Patient/Resident actually being a bully to staff

[TheFloorisCold]

I hate to say it but we actually have a resident/patient who actually in most sense is a bully to the nurses especially the RN's.

Everyday this lady writes everything we do (she has even accused us of not giving her medications even though its documented), constantly yells at us because we can't pay attention to her, and EVERY morning tells us we need to give her the emergency oxygen tank (we use it for when patients are in distress) so she can go outside to smoke. The last time someone denied her the oxygen tank she called the ombudsman office and the state came down on us. A lot of the staff are afraid to stand up to her because if we speak out some of the workers are not under the protection of the union.

Honestly, a lot of the residents are so demanding in the wrong sense and we can't speak up due to fear of being fired. I want to leave this facility but its the only job I have and I don't have enough experience to go anywhere else. The verbal abuse is horrible and some of the residents feel so damn entitled even though they have no insurance and do not pay a dime to stay there.

What can I do to stop these kind of residents? Honestly our facility is the one where if someone gets kicked out of their place, they come to us.

[biker nurse]

This is an issue for the social worker and /or administrator. I know it's all about residents rights , however this is to the extreme. All I can tell you is document, document and document!! (to CYA) Good luck. (If she owes facitliy money she can be evicited with proper notice.) If she gets sick and goes to hospital and DOES NOT pay for a bed hold, You won't have to take her back.

But understand too, She has had a loss of her independence, All she can control is the staff m(or at least try)

maybe a psych consult is in order!!

good Luck:clown:

[vampiregirl, BSN, RN]

I've had a few residents who have made demands that I am am unable or unwilling to grant d/t safety issues or other reasons. I always try to document in detail, as objectively as possible in these cases. I also communicate the resident's "requests" to management and social services.

Some of these issues can be care planned, if all staff approach the issues w/ similar responses (redirection, education etc) then sometimes these issues calm down. Or maybe there is something that needs addressed or even an alternative that could be presented to the resident.

My other concern would be if the resident is trying to bully the staff, how are they treating the other residents (especially when staff aren't around)?

[Catch22Personified]

This is an issue for the social worker and /or administrator. I know it's all about residents rights , however this is to the extreme. All I can tell you is document, document and document!! (to CYA) Good luck. (If she owes facitliy money she can be evicited with proper notice.) If she gets sick and goes to hospital and DOES NOT pay for a bed hold, You won't have to take her back.

But understand too, She has had a loss of her independence, All she can control is the staff m(or at least try)

maybe a psych consult is in order!!

good Luck:clown:

The State I'm in possesses one of those "safe discharge laws" so we can't kick people out on to the street.

In your case OP, the best thing you can do is to just CYA and hope to catch this crazy person in the act of lying.

[ninjago]

I had a similar patient. Very abusive to the staff. So what we did was called a meeting and confronted the patient, she was mad, of course and threatened to sign AMA. After she did and left, we celebrated as if we've won a lottery!

[optimist]

We have a pt like this at my facility. Its pretty much a 'right of passage joke' that you're not really an employee until he's accused you of neglect/abuse, youve been drug tested and suspended pending investigation (per protocol).The admin had to follow procedure and suspend herself when he accused her of neglect!! He has lawsuits pending against the facility that he claims is 'so abusive' yet he refuses to find alternative living arrangements.The only thing you can do is document until your blue in the face and CYA.

[IMOKAY, BSN]

Why would the facility put up with a patient like this...if it were a hotel or apt building they would be evicted....is filling beds and money that important?

[eriksoln, BSN, RN]

Even with the imcreased focus on "customer service" and all, I don't act like anyone's Butler or hand maiden. No value in it for me and TBH, it clouds the theraputic relation I am obligated to build. Who in their right mind listens to their Butler when they tell them they should not be snacking with a blood glucose of 500?

My point is, my personality leans towards the abrasive side and I don't change much when I'm on the clock. If you are being a PIA, I tell you so. Yet, despite this..........I have many more patients who like me than those who complain about me. Rarely am I reported to the higher ups by a patient.

A nurse on my old unit and I once had a long conversation about all this. She basically wanted to know "With how straight forward you are, how is it you are rarely complained about yet I seem to get one a week?" She was a very nice nurse, did everything the patient asked if she could...........no real reason to complain about her. Yet, once a week, she was in the manager's office explaining why the tea wasn't hot enough or why the corners of the bed weren't tucked in perfectly.

My answer to her: "Patients only report you if they think you care about them reporting you." I don't give off an air that my life is over because some patient decides I don't fit their mold of a good nurse. People pick up on this and realize...........making demands and threats won't get them any hotter tea or get their bed corners tucked in. So, they try other routes.

I do care that a patient is treated with dignity and compassion, but not to the point where I become anyone's floor mat over it. If you can't be made happy.........fine by me, I'll spend my time with the one's who can (within reason). I will go out of my way to help someone, but if their only enjoyment in life is abusing me...........good luck having a good day while I'm on shift. What the state or any administrator thinks about it is heresay, they can't do what I do. If your patient wants to call the state in, let her. Maybe they will be more concerned with making sure she gets her cigarette breaks exactly when she wants them.........me, I have higher priorities. Let the state come in every day if she wants them too. Maybe they'll see the poor staffing and do something about it.

There are many times where the only realiable judge of whether you are doing well as a nurse is yourself and your peers. Seems like the other nurses in your facility are having the same issues with this patient, so I doubt its any flaw in your approach causing the problems. Let her be miserable and focus on the good experiences you have throughout the day.

[CompleteUnknown]

This sounds like something that is way beyond the ability of individual staff members to 'fix' as they go about their duties. Has a sort of mini case conference or meeting with the resident been tried? If you're not in a position to initiate this, perhaps you could suggest it. With residents like this I think that sometimes the best you can hope for is a reduction in the bullying and intimidation tactics rather than a total prevention or cessation of the behaviour, and some workable strategies for dealing with it when it occurs.

I've found that a meeting with the DON and/or facility manager, a nurse, a CNA and the resident will often allow the resident to make his or her case and explain what it is they're wanting/needing/not getting/etc. Unreasonable and unsafe demands, such as wanting the use the emergency oxygen tank outside while smoking (yikes!), can be ruled out straight from the horse's mouth (DON/manager) and other things can be negotiated with input from the nurse and CNA to assist the DON to know what is possible and what isn't.

Strategies to deal with abusive behaviour (for example, if the resident begins to abuse staff, the staff will leave the room and return later) can be determined and agreed to by all. The resident will probably raise complaints about the staff during the meeting, that's okay, that's what the meeting is for, to get everything out in the open and discussed calmly and addressed in a way that is acceptable. Keep an objective record of what has been decided, and it can become part of the care plan. Decide on a date for a follow up meeting to see how things are going.

Sounds good in theory and it doesn't always work of course, but I think it would be worth a try.

[steelydanfan]

The last time, and the next time a pt. wants to smoke on O2 under MY care; my response is unvarying: "No". Call the state, call your lawyer and call your Uncle Joe. the response is the same.

[Midwest4me]

CYA like others have said. Unfortunately, at our hospital(it's a mental hospital) pts have the rights. Staff do NOT. Patients can verbally, physically abuse each other and the staff. There are NO consequences... we have to chalk it up to their "mental illness". When we do "hands on", someone always thinks we are at fault. Pathetic, I know....but it's a job in a bad economy.