Incredibly rude and disrespectful patients and/or their family members

DaniannaRN, ASN, BSN · Oct 7, 2013

I don't know when conditions got so bad in the hospital. I haven't worked in a hospital setting in about 7 years, but I don't remember patients/families being that bad. Sure, we had a few here and there, but not like it is now.

That's why I left the hospital setting. At my job, we do not tolerate rudeness from anyone. My boss tells us if someone is rude when we visit them, tell them right away to knock it off. If the rudeness continues, then we leave their home immediately.

Nurses need to stop bending over and taking it. Why did we go to college? No other college-educated profession is treated like this. Let's just become minimum wage workers so we can expect it.

sbfairy · Oct 7, 2013

ITA with GrnTea. You gotta stand up for yourself. I used to work on a med/surg floor and we had a repeat customer who was just awful. He had about 20 pills scheduled for a.m. meds and if you were lucky you may have gotten to take 4 of those pills. The rest would end up thrown at you. What's worse is if you reported it to his doctor the doctor would say "you're the nurse, figure out how to get those pills into him". This man slapped 5 nurses on my floor. The one time he threatened to slap me I let him know that I would not tolerate being threatened. When he drew back his hand I told him that if he hit me I would immediately have the police called and I would press charges. Guess what? That man put down his hand and never threatened me again. He did, however, continue to throw his morning meds at me.

Alnitak7 · Oct 7, 2013

How do you handle them?
I am a fairly new nurse (1.5yrs) and brand new to the hospital setting.
No one says "please" or "thank you" and they order me around like I am scum of the earth.
"Turn my light off"! I simply told him I would turn his light off if he would say "please".
When I turned around to look at him, he threw his urinal (filled with urine) at me and screamed again for me to turn off his light.
My supervisor told me when patients or their family members get out of control to "kill them with kindness".
One of the first rules I have always followed with these people is that I don't EVER expect them to say please. Telling someone to say please reduces them into an incompetent little child. As for him demanding that you turn his light off and throwing the urinal, he sounds like one of those brain damaged patients or someone with M.S. or a progressive illness that makes them agitated. Most nursing staffs have their own protocol for these types. As for them yelling at you for stupid things, this sometimes is the only thing they have any control over. I remember a patient who was dehydrated who was screaming and swearing. He was not able to say, "bring me a drink." I went in and looked at him once and figured out he was thirsty and brought him something to drink. Their discomforts can make them cranky.

As far as killing them with kindness, I don't think anyone should reward their abuse with a sweet attitude unless you're motivated to be this way and know this helps them.

If they really offend me, I try to get the others to help me with them.

applewhitern, BSN, RN · Oct 7, 2013

I would never tell a patient to say "please." I am not there to teach them manners. I would have simply made sure there was enough light for him to locate his "call bell" or bathroom, then I would have said goodnight and turned off the light.

Esme12, ASN, BSN, RN · Oct 7, 2013

How do you handle them?
I am a fairly new nurse (1.5yrs) and brand new to the hospital setting. I previously worked in a clinic and spent very little time with my patients. I was with a doctor at all times so if a patient was mad, upset or angry they would always take it out on the Dr. Well, now I work full time days in a short term acute care rehab hospital. I love my job, my fellow nurses and the hospital I work at. I have one problem though, I am struggling with incredibly rude and disrespectful patients and/or their family members. No one says "please" or "thank you" and they order me around like I am scum of the earth. I get yelled at all day long by patients and families about stupid things that I cannot control! I get blamed for everything, ordered around and feel like I constantly have to walk on egg shells due to the fact I am afraid the pt or family with complain about me. The other day, a man rang the bell and when I came in to see what he needed, he screamed "turn my light off"! I simply told him I would turn his light off if he would say "please". When I turned around to look at him, he threw his urinal (filled with urine) at me and screamed again for me to turn off his light. As I walked to the break room to change my scrubs I asked myself how long I will be able to handle this. How do you handle patients and families who treat you like this? My supervisor told me when patients or their family members get out of control to "kill them with kindness". I really try not to let things that people say/do get to me however I have always been that person who takes everything to heart. When I bust my butt all day long to help these people and nothing is ever good enough, it gets pretty discouraging.
Thanks :)

I think society in general have lost the ability to function in society with good manners. I have no idea where they went.....but they are missing. Personally, think that in this wireless society spending so much time behind computer screens...we have lost the ability to function in in public and with each other.

