Verbally abusive patient, worried I could have handled the situation better - page 4

Let me start out by saying this is a little long winded, but it has been weighing on me and I have to get it off my chest, so bear with me!!! So, my last shift, I had gotten report on a male patient... Read More

  1. by   Julius Seizure
    Quote from Been there,done that
    Did YOUR patient ask to stay?Was YOUR patient too weak to ambulate alone? So many risk factors and legal ramifications over a mis -handled cup of coffee request.
    I mean....technically he wasn't anybody's patient at that point. He had been discharged. He was her former patient, I suppose.
  2. by   23AtTheTeeth
    I don't know, I am not on board with "just giving the guy his coffee." If you were to give him his coffee and make him go over his restriction, you would be directly breaking a physician's order. I think the only thing different I would have done was to talk to the doctor about either increasing the restriction or lifting it completely. I think they're BS anyways. Seriously? You think we are going to work our asses off tuning someone up who is so grossly non-compliant and they're NOT going to just go right home and drink their heart into oblivion? Yeah right. I wouldn't have given him coffee either. I would have said, "I just barely met you, I don't know anything about you or your case. You just got here. I am going to need about 10 minutes to look at your chart. I can even stay right here and look at it right here if you'd like?" What a tool. I'm sorry that happened to you!
  3. by   Kooky Korky
    Quote from nursemike
    Sometimes our patients are having the worst day of their lives. They're frightened, they're frustrated, and acting out may be the one way they have of feeling like they have some sort of control. As much as it may not look that way, in our relationships with our patients, the power is disproportionately ours, and that can be hard to swallow for the one without the power. Indeed, we sometimes feel like we are powerless and have to kowtow to get those patient satisfaction score, which makes us want to act out a little, too.
    In times like these, it's very important to understand that people may be dealing inappropriately with their anxieties and stress because they just don't know any other way. Nor is it wrong to step away a moment, take a cleansing breath, and keep in mind that some of these people were probably jerks long before we ever met them, and will be long after they're discharged.
    You are wonderful re: understanding. However, neither OP nor any other nurse is required to be afraid for his or her physical safety. We're nurses, not police. Nurses, not in combat.

    His damned doctor totally disrespected the staff, who were trying to carry out the doctor's orders. So now the staff look like idiots, sadists while the doctor looks stupid but heroic.

    I am glad OP told him to begone. She now needs to let the doctor know that he made her look ridiculous and that she now doesn't know which orders he wants followed and which he doesn't.
  4. by   Kooky Korky
    Quote from Okami_CCRN
    To be honest, I would have just given him the cup of coffee when he asked for it, and educated him on his fluid restriction and why it is in place. If he wants to follow it great and if he doesn't you can inform the physician and document.

    I think that everyone saying let me ask your nurse/let me check your chart/let me talk to the doctor probably made him feel like people were avoiding him and his request.
    So you would have given in to his babyish demands and not followed orders? That would leave you open to claims of negligence or malpractice I think because you handed him the coffee or whatever liquids.
  5. by   Kooky Korky
    Quote from NurseMom2016
    YES lol-it is a female hospitalist and she is sometimes very good at throwing nurses under the bus, others she acts like your best friend.
    Report her to the powers that be. Also, sit her down and inform her that she is creating confusion about which orders she really wants followed.

    Better yet, wake her up a few times per night, call her every 1/2 hour during the day and ask for clarification because her pt is thirsty. Or whatever else you can question. LOLOLOL

    Gotta train them, you know.
  6. by   Kooky Korky
    Quote from Apples&Oranges
    Let me add one more thing - your original question was something like, "Could I have handled it better?"

    Of course. We all could handle 80% of of our patient interactions better.

    A more relevant question is, "SHOULD I have handled it better?"

    Maybe I'm just at the end of my patience allowance for the month, but...my vote is no. Some people just need to be shown the door.
    I think I handle at least 80% of my interactions well.
  7. by   Kooky Korky
    Quote from Been there,done that
    Any patient has the right to refuse a doctor's prescribed treatment. YOU had no right to refuse the patient's request. It's a hospital, not a jail.

