Manipulative patients always get the best of me....

allnurses Guide · Mar 22, 2012

I have had a couple of those types in the last couple of weeks. Just exhausting. I sympathize. I keep hoping as I gain experience I will get better at drawing boundaries with them. Drives me crazy how hard it is to get out of the room knowing someone else has needs that I am not effectively attending to due to being stuck.

DookieMeisterRN · Mar 22, 2012

These types of pts are like toddlers. Always follow through with limits you've set or they know they can get you to do anything and monopolize your time. Be firm and professional but don't let them see you get frustrated.

It seems I see more and more pts with some sort of undiagnosed psych disorder that just drains the system and takes time away from the pts that need it.

allnurses Guide · Mar 22, 2012

I had one who was not demanding in terms of wanting stuff, but just was a talker/rambler. Every conversation turned into a story about their past. Every encounter took 20+ minutes. Every question they asked lost its point and had a "but what about when....?" followed by yet another story. Not only is it a huge time suck, but honestly I found myself not wanting to go into the room, which obviously isn't ideal for providing excellent patient care. Combine that kind of a patient with hourly rounding requirements and I want to put a fork in my eye.

Altra, BSN, RN · Mar 22, 2012

This is ludicrously manipulative. Discharge?

And can we stop using the equally ludicrous phrase "fired the nurse"? Except in private duty situations when a nurse is not represented by an agency ... patients do not employ nurses. Patients do not discipline nurses. If patient assignments on the unit were reshuffled in an attempt to accomodate the bizarre interpersonal dynamics ... that does not equal firing.

DixieRedHead, ASN, RN · Mar 23, 2012

I feel like I got suckered in yesterday again. I haven't had a patient like this in awhile. I spent more time with him than I spent with any of my other patients combined. Even with setting limits.
This patient asked me if I thought he was a bad person. I refused to answer though he was asking me for my opinion I could have easily given it. I replied "I don't believe there are bad people." He continued to ask me and I did not waiver with my response, though, inside I was burning up.
This pt who is not a doctor and has never worked in the medical field is telling the nurses and doctors how to treat him. This was just one of a number of items but I can spare you the other details. Patients who do this type of thing always catch me off guard even if I am warned ahead of time. I told the attending who also had issues with this patient. He earned himself a psych referral. He also fired 2 nurses while he was in the ER. Tried to fire the attending but couldn't unless he could find a doctor who was willing to take over his care. He didn't know any docs at our hospital and wanted to come out to the nurses station and start interviewing doctors while they were rounding. When he initially got to the floor the nursing supervisor had to call public safety.
Any good responses anyone has for me. I'm all ears!

This man obviously needs to go home.

Dummyrn · Mar 23, 2012

Unfortunately with those patients there is nothing you can do but try to set boundaries. Most patients have been in an acute care setting many times and know exactly what their doing. The stinky part of it all is therr are other patients who want and deserve your time.

Been there,done that, ASN, RN · Mar 23, 2012

This is a Borderline personality patient.

I strongly encourage you to educate yourself on this diagnosis.

You will see it again... they will run the unit .. if you let them.

Altra, BSN, RN · Mar 23, 2012

This man obviously needs to go home.

Agree -- it's time for discharge.

noyesno, MSN, APRN, NP · Mar 23, 2012

I had one who was not demanding in terms of wanting stuff, but just was a talker/rambler. Every conversation turned into a story about their past. Every encounter took 20+ minutes. Every question they asked lost its point and had a "but what about when....?" followed by yet another story. Not only is it a huge time suck, but honestly I found myself not wanting to go into the room, which obviously isn't ideal for providing excellent patient care. Combine that kind of a patient with hourly rounding requirements and I want to put a fork in my eye.

The talkers/ramblers should be scored as high acuity patients because they take up so much time. They drive me nuts.

Cuddleswithpuddles · Mar 23, 2012

This patient asked me if I thought he was a bad person. I refused to answer though he was asking me for my opinion I could have easily given it. I replied "I don't believe there are bad people." He continued to ask me and I did not waiver with my response, though, inside I was burning up.

Sometimes it helps to turn the question back to them. This is one of those therapeutic communication techniques I scoffed at in psych but it has worked for me. Ask, "Do you have concerns about how others perceive you?" or "I am sensing you are feeling guilty about something. Would you like to talk about it?"

It sounds so hokey even as I type it out. But it does help focus the conversation back to the patient instead of the your views.

Of course, your mileage may vary. I am sure you will encounter people who will insist on you validating them and keep pressing the issue. Also, this approach may a huge chunk of your time if the patient does want to talk about feelings.

I wish all patient rooms came with silent alarms that will say "Nurse Cuddleswithpuddles to the nursing station stat" so I have a reason to make a graceful exit lol