That being said....you are not going to fix everyone. I would not instruct a patient I will do as they ask only after they say please. It is not your job to admonish them, like a petulant child, about their manners. I could see that as a potential trigger for their outburst. I can see the patient thinking "how dare she treat me like I'm a child!!!" when they are usually able to get up and do things for themselves....it is extremely frustrating to have to keep asking people to do things for you.....things you used to be able to do yourself. Trust me I know.

Patients are angry for many reasons. They go through the same phases that someone goes through with any loss. As Kübler-Ross model theory points out...patients go through "five stages of grief", it says that when a person is faced with the reality of impending death or other extreme, awful fate, he or she will experience a series of emotional stages: denial, anger, bargaining, depression and acceptance. They are feeling vulnerable. They are angry they are sick. They have financial worries. They are fearful their spouse won't stay by them. They have their own demon that plague them. And there are some that are just angry ill mannered people.....but it is not your job to correct them...you are not their mother.

I treat everyone equal....as if they are the nicest people on earth. What do I care what they think. I am in the camp of "Kill them with kindness" for you are not going to fix them.

I think throwing the urinal is offensive and assaultive...but if you just went in turned off the light and asked if there was anything else they would need.....try to make it so they can turn off the light themselves......I don't think they would have thrown the urinal at you.

Things to remember....people are jerks....they don't change just because they become ill. In fact they become worse. It isn't personal for they treat everyone poorly....and you can't fix stupid. I feel that I won't stoop to their level and know they get under my skin. Kind of like bullies they seek satisfaction in the response...I just don't give them the satisfaction of knowing they bothered me.

amzyRN · Oct 7, 2013

I don't care much about please and thank you's either as much as I do yelling and screaming and throwing things. Some people just don't say please and thank you. Maybe it's a cultural thing or whatever. Little things like that are annoying but don't make me angry. What makes me angry is unreasonable demands, like getting a private room when none are available, or breaking hospital policy like sleeping with the patient in an semi private room (on a cot). I've had a married couple wanting to sleep in the same bed in a semi private room! They were making out too and the man in the next bed wasn't too happy about that. I told them that was not allowed and the patient was ready to leave AMA. My charge nurse got him the paperwork and he decided to stay and follow the rules.

I've had patients start throwing things and one of the patients slammed a nurses aide's head against the wall. She had to go the ER. I have no tolerance for that. If a patient puts their hands on me, I will protect myself. I'm not saying I will fight with them but I will do what it takes to get away if I am in danger.

I don't think violent patients should be convinced to stay in the hospital if they threaten others and if they are dangerous should go to jail. For general rudeness, there are assertive ways to communicate so that respect is maintained for everyone involved. I don't believe in "killing someone with kindness" if they are blatantly rude and offensive. Pleases and thank you's aren't required of anyone and if someone doesn't say please they still have the right to have their light turned off. They shouldn't have thrown anything, but they could have made a complaint that their care seemed to be dependent on an unreasonable expectation. Being in the hospital sucks and when someone is sick and hurting they sometimes forget their manners.

Esme12, ASN, BSN, RN · Oct 7, 2013

I'm not saying condone violence and some need to be asked to knock it off or leave. I've had patients discharged by the attending for bad behavior.

