We had a woman admitted to our floor tonight that wasn't confused, wasn't a psych patient, she was just plain MEAN. The CT department called and said, we are sending her, be prepared, in 20 years we have never met anyone like her. Well, it didn't get any better for us. The nurse tried to do her assessment and was told "YOUR PUSHING TOO HARD WITH THAT STETHASCOPE, STOP YOUR HURTING ME!" She refused to answer any of her P&A questions because "her doctor knew everything and we didn't need to know her business." So I call the doctor and tell him, first thing in the morning, you need to talk to your patient, She is being abusive to my staff and I will not tolerate it. In the meantime, any advice you can give on how to handle her would be greatly appreciated. Ofcourse, she is on the call light every 3 minutes, the room is too hot, the dinner is too cold, can she have a second dinner tray, her stomache hurts, she is having chest pain, her hip hurts, her neck hurts, her back hurts. This went on ALL night. THEN, the nurse calls the doctor about her hip, because it seems to really hurt more than the others:uhoh21: she REFUSES to go to the X-Ray he ordered. We are in the middle of an RRT and she is screaming at the transport guy...I left the RRT room and told her that she needed to get on the cart because she told us of the hip pain and this is what her doctor wanted. Yes, ofcourse it is her right to refuse, but she was just doing it for attention....So, I go back to the RRT room where we are pushing 12mg of Adenosine:imbar and I hear this woman carrying on. I go back to the room tell the nurses to leave her alone and stop fighting with her, if she doesn't want to go to the X-Ray, she doesn't have to but to sit and fight with her about the reasons is useless. I then informed the patient that the swearing at my staff and the punches she was throwing and abusive behavior would stop NOW, I had a real emergency down the hall and needed the nurses to focus on her. I was DONE playing her games and she was not to call out anymore for nonsense issues, expecially when she would not let us do anything about i. I then called security and they came up to talk to her. After the RRT, I looked out in the hallway and she had found a wheelchair, she decided the X-Ray might not be such a bad thing and was waiting by the elevator for transport to come back up to get her. Poor doctor, I then called him back and gave him a piece of my mind, lol. He said, what do you want me to do, something for nerves? I said, yeah what do you have for me?:chuckle Luckily, I have a good relationship with him, I said, I am just giving you a hard time because I am frazzled and at my wits end with her. He told me he would try to get her home tomarrow:rotfl:
I would think too, especially calling 911 three times!! However, I guess the personnel/paramedics taking the calls figured she was demented, old, crazy & mean...and didn't want to pursue it any further.
I had a patient similar to this patient the OP described. She was just nasty, smoking in the room, c/o about her roommate, complaining about the attention she was getting from the nursing staff. She complained about the IV and wanted it taken out, called nursing administration, called me stupid. What she didn't know is that I understand a little bit of German (about every 5th word) so when she was on the phone with whomever she was talking to, I understood her conversation. She thought she was "having fun" with the nurses by being such a rotter. ( I was charting her assessment on the computer terminal in her room.)
The capper was the smoking incident. I was working PM's, and I walked past her room, smelled cigarette smoke, poked my head in. She was sound asleep. I called the Charge RN over for a 'second opinion'. She walked in the room, saw the cigarettes in the patient's open bag. She woke her up and told her that she would be confiscating the cigarettes until her d/c. The charge nurse told her in no uncertain terms that there was absolutely no smoking permitted in the hospital. Of course the patient denied having any knowledge of the cigarettes, how they got there or of having smoked them. She smelled as if she'd been on a weekend bender and was mad as a hatter. She completely pitched a fit. I've never seen such anger in a patient. When we told her that smoking is absolutely forbidden on a floor where nearly every patient has O2 on, she said she didn't care about other people. Then she called nursing supervisor/administration and insisted that she be moved to a different room, floor, nurse, whatever. We asked the supervisor to come to the floor and talk to her in person because we felt that this patient's outright aggressiveness was a threat to the rest of the unit.
The supervisor came up in about 10 minutes (lightening speed for this type of situation, luckily) She talked to the patient, explained that the hospital was full and there were no other beds except in the SICU. She said she wanted to be transferred to that unit then. The administrator looked her straight in the face and said "If you want to go to the SICU, get out of the hospital, get into your car and drive it into a tree. The SICU is reserved for medically unstable surgical/trauma patients who may or may not live, but under no circumstances am I going to waste a bed in that unit on a troublemaker who has nothing better to do than harass two hardworking nurses on a busy night. You can stay in that bed and cooperate or you can leave against medical advice and face the consequences, but you will not harass the staff any more during your stay here, or we will be calling the police and filing charges".
She then asked me if I wanted to continue with the case for the duration of my shift, and I said it didn't bother me; by this time I had only a few hours left on my shift. She said she'd tell the unit manager what had transpired, how it was handled and that I was not to be on the case again. Fine with me. The nursing sup put in a call to the patient's doc and told her what was going on; she ordered ativan 2-4mg IM prn. Yowch! (The patient refused to have an IV, even a SL.
I think the OP handled this bully with absolute perfection. I love the idea of a contract with patients. It's the way is should be. I've noticed that bullies become meek as can be when faced with limits. Kind of like handling a two year old.
I'd just like to apologize for my grandmother's behavior! :chuckle :chuckle :chuckle
Seriously, this does sound exactly like my grandmother. She acts exactly like this and she has her entire life - wanna know why? She's just plain mean. There's no underlying pathology, there's no psychological problem (believe me, we've had her checked out!), she's just mean.
You handled it perfectly. There is nothing you can do to please people like this, so don't sweat it.
I've taken care of 2 men recently similiar to these, just plain mean :angryfire . But, as another poster said, these type of people need boundaries. Put your foot down & tell them we aren't going to put up with their crazy behavior. Of course, this doesn't help everyone.
I've had a patient like this recently. I think you did great with her.
But I charted like crazy, and after a lengthy conversation with the doc, was able to get a psych consult.
In this particular case, my patient was trying to cover up for the fact that she was being abused and was nasty to the males to protect her abuser, thereby protecting herself from his retaliation.
Whew. That was a mouthful.
There's almost always more than meets the eye with some of these people, but I set the lines and let the shrinks deal with it after that.
Once or twice I've been known to get a patient's attention who's like that by making really good eye contact and saying something like, "Do you LIKE being this way to other people?"
I say it as if I'm really feeling sorry for them. After all, I can walk out of the room, and I'm done. That type of patient is stuck there, inside all that unpleasantness.
I had a patient somewhat like that...not quite as bad, but definitely needy, demanding & seeking attention. She ended up coding on me later during the shift & died.
Specializes in Case Mgmt; Mat/Child, Critical Care.
This is the kind of person that needs to be discharged ASAP. I would confront him/her, very calmly and politely, stating: "I am not arguing w/you, it is your choice to be here, if you choose to stay then your behavior will change, if not, here are the AMA forms....you will be discharged, whether you sign them or not!"
These people are simply spoiled, selfish individuals who have no respect for anyone, including themselves. I, for one, do not feed into that nonsense. Oh, offer a psych consult while you're at it.
I wondered though why you didn't let loose with a little German (like on your way out the door), just so she would have known you knew. I don't know if I could have resisted!
Probably not profession, but I would have done it anyway!
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Town & Country
789 Posts
Shouldn't calling 911 frivilously BE A CRIME??
I think so!