Verbally abusive patient, worried I could have handled the situation better - page 5

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   NurseCard
    Quote from blackboxwarning
    To be fair, I'm like that before my coffee too.
    You win.
  2. by   TriciaJ
    I don't think it would have mattered if he'd been given a cup of coffee or not been given a cup of coffee. Five minutes later it would have been something else. The guy is on a collision course with destiny and at this point I don't think it's a matter of education.

    The doctor gave him his coffee after she told him he was discharged; I agree it was her way of telling him she was washing her hands of him. Changing his mind about discharge after getting his coffee was just being manipulative and all the abhorrent behaviours would have just continued. I don't blame the OP for not allowing that and sending him out the door.

    Having worked psych for the first half of my career, there is one thing I always tell students and orientees: "You can't save someone from himself and it does no good to work harder for someone than he is willing to work on his own behalf".

    This is the kind of patient that always leaves you second-guessing yourself because they like to create lose-lose situations. It's unfortunate but you have to just shake it off. Hugs.
    Last edit by TriciaJ on Sep 21 : Reason: misspelling
  3. by   CollegeStudent1
    All the people saying "just give them the coffee" makes me think of a video we watched at orientation for my hospital. It's called "Give 'me the pickle". I'm not saying to just give in to the patient EVERY time, but weigh the pros and cons. If he's coming close to that cut off line say "this is your last cup until such and such time. You're close to your restriction line." Or "if I give you this cup now, you won't be able to get a drink later." I once had a patient who decided to start doing half cups of coffee to try to save some mls for later.

    Give 'Em the Pickle by Bob Farrell - Customer Service Training - YouTube
  4. by   Jory
    A paper in the room tracking intake really should have been in the room. The nurses check on these at my facility throughout the shift as it makes it easier for the techs to grant immediate requests for fluid.
  5. by   CrunchRN
    He made his own decisions and you are not responsible if he chose to make poor ones.

    I think I would have given him the coffee, but if he talked to you again that way after that I would have happily showed him the door. Just because a person is sick does not give them the right to treat their caregivers that way.
  6. by   Amethya
    I agree with a lot of these. Not a nurse, but CMA and I had my share of verbally abusive patients. I just gave them what they wanted and went to my OM to tell them what happened, just in case they came back and complained. I always did everything by the book and if they weren't happy, I could ask if they wanted another CMA instead of me.
  7. by   JKL33
    Quote from CollegeStudent1
    All the people saying "just give them the coffee" makes me think of a video we watched at orientation for my hospital. It's called "Give 'me the pickle". I'm not saying to just give in to the patient EVERY time, but weigh the pros and cons. If he's coming close to that cut off line say "this is your last cup until such and such time. You're close to your restriction line." Or "if I give you this cup now, you won't be able to get a drink later." I once had a patient who decided to start doing half cups of coffee to try to save some mls for later.

    Give 'Em the Pickle by Bob Farrell - Customer Service Training - YouTube
    What is your plan when "later" becomes now? Yes, it's slightly possible that some negotiations or concessions may have improved the OP situation. Very slightly, as in - probably not, but I'm not willing to say 100% impossible, and I would at least try. Lets acknowledge though, that patients who would negotiate with you like reasonable human beings are not usually the ones calling you a stupid, lazy, effin' fatass.

    Here's the second problem - which has always been the problem with customer service as it relates to patient satisfaction as it relates to things that make patients happy: We're not talking about restaurants or free pickles. We're talking about something that is medically contraindicated (and I'm not going to argue about how necessary fluid restrictions are; the fact is that currently they are generally an accepted part of a plan of care/standard of care for such a patient, which is why the physician ordered it in the first place).

    I have no problem with patients refusing aspects of their care or asking for concessions, such as cups of coffee, that may be medically contraindicated. But I think that they should take full responsibility for that, as opposed to making medical providers "give them a pickle." When patients receive care that is out of line with accepted standards, the care team generally retains legal responsibility for that. Conceding while retaining the legal responsibility goes well beyond "customer service." It's pretty disingenuous to conflate the two. This is a hospital. I don't care what the non-medical patient services people say, customer service is not things that are medically contraindicated. Don't you know -- Medical errors are ((supposedly)) the third leading cause of death in this country...?

    So which is it? We're killing practically everyone, or we should give people pickles that are medically contraindicated?
  8. by   Mulan
    Edit from beyond the grave?
  9. by   Mulan
    Almost everyone is focused on the cup of coffee and that is not what the OP is concerned about.

    This is:

    quote from NurseMom2016
    " THIS is the part I am questioning myself about-I told him "no sir, I have already removed everything and you have signed the paper to leave. The cab is on its way to pick you up." He did leave, and had to have assistance from the tech and officer to transfer from a wheelchair to the cab.

