How to set limits on inappropriate pt behaviors

MassED, BSN, RN · Jul 1, 2008

when you get REALLY good, you dont need to say anything....just the LOOK....will work......seriously.....dont go into apology mode.....too much of that , and they will think there is some reason you should be apologing.

on that note, death by "glares" - a guy was in the hall of the ER, by the ambulance bay, which I kept passing to get to my other patients. He had been triaged for "allegedly" being struck by a car in the parking lot of a Pizza Hut (happened to him a lot, by the way). Everytime I walked by, I must've looked at him (I usually look at most people that I pass!), because about the 3rd time going by, he swore at me "Stop looking at me with that F-ing face!" I told him that I look at everyone with my "face," sorry! :up: :yeah:

WondeRNurse · Jul 2, 2008

mpccrn has the right idea, in my mind.

After years of psych experience, I have learned that sending the angry energy back to the "problem" only keeps the anger 'fed', and the problem escalates. True control comes from being in control.

Another key to quelling the irate person: help them to feel heard. Like mpccrn said, when they feel heard, they are able to calm down, because they know you really care. Perhaps you could give them a paper to fill out, so it would be ready when you were done with the patient you were attending to? Did they need to get prescriptions filled?

Was there a reason that discharge #2 had to be Discharge #2? Perhaps Discharge #3 had left her dog alone for days and he/she was frantic to see how the pet---in his/her eyes, a member of her family---was doing. I have seen many times when the staff nurse wants to be the one in control, and exerts that authority over the needs of the patient--just so she can let others know who wields the power. (Yes, it's usually women who do this---very disfunctional women.)

Lastly, each situation has it's own 'flavor'. Not every situation like this is going to be resolved in the same way. That is where the communication skills of the nurse comes into play. And, that's where experience counts!

MassED, BSN, RN · Jul 2, 2008

mpccrn has the right idea, in my mind.
After years of psych experience, I have learned that sending the angry energy back to the "problem" only keeps the anger 'fed', and the problem escalates. True control comes from being in control.
Another key to quelling the irate person: help them to feel heard. Like mpccrn said, when they feel heard, they are able to calm down, because they know you really care. Perhaps you could give them a paper to fill out, so it would be ready when you were done with the patient you were attending to? Did they need to get prescriptions filled?
Was there a reason that discharge #2 had to be Discharge #2? Perhaps Discharge #3 had left her dog alone for days and he/she was frantic to see how the pet---in his/her eyes, a member of her family---was doing. I have seen many times when the staff nurse wants to be the one in control, and exerts that authority over the needs of the patient--just so she can let others know who wields the power. (Yes, it's usually women who do this---very disfunctional women.)
Lastly, each situation has it's own 'flavor'. Not every situation like this is going to be resolved in the same way. That is where the communication skills of the nurse comes into play. And, that's where experience counts!

and sometimes the patient is just crazy and the nurse is doing his or her best to speed things along.... and in my experience, even if you let it alone and not feed into that negative energy coming at you, sometimes it will STILL escalate. It's just best to not be backed into a corner and you need to have witnesses around to call security for you, if you cannot. It also depends on where you work, and in what region you work in, for instance, on how much respect (or should I say lack of respect) a nurse is given by a patient. You don't have time to reason all day long (and delay your discharges!) with the ones who are being petty and difficult. I know many people will go ahead and discharge them FIRST because of their griping. That is rewarding bad behavior and shouldn't be tolerated. :imbar Then there are those very ill patients who are quiet and don't ask for a thing... and for whom you would gladly jump through hoops, should they ask!

bethin · Jul 2, 2008

when you get REALLY good, you dont need to say anything....just the LOOK....will work......seriously.....dont go into apology mode.....too much of that , and they will think there is some reason you should be apologing.

I actually gave a pt 'that' look once. They got the hint that they needed to shut up, sit down, and wait.

Sometimes no words are necessary.

SecondGenRN · Jul 2, 2008

when you get REALLY good, you dont need to say anything....just the LOOK....will work......seriously.....dont go into apology mode.....too much of that , and they will think there is some reason you should be apologing.

Our hospital has decided that we should appologize to any patient who has had to wait lol

RN1982 · Jul 2, 2008

Our hospital has decided that we should appologize to any patient who has had to wait lol

I don't have a problem apologizing to a patient for having to wait. That is the polite thing to do. But if they start being beligerent thats another issue.

MassED, BSN, RN · Jul 2, 2008

Our hospital has decided that we should appologize to any patient who has had to wait lol

I love that when the "hospital" dictates what we should say to someone that has been waiting.... common courtesy is what dictates why I should apologize when someone waits forever to be seen by the ER doctor. The "hospital' should decide that doctors need to hurry up and see the patients quicker so we don't have to apologize for them. :up: