Happy Easter. Or Passover. Or April Fool's Day. Or Sunday. Whichever holiday(s) you celebrate.
Just the other day, there was a patient who was unhappy that I had set firm limits. So for the entire shift, I was yelled at, berated, harassed, taunted, made fun of, you name it. The patient kept doing it because they thought they could get a reaction out of me, so they trotted out the worst verbal barrage they could short of physically threatening me--which they were wise enough not to do.
For almost 10 years, I've worked on the worst of the worst psych units, so the
bar is set really high if you want to use your words to upset me.
So, for all their efforts at getting that rise, the best the patient got was a smile or a neutral expression followed with a laconic "OK." Or "I know." Or "Whatever you say." Or whatever other noncommittal benign remark comes to mind, followed by as-needed reiteration of whatever limit was being challenged. And naturally, complete documentation of their behavior which is then discussed with staff and the MD so we were all on the same page, because attempts at staff-splitting usually go hand-in-hand with such behavior.
I can usually talk a patient into dialing their behavior back once they see it won't get what they want. Sometimes they figure out on their own that it's not working and give up. But occasionally, I get a persistent one that is hell bent on leather, and no matter what I would say, it will be ineffective. I can usually figure out that they're one of those pretty quickly. Most psych nurses can--it's an essential skill that we must develop in order to survive.
I don't engage any more than necessary as then it would become a power struggle, and some things on the unit just aren't and can't be open to negotiation. Sometimes I think I should just not say anything and ignore whatever is being said, not even give that "OK" or whatever laconic response. I decide not to as that may give the impression that a. I didn't hear them, b. I'm ignoring them and/or c. what they are saying is getting to me...and any one of them just feeds the fire even more. If they think you didn't hear them or are ignoring them, they'll just keep going on until they do get a response. If a patient--especially someone with an Axis II diagnosis--thinks they've found a weak spot of yours, they will go after it like a bloodhound. Show them that something they said upsets or otherwise gets to you, and they'll latch onto it and keep launching barbs.
Caveat: if they are acting out, then as long as they're not hurting themselves or anyone else, the temper tantrum is ignored until it is completed. It's the same as Toddler 101.
I try to avoid getting assigned to such patients once I know they have it in for me...in fact, they often weren't my assigned patent in the first place! After all, there's a fine line between standing your ground and rattling one's cage. For me to willingly assume care of a patient who considers me Public Enemy #1 for whatever reason is not very therapeutic for them, nor would having to deal with me as their nursing contact "teach them a lesson." If anything, I think it comes across as antagonistic: "gee, you don't really like me, do you...well, guess who's your nurse today! Ta da!"
I have to admit that over the years, I've had some very creative insults and names hurled in my direction. I would love to share some of them, but I prefer not to run afoul of privacy laws or my organization's management. Oh well. Perhaps many many many years down the road, I'll publish a book that'll be released after my death: The Meriwhen Diaries: Detailed Adventures in Psych Nursing. And it'll be full of all the stuff that I wish I could have shared now but can't due to privacy concerns...but which in 40 years or so, would be impossible to tie back to specific people.
