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.

Specializes in Med-Surg.

My unit gets at least 1-3 patients like this a week. They are often frequent flyers so we already know their history. We have to all be on the same page about their care and set very firm boundaries. Often they get a psych consult and patient advocate gets involved. Bedside report helps too because the off going and oncoming staff repeat the set limits in front of the patient. We never hesitate to call security for outrageous behavior either.

We also have to share the joy of taking care of patients like this because most nurses will keep them for a shift then want a new assignment the next day.

Specializes in ORTHO, PCU, ED.

This post has me kinda lost from the get-go. OP, can you please explain this, "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." I am completely lost.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
This post has me kinda lost from the get-go. OP, can you please explain this, "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." I am completely lost.

The whole thread has kinda got me lost. If the patient isn't in a psych unit, he probably doesn't have a psychiatric admitting diagnosis, so how do we know he's a narcissist? Is that even a diagnosis? I'd just call the patient described in the OP "entitled and demanding." I wouldn't go sticking a mental health diagnosis on him.

As far as CRAZY goes, there's "having mental health issues that he's working on," crazy and bat-guano crazy. The patient described in the original post was probably crazy bordering on bat-guano crazy.

Specializes in ER.

I think the term Narcissist is often used colloquially, in everyday language, to refer to a self absorbed person. I've referred to my father, and others, as narcissists. Most narcissists would never bother to get help, or an official diagnosis, for their sociopathic tendencies, since they see themselves as perfect.

Specializes in Emergency.

Do...."just enough"

Specializes in Emergency/Trauma/LDRP/Ortho ASC.
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.

This. All day long. Eventually they will fire you as a nurse and then you don't have to worry about refusing to care for them either. :) Works almost every time.

This. All day long. Eventually they will fire you as a nurse and then you don't have to worry about refusing to care for them either. :) Works almost every time.

It took me a few times to figure out you meant the patient would fire the nurse, not the hospital. LOL!

Specializes in Behavioral Health.
I think the term Narcissist is often used colloquially, in everyday language, to refer to a self absorbed person. I've referred to my father, and others, as narcissists. Most narcissists would never bother to get help, or an official diagnosis, for their sociopathic tendencies, since they see themselves as perfect.

This is true (the colloquial use of psych terms), except narcissism isn't sociopathic. Sociopaths habitually violate the rights of others and are generally remorseless. Narcissists believe they're special, and expect to be treated as special. Borderline is probably more applicable to this type of patient, but I'm really, really against using diagnoses as pejoratives.

Specializes in Behavioral Health.
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.

This is more or less exactly what I would do. Firm boundary setting. Like other PP said, I never argue with patients. I state things matter of factly and I put them on the table. "I'm not here to be yelled at, I'll come back when you've calmed down." A thousand times a shift. Sometimes - don't bank on it - patients respond really well and settle down.

I recently heard a patient doing this to a doctor. She claimed not to have been seen by Dr. in months. He offered to show her where another Dr. on staff had seen her the previous day and she went ballistic. He remained calm and professional throughout. I was impressed.

Specializes in PCT, RN.
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.

Oh jesus.

Seeing as this isn't *medical* advice, then most certainly. I'm not giving medical advice that *only* a nurse would know that I'm just passing off (really this is just common sense). Your argument in regards to your photographer father isn't similar in the slightest.

Not to mention, I also work in healthcare and I have taken this advice and use it on a regular basis and yes, it does actually work well.

But you go ahead and be rude to your crazy patients and see how far that'll get you.

I think it pretty narcissistic to refuse difficult patients and expect your coworkers to take them instead.

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