What should I do about the patient from hell?

[mountain_biker_88]

Good evening everyone. I have a situation at my job and I would like you all to give me some advice. Three weeks ago, I accepted a position as a charge nurse in a skilled nursing facility. Most of the patients are good people, but I have one lady who is verbally abusive and she routinely slanders me.

For example, she has told the care plan coordinater and her psychiatric nurse practictioner that I come into her room every morning, and shoves all of her pills down her throat without telling her what it is. What really happens is, I put each pill, one at a time, on a spoon and place them in her tongue (She has MS and is unable to use most of her limbs, yet her mouth works perfectly fine). This woman also has her medicine memorized, however when she asks I am able to tell her what it is, and why she is taking it.

She also has large wound on her buttocks, which is unstageable, but most likely a stage four. And everytime I change it, she says I am „hurting“ her „like I always do“, and not doing it right. She has called me a lousy nurse. Has made personal insults, which I don’t care to repeat. It’s gotten to the point, where I have a witness with me whenever I have to do something for her.

At this point, I have come to the conclusion that, I am not going to jepordize my license because this horrible shrew of a woman wants to make up stories. I also not going to be insulted everytime I have to give this lady a pill or provide care. I decided that I am going to refuse this patients for the above reason. I refuse to accept the fact that people who are alert and oriented X3 can speak to me anyway they want to.

Has anyone been in a simular situation? If so, what happened? Anyone have any advice? I don’t really want to have to quit my job over this horrid little woman.

[Hygiene Queen]

She may be alert and oriented, but the fact she has a psych nurse is a big red flag.

Does she, indeed, have a personality disorder?

Doesn't matter how "with it" she is. If she is borderline, for example, good luck.

Excellent documentation and continuing to have a witness is a good plan.

No doubt, it is well-documented that she has some psych issues?

Do not let these types of patients get to you. They like that. Be professional and non-reactive to her verbal assaults.

Not easy, but bear in mind she is sick and not in a way that can be fixed... only managed.

Bless you. It's a hard thing to deal with, I know!

[Mrs. SnowStormRN, RN]

She's in her right mind and has a psych NP?

[sharpeimom]

one of my cousins has ms and there are some very subtle psych changes beginning and she said recently she feels as though she must rethink every single thing before she actually speaks to be sure it really is appropriate.

if she has a psych np, then someone is aware that she's a bit left of center. document everything and take someone with you when possible. could someone else do her decub care?

[NurseLoveJoy88, ASN, RN]

I have had situations like that before. Sometimes I politely excuse myself and take a short second to cool down.

We are humans. I would love to just be able to always smile, grin and bear but sometimes that takes too much.

Whenever she starts with you just ignore her, step away to cool down and document. I would also refer her to your supervisor if she has further concerns. Have her complete a grievance form along with the POA.

She is obviously not in her right mind.

Hope it get better for you.

[NurseLoveJoy88, ASN, RN]

Also it may be a good idea to pre-medicate with a pain meds before the dressing change.

This may or may not help. I'm sure you may already do this but its just another suggestion.

[LouisVRN, RN]

Order a home safety eval? (LOL joke pt from hell. Sorry not enough sleep)

But yeah like another nurse stated try not to give any reaction. I am concerned that you are not already telling her what all her meds are anyway, even if they have them memorized its an expectation where I work to tell the pt what the med is and why they are taking it and a couple side effects. As the other posters also mentioned with a psych patient it doesn't matter if they are A&O x3 or not, they have pscyh problems.

Have you tried giving her additional pain medication before doing the dressing change? Or asking her what other people do differently to make the dressing change more tolerable to her. While i understand it is hard to be empathetic when someone is being verbally abusive you shouldn't dismiss her complaints of pain.

[nikkicoliCCRN]

My advise to you is to evaluate what is really happening with the patient. This might mean getting her psychiatric NP involved in a sit down with this patient or even the social worker. If it is a mental illness problem then maybe it's not healthy for either of you to continue to care for this patient. It seems like this is very troubling to you. It might be in your best interest to arrange for someone else to care for this patient (if this is possible) until you can sit down and have a meeting. If it can not be resolved with just the NP and/or social worker I would also suggest having a family meeting with the social worker, patient and the family. Until then continue to bring a witness to provide her care and document well. If a resolution cannot be met in a reasonable amount of time you might want to consider transferring units or even finding new employment. Things like this can take a toll on your own mental health after a while.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

IMHO; I'd agree with her in everything she says! Being oppositional is a no win with her. By agreeing she can either shut up, or make up more and more exaggerated claims that will be so rediculous that nobody's going to believe them anyway.

Once you get this all smoothed out for yourself, quietly take a pillow and...........

Whoops, sorry, my evil twin nurse got the keyboard for a minute. Forget the pillow part.

[Chin up]

As you said, new to LTC. You cant refuse her, or you will be refusing half the patients. You will learn how to deal with her and folks like her. Until then, always have someone with you, when you enter. Peace!

[Nhenry2B]

Sometimes when an illness makes a patient dependent on others for care, that patient will take control the only way he/she can - which is most often, verbally and in this way may come across as verbally abusive!

I've had such patients. I can recall one in particular, who, like your lady was also dealing with the effects of MS. She had a huge decubiti, was immobile, and could only control her motor functions from the neck up.

She was difficult to work with. Meds had to be given at exact times and in specific order (she'd say the name and then you'd give that pill, one at a time, always with freshly iced water, cup and straw held a certain way; and believe me she knew if you did not give her the pills in the order that she called for (she'd roll it around in her mouth to assess the shape and taste). Her wound dressing had to be done at a certain time etc or all hell would break loose.

I had no problems dealing with her, even though she was sharp-tongued in telling what you did wrong and I never took anything personally only because I understood what she was doing. She couldn't control her body, she couldn't walk, couldn't dress herself, couldn't clean herself but her mind was still strong so she retained control in the only way she could. Everyone tiptoed around her, but try to understand where it's coming from and also remember to objectively document.

[mountain_biker_88]

Thanks everyone, for your replies.

Good call Hygine Queen. Now that I thought about it, a personality disorder is most likely what is going on.

I do understand that having a large bedsore on your buttocks is going to be painful, but this patient refuses any decent pain medicine. She is just on Neurotin and Tylenol. She states the last time she took narcotics, she slept for 3 days and almost died. I don’t really know if this is really true, but no doctor is going to prescribe anything for her when she tells them that.

Another thing I wanted to mention, I am not new to long term care. I have five years experience in it. I have dealt with difficult patients before, but I will not accept anyone who makes lies about the care she receives from me, or makes malicious personal attacks on me. We are not talking about a patient with severe dementia. We are talking about a grown woman, who knows where she is at, and what time it is. Mental health problems are a poor excuse for bad behaviour.

Chinup, I think you are wrong. I reserve the right to refuse any patient I please.... but I also understand that a home has the right to end my employment because of it. I have had one other patient with borderline personality disorder, and I quit my job because of her. In retrospect, I was much happier not having to deal with that person on a daily basis. Just because someone life is miserable, does not mean I will let them take it out on me.

Wish me luck.