Patient's "right" to abuse nurses...I need your opinion

[MsNewbee]

Hi, everyone. I'm a year out from graduation and have been working my job so I haven't posted or been on in a while, but a topic came up on the job and it just rubbed me the wrong way. I didn't want to ruffle feathers at the hospital so I decided to turn to my peers on allnurses for guidance.

I recently had a patient that really tried my nerves. I'm a super patient person and she made me question why I chose nursing (which I thought would never happen!). She would ask me for pain medication and as soon as I would leave her room she would be on her light again asking for the same thing. She literally rang her light 15 times in 10 minutes. I counted because I would answer her. She did this everyday for at least 3 hours every morning for the 5 straight days that I had her. She was cognitively intact. She wanted to go smoke outside, but needed staff with her and no sooner that she went outside by herself (while I was with another patient) she broke her wheelchair then demanded that I go with her. I only had 8 other patients to take care of, no big deal right? She complained about everything from the food, to the other staff, to the other patients. Her room was next to the nursing station and she would scream my name down the hall while I was charting because I was in her line of sight. I started hating my name just because of the shrill way she would scream it and she did this constantly. If I left to tend to another patient she would scream my name louder. I could hear her screaming for me while I took lunch breaks. She yelled at other patient's family members as they would passed by her room. I got so frustrated I told her we were human beings that should be treated the way she herself would want to be treated and her behavior was not acceptable. I didn't know what else to do or say to her. Eventually, she hit my tech and started smoking in the room and that's when administration said she had to go on the 5th day with me.

I made a sarcastic comment and said, "Can someone take the light and just put it somewhere, she knows I'm coming." The nurse supervisor who was getting off of work said, "it is her right to abuse you." I just looked at her back as she sauntered off to the elevator with my mouth open because I couldn't believe what she just said. I thought a better response would have been, "she needs to have her call light in case she has a need that hasn't been addressed." or something along those lines, but she was serious. I determined at that moment I would not pick up any more shifts because I was begged to come in that day and that was what I got. I felt like the "higher ups" really didn't care about me or my mental well being.

My question is do patient's have the right to abuse us? Am I just being a baby and should suck it up because this is my life/job now? I am really dreading going in tomorrow. I loved my job until I had this one crummy patient. I woke up crying in the middle of the night on my third day with her because I knew she was going to do this every time I showed up. I was fighting back tears for those 5 days at work and I cried once in my car on my lunch break. How do ya'll keep the fire that inspired you to go into nursing from going out?

Please help, I'm feeling sooooo helpless and drained .

[LauraJP]

No, that isn't acceptible. Obviously you're not getting the support you should from your superior who should be setting limits with the patient. Find a job elsewhere.

[kardz33]

"Educate" the patient. Write in a small log every few hours about her antics. Tell her that you have other patients, you won't be able to answer her call light as frequently as she likes, and by her monopolizing your time she is causing you to be negligent of your other patients. Therefore, I cannot answer your light or be in the room every 1-2 hours. You need to say this with a very passive attitude, but stern. If she tries to argue, walk away. Say nothing. Her goal is to get under your skin and be a B*****.

Every night/break update your log on her antics. Inform the nurse supervisor/director of her antics and your plan.

Also, as a male...you need to wear a voice activated recorder. Females including patients make a lot of accusations. Theres no way to prove a negative (innocence) after the fact. But...if you have a hidden recorder that looks like a pen or goes on your key chain....Then save it to your computer every shift.

[NunNurseCat]

"Educate" the patient. Write in a small log every few hours about her antics. Tell her that you have other patients, you won't be able to answer her call light as frequently as she likes, and by her monopolizing your time she is causing you to be negligent of your other patients. Therefore, I cannot answer your light or be in the room every 1-2 hours. You need to say this with a very passive attitude, but stern. If she tries to argue, walk away. Say nothing. Her goal is to get under your skin and be a B*****.

Every night/break update your log on her antics. Inform the nurse supervisor/director of her antics and your plan.

Also, as a male...you need to wear a voice activated recorder. Females including patients make a lot of accusations. Theres no way to prove a negative (innocence) after the fact. But...if you have a hidden recorder that looks like a pen or goes on your key chain....Then save it to your computer every shift.

Definitely make sure to only record things into the chart or in something like a nursing/nurses note or some variant. That's the kind of log I think is meant above.

