Wondering how others deal with RUDE patients, docs, colleagues?????

pagandeva2000, LPN · Sep 5, 2007

That reminds me of how annoying nursing journals are with their stories of reaching difficult patients. Some nurse will keep trying and trying to help a mean, nasty, gnarly patient, and finally she wins him over with some miniscule gesture of appreciation on his part, and she writes a sappy story about it.
I'd rather spend any extra time with a sweet little old lady with interesting stories to tell, not some bitter grumpy ingrate.

Reading those journals were annoying to me, at best, sometimes. I'm sorry, it is just not realistic to me to walk in being an avenging angel and reaching each and every patient. I can easily admit that some of them really agitate my last nerve.

Cognitively, I know that many of them are afraid, stressed, and are extremely vulnerable during illness. This is why I will do what has to be done for them. But, I can't promise that due to a high volume of patients that I will run back to the difficult one with my long, flowing gown and try to reach their souls. There just isn't any time. And, then, there are ones that just will not appreciate what you will try and do for them, so, you do all that is required and move on.

For example, I had a client that came to the clinic who had a medication change because of HTN. She was told to return to the clinic for a blood pressure check in two weeks. This required nurse counseling, so, I went over signs and symptoms of HTN, explained to her the importance of taking her meds as ordered, reviewed dietary and lifestyle changes, etc... I also explained that it was extremely important to take the medication as ordered because when she comes back for the BPC, if it remains elevated, we need to be able to determine if it is high because the new dosage needs to be adjusted or if it was because she missed a few doses. Patient tells me that she always took her meds as ordered. After reviewing this, the patient leaves and I went to lunch.

Upon returning back from lunch, the patient was standing in front of my room with her hands on her hips demanding me to 'revoke the nurse counseling' because 'counseling implies that she is an idiot', that she always complies with what the doctor said, and that I should not 'write her up'. I explained to her that nurse couseling is not a threat, nor does it imply anything; that any service provided by a nurse is documented. She follows me into the room in a threatening manner and again, demands that I 'strike that conversation out of her record'. I had had it by then, and said "How should I revise it? We did have this conversation and I also documented your response. Keep in mind, though, that I am not with you 24 hours a day, and I owed you an explanation of HOW and WHY we monitor blood pressure as well as the risks of unmanagable HTN". This spiraled out of control and no therapeutic interaction was going to stop this woman from thinking that I assumed she was an idiot. An aide almost had to call security because of her beligerance.

Now, would I look forward to interacting with this woman again? HECK no...but, when she came the following few weeks later, I counseled her again (it was still elevated), she still had an attitude, and I kept it moving. Period. But, I provided the service that she was entitled to, whether she believed it, or not, and I documented her behavior each and every time I encountered her.

TrudyRN · Sep 5, 2007

I'm probably reading too much into this, but what I'm getting from your last sentence is that you think that those of us who don't forget (purposely) that snack or don't put the chart at the bottom are goody two shoes. Maybe even liars who don't allow ourselves the personal indulgence and self gratification that could come from doing the things you mentioned.
Forgive me, I haven't slept in 24 hours so I'm a little edgy.

You are most definitely reading in. Never in my wildest dreams did I ever think anyone who could take the high road was a GTS or liar.

TrudyRN · Sep 5, 2007

The items listed in bold above, are deliberate and potentially harmful to patients. There is much to be said about being professional, while we are still flawed human beings, we chose a field and sadly---it isn't always nice. Some things we do, are never good enough/fast enough/thorough enough for some patients. It happens. Our professional and ethical behavior should always prevail,and in times when we seriously feel that it cannot, then we need to have the good sense and professionalism to seek out others who may be better able to handle the patient and his/her needs at that time.
A case in point, I have a gay coworker, who is open with certain staff about being gay. He doesn't announce it, but those of us he is friendly with, he is open about it. So in other words, not all the staff are 100%confirmed though they have their rumors about him.
Well, one day we had an emergency (I work in Forensic Psych) and we were escorting a patient to a room so she could be given a PRN. Proper procedures were being followed, but the patient was beyond agitated and began verbally lashing out on EVERYONE. She looked my coworker up and down and laughed at him and said "Well, look at this! You better not put your hands on me after you have been blah blah blah, gay this and gay that etc.:angryfire Did you know you are going to burn in hell you? ect." She continued to her tirade, yelling and screaming, although by then the coworker was not even part of the intervention. He looked hella embarrassed, almost ready to cry it seemed and also pissed off. He didn't lash out at her in return, I guess being in psych we make sure to intervene and try to refocus each other on the fact that our patients sometimes will behave this way, I dunno. I just walked with him up the hall, but he never presented an attitude or comment that suggested that he might me mad AT the patient. Rather, he walked off and took a breather and kept it pushin!
BTW I have seen people do mean things on purpose to spite a patient, and all I do is ummm, WE are the ones with the licenses and badges and keys. WE chose to work here to help these people. PLEASE don't do that around me, because when the investigation comes rolling in (I work for the state, not sure how other places work) I dont want to have to tell the TRUTH about what you are doing, and I damn sure aint gonna LIE for you. I have seen one of the LVN's on our floor, struggle with not letting her personal attitude overtake her professional attitude. She has told patients, REPEATEDLY "Don't talk to me Mr.so and so...I was really nice to you yesterday and you treated me like crap. So I am mad at you, so just stay away from me and don't say anything to me." as well as "you better not need anything from ME today. You gave me a real bad attitude earlier, so now, what goes around comes around. Don't ask me to help you, because I'm gonna keep walking." Ummmm, honey, that is patient abuse and in some cases neglect. She is new to psych but brags about how long she worked acute.

Did you report her?

TrudyRN · Sep 5, 2007

I saw where there was this study done where medical workers could answer anonymously and they admitted to deliberately using the wrong sized needles and in some cases not using anesthesia.
When I worked at the nursing home we had a patient who got her bath on the night shift. She was really crabby and always told the day shift supervisors she never got her baths at night. So, one night the CNA told me he had all the fans on in the shower room so it would be "nice and breezy" and he wanted to make sure this patient remembered getting her bath.
From all the fussing and griping going on during the shower I guess she remembered it.
Sounds like true abuse. How did you intervene?

JessicRN · Sep 6, 2007

If you think a patient has been rude to you, do you retaliate? Do you walk slowly instead of stepping spryly to get that washcloth he requested? Or give the lower dose of pain med? Put the ER chart to the bottom of the stack? Forget to get the snack he wants? Can't find an extra chair for his visitors? Other? Or do you not allow yourself such indulgences?
How about rude docs? Do you not help them get the lab results and suture sets they need? page them late at night for things that could wait?
Rude colleagues - refuse to cover their patients while they go smoke for the 15th time that shift? not help them turn, pull up, or transfer patients? Mentally make up stories about them suffering?
I am NOT asking if you would ever deliberately harm your patient. PLEASE don't ever do that, no matter how rude they are. We have to answer to our own consciences, to the law, and to God and I don't want to see anyone in trouble on any level.

Are you talkng rude and sober because I honestly do treat drunk and disorderly patients differently only as far as food is concerned. They can have water with security in attendance and only if they are not vomitting and they get crackers if they are beligerent and nasty but no I do not give them food. I am up front with them I tell them they only get food if they behave (No spitting hitting or screaming and I can draw blood and start and IV and they do not pull out their IV,take off their bandage etc.), If they urinate on the floor or throw their urine container at me or the wall no I do not run and get them water or food or a pillow. I believe in positive reinforcement and safety (beligerent drunks love to use their food nad urine as a weapon). If they change their behavior for 30 minutes they get their request this I always follow through with. I work in an ED if a drunk person behaves badly and gets his request anyway and the other drunk patients will see this and start acting badly as well. So it is not to be mean but to keep some control in a busy unit.

Sober people are different, I am with tweetyRN unless they throw things i usually ignore it or I follow through with the requst and quietly say to the patient, she did not have to yell or be nasty for me to help her or him I would have helped them anyway. I do not refuse any request. I have found the most miserable people are usually scared and lonely and sometimes just being nice will change the behavior.

faithful11 · Sep 6, 2007

Did you report her?

The incident I witnessed, I "educated" her :lol2: and reminded her that WE are here to be professional, not to be FRIENDS NOR ENEMIES with the patients. That if she is having a bad day, tuck it to the side and keep it pushing, do the job or don't come to work. I basically said "Look, you should tone it down a notch...you're griping at them like they are friends of yours on the outside. So what if she was mad at you or rude to you, aren't you here to provide a service and get a check? You aren't here for the patients to LIKE you or be NICE to you. You better learn to control that, because it could end up getting you moved for patient abuse."

No, I didn't report her---she has been an LVN for maybe 2 yrs, and only at this Forensic Psych on day shift for about 4mos and was on NOCS before that--i.e. not too much interaction for one year...it is evident there are things she has not learned (discussing personal matters with the patients/inmates, showing them pictures,arguing with them,bad mouthing staff around patients---LOL, but she is really a nice girl who just needs some fine tuning and more experience.

