Rant: Loopy narcissistic patients

[1Tulip]

Why is it that it only takes one patient (and usually not the sickest one on your list) to absolutely eat you alive?

Lady was 4 days post-op, had been on PCA Morphine, was confused, combative, disoriented. They took the PCA away, started PO opiates, she starts to clear up. I'm told in report that she's oriented and appropriate now, expected to go home.

Upon walking into the room to do my assessment I'm told she is going to "write the nurses and doctors up" because of her adverse drug reaction. Then she does a 180 and tells me what a great nurse I am (I've been in the room less than a minute.) Then she wants her bed up. No... too much down a bit. No, on second thought she wants to be flat. When will breakfast come. Food has been just awful here. When am I going to bring her a pain pill. She is going a mile a minute, with what I call a "sticky dialogue" meaning a rambling conversation without real information or questions, designed to hold the listener there.

So... I'm off to do my other assessments. CNA comes to me and tells me the patient has her own little stash of pills in her purse and has been taking one from a bottle labeled "diazepam". Cool. I asked the pt. directly and she said she was just rummaging through her purse for her check-book and there was this one pill sitting there by itself in the bottom of her bag... so she took it. Yeah. Documented this up the whahzoo.

MD comes by says he's going to put her on a fentanyl patch and when we're sure it's working well for her, she can go home. She tells me she wants to go. I tell her the onset of action of the patch is many hours, we won't know how she'll respond to it for quite a while and to not expect to go home immediately. Thus began a day long harassment about her discharge. I'm given minute by minute updates on when her husband is coming, told to get her a raised toilet seat, reaching device, shower chair, and walker so she can take them home. ("What do you mean my insurance won't pay for that!!!) We order her a walker any way. Now she's nesting at the nursing station demanding the walker, demanding copies of her chart, demanding to be allowed to walk to the pharmacy (in another building) to get her scripts filled yadda, yadda, yadda. ("Yes, ma'am, I can't stop you from goint to the pharmacy, but you'll be leaving against medical advice.") She's getting herself all worked up. She's oooozing righteous indignation.

Finally, I get her walker, get her discharge orders, get her paperwork printed off, am going through discharge instructions and... OR calls to get my pt. with the acute belly... I have to do final check lists, v/s, get her to void, and get her chart ready to go. I have to do that NOW. I excuse myself and go to the room across the hall.

This virago of a patient actually FOLLOWED me into the other patient's room! ("Now my husband's an hour late for work. We're just going to leave. We have a long drive to make to get home.)

OK... I lost it. I slammed a chart onto the bedside stand, wheeled around, pointed at her with my index finger and said "I am getting someone ready for surgery. I'll be with you when I can. Get out."

I don't know if that was bad. I know I was menacing... I meant to be. But I didn't raise my voice.

Looking for validation here. Should I have continued to be sweetness and light? I think I know where my last nerve is now. I'll probably ask colleagues to run interference for me if such a situation arose again. What would you have done?

[RNKITTY04]

Personally I think you deserve a metal for putting up with that for as long as you did.

Ain't nursing great? by the time I retire I figure I will have no tongue left from bitting it all these years.

I feel your pain, hang in there!

[UM Review RN, ASN, RN]

Sometimes that's what it takes with some of these people. Really hard to believe that there ARE people like that in this world, but I can attest to the fact that there are--and Florida has more than its share.

If there was a better way to do that, I sure would like to know.

[Kim O'Therapy, BSN, RN]

:yelclap: I think you did great. After all, when she followed you into the other pts. room - that was an invasion of privacy for that pt. HIPAA anyone?

[milky]

WOOOOWW!! Tulip ya done good!!!!

Heck of a lot better than I would have. Sometimes my temper gets the best of me. Only advise I would give, is I hope you documented all that woman's inappropriate behavior to cover your tail and then report to your supervisor what you said to cover yourself....some more!! Ha Ha. I can't tell you how many times I went to my supervisor to explain to them what actions I did in response to a pt and/or family member just in case they reported me HA!

[nursesarah]

wow. i dont know how i would have handled that. i think following you into another patient's room was a bit too much. being a nuisance is one thing...invading someone's privacy is something else.

[Medic/Nurse, BSN, RN]

Wow! Good girl. I know she would NOT have been so "fortunate" with me.

