How do you handle narcissist patients?

Nurses Relations

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I am an experienced nurse and the one thing that I just cant seem to handle is narcissist patients. I dont run into them often, but when I do, I crash and seem to fall for their games. At this one hospital I worked for, we had a program that wouldnt let you see the patient's diet until you answered some basic questions about them. There were maybe 10 including their pharmacy. I didnt have to answer them in detail, like if they had a different pharmacy, it allowed me to mark that their pharmacy had changed and get the details later. So I got a narc who was demanding water and I told her we needed to answer the questions for me to see her diet, but that they would be as quick as I could do them. We got to the pharmacy question and she went off because it was not her pharmacy. I could not calm her down, she was screaming. Luckily someone came into the room and stood beside me (unknown to the patient). In the middle of her fit, she asked for her pain button and I handed it to her. She threw it and as I went to get it, she pinched me. I said OUCH! and dropped her pain button onto her chest and backed up (all seen by my witness). The patient started screaming that I hit her. Luckily, she had not seen the other person in the room who had witnessed the entire thing, so her fake accusations got no where. Security was called and she backed down when she found out there was a witness.

So I have started refusing to care for narcissist patients that go after me. Last week, I had one screaming at me that her meds were "late" because it was 10 minutes after 8 and they were due at 8. When I explained that I had an hour to get them to her, she said I was being rude and called our patient advocate. I sent the charge nurse in and I heard her tell him everything was fine, then she got on the phone asking for our manager and an advocate. She then trashed talked me to several other people on the phone loud enough that several nurses asked me about it. I refused to go back into her room and asked for a different patient. I figured at that point, she was after my license and she was going to TRY to get it all day long and it was only 9am. My manager pulled me aside and said I could be written up for refusing to care for her for the entire shift and I said...so write me up, but I am not going back into her room, change the assignment. They also do this thing where they scream at you to get out, then they call you back into the room for something and its a set up so they can cause more problems.

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.

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

Yeah, that is one of the strangest things I've ever heard.

Specializes in Pedi.

What is described in the OP is not narcissism. Unless things have changed since I left bedside nursing, staff nurses are not qualified to diagnose personality disorders. Throwing around diagnoses you don't seem to understand isn't going to help your cause. Your patient is a jerk. Gotta say, though, I'd be pretty annoyed if I couldn't be given a glass of water until I answered a bunch of stupid questions about where I fill my outpatient meds. Does it affect my diet order whether I fill my prescriptions at Walgreens or CVS?

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

This thread has been moved to the Nurse Colleague / Patient Relations forum to stimulate more responses regarding this challenging situation. Good luck!

Specializes in tele, ICU, CVICU.

I can't believe she falsely accused you of hurting her... how crazy is she? Thank goodness you had a witness there.

I know I've had my difficult patients, and it is so much easier said than done, but I like the "kill 'em with kindness" motto, to sort of let them know you are completely ignoring their demanding, selfish and very inconsiderate ways. Like a PP said, it's like a toddler throwing a tantrum. If they see that their actions are having an effect upon you, then they've won. And, I'm way to stubborn to let that happen.

I would almost request to be assigned to them again, just to show them that you could care less (even though you secretly want to strangle them, or go smoke a few...I don't smoke, but it seems to help others). Of course, after another 12 hours with them, and probably family just as horrendous (or no family, because they know how they are and are sick of it) then it's somebody elses' turn.

I like hppygr8ful's solution of basically saying "I know you want ABC, but I cannot do that until you help me do XYZ. The longer you drag out my duties, the longer you must wait for what you want". Of course, smiling gently as said...

Eh, I revoke their rent on my headspace.

It's easier when you remember their lives suck. Just be objective and pleasant. Think robotic. They vacuum up your emotions and use them to spew back at you. I know it's awful, but I tend to pity jerks. They are usually alone, friendless, and sometimes are total wastes of humanity. It really has to be hard to exist like that.

It is their mission in life to get your goat. Don't give it to them.

In practical terms, you're buying in to their story. It's up to you to set the tone of your interactions. Present them with clear cut options and never get within arm's length without a witness, whenever possible. Whenever I have had a patient like this, I keep my demeanor calm and I reflect back what they are saying.

So, in your particular case, I would have listened to what she was saying. "So, _____ is not your pharmacy? _______ is your pharmacy." Just very matter of fact.

When she escalated, I would have (and have) said, "Ma'am, your behavior is disruptive at this time. When would you like me to come back and finish?"

When she screams at you again, put the call light in reach and say, "When you are ready to continue, please call. In the meantime, if this behavior continues, I will call security."

And walk out. Don't let anyone else go in there until she calls out calmly. If she continues to scream, then call security.

It usually only takes once or twice for these patients to realize they aren't going to get away with their behavior and to change it to get what they want.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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).

Really? You're going to give advice because your MOM is a nurse? My Dad was a photographer -- I guess that qualifies me to give advice on f-stops and composition.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
So I got a narc who was demanding water .

What does this mean?

Specializes in Hospice.

Narc = narcissist

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Is that a commonly used term? Is it pronounced "nark" or "narce "?

Specializes in Hospice.

No clue, klone. I've heard "borderline" used as a label for this kind of patient, never "narcissist".

For this old hippie, "narc" is slang for undercover drug cop or an informant.

Maybe the OP can provide a little background.

Specializes in critical care.
No clue, klone. I've heard "borderline" used as a label for this kind of patient, never "narcissist".

For this old hippie, "narc" is slang for undercover drug cop or an informant.

Maybe the OP can provide a little background.

That's what narc is in my brain as well.

It's making me think of The Heat. You guys see that movie? "A knock? What is a knock?" "No! A narc!" (Pronounced knock again.)

But, I digress....

I haven't had anyone quite so difficult yet, thankfully, but I've had some who I could tell I was never going to make happy. Unreasonable, demanding.... Only been assaulted twice. One was an angry dementia guy, the other was probably dementia, but she was definitely scared and confused. The guy, I took the older charge nurses in with me. He responded much better to older, assertive women. I'm tiny, young(ish - I look way younger than I am), and can bust out the mom voice, but it doesn't always work. The scared and confused lady was on and off restraints her whole visit. She responded best to the gentle, soothing approach.

Every one of these patients will respond to something different. You just have to figure out what they respond to and go with it

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
No clue, klone. I've heard "borderline" used as a label for this kind of patient, never "narcissist".

.

I have a provider who calls them "Axis II"

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