Quote from traumaRUs
Hi there and welcome. This speaks to boundaries. You are the boundary-maker. At the first inkling of impropriety, stop it dead in its tracks. That is the only way to not let things go so far. Yes, these people are sick, but that gives them no right to abuse you...take care.
I recently had a very belligerent drunk in the ER. He ended up being taken down by 4 security guards (and me!), strapped down to the stretcher and put in 4-point locked restraints.
We pulled a tech to sit 1:1 observation for him. At first, he was just wild and belligerent and my primary concern was for his safety - I ended up placing a wash cloth over his mouth (because he kept spitting at us) and pillow/padding the rails lest he hurt himself.
Once he figured out that his 'tough guy' antics weren't working, he resorted to other means. The tech watching him was a young girl and she wasn't used to the ED (plus, she was new to the job and had just recently become a CNA). He resorted to obscene, lewd talk and suggestive 'gestures'.
It was fairly obvious it was making her uncomfortable. It would have been simple for me to interject and handle the situation - but by doing that I'd be doing her no favors.
So, I just plonked down next to her seat and had a quiet discussion about "setting limits and boundaries", intimidation and de-escalation. IMHO, it's pretty pointless to try and talk sense to drunks (especially those with a BAL of 560...) but it depends on the situation and how you handle it. There are certain things they'll respond to and there are certain things best left ignored (so long as it doesn't harm the patient).
In any case, I let her handle the patient. I did let her know that I was only a few feet away and to either get me or security if the situation worsened...
And she did magnificently!
Her confidence grew with each passing hour and she was less frustrated and more in control.
Bottom line? Like traumaRUs said - YOU are the "boundary maker". Identify inappropriate behavior and kill it in it's tracts. Yes, they are our "patients"... but that never excuses inappropriate behavior.