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.
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.
THIS. I'm really disappointed at the apparent lack of understanding about mental health diagnoses in this thread. Borderline, Narcissistic and Antisocial (Sociopath) are diagnosable personality disorders with specific diagnostic criteria defined by the DSM-V. They are not words to just be thrown around to describe annoying patients. Axis II was, prior to 2013, the category under which personality disorders were classified. Not just a term to be thrown around either.
What the OP describes is NOT, in any way, narcissism and I'm not sure the OP understands what Narcissistic Personality Disorder is.
She(mirandaa) is a CNA and clearly has gained wisdom from her nurse mom. Is that so bad?
I, too, have a mom with 45+ years in the business and I have learned from her before, during and since nursing school 20 years ago.
I know you are a well respected poster on AN but I appeal to you...is this how we want to treat mirandaa and those like her who have learned along the way from various sources, even those that are personal?
FWIW, I agree with your advice mirandaa. Not always does it work but on occasion, killing a difficult patient with kindness is the ticket.
Anybody can exhibit narcissistic traits from time to time but that does not make them a narcissist or give us the liberty to diagnose them with narcissistic personality disorder.
I just want to throw this out there that I didn't think the OP was literally diagnosing this patient as narcissistic or having a specific disorder. OP described behaviors that I generally associate with annoying pain in the you-know-what patients. I thought the OP wanted some ideas of how to better handle difficult or manipulative patients in the future.
She(mirandaa) is a CNA and clearly has gained wisdom from her nurse mom. Is that so bad?
I, too, have a mom with 45+ years in the business and I have learned from her before, during and since nursing school 20 years ago.
I know you are a well respected poster on AN but I appeal to you...is this how we want to treat mirandaa and those like her who have learned along the way from various sources, even those that are personal?
FWIW, I agree with your advice mirandaa. Not always does it work but on occasion, killing a difficult patient with kindness is the ticket.
I appreciate it macfar!
I've learned a lot of great lessons from my mom, both nursing related and not. She's a good lady :)
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I appreciate it macfar!
I've learned a lot of great lessons from my mom, both nursing related and not. She's a good lady :)
I'm sure your mother is a good lady, and hopefully you have learned a lot of lessons from her. But your mother's experiences as a nurse aren't YOUR experiences. The fact that you have multiple family members (as do I) who are nurses does not expand YOUR nursing experience. Nor does it give you any actual credibility.
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
Don't know what kind of facility you work for... but even giving a hint that you are "too busy" to respond to the patient's needs and denying their access to request care would blow up administration , risk prevention, and your friendly local attorney.
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
I strongly advise against shutting off a patient's call light for staff convenience. Regardless of how disruptive a patient is being, the call light is the primary way the patient can call for attention if they need help, and it is our responsibility as nurses to ensure that patients have the means to call for assistance if needed. As I mentioned on another thread, my family member was a couple of days post-op after a big surgery, and had just that day transferred from ICU to med-surg, when they became stuck in a position in bed where they could not breathe, and could not reposition themself. They used the call bell to say "Help me, I can't breathe," whereupon several nurses rushed into the room. My family member was badly shaken up by the experience. I can't begin to think of the consequences for everyone if the call bell had been turned off.
I'm sure your mother is a good lady, and hopefully you have learned a lot of lessons from her. But your mother's experiences as a nurse aren't YOUR experiences. The fact that you have multiple family members (as do I) who are nurses does not expand YOUR nursing experience. Nor does it give you any actual credibility.
Apparently you missed the part where I stated this advice has also worked for me while working in healthcare. I never claimed that her experience expanded my experience, but that the advice she gave FROM her experiences helped me with mine.
I personally don't think that your patient is "narcissistic". I would classify her as rude and irate. Anyways, with regard to your concern, I would still take care of her like everyone else. Some patients are really tough to crack. Often times, you need patience. I had almost the same experience, my patient was very a chronic patient and have stayed in the hospital for a very long time. Most of my colleagues doesn't want to cater to her needs since she was rude. I just treated her like anyone else. After days has passed, to make the long story short, she became friendlier with me and cooperated better. She would even tell stories about her family. Sometimes all you need is that long thread of patience to get thru our daily work.
KelRN215, BSN, RN
1 Article; 7,349 Posts
THIS. I'm really disappointed at the apparent lack of understanding about mental health diagnoses in this thread. Borderline, Narcissistic and Antisocial (Sociopath) are diagnosable personality disorders with specific diagnostic criteria defined by the DSM-V. They are not words to just be thrown around to describe annoying patients. Axis II was, prior to 2013, the category under which personality disorders were classified. Not just a term to be thrown around either.
What the OP describes is NOT, in any way, narcissism and I'm not sure the OP understands what Narcissistic Personality Disorder is.