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

I see it happen all the time in the ED. A few examples of times patients have accused nurses of intentionally hurting them: pulling off electrode leads, putting in an NG tube in a "rough" manner, straight cathing, and putting tape/gauze over a phlebotomy site "too tight" (the last was a claim of trying to hurt a patient in the future). But these people are not narcissistic--they are just rude and, in some cases, manipulative. Unfortunately, any given nurse cannot refuse a patient just based on the fact they are rude (or have the potential to be rude). A witness is definitely a good idea once the manipulative patients are identified.

Specializes in Emergency, Telemetry, Transplant.
What does this mean?

DEA agent. :whistling:

Specializes in Med-Surg, OB, ICU, Public Health Nursing.

There are continuing education courses that deal with "Caring for the Challenging Patient." In the public sector, we care for everyone. The rape victim and the rapist or murderer. We don't pick or refuse patients, no matter how difficult. We also do not put up with threatning or abusive behavior and will call security (ours carry guns) in a heartbeat. Often we have dual diagnosed patients who carry a psych dx and a substance abuse dx and they can be very challenging. There are diagnoses that corellate with certain behaviors. Researching boarderline personalities may help you recognize some clients in the future. If you find someone might be boarderline, you can't call a team conference together fast enough. If you see a patient "splitting staff" again, a team conference is in order, pronto.

The word narcissist is way older than modern medicine, so please drop it.

Since this isn't a psychiatry board, it's a good bet the OP is using it as it is defined in general usage, not as a medical diagnosis.

Maybe, but we are professionals, not laypeople, and we should try to keep our terminology correct, especially as it relates to categorizing or labeling patients.

Maybe, but we are professionals, not laypeople, and we should try to keep our terminology correct, especially as it relates to categorizing or labeling patients.

The OP isn't labeling or categorizing anyone. She's asking how to deal with a difficult patient.

The OP isn't labeling or categorizing anyone. She's asking how to deal with a difficult patient.

Whom she labeled as a narcissist even though the patient as described doesn't sound narcissistic in the general sense of the term, much less as a diagnostic label.

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