    I had a hard time leaving some of the things he said to/about me at work that day. (I.e. You fata**, you shouldn't be a nurse, f***ing dumb nurse, I could go on). Remember, this man was as oriented as he could be, and was able to hold a calm conversation with others during this time. Probably some undiagnosed psych issues or something. I have never had anyone speak so poorly about me. So, yes I am glad he left within the first 2 hours of my shift, BUT my conscience keeps hanging on three things: one, that he wasn't able to walk on his own and we just sent him on his way. Two, that the foley was there for retention and it was removed almost immediately before he left. And three, that in the end I kind of told him he had to leave (I think he probably would have anyways).
    Thank you if you have read this whole thing, I tried to condense as much as I could! Let me know what you think, if something could have been handled differently, etc. "
  10. by   Ruby Vee
    Quote from TriciaJ
    I don't think it would have mattered if he'd been given a cup of coffee or not been given a cup of coffee. Five minutes later it would have been something else. The guy is on a collision course with destiny and at this point I don't think it's a matter of education.

    The doctor gave him his coffee after she told him he was discharged; I agree it was her way of telling him she was washing her hands of him. Changing his mind about discharge after getting his coffee was just being manipulative and all the abhorrent behaviours would have just continued. I don't blame the OP for not allowing that and sending him out the door.

    Having worked psych for the first half of my career, there is one thing I always tell students and orientees: "You can't save someone from himself and it does no good to work harder for someone than he is willing to work on his own behalf".

    This is the kind of patient that always leaves you second-guessing yourself because they like to create lose-lose situations. It's unfortunate but you have to just shake it off. Hugs.
    I agree with you that five minutes later it would have been something else -- there are no indications that he hadn't been educated or that he hadn't agreed to the planned fluid restriction.

    I love your quote: "You can't save someone from himself and it does no good to work harder for someone than he is willing to work on his own behalf."
  11. by   Ruby Vee
    Quote from JKL33
    What is your plan when "later" becomes now? Yes, it's slightly possible that some negotiations or concessions may have improved the OP situation. Very slightly, as in - probably not, but I'm not willing to say 100% impossible, and I would at least try. Lets acknowledge though, that patients who would negotiate with you like reasonable human beings are not usually the ones calling you a stupid, lazy, effin' fatass.

    Here's the second problem - which has always been the problem with customer service as it relates to patient satisfaction as it relates to things that make patients happy: We're not talking about restaurants or free pickles. We're talking about something that is medically contraindicated (and I'm not going to argue about how necessary fluid restrictions are; the fact is that currently they are generally an accepted part of a plan of care/standard of care for such a patient, which is why the physician ordered it in the first place).

    I have no problem with patients refusing aspects of their care or asking for concessions, such as cups of coffee, that may be medically contraindicated. But I think that they should take full responsibility for that, as opposed to making medical providers "give them a pickle." When patients receive care that is out of line with accepted standards, the care team generally retains legal responsibility for that. Conceding while retaining the legal responsibility goes well beyond "customer service." It's pretty disingenuous to conflate the two. This is a hospital. I don't care what the non-medical patient services people say, customer service is not things that are medically contraindicated. Don't you know -- Medical errors are ((supposedly)) the third leading cause of death in this country...?

    So which is it? We're killing practically everyone, or we should give people pickles that are medically contraindicated?
    The "customer service pendulum" has swung so far that we're now happily providing patients with liquids, foods, options that are medically contraindicated. And it seems that many of us nurses don't see the problem with just giving the patient whatever he asks for. That's good customer service, you see, and it obviously trumps good patient care for many nurses. Or maybe it's "give him what he demands so he'll shut up and my shift will go more smoothly."

    The original poster handled things just fine from the refusal to bring the cup of coffee to the refusal to let the manipulative donkey stay after he'd officially been discharged. Some of the rest of us . . . not so much.
  12. by   RestlessHeart
    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 so love almost every one of your responses. I may have to start stalking you (so I can learn more of course). Thanks for speaking out.
  13. by   RestlessHeart
    At the risk of getting my "membership" here handed to me on a platter..Id like to ask something. Please keep in mind I am not and never was a Nurse of any degree. I do have great respect for all of you in the Medical Field. My Medical side is only extensive as far as the patient view because Ive been one way tooooo many times.

    Anyway... I digress. Just be gentle ok? Im curious about the fluid restriction and how that comes about. How is it decided and who decides how much of a restriction is applied? Does it mean ANY fluid? Is it "touchy" (where a little too much or a little too little can be nasty?)

    My twin has kidney failure and when she was hospitalized and later in a Nursing rehab prior to going home they had her on fluid restriction. But...here's the thing I never understood. She would leave the clinic / dialysis and almost immediately drink 2, 16 ounce bottles of Mt Dew. Mind you she is a raging diabetic that believes you can eat or drink anything as long as you take the insulin. UGH.

    Anyway....I appreciate any responses...just be gentle.

    Have a super day and I wouldnt wish the treatment the patient OR the nurse received in this matter on ANYONE!!

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