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.

[rn4life2009]

When all admin cares about is patient satisfaction score there is no win in this situaton. A hard lesson I learned. Another reason I am being careful in what job I will accept.

[thehipcrip]

I agree that your responses were correct and professional -- the trick is figuring out how to keep things from escalating. Should this happen again, instead of trying to get the patient to understand and consent to what you were saying, try acknowledging their frustration and tell them what you intend to do to resolve the situation -- "I hear your frustration. I'm going to go call your doctor and ask him to change the orders to you can have Tylenol as needed." Then leave the room and do what you said you would do.

The motto for situations like these: Never try to teach a pig to sing. It will only annoy you and frustrate the pig.

[Midwest4me]

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

I agree; we have a combined order that covers temp over 100 and/or mild to moderate pain q 4 hrs prn. I applaud the OP for telling that pt he was rude. Our only recourse for rude/abusive patients is "that behavior is inappropriate." But then again, we deal with a lot of psych pts and we HAVE to put up with verbal and physical abuse.

[PeachPie]

His actions remind me of bratty kids screaming, "I hate you! You're the meanest mommy in the world!" when they don't get candy. Think of him as a bratty child. Even better, think of him like someone else's spoiled child whom you cannot discipline or tell what to do.

He probably tells everyone who limits him in some way that s/he is the worst (insert occupation here) ever. I've been told that. One women even said that I was the rudest nurse she had ever met, and that she'd been in hospitals a lot and had never had such a problem before. My coworkers assured me that she is a frequent flier and a manipulative brat who has pulled that act on multiple people.

[Scrubby]

Unfortunately there's no known cure for stupidity.....