question: can you chart on a pt. being rude? - page 2

by aligar89 7,779 Views | 35 Comments

Is it just part of our job as a nurse to deal with rude behavior and the name calling or can i document on a pt being mean, grabbing my arm tight when yelling at me, accusing me or just mocking me? These a various pt by the way... Read More


  1. 2
    Quote from Rhi007
    Haha at my ED we can fine people!!! One of the nursing staff, when he first started didn't speak great English and was told by a patient 'go back to where you came from' so he fined the patient $200
    Oh wow, if we could fine for that kind of behavior I can tell you LOTS of people would be paying out the Wazoo.... Although by my experience, in Quebec, they don't pay out of pocket for healthcare so it wouldn't apply, and since I've been in the US the behavioral issues tend to also be with those not paying out of pocket...Unless it is done like something legal, a fine for verbal/physical assault, have to go to court etc. That might miraculously teach some people manners!
  2. 5
    I'd chart something like that under psychological/behavioral. It's not about being petty or trying to "get back" at a patient for offending the staff. Charting on behavior/psychological/pt's affect has a legitimate place in your assessment.

    And yes, I definitely chart it with lots of direct quotes and objective observations. It not only helps to create a baseline for the patient, but it can track increasing aggitation, long and short-term psych issues, how patients are coping with their diagnosis/hospitalization/treatment course and it also warns your fellow staff: docs, nurses, PT/OT, techs--everyone who has to venture bedside.
    Last edit by SoldierNurse22 on Feb 13, '13
    anotherone, MedChica, Meriwhen, and 2 others like this.
  3. 4
    If the patient is rude, I'd chart the specifics of his behavior.

    0800 "Patient states, "I don't want to see your face, get the **** out of my room." Pt. refused vital signs, slammed the door to hospital staff. Tried deescalating...
    0845 Pt. paces the room, states he doesn't want to be in the hospital. Attempted to deescalate, patient slammed the door...

    Document what the patient did, what you did to bridge the behavior and if it's a success or not.
    Last edit by Meriwhen on Feb 14, '13 : Reason: TOS: removed profanity
    anotherone, Esme12, tyvin, and 1 other like this.
  4. 4
    You can describe the behaviors, but not assign labels.

    Even words like "agitated," "aggressive," "combative," "resistive" are not adequate when charting. Write exactly what happened, using quotes whenever you can.

    Also note what you did (again, describe exactly the actions you took, do not use vague words like "redirected" or "de-escalated") and then describe the pt's response.

    "Pt became agitated and verbally aggressive. RN redirected, pt continued to escalate, becoming combative. Code Green called, pt given Zyprexa 5mg IM, Zyprexa effective."

    That note has lots of very vague information. It is completely useless though, to anyone else on the treatment team. Why did the pt become agitated? What was he doing? What does verbally aggressive mean? What exactly did he say? How did staff respond? What does combative mean? What did he do? In response to the Zyprexa- how long did it take to have effect? What does effective mean? What are his behaviors 30 min after the injection? 60 min after?

    The answers to those questions will be much more helpful to everyone on the treatment team. It can help prevent the situation from reoccurring.
    It can help the physician decide if medication adjustments are needed.
    anotherone, MMaeLPN, Esme12, and 1 other like this.
  5. 3
    Quote from Rhi007
    Haha at my ED we can fine people!!! One of the nursing staff, when he first started didn't speak great English and was told by a patient 'go back to where you came from' so he fined the patient $200

    LOL how do you get them to pay up????

    Im sure the majority of them don't have money- so this is kinda a moot point...
    anotherone, RNperdiem, and Esme12 like this.
  6. 2
    Quote from Rhi007
    Haha at my ED we can fine people!!! One of the nursing staff, when he first started didn't speak great English and was told by a patient 'go back to where you came from' so he fined the patient $200
    Where do you work and how does this work????
    FlorenceFrightengale and psu_213 like this.
  7. 0
    Quote from Nurse_
    If the patient is rude, I'd chart the specifics of his behavior.

    0800 "Patient states, "I don't want to see your face, get the **** out of my room." Pt. refused vital signs, slammed the door to hospital staff. Tried deescalating...
    0845 Pt. paces the room, states he doesn't want to be in the hospital. Attempted to deescalate, patient slammed the door...

    Document what the patient did, what you did to bridge the behavior and if it's a success or not.
    I agree that facts, and only the facts, should be documented. I also like that someone mentioned to chart and intervention/evaluation. Suppose the patient grabs you, throws something at you, and cusses you out. A hour later another staff member goes in there and is physically harmed by the pt. It would not be a very good career move if you saw and charted dangerous behaviors but did not chart that you "dealt" with them.
    Last edit by Meriwhen on Feb 14, '13 : Reason: Quoted edited post
  8. 5
    Quote from sarakjp
    I have written things like irritable, frustrated, resistant to care, combative, demanding, although I agree it's important to be as objective as possible. Quotes are great. & that patient seems like my worst nightmare. NO TOUCH!!!

    Quotes are not only "great," they are the only thing you can write. "Pt could not hold his toothbrush to brush teeth, threw it on the floor and stated, 'I'll never be able to do this' in a loud voice. Pushed nurse's hands away when handed a new clean one. Stated, 'I want you to brush my teeth, the nurse yesterday did it, why are you making me? You do it, that's what you're paid for.' "

    See, now you have established that he is irritable, frustrated, resistant to care, combative, and demanding in terms that anyone who reads that four years later (as I will when I review the chart) can visualize. Without that, it's your word against his. Word to the wise.
    rn/writer, anotherone, BrandonLPN, and 2 others like this.
  9. 1
    I almost always quote verbatim. Rude is subjective. If the pt gets physical, I chart specifics. Grabbed, pinched, squeezed, hit...
    psu_213 likes this.
  10. 1
    As previous posters have said, document objective findings only, nothing subjective. This also covers you, because if you have a patient who is extremely agitated and won't even let you get near them (we had a patient like that once...she even threw her lunch tray at a nurse when she walked through the door! ) and then they complain because you didn't do anything for them or they didn't get this med, this treatment, etc...your charting will cover you for that. And make sure to tell the doctor, too, that way they are aware and that also covers you. And document that the doctor was notified.
    rn/writer likes this.


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