It is so hard to be nice sometimes.

Mandychelle79, ASN, RN · Dec 10, 2013

After the weekend I had, I can totally relate. I usually do ok with the addicts, I just tell them that my cousin has been am addict since 98 so there is nothing they can say or do that I haven't already dealt with. I had a patient throw nicotine gum across the room and I said, pick it up or the doctor would be contacted and the order would be discontinued. When asked why I didn't believe what was being said, listed the lies I was told that night.

SoldierNurse22, BSN, RN · Dec 10, 2013

I have a patient like this who comes in every now and then. I feel the same way. I intensely dislike interacting with her for the same reasons you stated in your post. It isn't a matter of wondering if she's manipulating me with flattery or trying to get her way with pitching a fit. It's a matter of fact. She's passive-agressive, condescending, and wildly insecure. I often pity her, but she does get under my skin. When possible, I try to trade off with another nurse so that we both don't have to put up with her all the time.

Hang in there! You're not alone!

taggart84 · Dec 11, 2013

I get how frustrating it can be. My addicts don't bother me much, but the manipulative behavior in general does! I can't stand manipulators.

elkpark · Dec 11, 2013

I try to keep in mind that people aren't doing this on purpose just to be difficult and ruin my day -- the vast majority of people, the vast majority of the time, are doing the best they can do with what they've got to work with. It's just a shame that they got dealt a poor hand at birth (nature and/or nurture) and have ended up with such poor coping skills, and our job is to help them learn better coping skills so they won't automatically **** off everyone they encounter.

I also find reframing can be helpful (for staff, as well as clients :)). I've spent years responding, when someone in report complains about a client being "so manipulative." that the problem isn't that they're so manipulative -- the problem is that they aren't as successfully manipulative as the rest of us. All of us human beings manipulate our environment and the people around us to get our needs met. All day every day. In fact, I consider that a pretty good definition of what separates humans from other animals. We manipulate our environment, inc. the people around us, to get our needs (and wants) met. The problem with the people labeled as "manipulative" on psych units is that they don't do it as smoothly and successfully, and in as socially acceptable ways, as the rest of us -- when they do it, they stick out like sore thumbs and everyone gets mad at them. Our job as psych nurses is to help them learn how to manipulate in socially acceptable ways that will produce the results they want without getting them in trouble, labelled, or ruining all their relationships. :)

taggart84 · Dec 11, 2013

I try to keep in mind that people aren't doing this on purpose just to be difficult and ruin my day -- the vast majority of people the vast majority of the time, are doing the best they can do with what they've got to work with. It's just a shame that they got dealt a poor hand at birth (nature and/or nurture) and have ended up with such poor coping skills, and our job is to help them learn better coping skills so they won't automatically **** off everyone they encounter. I also find reframing can be helpful (for staff, as well as clients :)). I've spent years responding, when someone in report complains about a client being "so manipulative." that the problem isn't that they're so manipulative -- the problem is that they aren't as successfully manipulative as the rest of us. All of us human beings manipulate our environment and the people around us to get our needs met. All day every day. In fact, I consider that a pretty good definition of what separates humans from other animals. We manipulate our environment, inc. the people around us, to get our needs (and wants) met. The problem with the people labeled as "manipulative" on psych units is that they don't do it as smoothly and successfully, and in as socially acceptable ways, as the rest of us -- when they do it, they stick out like sore thumbs and everyone gets mad at them. Our job as psych nurses is to help them learn how to manipulate in socially acceptable ways that will produce the results they want without getting them in trouble, labelled, or ruining all their relationships. :)[/quote']
Very well put! I love it.

TerpGal02, ASN · Dec 14, 2013

Oh trust me I know how you feel. The week before Thanksgiving our adult unit was full of PDs and addicts. It was misery to he down that hall. But whenever I have the 6th staff within 5 minutes come to me and say, "Joe Schmoe is asking about his pain meds" when I just TOLD Joe Id be with him in a few minutes, I have to just breathe and say to myself, "Self, this person is in a locked psychiatric ward. You can come and go as you please, they cannot. Their current behaviors are has what has worked for them in the past to get by, it's your job to teach them better coping skills". Don't make ek any easier to deal with though.

taydian · Dec 18, 2013

I'm not so sure I entirely agree. Maybe its because of the type of facilities I've worked at. I've never worked at a private facility before... The types of units I've worked at were rampant with malingerers. The way I see it, personality types have been very successful in manipulating people in the community. They put on their charm or are really good at garnering sympathy and most of the time they get the response they want. Then they come to a unit like my current one where it is more or less a homeless shelter until their next government cheese payout comes along...then they request an AMA and say peace out. Then we see them again within a month or two. At my previous job, it was a forensic unit...a lot of guys there were trying to get a NGRI (unfortunately for them, many of them weren't smart enough to maintain their facade and didn't take into consideration that nurses and staff actually communicated with the forensic treatment team regarding their behavior when they weren't around). They try to play the same game with the workers on the psych unit but since most of us KNOW what they are doing, most of us don't let them get away with it. It's the ones who fall for the splitting, they like the compliments they receive from these types of patients, the ones who are duped into feeling like "oh, this patient hates my co-workers but he likes me..." which makes them give into whatever they want.

It's a shame, too....such a waste. These guys are socially smart. They know how to get their way for the most part. They would make awesome salesmen or could climb the career ladder by their manipulation alone. Instead, they choose to spend a life committing crimes or substance abuse (I'm speaking only about the patients I've worked with on the types of facilities I've worked for...can't speak for others). It is we experienced health workers that don't fall for the charm.

I work with amazing nurses and a great treatment team...but because of WHO/WHAT we work for, sadly, in the end, our patients are only being enabled and its out of our hands. We can't change it because it is WAY too big for us to fight against.

taydian · Dec 18, 2013

Oops. The last response was in reply to Elkpark