What should I do about the patient from hell?

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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.

Specializes in Peds Medical Floor.

I'd have someone stand outside the door if you can so you have a witness. If she refuses to be medicated before the dressing change, chart it. And whatever she says, chart it.

Specializes in LTC.
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.

The parts in bold really sit uneasy with me. I honestly think it may be time for you to either find another area of nursing or hang up your stethoscope.

One thing that will NEVER change in nursing is dealing with difficult patients. You cannot continue to allow patients to cause you to loose your job.

While they are still getting good care you are jobless.

These are patients NOT your friends. So what if they verbal attack you. Walk away, cool down, and learn how to deal with it.

They are sick. Some people are at their very worst when they are sick. Does it justify their behavior ? No, but I can certainly empathize.

This lady has MS for goodness take. You have your motor skills taken away from you and see how you would treat people.

Go to a counselor and figure out why you take this so personally.

Specializes in LTC.

Also... you can't control other people behaviors you can only control how you react.

Specializes in Pediatric/Adolescent, Med-Surg.

I'm sorry you are having to deal with this. I swear we must take care of the same MS pt! I have one that is frequent flyer at my hospital that is verbally and physically abusive. When she tries to hit me, I just tell her that I don't have to take that **** from her, and walk out of the room. She always acts like I don't have a right to do that, oh but I do. If you are A&Ox3 and are going to try being abusive toward me, I don't have to take it.

Specializes in Professional Development Specialist.

You work in a SNF, so I'm assuming this patient is a short term stay? Or is it LTC. I work in a SNF and we have a patient like this. I only had to take care of her twice a month and still I dreaded that day like it was the end of my career. :lol2: I have dealt with difficult patients and borderline personality disorder and bipolar disorder many times but this one patient is just beyond all that.

I will say in most cases the key for me has been trust. I set limits and follow through. If I say I will do x at y time, I make sure I DO it. If she's having pain issues with dressing changes, go to the doctor every time and explain your concerns about her pain. How about a lidocaine spray, etc? Cover your butt and advocate for your patient. I can imagine a wound like that really is painful. Over time those with control issues will settle down once they realize they can trust you. This takes an investment of time which is tough in a SNF, but it's a worthwhile investment. For that one patient that this doesn't work on, document, document, document. Bring a witness along for EVERY interaction.

I don't know that quitting is really the answer. This is one patient and those types will continue to crop up over time. They have in every career I've had, even when you think you couldn't possibly come into contact with such a person in a way that could cost you your career. But that .01% KNOW what to say and to who, and know how to twist your words, and they truly enjoy putting you in a bad position just because they can or because of some perceived reason not based in reality. Better to find a way to deal effectively, for your own sanity.

Specializes in MCH,NICU,NNsy,Educ,Village Nursing.

Sorry you are having a rough time with this lady. But, remember, she is ill. She has MS. She's in a LTC facility. Her life has been shattered. And, she obviously has been recognized as one who is "left of center" to quote another poster, and probably is not of her right mind. Try to put yourself in her shoes. And, if need be, as another poster also said, allow yourself time to cool down, and have a witness with you. Hang in there....

You need to be the professional. If you consistently refuse this psychotic, difficult pt, then that means you are shoving her off on others. Do you honestly think she treats others any better? That your coworkers enjoy working with difficult patients? You and I would be having a nice chat if I worked with you and you refused crazy, angry patients with whom you couldn't get along.

Talk to your boss and explain your concerns with this pt. If you are having problems with her, so is everyone else. Your fellow nurses, aides, and other coworkers all need to be on board with a plan to set appropriate boundaries, provide good care for her, and document appropriately. It also sounds like there needs to be a rotation on who takes care of her, so the same people do not have to shoulder the burden. Simply avoiding the issue by refusing to care for her isn't helping her, and it certainly isn't helping your coworkers or your workplace.

Specializes in cardiac-telemetry, hospice, ICU.

