Crazy, abusive patient? What do u do?

[Anagray, BSN]

I had a very discouraging experience a few weeks ago.

I'm a tech on a cardiac floor. One saturday night about 8 pm I saw a stretcher coming my way, so as usual, I went to check out the patient and help to get him situated. It wasn't an old man this time, but a 30 y o guy.

The patient was pissed off by the ER nurse who transported him. For something she did that he didn't like, he called her names, said very nasty things about her right to her face. He yelled: " u get paid to do such and such" She turned around on her way out, obviously upset, and said " i don't get paid to take the abuse from you"

I thought that he was irritated by the 7 hour wait in the ER or something like that, i had no idea this would be the night from hell.

Noone could figure out what was up with this guy. He yelled and screamed all night long, refused his nurse, tried to call the police, cursed out the resident on duty, cursed out the security, and then yelled and yelled and yelled. He wouldn't leave ama, but he wouldn't take anything besides morphine and not just from any person.

I was supposed to go in and try to take blood from this guy and do his vitals. Iw as probably the only person who could go into his room without being cursed out or yelled at, but i was seriously concerned about him punching me out or something.

Of course, he was on the bell continuously. Every little thing caused a HUGE blow up - like the fact that he couldn't have mountain dew on a cardiac foor.

At the end of my shift I sat and talked with him, trying to settle him down, so the nurses can do their jobs and the rest of the patients can sleep ( it was close to 11)

The only thing that kept him quiet was me rubbing his back with lotion ( and i will never EVER do it again to any man, because this pig started hitting on me and asking me personal questions)

His doctor didn't come to see him until the next day and he basicly kicked him out.

In the mean time, the whole staff had to put up with abuse all night and all morning.

Have u ever had an abusive patient who was out of control?

I feel now that we are not protected enough against people like that, regardless of what their issues are. I have a hunch this guy was de-toxing, but it was just luck that he didn't lash out at anyone.

[Nurse Ratched, RN]

I have two words for you:

"psych consult"

We're waiting for the call :).

[Nurse Ratched, RN]

And that wasn't to be flip or minimize the abuse you took. In my facility, any patient who treated the staff like that would find himself on the psych floor or out the door so quick his head would spin. You are nursing staff, not abuse receptacles. I'm thrilled for you he got out the next day - sorry you had such a crappy night .

(And he wouldn't have gotten morphine.)

[P_RN, ADN, RN]

Amen Ratched. What I did about an abusive patient is:

Fell to the floor after being kicked in the face breaking my cheekbone. I then proceded to have a 20 min LOC and spent the night in the ER. That's what *I* did. I don't advise it.

Your guy sounds whacko. He's either on something or not taking something he should be on!!

First abusive word/act I'd walk out and call security.

[amy]

I am beginning to think I am not very nice compared to you guys. I give them a coule chances to correct their behavior, then I tell them that as longas they continue to treat people like that theywill find NOT ONE nurse coming to help them...remember the little boy who called wolf? Then, I do not go into the room, give them meds, or anythin else. And our security folks are great! They don't take any sh** and do not expect us to.

[joenp]

I am sorry that you had that bad experience. I agree with Ratched, a psych consult would have been a good idea. I am also wondering if some type of sedative could not have been ordered with the morphine that could have been given. I understand that his medical condition may have precluded that as an option. I think that the resident should have taken more of a lead and called this patient's attending to get something done alot sooner. In case of abusive patients, I would be calling the resident every 15-30 minutes with updates. If they started to get abusive, I would immediately invite them into the room with me to experience what I was going through. The resident would then have to start to do something, because I would not stop my updates until something was done. I think involving your shift supervisor would have been a good idea, they might be able to do something to help things along from an administrative standpoint. It is easy for me to say, but I have been in situations like yours and I did exactly what I said, and the resident got so tired of me that he finally called the attending and got a sedation order which we gave to the patient. I hope that this helps. By the way, I worked with frontal lobe head injuries, guys who were young and very strong! Good luck, and do not take abuse from anyone, you do not deserve it! Plus is your resident had any "testicles", he/she would have been more proactive with this patient. joenp

[shay]

Haldol blow darts.

[ernurse728, LPN]

Can you say Ativan and leather restraints!!

[ERNurse752, RN]

J-A-I-L!!

If he was there for detox, why was he on a cardiac floor? Seems like he'd be better suited for psych or a detox unit...

Do you remember if they did an etoh and/or drug screen?

Might be interesting...

[deespoohbear]

I would have done this in this order: notify the pt's doctor, notify the shift supervisor, notify the hospital administrator, notify the police. We do not have security at our small hospital, so the PD is it. I would have not stood for this abuse for one moment. I may be a nurse, but I have rights also. One of them is not to be abused by patients, their families, staff, or doctors. Period. I don't go to work so I can be abused and cussed at. I go to work to help patients (and to earn a living). I doubt if many other professions would be subject to take this nonsense, so why should nursing? My guess is that is stems back from the days that when almost all nurses were female. We no longer have to take this bull. Hopefully you will never encounter this again.

[Anagray, BSN]

P_RN - i am so sorry for what happened to you! This is exactly what i was afraid of with this guy. I hope u recovered and feel better now.

About the guy again - he refused haldol and all the rest of the meds. Every administrative and non administrative staff member went to visit this guy and when they called his doctor, he basicly said " deal with it till morning".

The reason why he was on our floos was because he was admitted with chest pain, he had previous cardiac surgery also, so they sent him right up to us.

Up until this point, I was considering going to medical school some time before I die , but now i am not so sure.

DO I really want to be responsible for a person like that? Do physicians have the right to refuse a patient?

Anyway, thanks for all your advice and support. If i ever encounter this again, I will know what to do. I'm not going to try and put my face forward and let the supers deal with it.

[Nurse Ratched, RN]

Anagray, that doctor should be shot. I'm sure from a liability standpoint he couldn't discharge him without a 23 hour observation (sure as he did, the guy would have keeled over on the hospital steps.) BUT, that doesn't mean the doc disavows all responsibilty for this patient's behavior.

Every hospital should had a medical psychiatric floor. No one wants to float to our unit, but, boy, do they love us when they have these kinds of patients! :)

Even when I was working medsurg, tho, such a patient would have gotten the following options: (1) simmer down now! or (2) go AMA and don't let the fire doors hit you in the orifice on the way out. Our unit was the dumping ground for drunks, so we got lots of practice. Security backed us up. I am hoping that your nurses and administration take this example as a way to learn how to handle the inevitable future buttheads that will come your way. What provisions do they have in place for an abusive patient if the pt is potentially medically unstable (read: the police won't take him) but is not manageable on a traditional medical floor? This incident should tell then they need to have protocols in place.

Good luck!

Oh, and P_RN, I hope you pressed charges against that patient.