Patient rage

Really, IMO, when this occurs you've already let things go too long without getting help. We are human and have our weaknesses, and some people, for whatever reason, have the capacity to "get to us" more than others. I had this happen the other night, and looking back on it I couldn't figure out why this guy was able to get under my skin so much. As it happened, I took care of every single need he could possibly have from his nurse's perspective and then enlisted the help of a co-worker because he and I just weren't getting along. It wasn't good for him or for me.

There are a variety of ways to handle this, some more effective than others. I don't understand the set which hangs on to the patient for the entire shift, despite the fact that your mutual dislike has already compromised the nurse-patient relationship. (I am referring to cases where the nurse and patient are just constantly in conflict, not just minor incompatibility of personalities.) If possible, trade with someone else. At the very least, ask a co-worker to answer a couple call bells so you can take a break.

Lastly, remind yourself that there's really nothing to be mad about. Anger and rage are indicative of a control issue, IMO. You're their nurse, not their Mama. They don't want to do X or Y? Big whoop. They're being abusive? Leave. Ensure basic safety and leave. Usually a little break will help matters, and if it doesn't there are other ways to handle the situation.

Some patients, even after you've met all their physical/comfort/medical needs remain... needy. Nurses I know, myself included, will go an extra (half) mile beyond that depending on the situation/how much time and energy they have. Sometimes that's all it takes, sometimes it just makes matters worse.

Being honest with the patient may help. By that I mean admitting out loud to the patient that you're feeling frustrated with trying to meet their needs. Sometimes patients need to be reminded that nurses are people, too.

You don't mention what made you so angry with this particular patient...?

Oh wow ... thank you "NursingAgainstTheOdds" for such a thoughtful response. In school reflection was a huge focus in almost every single class. You are completely right when you say I need think and reflect on why I allowed this patient to get under my skin.

I truly appreciate your valuable and very thoughtful response. Thank you ... it is helping me cool down a little :)

MoopleRN:

Pt. was relatively young, extremely needy, expressed to me that she was in a lot of pain (the type of pain that allows you to breathe easy, make demands, and hold a normal conversation with others). Every time I touched her she would scream out in pain and act as though I had pinched or punched her. And then, on the other side of the spectrum I had this pale and very thin and very elderly patient who would sob because she was in so much pain. Nothing I could do could comfort her. It is very difficult to see an elderly person cry because they are in pain.

Then, in the last 10 minutes of my shift, the younger patient decides to have a bowel movement and she won't do anything for herself so it takes 3 people to help her up - all while she is screaming out in pain and acting as though we are the roughest people on the planet.

Everything about her just really annoyed me ...

Thanks for the great tips, NursingAgainstDaOdds, I have had two patients like this, one in nursing school and I was just ready to sream with her and another one who was a substance abuser and violent. I did have to step back and really reflect on both of them and why they made so ticked off, not an easy thing.

MoopleRN:

Pt. was relatively young, extremely needy, expressed to me that she was in a lot of pain (the type of pain that allows you to breathe easy, make demands, and hold a normal conversation with others). Every time I touched her she would scream out in pain and act as though I had pinched or punched her. And then, on the other side of the spectrum I had this pale and very thin and very elderly patient who would sob because she was in so much pain. Nothing I could do could comfort her. It is very difficult to see an elderly person cry because they are in pain.

Then, in the last 10 minutes of my shift, the younger patient decides to have a bowel movement and she won't do anything for herself so it takes 3 people to help her up - all while she is screaming out in pain and acting as though we are the roughest people on the planet.

Everything about her just really annoyed me ...

I think we can all relate. People just don't understand. You wonder what those people do at home. :uhoh21:

Took care of a "diva" once in the home setting. She had a habit of complaining about every thing and constantly tried to manipulate her caregivers, family included. I finally just sat down and had a truthful chat with her, told her I felt as if she'd forgotten that others had feelings too. while we're caring for the patient, it's ok to be honest, sometimes the truth can make things better. It can be delivered quite kindly too. Hey I'm really trying to help you, but you're (behaviors etc) is going to affect my ability to deliver what you need and possibly make people you need avoid you. I know that's not what you need...let's try another way. It works for families too, they often don't see they're alienating the ones who can help them.

Was she a borderline? Drug addict? Abuse history?

Is it possible she really was in that much pain? People with nerve impingement, as in back situations, can indeed be extremely sensitive. Burns, other conditions that fail to come to mind right now can do it, too. Once saw a woman in for her gyn checkup who was lying perfectly comfortably until the doctor began to examne her. Then she started screaming! I think she thought she was supposed to do that with him because her husband was present in the room and maybe she was expected to do that with him or to show horror at being touched by another man, even a doctor. Don't know - it freaked me and doc out.

I agree that nicely-spoken, gently-worded truth can work miracles.

Was she a borderline? Drug addict? Abuse history?

Is it possible she really was in that much pain? People with nerve impingement, as in back situations, can indeed be extremely sensitive. Burns, other conditions that fail to come to mind right now can do it, too. Once saw a woman in for her gyn checkup who was lying perfectly comfortably until the doctor began to examne her. Then she started screaming! I think she thought she was supposed to do that with him because her husband was present in the room and maybe she was expected to do that with him or to show horror at being touched by another man, even a doctor. Don't know - it freaked me and doc out.

I agree that nicely-spoken, gently-worded truth can work miracles.

Her joints were stiff from inactivity therefore she stated she couldn't roll. And wouldn't even try either. I tried to explain to her that continuing to remain inactive was just going to make things worse. She stated she hurt everywhere and that everything ached. So, touching the tops of her feet would make her scream out in pain. Palpating her abdomen would make her scream out in pain.

It is just annoying to have a demanding and needy patient act as though every little touch causes her so much pain when you have a really weak and frail little old lady in the next room legitimately sobbing and grimacing because she is in genuine pain.

Her joints were stiff from inactivity therefore she stated she couldn't roll. And wouldn't even try either. I tried to explain to her that continuing to remain inactive was just going to make things worse. She stated she hurt everywhere and that everything ached. So, touching the tops of her feet would make her scream out in pain. Palpating her abdomen would make her scream out in pain.

It is just annoying to have a demanding and needy patient act as though every little touch causes her so much pain when you have a really weak and frail little old lady in the next room legitimately sobbing and grimacing because she is in genuine pain.

Is it possible that both were in severe pain? I've been there myself where it seems that the least touch/pressure or movement causes extreme pain. I tend to withdraw and not be as demonstrative as what you describe so many close to me never know what I'm going through. I still have days where I wonder how I'm going to make it, and nights where simply rolling over in my sleep brings me wide awake, crying in pain.

Now that said, I've also cared for those who act out. They are very difficult to care for.

Just curious, what is her diagnosis (as it relates to her pain)? I admit my first thought was sickle cell, but that may be because it's in my field...

She has general muscle and joint aches. She has been in the hospital for a while and is supposed to be discharged in the next day or two. The only thing she has prescribed for pain is acetaminophen. She is diagnosed with renal failure and came to hospital because of cellulitis to her hand.

Just needed to vent. I am a relatively new nurse and I have never felt such rage against a patient. I wanted to hit the patient on the head with a hammer. No hammers in the vicinity and I would never truly do something like this but I felt this rage inside that felt kind of awful. I was so incredibly annoyed.

Please ... has anyone else felt this way? What to do? I feel kind of bad that I had this terrible and violent rage. Ugh.

Learn to meditate. You will become more detached from the negativity coming your way.