    "but could that have made him stay longer in the day, and then I would have had to deal with him even longer?"

    This is not about you, it's about the patient. You basically bounced out a patient that was not ready to go home, that even rescinded his own discharge and was visibly too weak to manage his own care... because your feelings were hurt.

    Talk to your risk manager, make sure your malpractice insurance is in effect.
    I have to disagree, BTDT.

    The patient can refuse treatment, but the nurse has to follow orders. OP had every right to try to follow orders.

    When the patient is a safety threat, when he starts battering her, it is indeed about the nurse/staff.

    She didn't bounce anyone. The doctor released him. She had her manager's blessing, too. Patient can always come back anyway.
  8. by   Lil Nel
    Did the doctor give the patient coffee AFTER she had written the discharge order? I guess I thought that was how it happened, but maybe not.

    If it happened that way, I took it as the MD's way of saying: Bye-bye fella, and good luck to you!

    But if she brought the coffee BEFORE the discharge order was written, then I would speak to her.

    While it is commendable that you are analyzing your behavior, OP, I really hope you won't sweat this one too much.

    The patient was alert and oriented and sometimes you can't save people from themselves because they aren't looking to be saved.
  9. by   JKL33
    Quote from Kooky Korky
    Report her to the powers that be. Also, sit her down and inform her that she is creating confusion about which orders she really wants followed.

    Better yet, wake her up a few times per night, call her every 1/2 hour during the day and ask for clarification because her pt is thirsty. Or whatever else you can question. LOLOLOL

    Gotta train them, you know.
    Kooky...

    Come on, you don't really mean that, do you? She'd already discharged the guy, after telling him that he may NOT treat staff that way.

    I'll take that for support, in a heartbeat. I would've brought him the coffee myself at that point, seriously.
  10. by   Kooky Korky
    Quote from Been there,done that
    Feel free to take a break.

    Use your assessment skills to look at the big picture. This is not about serving a patient a cup of coffee. This is about managing a patient that is declining doctor's orders.

    Certainly, an alert and oriented patient does not have the right to abuse a nurse. The POINT is the nurse escalated the event.

    "I'm glad he left." Why is that? So the nurse no longer has to deal with a mis-managed patient.. that is clearly unable to be discharged.. and asked to stay? You won't be so "glad" if he comes back in fulminating pulmonary edema and it was YOUR name on the discharge.
    The doctor ordered the discharge. The doctor handed the guy coffee.

    The nurse did not escalate the event. If she had thrown stuff at him and screamed at him like Gunnery Sergeant Hartman, that would have been her escalating the event.
  11. by   turtlesRcool
    Quote from JKL33
    Kooky...

    Come on, you don't really mean that, do you? She'd already discharged the guy, after telling him that he may NOT treat staff that way.

    I'll take that for support, in a heartbeat. I would've brought him the coffee myself at that point, seriously.
    I agree with you about the support, and I assume Kooky is also kidding about unnecessary pages.

    But I think talking with the doctor about what orders she wants followed is a good one.

    This thread opened with several PPs stating they would just have brought coffee, and others stating that nurses can get into trouble for actively going against an order (different from documenting a patient getting his/her own drink). Several staff members ended up in a power struggle with the patient and were verbally and, in OP's case, physically assaulted as a result of trying to carry out the doctor's order. When she gives him a cup of coffee, it undermines the efforts of the other staff members.

    If she's okay with staff carrying out patient requests that contradict her orders, that needs to be known, and there should be some kind of protocol in place for nurses to cover themselves in those situations.
  12. by   NurseCard
    Quote from Been there,done that
    Any patient has the right to refuse a doctor's prescribed treatment. YOU had no right to refuse the patient's request. It's a hospital, not a jail.

    "but could that have made him stay longer in the day, and then I would have had to deal with him even longer?"

    This is not about you, it's about the patient. You basically bounced out a patient that was not ready to go home, that even rescinded his own discharge and was visibly too weak to manage his own care... because your feelings were hurt.

    Talk to your risk manager, make sure your malpractice insurance is in effect.
    For real???? Wow. Harsh.
  13. by   blackboxwarning
    To be fair, I'm like that before my coffee too.

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