Advised not to use security to "intimidate" agitated individual.

[MrsWampthang, BSN, RN]

I am so upset. I need to vent. I had an incident this past week while we were having one of those nightmare evenings in triage. Had parent bring a child in with a high fever so I triaged the child, had him checked in, and got a fever reducer to give the child. The child vomited while being given the med, which made me laugh when everyone in the immediate vicinity got tagged with the vomit. Well, long story short, the parents didn't like me laughing, and expressed it, I apologized and told them that I meant no disrespect, but the parents proceeded to totally blow up and become loud and beligerent, yelling and screaming at everyone in the immediate vicinity. Well, I was rattled, needless to say, and things went from bad to worse. Security was called to come and try and calm things down. The security officer proceeded to wander out to the area, and when I asked him to help me, he replied that he was needed in back. He immediately left, and went to the charge nurse and told her that SHE needed to go out to triage, that HE didn't want to get in the middle of things out there. She came out and tried to talk to the mom, the house supervisor tried to talk to the mom, and no one was able to calm this woman down. She continued to scream and yell and demand to talk to the "highest" she could talk to. I know I didn't handle things right, I got upset and showed it. Not good, but with the waiting room FULL, and people continuing to come in and wanting to see the doctor, what I needed was more rooms, more doctors, and someone to do crowd control. None of which I had. At one point the dad looked at me and called me a "f@#$%&* b@#$%$! When he said that, the charge nurse told me that the dad was not to come back when we finally got a room for the kid. So when time came for the child to go back, I told another security officer that dad was not allowed back because he had been abusive to staff. Course, mom got taken back but threw a fit until they finally agreed to let dad be escorted back by security if he behaved. I know I handled things badly; we were so busy, it was one of those shifts from hell. I didn't allow the dad to go back, then the grandma asked to go back and we were so busy I said no, which was wrong, in hindsight. Ok, so this did turn into a long story, sorry. Now, the reason I am upset, this morning I was called into the office with the manager and the head of the department. I had already told the manager what had happened, and so did the charge nurse. The charge nurse told the manager that she didn't feel that I was inappropriate, and that the mom and dad were way out of line, so the manager wasn't just hitting me with this from the parent's point of view. Anyway, my manager called the mom to get her side of the story; the mom told her that, yes, she behaved inappropriately, but felt like I didn't care about her sick child, (despite the fact that I had obtained a fever reducer, and I had advised her things to do to help bring down the fever) and that she felt intimidated by security being called on them. In questioning the security officer, he told my manager that I was acting inappropriately and probably escalated the situation. (This security officer is well known for being a wimp, when it comes to handling crisis situations, we all know we can't count on him if things go bad) The outcome on this was that my manager told me that I handled the situation wrong, which I agreed, and the head of the department which was also in the meeting, told me that a) I shouldn't have called security to use them as an intimidation tactic, and b) as long as the dad wasn't physically threatening me that I should have just let the dad back, and not called security to come and help intimidate the dad and mom into behaving. I told the director that in hindsight, I would have preferred that the dad be escorted from the building since he was being verbally abusive to me, and I felt threatened by it, but he told me that as long as the dad wasn't physically threatening me, that he wasn't being abusive and I should have just let him back, and allowed him to cuss at me and call me foul names. I feel that, yes, I handled the situation wrong, I know it, but I also feel that to be told that I have to allow people to cuss at me and not be allowed to call security to stand by as an added incentive for people to not get out of control was just too much. I can handle being chastised for behaving badly, I deserved it, but to be told that I had to take abuse from patients and families....I still can't believe it! Oh and by the way, this is one of those hospitals that swear by the Press Gainey so I guess patient satisfaction is more important that making staff feel that they are safe when they work. I would like honest feedback, am I wrong to expect not to allow people to verbally harrass me? Am I wrong to call security to help control crowds by their presence in triage? Oh BTW, there are only two night shift security guards (and a lot of the staff has complained about them), that don't think that it is their job to help with agitated individuals, the rest of them, have no problem making sure the staff feels safe where we work. Thanks for listening to my vent.

