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.

[CompleteUnknown]

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.

Lol, love this. I've used this approach sometimes too, and it really can work with some residents. I agree with you that both parties start enjoying the back and forth, and there comes to be almost an underlying respect there, not that the resident would ever admit to it!

[steelydanfan]

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

When it gets REALLY bad, when I have NO more empathy, kindness or patience to give; I repeat this mantra to myself: "I get to go home today, you don't".

It frees up that extra ounce of patience in me.

[FunRun]

When I read the original post to start this thread I felt a slew of emotions come over me. If you read your post again it sounds very insenstive. You are very concerned about your feelings and how this woman makes YOU feel, what about her? I have worked in nursing homes and long term care facilities for many years and have encountered many of these "difficult" patients. My advice to you would be to first figure out why her feelings towards you are bothering you so much, could it be that she is just very unhappy herself and this is how she copes? Also, when I have encountered patients like this in the past and they make a mean or rude comment to me I simply ask them how they would like me to do things. It is important to remain patient and calm and never let your patients see that they have hit a nerve and they are making you feel bad-not only is it not worth it for you to get upset, it only leads to problems. It also sounds like your giving up, refuse to take care of a patient? I don't understand, it is our job as nurses to care for all patients easy or difficult- now I understand there are extenuating circumstances but this just sounds to me like a very sad, sick and difficult patient. Goodluck to you in the future, I challege you to make ammends with this patient and show him/her how compassionate and interested you are in improving the way you care for him/her and how you make them feel. You would never believe how far unrelenting kindness will go no matter how poorly you are treated:D

[eriksoln, BSN, RN]

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

I used to love this saying, not so much anymore. Problem was: Sometimes controlling your own behavior means setting boundaries. Often, I found myself having to take full blown intervention measures with things I could have been more assertive with earlier. I'd repeat this montra to myself but things would get to the point where.........something had to be done. Often, looking back, I saw that I lacked assertivness.

With that said, I agree with all the posts that this is a sick person and there is probably a lot of anger that gets overlooked. Our medical model here in the U.S. fails a lot of it's clients on the "emotional" side of the treatment plan. We are great at giving the right anti-biotic for someone's cellulitis, not so great at comforting them and explaining where it came from, how to avoid it happening again and showing compassion when the pt. makes statements like "I just feel like a dirty person." That's the inevitable truth of a medical model that lets the business minded run things.

As far as what I mentioned before goes: You do have a place to "set boundaries" and get away to cool off. Mind you, as a nurse you are still responsible for this pt. and that includes being there for her while she expresses her anger, but you don't have to be a punching bad either. Just excuse yourself with the explination "You seem a little upset right now. I'm going to let you have some time alone unless you need something right now. I'll come back later and maybe the (insert dressing change or medication taking or w/e you were doing at the time) won't be so upsetting to you." Then leave. If they put their call bell on, answer it. Give them ten minutes to dehiss, then go back.

Mind you, if you have to do this too often for the same pt., then there are problems that need addressed. Also, if you find yourself doing this often, with different patients, then it's probably just time for a vacation or w/e de-stresses you (shopping trips, a night out with friends and a few drinks, w/e).

[hannahmaepunk]

What you say the patient is habitually doing is suggesting, maybe, a borderline personality disorder. I don't know, but the best way is to really have continupus therapeutic communication, even when there are times that you really get ****** by these kinds of patient behavioral patterns. Trust me, i've done this, and it worked (for me). If until the end a patient stays that way, it's the family's problem, and the psych NP's jurisdiction, not yours. Don't let it get to your head, don't base your career decisions on a single "hell" patient.

[FunRun]

I agree with Chinup- Mountain Biker 88 you have a very poor attitiude, and again I am not sure why this lady is bothering you so much if you are providing her with excellent nursing care. Go in to your job, do it well and if the patients are rude and make up lies then so be it. You cannot quit your job everytime a patient makes you upset, I find this rather disturbing. I do wish you luck, it sounds like you will need it.

