The Disrespect Of Nurses

[TheCommuter]

I was at my workplace earlier this month when my supervisor told me about a volatile situation that was unfolding on a different floor between another nurse and a verbally abusive family member. This particular family member was at the bedside for twelve hours straight and refused to leave when gently prompted. She was confrontational, hollering, taking pictures with her cellular phone, and interfering with procedures that needed to be performed on the patient. Nothing seemed to please her.

And guess what? The verbally abusive family member was coddled by management and allowed to stay well beyond the visiting hours that other visitors are expected to follow. I suppose the old saying applies in this situation: "The squeaky wheel gets the grease." Too many members of the public know that they can act like loudmouthed fools, behave disrespectfully toward nursing staff, and basically get away with it.

I clearly recall another instance of blatant disrespect at the same workplace. A group of surly family members were yelling obscenities and threats at the floor nurse and supervisor after being informed that the patient contracted a urinary tract infection: "You haven't seen crazy until you've seen me!" "I will put my foot up your ***!" "You'd better get my mother out of this place before I get you out of the way!" To keep a long story short, the patient was sent to another hospital to receive the same intravenous antibiotics that my workplace had been providing.

These same instances of disrespect would be totally nipped in the bud at other places of business. For instance, the frustrated traveler who attempts to enter the cockpit and give the airline pilot a 'piece of his mind' will be jumped on by the air marshall. If I start acting out irrationally and refuse to leave the local new car dealership once closing time has arrived, the workers will call law enforcement to physically force me off the property. The customer who threatens the safety of the teller at the credit union will be escorted to the parking lot by security guards. If any of you try to walk to the back of the bakery to harass the staff and take pictures of the employees and equipment with your cell phone, you will not be in the bakery for very long.

According to polls, nursing is the most trusted profession. For the 12th year, nurses were voted the most trusted profession in America in Gallup's annual survey that ranks professions based on their honesty and ethical standards (American Nurses Association, 2012). However, trust must not be confused with respect. While nurses are certainly trusted, we are not respected by the public, management, or administration.

Although it is generally not constructive to babble about a problem without offering possible resolutions, I do not pretend to know of any solutions to this complex problem. For starters, it would be nice if we had the backing of management more often. Do you have any real life tales of disrespect from patients, visitors, families, or other members of the public? If the answer if yes, please share. And most importantly, please stay safe!

[JDZ344]

I think this problem is universal. It certainly occurs in the UK.

[sckimrn]

If someone touches you, ie bodyslams and puts you in a chokehold, you most definitely have the right to press charges. The facility may not like it, but no one has the right to touch you, or even get in your face and yell. I am pleasant to all of my patients, but have learned to be friendly, but very firm. It usually works. But I have no problem calling security or the nursing supervisor if need be. And thankfully I work in a facility that will back me up. And we have had a couple of our ER nurses to press charges on abusive patients. Our employers have a responsibility to provide us and other patients with a safe environment. That is the part that usually gets management to listen, if you mention you also fear for the safety of other patients.

[cienurse]

At my facility, the nurses are instructed, and empowered to, ask unruly, disruptive visitors to leave. If they refuse, the nurses have been instructed to notify the local police for assistance. This type of behavior is not tolerated-it is frightening for our confused residents and the nurses just plain do not have time to deal with this crap!

[applewhitern, BSN, RN]

Management at my facility does nothing to protect the nurse. All that matters is the "patient satisfaction scores." They don't want police involved because it looks bad "in the community." If a patient or family is abusive to you, they will send YOU home to avoid further interaction with them. If the "customer" gets mad or upset, apparently YOU did something to set them off. I don't know how or why the general public has become so abusive toward nurses (both verbally and physically) but I have noticed a definite trend the past few years. Unfortunately, at my facility (hospital) management will not back you up.

[monkeybug]

applewhitern said:

Management at my facility does nothing to protect the nurse. All that matters is the "patient satisfaction scores." They don't want police involved because it looks bad "in the community." If a patient or family is abusive to you, they will send YOU home to avoid further interaction with them. If the "customer" gets mad or upset, apparently YOU did something to set them off. I don't know how or why the general public has become so abusive toward nurses (both verbally and physically) but I have noticed a definite trend the past few years. Unfortunately, at my facility (hospital) management will not back you up.

