had a female accompany him--for his protection.

I'd consider false accusations immediate grounds for never entering the room alone. Of course you'll have to involve your colleagues--and be willing to be the witness for them, when they are assigned to her.

I wouldn't refuse to care for her, though. Having already taken report, that would be considered abandonment -- which does put your license at risk. Besides, none of us are so special that we shouldn't have to deal with the difficult ones. People like this are generally made one-shift assignments, so everyone shares and nobody is stuck day after day.

As for the other manipulative behaviors, I set clear boundaries. PCA button gets thrown down, I'll give it back with a "fair warning, if you intentionally drop it again, it will stay there. We're both adults and beyond that game." Then clip it to their gown so they can't claim an accidental drop.

Call light use to the point of being disruptive gets a "This is not appropriate. We have critically injured/ill people in our unit and can't We round hourly, and this will be when requests are addressed." And then we have shut off the call light from the deskl

allnurses Guide · Jul 2, 2015

I don't think narcissist is really the right word for the patients you're describing, but I know exactly the kind of patient you're referring to.
Frankly, I think refusing to care for them is wrong and unprofessional. No one, and I mean NO ONE actually likes caring for those kinds of patients. It is almost as self-centered of you to refuse to care for them as their behavior is, because now you're just dumping it on someone else who probably hates it as much as you do.
I'm not saying that to attack you, just to point out that you really need to find a way to deal with these types because they will always be there and you will always come across them no matter where you go unless you get out of direct patient care altogether. No matter what industry you go into you will have people like that as well. There are just people out there who are unaware that anyone else in the world exists, or at least they just don't care.
Learning to deal with all types of people is just part of our job.

Narcissistic Behavior Disorder is a psychiatric medical diagnosis that you as a nurse are unqualified to make. That being said there are many ways to deal with troublesome patients.

First, since you have low frustration tolerance for this type of patient I would suggest you focus your attention on why this is so. Often this goes back to our own history with people who demstrate these traits; Parents, siblings, ex-lovers etc.... Take some CEU classes in how to handle this time of patient and get good at it. No more refusals unless that patient has threatened you with actual physical harm. Ask youself what kind of secondary gain the patient gets from their behavior. Most of these folks are attention seekers and are fully self absorbed - They really don't care about anything other than themselves. A true Narcissist is incapable of thinking outside themselves- so does not have the mental capacity to be "after you license."

When it comes to meds given on time the patient is right.If their meds are due at 8 and it's 8:10 the patient's perception of the meds being late is correct. If a patient tells me this I d my best to make them 1st on my run. Why - if I can keep them moderately happy I will have less behavior to deal with.

Remember you can never have a rational conversation with an irrational person so don't even try. In and out of the room quickly, all business with a smile, no endorsing their behavior. I had a patient who was refusing a straight cath for 3 days and he was so difficult that no nurse would do it or even try. I came in after 4 days off and grabbed the supplies went into the room. The patient saw me and what was in my hands and said "Out of my room you &(*&%" I smiled and said - MR. so and so - I know this procedure is uncomfortable but Dr.Z is not comfortable discharhingyou without knowing your UTI has cleared up. So can we get this done so you can go home?" All delivered with a smile. He agreed and I did the cath and got the sample. He called me several choice names in the process but that's ok - I have a thick skin.

Remeber what they do is all about them and they don't give a hoot about you, your license or the horse you rode in on....

hppy

Horseshoe, BSN, RN · Jul 2, 2015

At this point, my only tool is to refuse to care for them and I know there has to be a better way. I am not talking about the hard to deal with patients, I dont really have an issue with them, but these are the worst of the worst and they are too demanding.

So you are the special one who gets to refuse patients who are "too demanding" and inflict them on other nurses? Keep that job, seriously. If you came to my facility with that demand, you'd be gone the first time you played that card.

dirtyhippiegirl, BSN, RN · Jul 2, 2015

You can only see the diet order after you answer a bunch of questions? Wut??? That is irritating me just thinking about it.