Sounds so bad when I read it in black and white. and I know that students/new hires etc need to learn things. Now, if she were to do this around me again, I would let our supervisor know. In all honesty, people do things very often that are not "reported", but when you choose to be blatant about it, sorry---I ain't losing my job nor license for ya. Other people complained they have heard her say these things, but so far I haven't anymore. The patients have no complained either, because I guess they chalk the rapport up to being FRIENDS or whatever. Anyhoo, this same chick requested to transfer to another unit---by putting her request into the unit she WANTED and not even letting our unit supervisor KNOW she was unhappy on our unit. :nono: Ummm, burned bridge anyone.

MAISY, RN-ER, BSN, RN · Sep 6, 2007

I agree with the kill them with kindness theory, however, I am human and sometimes you want to tell needy, (don't belong in the ER) patients "too bad, wait, or NO!" If the ER is crazy, I try to anticipate early in the shift or initial room time any and all things the patient might need. Some days, you get that one patient that keeps you running and a family that could drive a saint to sinning! On those days, if I've told a patient they must wait for something and they keep bugging me-I will make sure they get whatever important item they need at that SECOND (usually ice water or extra blanket/pillow) but I will not bring it-I will make sure a tech or patient rep provides. I know that sounds crazy, but I feel if I am truly that busy and bring it, they will discount what I've told them and continue to ask for inane items.

As for pain meds, Always on time, always reassessing pain-I would never withhold from a patient.

I always make sure people are fed, and informed of their current status, otherwise they will drive you nuts! But will also involve ancillary staff in keeping patient happy with little things and that extra smile. Patient satisfaction is a shared job.

Maisy

RN50, ASN, BSN · Sep 6, 2007

I have been unfortunate to have to deal with rude patients. When they are screaming obscenities at me I will walk out, come back in a couple of minutes later, and politely remind them that I will be more than happy to do what ever it is that they need, but they should ask me politely and without the swearing. I have gotten an apology and then kept my end of the bargain and got them whatever it is they were requesting. In fact I try this first with all of the rude patients I have dealt with, and I have almost always gotten an apology and I had one patient ask "Can we start over again" I said "sure", I walked out, walked back in, reintroduced myself and the rest of the time we got along very well. Generally the patients feel really bad about how rude they have been, and I just let them know that I have accepted their apology, and it is now "water under the bridge" it will have no affect on how I will care for them the rest of the day.

When that dosen't work (and it hasn't worked on one or two people,) then I just do what needs to be done, and as another poster said, limit my exposure to them. I also try not to take it personally and tell myself that they are just generally not nice even when they are not sick. Oh of course I have silently thought that pillow therapy would be helpful, but NEVER would I act on that!

As for rude doctors, I don't bend over backwards to help them out! If they ask "who is this patients nurse?" I point to the assignment sheet and tell them to look there. No I am not going to hand them the chart, no I am not going to go get them what they want. I remind them where the charts are, and where they can get supplies and that is it. They can get it themselves. When they are rude on the phone, I also don't take it, I will hang up (and have hung up) on a rude MD. We are all co-workers and they are not on some level above us, although they would like to think they are. I treat them how they treat me. I don't take anything from other nurses, or PCA's either, but the patient dosen't suffer because of it.

maryloufu · Sep 8, 2007

Had a patient with issues that I won't go into specifically re:HIPPA - unsteady- would not stay in bed, being rude to family. He was rude to me when I came in the room to give him pain meds, assess him and such. When he opened his eyes and saw it was me and not his wife he said "I'm sorry maam". I think she had wheedled him to come in to the hospital- he wanted to stay home. The docs were taking their sweet time coming to see him- I bothered one doc so many times she told me not to call her back. (And to be fair what we needed was the specialist) Such a terrible difficult case- sent to the unit as soon as the specialist came up. (And why is it that the doc comes in and states- "He needs such and such drip and and ICU bed, his encephalopathy is worsening." THANK YOU CAPTAIN OBVIOUS:trout:) Did he think we are calling him a thousand times because the patient is doing so well? Patient died soon== not really because of the slow doc- this patient was a frequent flier who did not follow DC instructions last time. So sad for him and his family- But while it was going on it was so difficult to deal with- I sometimes we need a debriefing session to vent and find ways to get through these situations better next time. I know for me it helps to remember that they are hurting and they are afraid they will die. I personally believe that we are all God's children and He loves this turkey:troll: of a patient as much as He loves me, and He might be trying to love this patient through me. I am not always this thoughtful and nice, you will hear me :devil:cursing under my breath down the hall, but I TRY to live up to standard that I feel God set for me.