[gentlegiver, ASN, LPN, RN]

I think we had her at my faculity!! She would scream and swear at my CNA's. She called them every name in the book, she would insist that we were all hurting her on purpose. I would permedicate her and she still continued. So one night (worked 7-11) she started her routine, my CNA's did not want to enter that room, I told them they had to clean and reposition her just like everyone else. But, I stood by the door where she couldn't see me and watched and listened. When she began her tirade (before the poor CNA's even touched her) I stepped in, informed her she was NOT to talk to my staff in that manner and told the girls to leave the room. As they were leaving I informed the patient that if she wanted to be cleaned and repositioned she would stop the yelling, screaming and general abuse of my staff and to ring her call bell when she was ready to act like a normal person. Within 15 minutes she rang her bell, my CNA's went in and she behaved like a very nice person. While she continued her antics on the other shifts, she never pulled it on mine again. Sometimes you just have to set limits. And yes I did document her behaviors and what I said to her, who was in the room with me when I said it, and the resulting behavior change.

[Moogie]

I remember a resident like this when I was working as a nursing assistant in high school. Much like the OP's patient, this woman was in her late 50s and I think she had either a stroke or MS. She was always yelling at me because I was young and new and didn't quite know what I was doing yet. I remember her calling me stupid because I couldn't get her foot right on the wheelchair foot rest.

One of the nurses took me aside and pointed out that, prior to her illness, the woman had been completely independent. She lived alone, traveled with her friends, enjoyed her career, and had a wonderful life. And then, at a young age, she became ill and needed to be put in a nursing home. The nurse explained to me that the woman was angry at life but that I was the temporary target. Her life was out of her control and she desperately needed to control something, even if it did take five minutes to situate her foot just right in the foot rest.

When I looked at her from a different perspective, her behavior didn't upset me quite as much. She eventually stopped yelling and on occasion would ask for me to get her ready for bed because she liked the way I treated her. I actually started enjoying taking care of her. We would talk about her life and her travels and maybe those talks helped her grieve her losses.

I wish you the best as you work through this situation.

[Hygiene Queen]

...

[Poi Dog]

I think we had her at my faculity!! She would scream and swear at my CNA's. She called them every name in the book, she would insist that we were all hurting her on purpose. I would permedicate her and she still continued. So one night (worked 7-11) she started her routine, my CNA's did not want to enter that room, I told them they had to clean and reposition her just like everyone else. But, I stood by the door where she couldn't see me and watched and listened. When she began her tirade (before the poor CNA's even touched her) I stepped in, informed her she was NOT to talk to my staff in that manner and told the girls to leave the room. As they were leaving I informed the patient that if she wanted to be cleaned and repositioned she would stop the yelling, screaming and general abuse of my staff and to ring her call bell when she was ready to act like a normal person. Within 15 minutes she rang her bell, my CNA's went in and she behaved like a very nice person. While she continued her antics on the other shifts, she never pulled it on mine again. Sometimes you just have to set limits. And yes I did document her behaviors and what I said to her, who was in the room with me when I said it, and the resulting behavior change.

:cheers:

Absolutely awesome!!!!

I wish I worked with you.

[Katie5]

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

That was a low blow.

[DizzyLizzyNurse]

I think we had her at my faculity!! She would scream and swear at my CNA's. She called them every name in the book, she would insist that we were all hurting her on purpose. I would permedicate her and she still continued. So one night (worked 7-11) she started her routine, my CNA's did not want to enter that room, I told them they had to clean and reposition her just like everyone else. But, I stood by the door where she couldn't see me and watched and listened. When she began her tirade (before the poor CNA's even touched her) I stepped in, informed her she was NOT to talk to my staff in that manner and told the girls to leave the room. As they were leaving I informed the patient that if she wanted to be cleaned and repositioned she would stop the yelling, screaming and general abuse of my staff and to ring her call bell when she was ready to act like a normal person. Within 15 minutes she rang her bell, my CNA's went in and she behaved like a very nice person. While she continued her antics on the other shifts, she never pulled it on mine again. Sometimes you just have to set limits. And yes I did document her behaviors and what I said to her, who was in the room with me when I said it, and the resulting behavior change.

I have done this as well. It works wonders. :)