Why do I let them get under my skin?!

[Paravell]

Hello all,

Hope everyone made it though this Monday relatively unscathed! I've been working in the ER for the past 3 years, mostly in our fast track area. For the amount of people that I've seen over the years, why is it that one particular patient can really make me want to quit nursing and start buying lotto tickets for a living?!

Pt came in with migraines/nausea. Pt hobbles to room, ice pack in tow and turning off the lights as soon as she gets in the room. Pt warms up to me, tells life story to RN, joking and laughing. Doc sees pt, doc orders his usual combo of im phenergan and IM toradol. Pt becomes livid, screaming, crying, berating rn for bringing said meds to bedside. pt agrees to receive meds. Pt screaming, crying, yelling at rn for giving her "really bad shots that made my head hurt worse" Rn notifiying md of pt's concerns. Rn reevaluates pt, receives another verbally berating tirade. Do we get where this is going? At the end of it all, house supervisor comes down, apologizes to pt for having a bad experience. Of course, I'm sure when the pt complaint board calls me on this one I'm going to be the bad guy. The house supervisor tells me that the pt says I have a personality disorder, that I threatened her, was "mean" to her, etc, etc. How I wish our rooms had cameras!! How do I defend myself against a liar??? Ugh, it just made me sick to my stomach...I charted my little heart out, and I know the doc on the case has my back, I'm just not looking forward to the call from my manager next time I work.

I guess this was more of a vent than a question...although I could use an instructional manual on how not to let the trolls in life bring me down

[Paravell]

Even with great documentation, management usually blames the nurse.

yup, I've seen that to be true. I'm glad they have a "patient complaint" committee, but no "Back up our nurses" committee:mad:

[JKL33]

Lesson learned.

When she started to tell you her life story, it was because she was reeling you in as one of the *special ones* who is going to do something as a favor to her. Next time ...

RN: "The doctor has ordered these meds so that we can get your headache under control. They often work pretty well for migraine-type headaches."

Patient: ... tirade ... dramatics ... wailing ... etc.

RN: "These are the meds the doctor has ordered, but I certainly don't push medicine on anyone. If you'd prefer not to take them that is absolutely your choice. I can let the doctor know you don't want the meds and we'll get you going on your way."

Precisely. This is almost always the general track I take with these people. Don't get sucked into their drama.

To the OP - Another useful strategy (at least in my experiences) - ALWAYS beat these people to the punch with the idea of "reporting" you. As soon as they start trying to really up the ante, I tell them, "It sounds like you have some concerns that are beyond my purview. I'm going to have the supervisor in charge of the hospital (or "the nurse in charge of the ER") come down so that you can let him/her know that you have concerns about the way we are trying to help you today".

Or...

"I'm not sure how I can best help you at this point.....it seems like you have not been happy with anything that has happened since you arrived. So I am going to have the supervisor come and talk with you so you can discuss your concerns."

9 times out of 10, they feel that is (of course) not necessary.....it takes on a different light when they get the idea that THEIR situation will be "reported" before they get their chance to report you. The ones who DO talk to the supervisor - - GREAT!!! Great for me, because the manipulation then becomes obvious to more than just me. I am always a fan of getting those involved who might otherwise criticize me after the fact. This also has the benefit of projecting your belief that YOU have nothing to hide.

If the patient declines to report their concerns to the supervisor and then you are criticized after the fact, you have evidence that you tried to rectify the situation while the patient was still in the department, and the patient declined. Everything being documented, of course!!

[Paravell]

Thanks again everyone for the replies. So, another incident happened yesterday involving the same type of thing! But, I had learned from my previous experience, and this one ended up so much better :) The pt in this case left a happy customer, and I was not berated and insulted for not giving narcs :)