How to manage paranoid nurse

[Nurse Beth, MSN]

It's a unique and challenging situation, and you're handling it with care and professionalism. These sound like symptoms of a severe mental illness, and you are right to get her help as well as remove her from patient care.

When documenting such concerns, it's important to be clear, factual, and objective-basically exactly how you reported your observations above.

Documentation Structure

Here are some guidelines on how to structure the documentation. It's similar to an SBAR (situation, background, assessment, recommendation).

Subject: Incident Report – Paranoia and Behavioral Concerns

Date of Report: [Insert Date]

Employee Name: [Nurse's Full Name]

Position/Title: [Nurse's Position/Title]

Date of Incident(s): [Provide specific dates or date range]

Summary of Concerns

Over the past [insert time frame], there have been multiple concerning behaviors exhibited by [Nurse's Full Name] that have raised significant concerns regarding her mental and emotional well-being, as well as the potential impact on her ability to perform her professional duties effectively.

Behavioral Observations/Paranoia and Delusional Thinking

• On [insert date(s)], [Nurse's Full Name] made statements implying she believed staff members were hiding cameras in her home to observe her activities. This belief appeared to be unfounded and irrational.
• On [insert date(s)], [Nurse's Full Name] expressed concern about the color gray, interpreting it as a personal attack on her appearance, stating, "They think I am old and gray."
• On [insert date(s)], [Nurse's Full Name] observed a Snickers bar placed on a patient's bedside and interpreted it as staff members snickering at her.
• On [insert date(s)], [Nurse's Full Name] expressed concern over a black ink pen placed near her work area, believing it to have a hidden meaning or message directed at her.
• On [insert date(s)], [Nurse's Full Name] found a partial candy wrapper near her car and indicated she believed it had been intentionally planted there to send a message.

Distress and Inability to Cope with Perceived Signs

[Nurse's Full Name] has repeatedly expressed confusion about these incidents, suggesting she feels others are planning a game or orchestrating events she does not understand. She has expressed a heightened sense of suspicion and distress surrounding these occurrences, which has impacted her emotional well-being and ability to concentrate on her duties.

Actions Taken

[Insert date], I met with [Nurse's Full Name] to discuss her recent behaviors and the concerns raised by her colleagues regarding her well-being and her perception of interactions with staff.

I recommended that [Nurse's Full Name] take medical leave to allow time for professional assessment and treatment.

I strongly recommended that she consult with a behavioral health counselor to understand the source of her distress better and receive guidance on managing her symptoms. [Nurse's Full Name] was informed that this was necessary to maintain her fitness for duty.

Next Steps/Recommendations

Medical Leave:
I have advised [Nurse's Full Name] to take a medical leave for the evaluation and treatment period. I will ensure that the necessary documentation for her medical leave is processed.

Behavioral Counseling

[Nurse's Full Name] has been advised that she must seek behavioral counseling to address the symptoms she is experiencing. If she refuses to attend counseling, it will be necessary for me to report this situation to the state nursing board, as this may impact her ability to safely and effectively carry out her duties as a nurse.

Additional Notes

[Optional: Include any other interactions with the nurse regarding this issue or any scheduled follow-up meetings.]

Signature:
[Your Name]
[Your Title]
[Your Contact Information]
[Date]

By maintaining a neutral, clear, and objective tone, you're creating documentation that focuses on the facts and can serve as a valuable record should you need to escalate the situation further.

Make sure to retain copies of any emails, text messages, or other correspondence related to this issue if you need further documentation later.

Best wishes,

Nurse Beth

[JKL33]

Only thing I would add is that I am not sure it would be appropriate to suggest a specific course of therapy such as behavioral counseling.

More appropriate to expect that a person will take steps to undergo medical evaluation. These behaviors could represent any number of conditions including a medical condition, a psychiatric condition, a SUD, an iatrogenic cause, etc., etc.

[JohnHood, BSN]

This is a very difficult situation. Your first concern needs to be patient safety. She needs to be removed from patient care immediately. At this point she seems very paranoid. I don't know that you will be able to communicate with her at this point. I think that you need to have HR involved. If possible her family needs to be brought in, because at this level she will probably require hospitalization. I really think that the board needs to be involved because this is a very serious safety issue. She is not safe to practice. You do need to make sure that you have documented everything, but that should not delay action.

[Nurse Beth, MSN]

JKL33 said:

Only thing I would add is that I am not sure it would be appropriate to suggest a specific course of therapy such as behavioral counseling.

More appropriate to expect that a person will take steps to undergo medical evaluation. These behaviors could represent any number of conditions including a medical condition, a psychiatric condition, a SUD, an iatrogenic cause, etc., etc.

Excellent point, thank you

[NRSKarenRN, BSN, RN]

Been in your shoes quiet hardworking RN with Bipolar had manic episode, overnight personality change, Loud colors worn with garish makeup., boisterous upset entire office staff. Multiple staff in my office distressed over personalty change asking me to get her medical help as they all liked person.. Took 3 weeks with HR involvement to place on leave as work still being performed.

Beth advice spot on re how to document situation.  Request should be for medical eval  only prior to return to work. Provide number for Employee Assistance Program (EAP) if you have one under recommendations.  " Employee Assistance Program (EAP) 800-888-9999 is available to help with health and wellness, locate resources and support you with workplace concerns."

Please discuss your concerns with HR including documentation -- neutral tone.  I was advised to have another manger/VP nursing be present during meeting with nurse as witness and help deflect any anger from myself.  HR told me to call their next of kin to inform them our concerns re health eval + family support for staffer desired.

Nurse had brief hospitalization,, returned to work  within 2 months with meds adjusted, warmly welcomed back,  Took 2 months post return for RN to resolve anger directed at me; best idea HR had was to have another Manager be assigned to discuss her concerns about me  who helped her refocus on her "health goals for long term work here".   They remained staff lost touch after I retired in 2018.

Best wishes in resolving this workplace issue not taught in nursing school!.  Remember EAP can be there for you too to destress/get advice, There are also EAPs specifically designed for supervisors to help them manage workplace crises and employee performance.  Carebridge EAP was my companies -- benefit included 3 free mental health sessions+ locator service for longer term.counseling. Additionally they offered info on how to locate college for child, financial education and legal information. I gave out brochure yearly to staff and anytime staff seemed stressed.

Let us know outcome +pearls you learned from the situation.

[subee, MSN, CRNA]

I'm stunned reading the op that rhis nurse wasn't taken immediately to the ED for an evaluation.  She us as ill as someone with an. incipient MI.   She us a danger to herself and the patients.  I hope someone has reached out to help her and she is being treated.