Abusive patient...How far must I go to be a PT advocate?

[GreenApplesauce]

How far would you go for a verbally abusive patient? I have one of those and it is tiring caring for him. I find I can only do what is legally required for him, no more no less. If he was semi-decent I would go the extra mile.

But with patients like this, I cannot be a verbal punching bag. I try to sympathize considering they are in the hospital, but when they are in their right mind and choose to abuse staff, I could care less about their progress. I wish them no harm but my well of compassion dries and my compassion is withered by these type of patients.

Dealing with this type of patient I question how compassionate I am. For me I guess 'kindness is reserved for the kind.' If they are decent, I will go the extra mile as much as I can. But I won't do it for people who could care less and dont care that there are people in the hospital who really want and need our help and who are not drug seeking.

I will always give 100% when caring for all my patients. But for those who are intentionally verbally abusive and manipulative. They will just get the bare minimum of what I need to as their nurse.

I know this sounds depressing but dealing with this patient and trying giving him the benefit of the doubt and give him 100% and even going the extra mile to talk to the Doc and nurses about this social issues that would help him get better, were just a waste of my time. This experience has left me a bit jaded and annoyed.

Dealing with this guy really was so draining, it my day off and I am still fuming about it.

How do you handle abusive patients?

[CodeteamB]

Post deleted as either I was hallucinating when I read it or the OP has changed. Either way it made I sense when I went back and read it. Oops!

[GreenApplesauce]

I felt I put too much info, so a basic summary of my feelings seemed better than the prior, so other nurses who have been in such a situation can put their 2 cents.

[Tait, MSN, RN]

The fact that you are spending time trying to come to a place where you can help this man, but not sacrifice yourself does show compassion. For every five great patients I had, there was always one who just made life difficult.

I feel that rotation is a key to difficult patients. Everyone has to have their time, plus sometimes other nurses have a different way of managing these patients and it is easier for them. Some patients require the riot act be read to them, or like one nurse I know did, pulled in a security guard that had been in the army and he had a stern talk to a patient that was also army.

Some people are victims and know if they act a certain way they will be ignored and they can go on being victims. Some people just don't have a clue how they come across, and some are just so isolated within themselves they don't care.

My husband has been working with me a lot on remembering that a person's actions towards you aren't a reflection of you, but a reflection of the perception they have on the world. It goes the same for sexual harassment.

I have a hard time letting go of situations like these as well, but often reminding yourself that you can "stop them from renting space in your head" or that the more you muse over it, potentially the more obsessive and frustrate you can become.

**hugs**

Tait

[GreenApplesauce]

Thanks Tait,

You reply has helped me a bit. I really don't want to end up jaded and cynical.

[sharpeimom]

As a retired psych nurse, something that helped me from becoming to agitated with certain patients, was to frequently remind myself of the person's diagnosis and the fact that they often became enraged with staff members as a substitute for getting angry with either the person he was really upset with or dealing with the issue of having whatever disease or condition they had.

[sandyfeet]

I believe you can still be compassionate while protecting yourself emotionally. The bigger risk to me is becoming burned out and having your quality overall suffer. You are still providing care, being an advocate, and meeting your patient's needs. There are always going to be some patients whom we are able to go the extra mile for and some whom we can't. But we are still doing something, and something is better than nothing. At the core of our jobs, we are being compassionate every day.

[Ruby Vee, BSN]

​I don't understand . . . why do you have to advocate for Physical Therapy?

[classicdame, MSN, EdD]

I have more tolerance than some with these patients because I look upon the behavor as a "symptom". But you are right, it is very hard to deal with over time. I recommend you find out if your employer has an employee asssitance program (possbile part of your health insurance). Ours does and we can call a psychologist or other counselor and do phone therapy or in person. I tried this last year with good results. I was given some tools to help me cope.

[SoCalGalRN]

Gosh I wish I had 5 nice patients to 1 mean/hateful patient. I easily have 5 abusive/angry patients to 1 nice/reasonable patient.

[jadelpn, LPN, EMT-B]

It is a disease process. No need to personalize. Disease process coupled with a less than incredible personality--just be thankful you don't have to go home with the patient.

No sympathy, try empathy. You DON'T have to "treat kind with kindness"--that is something one does in their everyday life, not in work mode--professional, yes, kindness and sympathy not so much.

And you should perhaps think about the patient's progress. Because if they are not progressing, then it is something that needs assessing. There are people who are just not semi-decent. They are ill, they are in pain, they have some cognitive or organic process happening, and it manifests itself by the patient being less than decent, manipulative, demanding.

You do not need to be your patient's friend. You could go the extra mile by speaking with the MD about an alternate plan of care if the one that is currently in place is just not working.

I have seen some lovely patients become sour pretty quickly because of a variety of things--mostly related to the realization that they are not progressing quickly enough for them, relentless chronic pain, or it dawns on them that the "carefree days of yore" are gone. I have also seen the worst tempered patients become different people once the disease process or sickness that has overtaken them is finally under some sort of control. And that is what it is--control and/or lack thereof. So don't make it a power struggle.