Verbally abusive patient

[Tortoiseshell]

I work at a hospital. One of my patients was requesting Tylenol. His temp was 36.2, but the Tylenol was ordered specifically for temp > 37.5. I explained to the pt that according to the current order I cannot give it to him unless he has a temp >37.5, but I can call MD right now to ask for a change in Tylenol order. The pt became very angry, saying: "The order is already there. I have been getting my Tylenol. I tell the doctor what to order." I reassured him again that I can take care of it by calling the doctor. I also said that I can show him the actual doctor's order so he can see it for himself . He said: "No, I am not interested". I was being very sweet and polite with him. The pt was getting more and more frustrated, to the point of becoming verbally abusive: "Your care is lousy. You are the worst nurse I had in 15 years. I pay the bill". I told him: "I am just doing my job. I can call the doctor, but I cannot override doctor's order. And you don't have to be rude to me".

He said: "You are not doing your job. You are the worst nurse." He kept going on and on degrading me and refusing any interventions I offered to improve the situation. I said:"OK, I will get you another nurse", and left the room. I told a team lead what happened, and she overheard it is well, as the pt was speaking loudly. The team lead went to talk to the pt and tried to explain how the system works, but he kept saying: "She doesn't understand anything. I want you to write a report about this her".

When I left his room, I thought that I wasted my breath trying to reason with him. Many times the patients want what they want and when they want it. It doesn't matter to them why we cannot do something for them.

I can let go the feeling of hurt. I am mostly worried that the pt can write a report about me, and it can affect me negatively. I feel that being named in any kind of grievance puts a person into a negative light, even if I haven't done anything wrong. Everything is about patients satisfaction.

I appreciate any input.

[medicrn13]

Patients can be difficult, I think you handled the situation very well. He just wasn't going to have it any other way than his way. There is no arguing with someone who is always right.

I wouldn't worry too much about it reflecting badly on you.

[TopazLover, BSN, RN]

I am sorry this happened to you. Of course he can write you up. You certainly can defend the action of not giving a medication that was not ordered. That being said I am wondering if he ever got the med? Any idea why he wanted it? Was he in pain? Certainly pain can make one short tempered.

I have found it better not to engage when things are going sour. Could you have left the room and simply made the call without getting sucked into an argument that you were sure to lose? Was the doctor one who would have been agreeable to changing the order after you gave the med? If you have worked with a specific MD for a while some would rather you give the med and let them know. Others would have your skin tacked to the wall for such a thing.

As with most situations in life learn from it and move on.

[nursel56]

QUOTE=Tortoiseshell; When I left his room, I thought that I wasted my breath trying to reason with him. Many times the patients want what they want and when they want it. It doesn't matter to them why we cannot do something for them.

A nasty by-product of the "customer service" model.

You can't reason with an unreasonable person. You did everything right. So sorry this happened. (((:redpinkhe))) I probably would have bailed sooner than you did, though.

[morte, LPN, LVN]

yup, dont engage.....leave the room and call the doc.

[zofran]

I agree with the above posters...most times you will never win an argument with pts like this and it's best to just leave and get the charge nurse/call doc.

But...I am wondering about this Tylenol order. You could ONLY give it for the temp? I just have never seen Tylenol written this way......Usually there are PRN meds available and we can use our nursing judgment to decide what to give.

[Jules A, MSN]

He was out of line but I'm not sure I'd have argued with him over Tylenol. At my hospital we have more leeway and unless in an unusual case like wonky liver values for example I could have just given it and avoided the grief. Hang in there!

[Siddhartha]

sounds like a lot of grief over tylenol...

[morte, LPN, LVN]

if the order was as the OP stated, that would be the ONLY thing that the APAP could be given for.....odd order, yes, but the order none the less....the patient asked for something that wasnt ordered. go call doc and get the order, or an explanation as to why it wasnt ordered.

[Virgo_RN, BSN, RN]

What was he in the hospital for? Pertinent medical history? He really sounds like someone with impaired thought processes/emotional lability. This can be driven by the disease process.

[kimima01]

I don't waste my breath. I don't engage just so I don't get worked up. You have the doctor's orders so that works in your favor.

[nursej22, MSN, RN]

It sounds like this interaction turned into a verbal scuffle between patient and nurse--and neither side was listening to the other. As simplistic as it sounds, you need to acknowledge that the person is upset, find out exactly why they want the Tylenol, morphine, donuts, cigarettes, whatever, and then explain what you are going to do, period. You are not going to "win" a battle with someone who is upset. Sometimes is a power struggle--pts can feel helpless and are struggling for some control.

"Here, put on a backless nightie, strangers are going to come in at all times day and night and poke and prod, and you just sit there and behave. No you can't eat, you can't know when you test is or the results and who knows when the doc will be in. Have a nice day."

And some people are just *******s and there is no pleasing them.