At the point that she was "primed" for d/c & just hanging at the nurses station, I would have cried "foul". At that point, the patient has an ear to the world with all the happenings at any typical nurses station.

As for the demands = call the CASE MANAGER, but that would have been a bit moot - I'd have had an ADMINISTRATIVE SUPER get involved during the hang out. I do have other patients and her nursing needs are decreasing rapidly!

Then the "following" would not have been your problem!

The facility does need to ascertain if a HIPAA violation happened with her behavior.

Anyway! Great job...

[cardsRN]

i simply cannot believe the s**t that people will do! i've had people follow me into another pt's room before too and i reacted in much the same way! you're protecting the other pt's privacy. how pissed would the belligerent wandering pt be if someone walked in on them- but they are completely willing to do it to someone else- unbelievable! second the motion to get you a medal...

[Altra, BSN, RN]

Looking for validation here. Should I have continued to be sweetness and light? I think I know where my last nerve is now.

Validation back at ya >>>>>>> :flowersfo

Some people truly have no idea that the world doesn't revolve around them! Sad.

[Antikigirl, ASN, RN]

Once she would have hit the RN desk it would have been game over at my hospital. The MD's and charge RN would have put her back in her room, followed by a rep from Administration to talk to her. This was made into a protocol because of HIPAA, and wow...sure takes some of the extra pressure off us nurses who typically have so many other things to do but babysit one patient.

We also have this in place for patients that take up too much of our time as this one was. If you are spending too much time in the room and you know it to be a risk to your other patients and typically non-urgent for you to be there...again the charge nurse will visit along with orders or their MD...and a visit from administration. They try to figure out the probelms the patient has and quell them so that nurses aren't tied up trying to figure that out...or be a victim of it! WHEW!!!!!!!

What you did was AWESOME! I too have actually had patients follow me, or one time a man went room to room looking for me! NO NO! I turned from sweet TriageRN to strictly by the Book TriageRN with no smiles and no nonsence...to me at that point they are risking my patients health, confidentiality rights, and right to have a nurse as well!

I do however, love that charge nurse/MD/Admin policy! I mean, most times it is those guys that will have to become involved anyway to help the situation...why not early on (my hospital did a study on how much time and money is lost to this probelm of extremely 'needy' or constant complaining pts in regards to ALL staff...it was several thousands a week! That got the attention of the facility! LOL!).

[1Tulip]

Wow! Good girl. I know she would NOT have been so "fortunate" with me.

At the point that she was "primed" for d/c & just hanging at the nurses station, I would have cried "foul". At that point, the patient has an ear to the world with all the happenings at any typical nurses station.

As for the demands = call the CASE MANAGER, but that would have been a bit moot - I'd have had an ADMINISTRATIVE SUPER get involved during the hang out. I do have other patients and her nursing needs are decreasing rapidly!

Then the "following" would not have been your problem!

The facility does need to ascertain if a HIPAA violation happened with her behavior.

Anyway! Great job...

Dear NREMT-P/RN & Triage

Excellent point about the nesting-at-the-nursing-station. I hadn't thought about the HIPAA ramifications and the issue hasn't ever been raised (in my memory) at any staff meetings. I think I will talk to our unit manager/head nurse about it. THANKS! Oh, and did I tell you she wanted my full name and home phone number???? Yeah, "just in case I forget something about my hospitalization."

Vis. the case manager... about an hour before the stalking incident happened the case manager took me by the arm and essentially said, "I can't take it any more. I'm going home. I'll follow up on the home-health issues tomorrow."

And if I had it to do over, I think I would call our in-house nursing manager. Just to have her physically block the woman and keep her off my back.

Yes, I did document the poop out of the situation including my assessment that she did not understand her discharge instructions nor her physical limitations, did not expect her to be compliant with regard to her meds and that my instructions were given in the husband's presence.

I sure hope it's a while before I meet one of her kind again.

[Daytonite, BSN, RN]

Should I have continued to be sweetness and light?

Absolutely. Your anger was misplaced.

What would you have done?

I would have started calling up the chain of command demanding help with this patient and their family immediately as it was keeping me from doing my other duties. It is part of their function to help provide support to the staff when it is needed and this is a situation where it was definitely needed.