I am still a student, but have worked with the public for a very long time. A humble suggestion. You probably have tried this, but I have had some success in redirecting the client's mindset. I have ignored the negative attacks entirely (as others have mentioned). When it seems appropriate, begin asking personal questions of the client. Where did you grow up?, tell me about your family, were you a good student?, etc... Sometimes (if you are lucky) the client will focus on better times, and as everyone knows, delight in talking about themselves. Mind you, I am no Pollyanna, but it does work sometimes! Worth a try or six maybe? Not that it is an excuse, but if I were bedridden, immobile, and in pain, I might have a sour outlook too. She just might enjoy the chance to mentally escape for a few minutes with a willing ear.

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.

This patient has a terrible medical condition, and you do often see this type of personality/psych issue when someone has MS. Try to remember, it CAN feel like 'pills are being shoved down your throat' when you're being given pills off a teaspoon. You say she can't use her limbs so she probably can't even push your hand away, try to imagine how powerless that would feel. If you're even the tiniest bit impatient and wanting to 'get it over and done with' so you can get out of the room (and let's face it, what nurse wouldn't feel like that with this patient?), she will pick up on it and become more demanding and insistent that you slow down and do it her way. If you can try and give up some control and let her set the pace and follow her instructions to the letter and listen for the six millionth time to her telling you what to do and how to do it and why it has to be done that way you might just be able to start building a small amount of trust with her. Yes, it's exhausting and frustrating and you don't have to like it but honestly, it's better than what is happening now.

The same goes for the dressing change. Give up your need to be right and in control. I'm sure it DOES hurt and if various pain medications don't suit her for whatever real or imagined reason, it's going to keep hurting. Sympathise and apologise for the pain (saying "I'm sorry this is hurting" is NOT admitting you're in the wrong, it's just acknowledging the facts). Say you wish it didn't hurt, say you wish you could make it less painful, ask her how she would like you to do the dressing and do this unless it's totally unreasonable.

You're going to have to cope with patients like this from time to time wherever you work, it would be a real shame to leave a job because of one patient. The patients that make us 'dig deep' and give what we thought we didn't have are often the ones that teach us something about ourselves and make us better nurses in the end. You're understandably angry with her because of the way she is treating you and talking about you to others and no matter how well you try to hide that she will pick up on it. Giving up that anger might be a great first step to improving things with this patient. Everyone is probably having the same problems with her but are there some who are able to cope with her a little better? If there are, could you ask them for some tips?

Try to stop taking her attacks personally, be kind to yourself, recognise that others are not likely to believe her dramatic stories about you because she will have said similar things said about them, and seek help and support from your co-workers. Good luck!

Specializes in Critical Care.
I refuse to accept the fact that people who are alert and oriented X3 can speak to me anyway they want to.

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agreed!! the alzheimer pts, ehhh, i dont like it but i can understand. people with healthy brains should be able to interact appropriately with someone who is tending to nearly their every need.

I'll bet she's really angry about what her life is like. That anger has to come out somewhere. Maybe she doesn't want pity, and treating others horribly is a surefire way to make sure people don't feel sorry for you.

Specializes in LTC Rehab Med/Surg.

Her entertainment is torturing the staff. Attacking and watching the reaction. If she doesn't get a rise out of you there is no pleasure. She wants to minimize your worth, because secretly she feels worthless herself. My psycho babble for the day. As one poster suggested, agree with everything she says. "Yes Mrs Doe, I don't give the pills as professionally as you like, but I'm sincerely working on it. Go over the top, so that you both know it's a game, but nothing offensive that she can legitimately c/o to the boss. Smile, smile, smile.

If you go toe to toe with a resident or patient you cannot ever win. Management will placate the customer no matter what. Good luck. I'd love to be a fly on the wall.

Early as a nurse there was a female resident who would attack me as a nurse as well as my appearance. Vicious attacks that would leave me in tears. (A long time ago). I practiced the above. "Your hair looks like a helmet." Me.."I know. I wish mine were as lovely as yours." Said with a seriously sincere look on my face. "You are a lousy nurse" 'I need some improvement, what can you suggest?" It became a game. She wasn't stupid. She knew exactly what I was doing, but she couldn't call me out because my delivery was sincere and without a single bit of humor. We never really liked each other, but eventually I think we both enjoyed the exchanges.

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