Pam

[fergus51]

IMO, you were completely right to call security on this man. Should you have waited till he took a swing at you? Parents of sick children sometimes go absolutely nuts, and that's understandable, but they DO NOT have the right to be abusive to staff and calling security when you feel threatenned is not an intimidation tactic.

[Katnip, RN]

Wow. At our place, somebody swears at staff, they're outta there. Security is all over them.

As far as our security folks are concerned you don't mess with the nurses. Same with our DON.

Sure, the mother felt intimidated. So did you with two people ganging up on you, physical violence can erupt at any time.

The parents and your management are the ones who are behaving innapropriately. I'd write a formal protest about how you do not feel the hospital is providing a safe environment for its staff, and maybe try to find an article or two about violence in the workplace.

[talaxandra]

Hi traumamama, sorry you had this awful experience. It would have been bad enough if you'd had supportive bakup, but this just sucks!

I agree with other posters - verbal violence is as intimidating, illegal, objectionable and inappropriate as physical violence. I believe that if it's not jumped on in the first instance we give perpetrators permission to continue like that. At my hospital such offenders are given a verbal warning and, if their behaviour does not change, we call a code grey - four security men pound up the corridor at lightning speed. That this is intimidating is the point - yelling abuse is also intimidating, threatening bodily violence is intimidating. In public that behaviour can get you arrested.

Good luck - hope you're feeling a little better.

[MrsWampthang, BSN, RN]

I had to stay home last night, I just had to regroup. I know I left them in a bind, but I was just still to upset to face another possible shift from hell. I get so frustrated sometimes. I have no patience for fellow coworkers who are sitting around, while I and others are running around crazy. When I am at work, I am literally a blur. I do everything at high speed so it gets done quickly. If there are people in the waiting room and I have open rooms, I'll get them back so they can be seen and be discharged or whatever. All of us gets frustrated with some of our docs. The turn around time in our ER for patients whether they are admitted or get discharged is sometimes ridiculous. There are times when patients are there for 4 or 5 hours! Sometimes longer, because the doc is not satisfied with making a decision about the patient based on initial test results but has to add on tests like MRIs which are long tests! Not proper or appropriate in an ER setting, IMHO. Or we have to wait for the admitting doc to come and see the patient in the ER! When we have one of those shifts from hell, our rooms are full in the back, we have people lined up to come back, I don't understand why the patients are in our ER rooms for longer than two hours tops. It just adds to the stress when we have people piling up. I was told by the manager that I needed to try and handle my anger and frustration better, I know that, but sheesh! Our triage area is the stupidest arrangement there ever was. When patients are piled up to go back, patients are piled up to be triaged and then on top of that, we have family members standing at the window wanting to go back, and people coming up to the desk and asking how much longer it is going to be, and people are getting irate because they're not going back, oh, and the famous "I work here, I should go back ahead of everyone else" or "I'm the doc's neighbor, etc. I should get priority." I'm supposed to try and remain calm?!? Guess I had better get the doc to write me a script for valium then. Sorry this is rambling this morning. Just kind of writing my thoughts down as they occur. Wonder how much Walmart greeters get paid? :chuckle Again, sorry this is so rambling, just needed to vent. Right now I'm feeling like a don't do anything right, so I'm a little bummed. Thanks for listening.

Pam

[ERNurse752, RN]

Yelling and calling you a FB *is* physically threatening, IMHO. Like someone else said, what are you supposed to do - just sit there and wait for him to punch you or something, and then call security? I dont' think so!!!!! Especially in a crowded waiting room where things can quickly escalate out of control.

In my ER, he would have been given the speech that assault against a healthcare worker is a felony, and that we do consider verbal abuse to be assault.

If the security guard is going to sell you out to protect himself, I'd also file a complaint about him.

I disagree that you called security to be used as an intimidation tactic - make sure your admin understands this, in writing. You called because you felt threatened by the father yelling and cussing at you.

I agree with someone else who said to make a formal complaint in writing, and be sure to mention the words "unsafe working conditions," and "workplace violence." Keep a copy for yourself.