Regarding voice recordings, yeah I say never do that. At the very least we'd have to get permission from the patient since recording a patient without it would violate HIPPA and probably some other state laws and/or hospital policies. Taking that recording home would not be good either since it could be lost or compromised; Even the IDEA that it COULD have been lost or compromised would make a nurse look bad.

I've seen patients accuse both male nurses and female nurses of innapropriate actions. I've even been accused of things that were laughably untrue. Coworkers might get a good laugh about it too, because some claims are outrageous.

Back to the OPs topic that patient is a pretty good example of someone who, if they dont get their way, might make a false accusation. When an accusation is made it is annoying and you'll end up doing some paperwork for your side of the story. That's why you want to be sure you take good notes and keep a timeline.

Obviously if numerous complaints come in over time, and from different patients, well then you have a history...and a serious problem.

[Purplemommy, BSN, RN]

No a patient doesn't have the right to abuse staff or visitors. The patient does have the right to hit the call light 1000 times and you can't "hide it". Hitting the call light, yelling your name - not abuse. Inappropriate-yes. It's not personal- she probably has a personality disorder. You can set limits, return when you say you will and take good care of her despite her manipulative and difficult attitude. You did a good job saying her behavior wasn't acceptable and trying to set limits. Yes you still have to treat her with respect, say Ill take you to smoke 3 times today -at 10am, 2pm and 5pm give it take an hour depending on my work load. If i can't take you I'll find someone who can but I'll need you to be patient with me- then keep your promise. ( i assume you work in LTC)

Admin should have intervened when she became unreasonable and yelling at staff. (Provided someone requested they come help-they're not psychic) They REALLY should have intervened when she began to yell at other families.

Do perfectly sane, A & O x4 PTs have the right to actually abuse you? No. Hitting your tech was way over the line. And smoking inside put all the patients at risk. You're Admin missed their opportunity to support staff. The supervisor might have been making an equally sarcastic comment, just as you were. Or she may really believe that and she's wrong. Hopefully she was just being sarcastic.

[Juleshop]

FIRST of all, any charge nurse worth their salt would not have put you with a patient like that, that many days in a row! Shame on them!!!! Patients like that should be rotated thru the staff on a daily basis, ie one and done!

And NO! a patient DOES NOT have the right to abuse you. Shame on admin for not doing something about her. If she needed pain meds that often, she didn't need to be going off the floor. I am sorry you have had to endure abuse by the people you work for!

Go become a wonderful nurse AT ANOTHER HOSPITAL!

[SVRegisteredNurse]

My second comment; many times there are psychological issues that need to be addressed. Again The MD needs to be in the loop. Concerning actual physical abuse, I knew a nurse who was kicked in the face just as she finished putting a foley in. Without thought she immediately hit the patient in the upper thigh. She was fired.

Years ago, I bent over to look at a pump that was delivering cardiac drug 200x the rate I had set it. The patient, a 20something young man, reached from the bed and grabbed a handful of my hair. I was bent all the way over and he was twisting my neck. I pled with his elderly parents to pull the bell out or go in hall and yell. They were frozen in shock. Before he twisted my neck so far I fell...I kicked him in the stomach. It was him or me.

[dec2007]

My Quote function is not working properly. I apologize. Regarding the previous poster's statement below:

"Regarding voice recordings, yeah I say never do that. At the very least we'd have to get permission from the patient since recording a patient without it would violate HIPPA and probably some other state laws and/or hospital policies. Taking that recording home would not be good either since it could be lost or compromised; Even the IDEA that it COULD have been lost or compromised would make a nurse look bad.

I've seen patients accuse both male nurses and female nurses of innapropriate actions. I've even been accused of things that were laughably untrue. Coworkers might get a good laugh about it too, because some claims are outrageous.

Back to the OPs topic that patient is a pretty good example of someone who, if they dont get their way, might make a false accusation. When an accusation is made it is annoying and you'll end up doing some paperwork for your side of the story. That's why you want to be sure you take good notes and keep a timeline.

Obviously if numerous complaints come in over time, and from different patients, well then you have a history...and a serious problem."

I certainly understand the points made by the previous poster; however, in the current climate you need protect yourself against false accusations of abuse and molestation. The existence of an audio recording would never need to be known about by anyone but yourself, unless a false accusations is made, and in that case HIPPA will be the least of your worries. Careers and lives are ruined by frivolous, but false, accusations. After 25 years of nursing I know that ridiculous claims are sometimes believed by co-workers, management, the press, and the courts. Protect yourself, quietly.

