How do you handle manipulative/demanding patients?

Specialties Psychiatric

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Meriwhen, ASN, BSN, MSN, RN

4 Articles; 7,907 Posts

Specializes in Psych ICU, addictions.
Night said:
I've discovered, after a LOT of practice and screw ups, that your tone and facial expression are key in managing manipulative patients in psych. I've had people bad mouth me and be snide as well. I've had some success with saying, very calmly, 'You know, that's kind of rude." It's also perfectly acceptable to let the patient know that you will be happy to talk to them when they calm down, then walk away. Learn to cuss in your head while keeping your face pleasantly neutral LOL.

I like to kill mine with kindness. Kindness with firm boundaries though.

Orca, ADN, ASN, RN

2,066 Posts

Specializes in Hospice, corrections, psychiatry, rehab, LTC.

I once had a lawyer who tried this on my unit. A patient on my unit wanted to leave AMA, but the psychiatrist did not agree to it. The patient called his lawyer, who then showed up at the unit to visit. The lawyer asked me to release the patient. I explained that I could not release any patient without a physician order. He said "You release him right now, or I will have you arrested." I told him, "Fine, but I'm taking the keys with me." The lawyer and the psychiatrist then went nose-to-nose in a shouting match.

The house supervisor happened by while this was going on. She had several other things to attend to, but she didn't want to leave me in a lurch. I told her, "Finish your rounds. I will call you when this is over and let you know how it turned out."

The patient, who was very calm throughout the whole thing, told the nursing staff, "I'm sorry about this, guys." I told him, "You're not the one who is acting like a child."

The patient was finally allowed to leave AMA.

MrChicagoRN, RN

2,597 Posts

Specializes in Leadership, Psych, HomeCare, Amb. Care.
Orca said:
I once had a lawyer who tried this on my unit. A patient on my unit wanted to leave AMA, but the psychiatrist did not agree to it. The patient called his lawyer, who then showed up at the unit to visit. The lawyer asked me to release the patient. I explained that I could not release any patient without a physician order. He said "You release him right now, or I will have you arrested." I told him, "Fine, but I'm taking the keys with me."

Made me laugh.

When folks demand AMA, I'll usually say "The Illinois state mental health code does not allow for AMA discharges, blah blah blah, this is what you can do at this time, blah, blah. And we do follow the mental health code. Would you like to sign a request for release(AKA 5 day notice)?"

And sometimes it's just not worth it to keep them there if they don't want to be there. Some won't take meds, won't go to group, aren't an imminent danger, so why bother?

Meriwhen, ASN, BSN, MSN, RN

4 Articles; 7,907 Posts

Specializes in Psych ICU, addictions.

Whenever I'm threatened with a lawsuit/lawyer visit/other legal action, I say, "OK, that's your legal right" and keep on with what I'm doing. Most of them are surprised that I don't get upset or scared when they mention the world "lawsuit." If they ask, I tell them that I'm practicing within the Nurse Practice Act for my state and so I don't worry too much about lawsuits.

One kept stating he was going to call the facility's legal department. I told him that the phones will be on at 0800 and I'll get him the number. He never did call :)

To be honest, many of us have had "lawyer", "lawsuit" and "sue" thrown so much at us, that it no longer fazes us. Though that doesn't stop me from documenting as though my charting is going to be read in front of a jury.

Davey Do

10,476 Posts

Specializes in Psych (25 years), Medical (15 years).
kimmyanne02 said:
I am a new psych nurse (this is my first nursing job)...

My question is, did I do the right thing?

How do you experienced nurses handle patients that demand you call the doctor when you know it's not an emergency? Do you just flat out say no?

You, kimmyanne, handled that situation well! An experienced nurse could not have done much better!

Regarding the lawsuit threats, I handle them pretty much the same way as mentioned. Like Meriwhen, the threats don't really even faze me anymore.

This thread reminds me of another about alleged neglect complaints. For example, one patient told me it was their right to request a PRN. I agreed that it was their right, but I administer or hold medication based on my nursing judgement:

Davey Do said:

Here's a recall of my documentation:

States, "I want my PRNs". Enquired of specific sx. Stated, "I'm having lower back pain and want my dicyclomine". Informed dicyclomine is for GI distress and not for structural pain. Sates, "Then I want my Tylenol". Reminded Percocet which contains acetaminophen (Tylenol) previously administered. Requests denied.

Stated, "I want your full name". Informed I am only required to give my first name and title. Stated, "Then I want to talk with your supervisor". Request fulfilled.

If you'd like to read the entire discussion, here's a link:

https://allnurses.com/possible-alleged-neglect-complaint-I-t629720/

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