That is exactly the way it is here. Well, I say here, I only have a couple more weeks as an employee at the hospital, but I still feel like I'm in the middle of it. Our manager believes the patient and/or patient's family implicitly. If a family member said one of the nurses was sacrificing chickens to Satan in a room, my manager would absolutely believe it, even absent any evidence. And there's never been a case of her patting down the family and then letting it go. Oh, no, no, no! If there is a complaint made against you, no matter how ridiculous, you are called in the office and reprimanded. One of my last patient complaints stated, "The nurse didn't keep my vein from rolling." I was brought in and talked to about this. I demanded a solution for this from my manager. She admitted that there really isn't a way to keep a vein from rolling if its bound and determined to do so, but that obviously I had not been nice enough about it.

[Music in My Heart]

TheCommuter said:

I'm just stirring up the inkwell here. . .

What if the threatened nurse works at a facility where management and administration implicitly discourage getting local law enforcement involved when crazy patients, families, or visitors step out of line?

I know for a fact that many managers and people who work in marketing actively discourage healthcare workers from calling law enforcement on the nutcases because they want the hospital to be viewed as a 'safe haven' and not a place where the police regularly visit.

I worked at a place that was sometimes more tolerant than it should've been. I helped a couple of colleagues write a letter to the CEO, HR director, risk manger, and medical chief-of-staff a few key phrases from an interaction including "sexual harassment"... the guy was discharged the next day. For some totally inappropriate actions, the DON was ultimately terminated.

One contributor to my decision to take the position that I recently did was that it's a university medical center with its own peace officers, at least one of whom is in the ED 24x7... not to mention the city cops who are regularly present for med-clearance, etc.

It makes such a huge difference to have cops walking through the department on a regular basis.

[TamJonesRN]

I am so glad that you touched on this issue TheCommuter. If I have one pet peeve about my profession, that is it! As nurses we are verbally abused by families and physicians. It angers me that disrespectful behavior is ok and not reprimanded. I have experienced and seen many situations where families and physicians have gotten out of hand, however, the discussion with management is how the situation could have been prevented on our end. They consider families and physicians to be "customers" and the adage, "the customer is always right", is forever engrained into our heads. I developed a powerpoint about the image of nurses and I touched on the blatant disrespect for nurses that is evident amongst the public and the medical community in general. We are the eyes and ears of patient care. We are the ones that are in the trenches 24/7 caring for loved ones and appeasing physicians, we give up our holiday time with our loved ones to take care of those that need us. So we deserve more respect. It is not fair and it is partly the cause of why there is a nursing shortage. Why put up with verbal abuse, something that you wouldn't even put up with outside of your workplace, and get paid meagerly for it? That is the mentality of a lot of nurses and they are making a quick exit out of the profession. As I mentioned in my powerpoint, the first step in changing the public's and medical community's view of nurses is to believe that we are important. We need to realize that we have evolved from the mindset that existed during the Dark Ages of Nursing. We need to realize our worth. We, also, have to take a stand against the volatile behavior that is targeted at us. If we have a volatile family member even after trying to rationalize with them, call the behavioral response team or security. That will let them know that behavior is not acceptable. If we have a physician acting inappropriately, tell them: "we aren't getting anywhere with this conversation, so when we are able to have this conversation again, as adults and professionals, I will be more than willing to speak with you. Because I am not receptive to anyone that raises their voice at me". And write that physician up and keep your own copy of it!! If they want to be treated like professionals, they need to be held accountable for their actions. We know management is not going to have our backs most of the time, so we need to start looking out for ourselves and each other. That is what nurse empowerment is all about. They are trying to raise the bar for the nursing profession, but we still are viewed as handmaidens to physicians. So we need to raise the bar ourselves! We need to show them that type behavior is not acceptable. We are adults and we are professionals. We are not anyone's slave or handmaiden and we are definitely not anyone's punching bag!

Sorry, I'll get off of my soap box now.