[NunNurseCat]

I certainly understand the points made by the previous poster; however, in the current climate you need protect yourself against false accusations of abuse and molestation. The existence of an audio recording would never need to be known about by anyone but yourself, unless a false accusations is made, and in that case HIPPA will be the least of your worries. Careers and lives are ruined by frivolous, but false, accusations. After 25 years of nursing I know that ridiculous claims are sometimes believed by co-workers, management, the press, and the courts. Protect yourself, quietly.

Ugh, I wish that wasn't true. Perhaps there are cases when a recorder would be useful. I can only speak for myself, but I wouldn't care if you recorded interactions for personal protection reasons. I worry about such things a bit more since the friendly note in my box and emails regarding the use of private devices and their needing to be registered with IT, HIPAA worst cases etc. (you all know the drill).

I too have been lunged upon, hit, threatened, once I even dodged a fist only to have the person hit a coworker seconds later. Most of the incidents had mental/psych issues. I don't ever take it personally. Certainly a psych consult is a good thing, but still any patient who hits or is continually violent for any reason poses a serious risk to themselves and others. Security and the physician should definitely be notified immediately. Restraining a violent patient who isn't AO really is terrible work, but sometimes its necessary and I don't consider it assault. However if they are AOx3, then they are aware of their actions and, even with a background of bipolar issues, it is unacceptable behavior and has to be firmly addressed.

[NunNurseCat]

Too late to edit my post above but I wanted to delete the part about restraints. It's not really on topic. Also it sounded like I dont consider restraints assault. To clarify my vague statement I don't consider a person who is not oriented, and who attacks me, to be assaulting me.

[Stitch22]

As a nurse for 20 + years I have always believed that patients should treat nurses with respect. I have had patients that have thrown things at me cussed me out and I was reprimanded for standing my ground ( pancreatitis patient that wanted food) my boss came up took her side and even walked her to the cafeteria. It is ALL about " HCHAPS " and the patient experience . Long story short I made the mistake of taking a director position and during that time I found out very quickly the nurse is ALWAYS wrong it's always the patient and no matter what the patient says the nurse is the one that ends up getting the raw end of the deal. The nurse is expected to smile and take it! Upper management does not care about the nurses they only care about the reimbursement and the scores and no excuses are excepted. Yes I was hardened from this experience and even consider quitting nursing once you have seen the dark underbelly of the Hospital corporation it's hard to go back. Your supervisor was NOT joking, this is how the upper management is being taught the patient is ALWAYS right no matter what! The patient is throwing something at you or cussing at you then you must've done something wrong especially if they make a comment on their HCHAPS survey, this is how they think! It's true insanity! Or maybe this was just my expirence and it is abnormal , I hope that is true! Continue to set limits with these patients and stand your ground! Good luck!

[dec2007]

As a nurse for 20 + years I have always believed that patients should treat nurses with respect. I have had patients that have thrown things at me cussed me out and I was reprimanded for standing my ground ( pancreatitis patient that wanted food) my boss came up took her side and even walked her to the cafeteria. It is ALL about " HCHAPS " and the patient experience . Long story short I made the mistake of taking a director position and during that time I found out very quickly the nurse is ALWAYS wrong it's always the patient and no matter what the patient says the nurse is the one that ends up getting the raw end of the deal. The nurse is expected to smile and take it! Upper management does not care about the nurses they only care about the reimbursement and the scores and no excuses are excepted. Yes I was hardened from this experience and even consider quitting nursing once you have seen the dark underbelly of the Hospital corporation it's hard to go back. Your supervisor was NOT joking, this is how the upper management is being taught the patient is ALWAYS right no matter what! The patient is throwing something at you or cussing at you then you must've done something wrong especially if they make a comment on their HCHAPS survey, this is how they think! It's true insanity! Or maybe this was just my expirence and it is abnormal , I hope that is true! Continue to set limits with these patients and stand your ground! Good luck!

Stitch, it is not just your individual experience. What you said is spot on! My heart and spirit have slowly broken over the course of these changes in nursing. I pray for the future of our profession, and for the welfare of our patients.

[nursesherry7]

If your not working a psych unit, those pt. have rights and RESPONSIBILITIES. I'm saddened by the reply you received from the "higher up", and I personally wouldn't put myself in that position again.ps. CHART those behaviors and your attempts to modify by explaining that the call light is for real needs, CHART it all.