I am a second career new grad RN. My first job was six months at a nursing home, and I have now been working for 2 months at a freestanding psych hospital. I have loved psychology since childhood, and am enjoying this opportunity, but would like some feedback on how to better handle some situations. Prior to nursing school, I recognized that I have codependent issues, and I worked on them for several years and continue to do so. I no longer worry about what people think of me, but I must still present as a people pleaser, based on how people react to me - that is part of my problem. So, I am working on becoming more assertive and confident in my reactions to people.
Yesterday at the start of PM shift all the rooms were taken, so we decided to do report in the day room. One patient I'll call A was in there. I asked him to leave temporarily, and he said in a very irritated voice "I'm not leaving, you people treat me like crap, I have a right to this room." I need to exert my authority, but I feel like if you meet anger with anger, it escalates the situation. What would have been a good response? How about "A, we're just asking you to leave the dayroom for 15 minutes so we can take report. You can come back here then." Is that too soft a response? Do I need to confront A's bad attitude because he is being disrespectful and if I don't confront it it will just lead to more of the same? I truly am not bothered by whether or not A is respectful to me or what he thinks of me, I just want to get my job done and have a good milieu.
Next scenario: recently a "frequent flyer" came back, a young woman. Another fairly new nurse assessed her. She appeared completely out of it, kept repeating some nonsense phrase, and had to be practically carried to her room because she was too limp to walk. A little while later, she walked to the day room and calmly ate a snack, stating "I was just tired". My colleague said "She was just faking it!" (which I think she had suspected already, this just confirmed it). What would be a therapeutic response to this behavior?
Next scenario: a 40-ish female pt is admitted. She claims to be a BSN who just got fired from her job "for teaching the MAs how to give IVs", had her two kids taken away by CPS because of her boyfriend's drug use, etc. She claims to be in a lot of pain. I call for initial orders and am able to get her 1 Percocet every 6 hours. She isn't happy about this, but I explain that this is all she can get now and will have to talk to the internist tomorrow if she needs more pain meds (our hospital is cracking down on pain meds so as not to enable drug seekers). She is constantly at the nurses station and tries to split the nurses. I am polite to her, but not real attentive as I don't want to encourage her attention and pain seeking behavior. I was off for a few days, and then she was my pt again. By this time we had found out she was not an RN or any other licensed professional by checking the BON website. She told me that she had 10/10 chest pain that was radiating down her arm. I thought I detected BS, so I had her VS taken and they were OK (BP a little high, but not majorly). Since she had no other objective s/s, I didn't do anything else. I found out yesterday that a colleague sent her out to the ER while I was off for these same complaints (she was sent right back after getting some morphine, which I guess is what she wanted). My colleague stated "she knew just what to say". My question: should we call her on her BS i.e. "we checked and found out that you are not a nurse"? I don't feel offended by her behavior but just want to be wise and therapeutic. Also, what's the best way to chart on this? "pt c/o chest pain 10/10 radiating down arm but after assessment & VS found no objective evidence so just continued to monitor"? Doesn't seem very CYA which they are always telling me to do.
Sorry this is so long! I appreciate any feedback.