[tokmom, BSN, RN]

Yeah, I'm all to familiar with abusive behavior. I had a pt's son be a threat to me and the staff. He was over 6 feet tall and easily weighed more then 300 lbs. He also told us he had an anger issue. When we didn't medicate his father quickly enough, all hell broke loose, even though it wasn't time for the medication to be given. He threatened us, big time. I won't go into details for obvious reasons, but the secretary looked at me and I nodded for her to call security. Even the RT who is a guy, backed off.

I then went to my manager and talked to him. He went and talked to the son and then manager came to the desk to talk to us. He told us calling security was a bad idea, it would ramp up the son. We were only to call security if the son gave us 'direct and threatening eye contact.' I told my boss I would call security if *I* felt threatened and wasn't going to wait for this giant of a man to get that close to me so I could be hit and THEN call security!!

[Esme12, ASN, BSN, RN]

Historically, hospitals have covered up the fact of nurses being injured on the job by stating that we, the nurse, are responsible for the patients lack of control. That we reacted poorly to their escalating demeanor. I have seen some appalling behavior on the behalf of the hospitals for their poor handling of assault on nurses from patients. I know of a nurse that was suspended and ultimately fired, for breaking policy and procedure, after being bitten by a patient.

When I say bitten this jack_, I mean jerk, I am moron, I mean ingrate, I mean distressed patient .........bit a chunk out of this nurses arm and spit it on the floor. She was told she agitated the situation, she was told she provoked the patient, she was told it was her fault for agitating the patient further and there were alternative means to subdue the patient. This patient had already during the course of his ED stay had punched several staff members, thrown a chair through the triage glass, had the police called and had been restrained multiple times and as according to ploicy had the restraints removed ASAP.... This was one of the professional criminals of the ED who had been in and knows the system well.....and was awaiting placement in a psych facility when there were no beds.

I have mentioned Charlene Richardson a nurse who was a victim of workplace violence and maltreatment by the facility who is now an advocate against violence multiple times as a perfect example of the violence against nurses. This patient grabbed her crotch with enough force he tore her under garments......he was arrested. The systematic abuse that this nurse subsequently suffered should make those involved hang their heads in shame. It's quite the story........

Quote

Since the story of my March 2003 indecent assault was published in The Salem News, I have been overwhelmed by the public response and the questions I have been asked in regards to this incident. Most people are quick to say they are impressed with the article, yet wondered after reading it how this incident has impacted me and affected my life both personally and professionally.

Since then, I have taken extensive time to think about how to even begin to answer these complex and difficult questions. Most times I find myself unable to find the words to describe the turmoil this incident has caused in my life and the impact it has had on me. In searching for the right words, I have been told by my closest friends and support systems to "search my soul" and the words will follow. While trying to follow this advice I came to the realization that an incident of this magnitude is more traumatizing than any words could ever express. I have also come to the realization that such an experience can rob you of your soul.

I became a nurse to help people and working as an ED nurse was always a dream for me. For nearly 12 years I functioned in this role and although ED nursing is a stressful career, I welcomed each new day and enjoyed the challenge that came with the profession. As ED nurses we must be skilled and ready for anything to happen in a moment's notice.

Job includes violent patients

Unfortunately our job includes taking care of violent patients; those who sometimes assault. There are people who present to the ED for legitimate help with their illnesses and I have always felt more than up to the task in those circumstances. However, many people present to the ED with the primary intention to be disruptive and maybe even violent to the ED staff and other patients or visitors. With this in mind, nurses are often put in a situation of being on the "front line" without the adequate support and resources to keep us safe.

My incident has been completely life altering. I no longer work in the ED, something that was always my dream and that I dearly loved. And it has left my husband married to a completely different person, one who he describes as "not being a whole person anymore." This is emotionally distressing because I know he is right. I have feelings about this incident that I am unable to convey, even to him. How do you tell the most important person in your life that you feel destroyed by one 90-second violent incident? It is especially hard since he works in law enforcement and prides himself on putting such criminals away where they belong. I guess the bottom line is that admitting to my peers how deeply this episode hurt me—more deeply than I ever thought I could hurt—was more than I could bear. Perhaps admitting this to my peers was so hard because I was their leader for so long. However, even leaders bleed when cut.

