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ADVANCE Perspective: Nurses

Challenging Patients ... Very Challenging Patients

Published August 28, 2008 7:29 PM by Adrianne O'Brien

By Adrianne O'Brien

California RN May (just May) has a blog,, where she writes about finding humor on a med/surg telemetry unit. Earlier this week, she had a very, shall we say, challenging patient encounter.

Here it is (courtesy 

I never thought I'd say it, but last night, I did.

As always, I'm sort of beating myself up for saying it, but what can I do, I can't take my words back.

One of my patients was having DT, and by far, he has exceeded every encounter I had with expletives. He has called me every unacceptable name in the book, including fat face and pig face. H started, ended, and elaborated his every sentence with the F word, I just got tired of cringing.

At 2000, his repeat potassium was still low, so the doctor ordered two doses of potassium tablets. If you have taken or seen those things, they are humongous! I cut two in halves and offered it to him after convincing him that he badly needed it. He did take the tablets in between cursing and yelling for me to get the f#*k out of there. He started chewing the tablets, and I imagined how bitter it was, so I offered him apple juice, which, to my surprise, he sipped without argument.

When he started gargling the juice, I should have taken the hint, but sometimes, to my disadvantage, I have too much trust in humanity, even for people like him who was logically out of logic. He looked away, I breathed a sigh of relief, expecting he was swallowing. It was too late when I realized that he was aiming his lips directly at my face. With all the strength he could muster, he spit the chewed KCl and apple juice mixture. Most of it went to my scrub, but my face wasn't spared. he then belted out a devilish laugh and said, "I told you to get the f#*k out of here, didn't I?" then he started kicking, missing the doctor's chest by an inch, because she pulled away by instinct.

Giving in to the frustration that had been building up in the past hours, I wiped the goo off my face, stopped myself from crying out of frustration, and said "I am not paid enough to do this job!"

Words, that in a million years, I have never imagined I will ever, ever say for real. You know, like I really mean it. And last night, I really meant it.

I did, and though I hate to admit that I am one of those stereotypical guilt-ridden Christians, I would be lying if I say I do not regret saying it.

Anyway, it's past now, and there is no way I can take it back. It made me wonder if this sudden change in behavior is a sign that I am not cut for the bedside nursing challenges anymore. If my patience quotient has reached it limits and I am now devoid of compassion that I should seriously consider other nursing options, those that do not involve dealing with confused patients.

I'm just reflecting, just wondering out loud.

Does any of this sound familiar (hopefully not)? Have you ever had a patient encounter that made you question your position?


You mimick an incident that I encountered with a patient when I was working the night shift a few years back.  In addition to being spit at, however, I also missed a punch by about the width of a hair.  I, too, cursed the incident and "hated" my job.  It doesn't make you a bad nurse, it just shows that you are also a human being with your own limits. Yes, we need to have compassion for our patients on a daily basis. Yes, when we lose this compassion it might be time for a reality check. But, you were in a situation where your self respect was compromised. Your reaction was the norm. Don't let this one incident allow you to question your compassion for bedside nursing.

jacquie September 16, 2008 7:32 PM

Yes to your last question. It was like a trip down the m. lane.%0d%0aI am doing a series of articles on my blog - Nurse - Who and Why. I am going to feature some interview with RNs in the conclusion of the postings. It will be a very short interview. Reading your blog, I would like to invite you to be interviewed.%0d%0aMy url is

Agapelife , entrepreneur - RN September 1, 2008 10:43 AM
Ontario IT

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