But we should also not try to change people...some people are just not nice...treat them professinally and leave the room.

cardiacfreak, ADN · Oct 7, 2013

What disturbs me the most is that the supervisor said to kill them with kindness, he/she should have went in and spoke to the patient about the behavior. Have you thought about changing jobs? I know we all deal with a certain amount of abuse but if management is not going to have your back you should think about leaving. Thankfully we have a manager that will not tolerate patients being verbally or physically abusive. There is a big difference between being rude and abusive, rude I can deal with but abusive...not in this life time.

lalexa15 · Oct 7, 2013

Thank you for all the responses. I didn't mention in the post that I did in fact go to my supervisor and she went to the CNO and they both proceeded to speak with the patient about his behavior. He was not AMS, just a jerk and was not my patient. I was instructed to not answer his call bell again and to ask someone else around if he were to call again. When my supervisor told me to "kill them with kindness" she actually wasn't talking about the urinal throwing patient but about a patient's family members who were yelling to me about a narc that could only be given Q4H that they were not understanding. I totally agree that I need "to grow a backbone". One of the nurses I work with who has many years experience told me to "grow a pair" (in a funny way) haha. I guess I am just used to people being respectful of one another as this is the environment that I am used to. I know I will never "change" anyone and hopefully I will be able to get used to the fact that their are just horribly miserable people in this world!

RNInterupted · Oct 8, 2013

Assuming it wasn't altered mental status, that urine tossing patient would have had their next conversation with the police at the hospital and would have received either a ticket or a summons, and management would have had my back too.
Short of that, the charge RN, the police, and sometimes even the MD are happy to join me in a group reading of the riot act (third strike) to patients who aren't receptive to the first discussion I call "the benefits of mutual respect" and second which I call "the easy way and the hard way to make sure you receive excellent care."

Unfortunately, not all hospital management has the backs of their nurses. I have been in nursing for 25 years and I have seen people go from being completely respectful of their nurses to downright mean, ugly, and abusive. Anymore these days hospitals and doctors are more concerned with keeping patients (competition amongst hospitals and doctors) than keeping nurses, especially if they can replace you with a newer, less educated nurse (the longer you have been a nurse and the level of education you possess often dictates what a hospital pays an RN/hr).

Having stated the above, I have learned to pick my battles. However, this is a situation that requires further inspection to insure that your patient's mental status is not deteriorating or you might find yourself sitting in front of the nursing board. I would have gotten the resident up their to do an assessment of the patient. If the patient doesn't have any deficits as determined by the medical staff, he might think twice before pulling that number again.

ThePrincessBride, MSN, RN, NP · Oct 8, 2013

There was a family member today who came up to the nursing station screaming at the staff about a nurse giving insulin to her father's roommate while her father was supposedly writhing in pain, nevermind that the call light hadn't been on for more than four minutes. I was shocked (along with everyone else) and this close to calling security.

I've had some downright unpleasant patients, and I have left a shift crying a couple of times. Now? I put my foot down. I'm an aide, not a slave. Unless you are confused, elderly, MRDD or a very small child who can't understand, I will not put up with your crap. I'm an aide, not a slave. But I have noticed that the meanest patients are also some of the most miserable and unattractive people I've come across, and misery loves company. As my grandmother says, you don't have to take them home with you! Be glad.

RNlove17 · Oct 8, 2013

Wish I knew. I work 2 shifts a month on a unit that does nothing about abusive patients. Supervisor will just say "you have to deal with them" and leave it at that. Their number 1 priority is looking good and patient satisfaction so they don't care if staff gets injured by abusive patients (and they have). if you speak up to a patient or family and they go tattle to management, YOU get a warning. I'm pregnant now and have to be extra careful. Some people are flippin crazy and they seem to be the ones that land in the hospital the most. I work FT as a school nurse and love it, even a cranky parent isn't as bad as some of these patients at the hospital!

Once i have the baby I am finding a new per diem job because i can't stand the abuse anymore and how management does nothing. So I guess I'm handling it by just leaving... although my unit clearly has management issues behind it. People you deal with will always be nasty, that's part of the job. But having a good team behind you is what's important. I don't have that managerial support, which is why i'm going but if you have a good manager who "has your back" then report it to them.