Since this incident I have to kick-start myself daily where previously I was a generally happy and energetic person. I fight every day to find the "pre-incident me" as I continue in my multiple roles as nurse, wife, mother, daughter, grandmother, and friend. It is grueling to rise each day and look in the mirror only to see myself as someone's victim. Friendships become altered due to lack of understanding of a normal post-traumatic response. An incident like this is haunting and causes sleepless nights, restlessness, and generalized feelings of insecurity in all aspects of life. Life stays disrupted long after the bruises are gone …and the scars last forever. There is no longer any sense or feeling of security or safety.

The article continues

https://www.massnurses.org/health-and-safety/articles/workplace-violence/p/openItem/1629

Quote

No support or counseling

I would love to say my employer was one who took this issue seriously and the necessary steps to provide me with the professional support and compassionate care that victims of such trauma deserve, but my employer didn't do that.

Instead, just the opposite occurred. I was never provided support or counseling, and no one ever even said "we're sorry this happened to you." When I finally decided to share my story through activities sponsored by the MNA and in the media, I was made to feel intimidated by my employer and asked to sign a document pledging me to remain silent. I was made to feel as if I had done something wrong and that I was making things worse by trying to protect myself and other nurses in my department.

https://www.massnurses.org/health-and-safety/articles/workplace-violence/p/openItem/1629

I was once attacked and slammed into a wall by a Commercial Airline pilot who felt his daughter wasn't seen quickly enough (3 month old had a 100.1 rectal temp after immunizations).....luckily he spent the night in jail.

[nyteshade, BSN]

hherrn said:

While it may be appropriate to involve management with rude, nasty people, this is not the case if you are threatened.

If you are threatened, call security. If they are unable to deal with it, call the police.

I totally agree. I think we should nip it ourselves, and call security or if it is that severe, police. Nurses must protect themselves first and foremost if we want respect.

[turnforthenurse, MSN, NP]

If I were in that situation, I would have called security immediately. Shame on the higher ups for allowing that behavior.

And I agree, I think it's all about the satisfaction scores.

[echoRNC711, BSN]

The times that we have involved security for psychotic pts they invariably only speak to the patient , (like that's gonna help )but do little more. Meanwhile the nurses are left carrying a biting,kicking,spiting pt whose goal is to claw at least one person's eye out. Yes, thanks security it just fills me with peace knowing you dutifully rush to the scene to WATCH it unfold!

But......

On a good day (We have so many:roflmao: ). OK on a rare good day.....I can distance myself, recognize that people "act out " only because they feel afraid. The less control they feel the more they will attempt to control by pushing back. My philosophy, yield. I don't mean yielding from a place of weakness. Yielding because I have learned that this person/ situation in front of me does not merit me carrying them on my back emotionally for the rest of the shift or home in the car with me or to sit in my living room to "let them out " on my family.

So what does this raging,arm flapping pt want? I have learned it is never "the problem " as its appears but rather the pt outcry -To be heard.To feel in control.To not longer feel afraid. So,in those better moments, that's where I go straight to the real problems. Remember Erickson? Trust vs mistrust, infantile behavior well it lives loud in hospitals. They regress and their families right on with them at the first sight of what they are perceiving a threat.

So do we want to be "right " or to solve the problem. Sometimes,that can feel like a tough call. It's about digging inside to find that better part. I'd say consider it's your child behaving badly so you can regain control ( In my case that wouldn't work as I have a teenage son who only escapes being drowned by me in the bathtub simply because he's just too big to get him in there!! ) ok, back to professional self....Keep it simple. The patient is scared. Respond to THAT not the behavior. The moment it becomes a power struggle you have already lost.

So for me,in situation like this I soften. If I am not going to remember this incident when I am sitting in my diapers in the nursing home it really isn't worth it . So with that beautiful future in diapers it seem to show me the future and present, Just let go!

If this doesn't work for you....May I suggest taking the pt to what I like to call the "cliff face " to the very edge of the abyss. You do this by saying "Aren't you just making a fuss over nothing", " Mr. X Please learn to be calm " " Mr. X. we both know You are not making much sense.Do you need a little time out" Then sit back and watch the fireworks!A full blown 4th of July. OK....Ok , I haven't done it but in those nights in the car where I am carrying one of those pt home with me on my back I like to dream . To dream it in full pantomime, where I give the pt a Ralph Kramden punch "Bang ,zoom To the moon Alice! to the moon! "