I am an RN working at an outpatient/ residential psychiatric facility. We also work with people living in group homes and scattered-site apartments. I was told the other day one of the clients living in the scattered-site apartment wrote a letter saying that she does not want me to have access to her records or speak to her psychiatrist. She then went on to say that my conduct has been unacceptable, and I have been warned several times.
She supposedly stated my contact has caused stress at school as she is back taking college courses. I do not work with this woman one on one and only deal with her very superficially when she sees her case manager at one of the group homes where I have an office.
Our conversations have been very cordial and very casual. We have never had an unpleasant conversation. I have very little knowledge of her health needs and all of this comes out of left field.
I am not even clear about her mental health diagnosis, but I believe she is bipolar. She is not overtly psychotic. She does have a personality disorder, which appears to be more malicious and vindictive since Ive been working with another client at the same agency, with whom this patient is friends. This other client feels I am trying to get one of his medications discontinued, and on his part this is delusional, but nonetheless he is angry.
My nursing reputation is excellent and I have been employee of the month and have wonderful evaluations. My supervisor stands by me, but this is causing me so much anxiety and stress since this client has written this in a letter. Do I have any recourse here?
Dear Nancy replies:
It is difficult to comment on your situation since there are many factors still unknown about this resident and her difficulties with relationships, particularly with those in authority. It is positive your supervisor stands behind you, which he/she should since, at best, the resident’s allegations may be meant to create a rift between you and your supervisor.
You might want to speak with your supervisor about how to handle the letter. You did not say to whom it was directed or where it is in the system. If, it is in your personnel file at the facility, you may be able to write a response to it that remains in your personnel file. Writing a response might be a good idea in any event: to present your summary of the situation in an objective, professional way so that it stands as your comment on the situation if it goes any further. Your supervisor can advise you about this and also review your comment for accuracy, professionalism, and so forth.
If your supervisor does not want to get in the middle of this difficulty with this resident, you might want to consult with a psychiatric advanced practice nurse on your own who may provide you with ways to keep the allegations by the resident to a minimum and to provide guidance about dealing with her. Sometimes, such facilities have psychiatric consultants available to staff when such difficulties arise and that healthcare provider may be of great help to you as well.
You also may want to review on your own some literature online on the subject of bipolar disorders, since you believe this may be her diagnosis. One resource that may be of help with the personality disorder you are dealing with as well with this client is the following article: Hall and others (2012), “Borderline Personality Disorder In Residential Care Facilities”, Annals of Long-Term Care, available http://www.annalsoflongtermcare.com/issue/1387.