Grrr...you should not EVER EVER EVER have to sit there and take that from someone.

[gotaluvtheER]

If you act up in McDonalds, the mall, grocery store, or wherever, you will either be asked to leave or arrested by police for disorderly conduct. What makes people think it is any different in the ER? Is it because "I'm sick and you can't refuse me treatment?" HOOEY!! :angryfire I realize there are people who get very stressed when a loved one is sick or injured, but that still doesn't give them the right to abuse the people they came to for help in the first place.

NOBODY has the right be be verbally abusive or threatening in a public place, especially the ER, where crowds of people are. My patients are sick, and deserve to receive competent care in an environment in which they feel safe. They get neither when I am busy calming, restraining, or having police arrest an SOB like that. It prevents me from spending time and delievering the medical care my pts need and deserve. If press-ganey matters so much, why don't we start encouraging pts who witness and feel unsafe in an event like that to blast it loud and clear on their surveys. 50 complaints are much louder than the one complaint from an uncivilized moron.

[asapstat]

It sounds like everything snowballed and was blown out or proportion!!! I think you did the right thing to call security in an effort to regain control,... whenever we feel threatened, we need back up .. Too much workplace violence risk,especially with freaked out parents. and of course the fingerpointing is always going to go in our direction ,as in "how could we have handled this better " except that the "suits" have never had to experience it first hand- or have forgotten how frightening it can be..I can deal with the verbal stuff because it comes out of a frightened parent who is feeling loss of control of the situation, but when it starts to escalate beyond frantic parental yelling...it is time to call for security backup and prevent physical injury.

I say, chalk it up to another day in the life of the Er and don't let waste any more negative energy on it..concentrate on all the positive things you did...

[Stitchie]

The security guard should be near triage so that these 'misunderstandings' don't happen. After all, arent't they there to make sure these sick people are safe, and that the staff is safe from them. He's as bad as the management!

IMO, you did the right thing. Verbal abuse isn't any more acceptable than physical violence, and you acted appropriately in treating the fever of the child. What were you supposed to do? Bring down angels from heaven to comfort this child while you ran out to McDonald's for the parents?

Sorry you went thru this. Hope your next shift is better, and I also encourage you to protest protest protest what management told you. Remember, they weren't there...they never are when the ER explodes into complete chaos!

[traumaRUs, MSN, APRN]

Pam - I feel very sorry you. Is there any chance that you are getting burnt out? I work a level one trauma center and it sounds very similar to yours - way too many patients and few resources. I was the night charge nurse until Jan 04 when I took an ER case manager position. Have you considered changing either shifts or units? Even if just temporarily? It was a very hard decision for me to make because I love the excitement of the ER and I miss clinical practice very much. However, I realized that I was becoming pretty nasty with people and I didn't have the patience that I needed to do the job well. I really wish you very much luck because it is difficult job to say the least. Whether you were right or wrong in this situation isn't important (IMHO). Please take care of yourself first!

[chris_at_lucas_RN, RN]

Putting things into perspective, the child had a fever and vomitted. So? That's what kids do. He wasn't brain injured, didn't have a chronic, debilitating or terminal condition, so what was up with that?

At least your charge nurse backed you up.

Sounds to me like you did a tremendous job--laughter can disperse tension. You weren't laughing at the child, you laughed spontaneously! A normal--and may I say, healthy--human reaction to a messy situation!

Don't you sometimes wish you could have people like that dad drug tested when they act out?

Take care. If I get sick, I hope I have someone like you to take care of me. (Kids are grown--I used to laugh sometimes when they puked too. We both did, the kids and me.)

[hipab4hands]

It's too bad about what happened. However, you have every right to be protected against agitated or verbally abuse people. You do not have to wait for the the person to take a "swing" at you, before you call security.

I would request to have a meeting with a security dept and management and get in writing what situation will security respond. As far as I know, security doesn't have the right to pick and choose, what calls for service they go to. If you request help, then they should respond- no questions asked. If security if failing to respond to calls for service, then call the Police. I can pretty much quarantee you that management isn't going to like it, but if you feel threatened you are entilted to get protection.