Frequent Fliers and caring for them

Long Term Care Columnist / Guide · May 21, 2005

I'm concerned. You say 'everyone' is aware of this patient's abusiveness and threatening manner, so why is it being allowed to continue? He sounds alert and oriented; the only reason he gets away with acting out like this is because nobody---not the doctor, the nurse manager, or even the house supervisor---is setting limits on his behaviors. That puts you, the new staff nurse, in a highly vulnerable position, and that's not right........SOMEBODY in authority has to step in and make this man accountable for his actions, and to protect the staff who have to work with him.

While I'm sympathetic to the needs of all patients, there are things that no one pays me enough to put up with. I will not tolerate being cursed at, kicked, punched, threatened, slapped, or otherwise abused, and I have NO problem letting patients know it. It's one thing when they are mentally ill, or demented, or in agonizing pain; sometimes the only way to deal with them is medication, seclusion, even restraints.......but an A&O patient such as you describe, who sounds like he's just pissed off because his lifestyle caught up with him, has no excuse for being abusive. Do NOT put up with it......go up the chain of command at your hospital until you find someone with the courage to set some limits on this patient's behaviors.

A word to the wise: Some of the verbal stuff, you just have to learn to let run off your back; you can't escape it entirely, and the best you can do sometimes is to not take it personally (most of it isn't personal). But at no time should you feel obligated to stand there while a patient calls you filthy names or makes derogatory remarks about your race, body size, personal habits, etc. At that point, you simply make sure he is physically safe, then tell him something like "I see you're pretty upset, so I'll leave you alone for a little bit. I'll come back in fifteen minutes, and maybe by then we can talk more calmly". Make sure you keep your word, though---patients need to be able to trust us---and if he starts in again, say "I want to help you, but I can't if you keep swearing at me and threatening me. If you like, I can bring in my supervisor and maybe she can help you with what's bothering you". (Sometimes mentioning an authority figure will calm people down.) Then go get her, and if THAT doesn't work, keep going up the line until you find someone who has enough cojones to confront this patient and set some rules for him.

And if none of this works, or if no one is willing to deal with this patient, start looking for another job where the management and the doctors refuse to allow patients to abuse the staff. I work at a place like that; I once had an OB patient whose live-in boyfriend could be heard yelling and cursing all the way down the hall, and when I went down there to ask him to tone it down he began cursing me and saying he was gonna do what he wanted and no fat-*** nurse was going to tell him differently. I immediately called security, then the supervisor........within a minute there were three big security guards, the super, AND a couple of other nurses. The guy was promptly escorted to his car and forbidden to return, the police were notified, and charges filed. :stone

We don't get paid enough to put up with crap like this. In a word: DON'T.

RNAnna · May 22, 2005

Hi,

Thanks for your reply and your words of advice. I was just at a staff meeting the other day and this client was the topic of much discussion. Our DON is aware of the situation and is trying to get all of the nurses, doctors, and administration on the same page in handling the situation. We are giving the pt the option of calming down or being discharged for refusing care. As a new nurse, and one that has no history with this client, I think that I am the target or testing grounds for how far he can push the limit. I know that I need to get a little tougher in my resolve not to be bullied. I may be new and idealistic, but I thought that all the people in hospitals truely wanted to get better and this is obviously not the case with this gentleman. It is all a control game to him, and I am the one that needs to take control of the situation when it comes to my own personal well being and how I am treated.

Thanks again for the reply and advice. It gives me a sence of empowerment in my own feelings of the situation.

Anna

Long Term Care Columnist / Guide · May 22, 2005

I'm glad to be of help. :) However, one statement really jumped out at me---the part where you said "I thought all people in the hospital really wanted to get better"---and I've got to warn you, there are many, many more people out there just like this patient you've described, and worse.

In my practice in a small community hospital, just as in every city, there is a certain hardcore contingent that is admitted time and time again with the same complaints, for which no cause is ever found despite multiple tests and tens of thousands of dollars worth of hospital care. I'll be diplomatic and say simply that most of these patients are hell on earth to deal with; they are mean and nasty and manipulative, and there isn't a darn thing we can do about it except not take any of it personally (and not put up with physical abuse). The thing is, we can't change them, because they have no desire to change.....and looking at it from their point of view, why should they? They get what they want---attention---and if being an ***hole gets them what they want faster, why not be one? Why work, or do your duty as a member of society, when you can be 'sick' and get everything handed to you on a silver platter at the hospital?

It's OK to be idealistic, especially as a new nurse, but you also have to inject some realism into your practice and know that you will meet many more patients like this one. You also should realize that YOU have to set limits and boundaries with patients, as well as with your management. It's a bit unfair that they seem to be using this patient to 'test' you; all of us have to deal with unruly patients, to be sure, but to turn a new grad loose to deal with someone whom NO ONE has been able to handle seems a tad harsh to me. Please ask for a different assignment if you continue to feel unsafe with this patient, but just know that his case isn't unusual, and that you will encounter others in the course of your career who will make this guy look like a pussycat by comparison.

Good luck to you. Like all nurses, you will need it. :)