I don't get it.......vent

[BCgradnurse, MSN, RN, NP]

Just for some background......I work in an urban community health center in a relatively high crime area. Many of our patients have substance abuse issues coupled with other psychiatric issues. So today we had a meeting to review a couple of patients for discharge from the practice. One patient had stolen stationery and forged work excuse notes from another provider and myself. With almost no discussion it was decided to dismiss her from the practice. I agree with that decision, but then we discussed another patient who came to her appointment either high or psychotic, screamed, yelled, and phsyically and verbally threatened the provider, and had to be removed from the premises by security. Should be a no-brainer for discharge, but no......she gets to stay with barely a reprimand because she "is ill". The chair of this committee is a former social worker who doesn't have to deal with these patients, but absolutely refuses to consider the well being of staff, not to mention any potential liability if something happens to one of us. I'm all for helping people and being a "kinder, gentler" health center, but not at the expense of safety. Yes, I work here by choice and understand the population I deal with, but I think limits should be set about the kind of behavior that is tolerated. Not really looking for any advice, but needed to vent. Thanks for listening if you made it this far.

[NPpeeon]

I don't blame you, I get rid of patients every week for a lot less than that. At some point we have to require that adults act like adults and hold them accountable for their behavior. Our country already gives them rewards for not working and having more and more kids regardless of their ability to raise them.

You could always say, "Fine, keep them in the clinic, but I better not see them on my schedule". If that won't fly with the powers that be in your administrative architecture, start looking for a new job. Life's too short...

[BCgradnurse, MSN, RN, NP]

Well, my issue is not with the lifestyle choices people make, but purely with working in an unsafe environment. I just don't believe staff (and other patients') safety should play second fiddle to keeping a patient at all costs. People do need to be accountable for their behavior, and if that means they lose their health care provider, so be it. 17 months left on my contract, but who's counting....LOL.

[VivaRN]

I agree. I am in the same practice setting as you and the behavior that is tolerated is outrageous. I mean, I understand the struggles of the population we serve but at some point the interaction becomes unproductive when patients are high/screaming/psychotic at every visit. It's hard to get anything medical done... you know, like for their health... in between the screaming...

In a perfect world all such patients would be REQUIRED to access mental health and substance abuse treatment prior to being seen in care. Otherwise you can't get anything done for them, you really can't. Your social worker chap obviously doesn't get it. Maybe he can see the patient.

[sandnnw, BSN, MSN, EMT-B, APRN]

Wow, just refuse to see her, sounds like you may have that option. Stick to your guns, others will eventually see the light or get burned. Ever sat through a deposition? You'll wish you never had!!! Good luck!

[mammac5]

Once I'm in practice, I will refuse to see patients who have threatened me or other staff members. I can't imagine a practice that would take on the liability for NOT dismissing a patient from the practice who has documented threatening behaviors toward staff. Just a few years ago a physician in my area was shot in his office by the father of a patient who died.

I think if I were in your shoes I would pull a few articles from journals where violence toward providers has been highlighted, bring them to the next pt dismissal meeting, and inform others that you will hold them responsible for any violence perpetrated on you or other staff should they refuse to dismiss threatening patients.

[NPpeeon]

Well, my issue is not with the lifestyle choices people make, but purely with working in an unsafe environment. I just don't believe staff (and other patients') safety should play second fiddle to keeping a patient at all costs. People do need to be accountable for their behavior, and if that means they lose their health care provider, so be it. 17 months left on my contract, but who's counting....LOL.

That makes it even easier. Get a lawyer, and get out of that contract. It would be best for you to set them up by finding a way for them to fire you in a matter so you can sue them for wrongful termination. Sooner or later, this world is going to have to get rid of all the BS politics and laws and documentation and HIPAA and blah blah blah and just do the right thing. When they don't, you strategically position yourself and retire early with a nice settlement.

[BCgradnurse, MSN, RN, NP]

First, my contract is not with my place of employment but with the National Health Service Corps. If I leave before my allotted time I have to pay back the lovely $50,000 loan repayment they gave me. No can do..... Second, I don't have the time, energy, or inclination to "set myself up" so they can fire me. That's not how I work. I'm certainly not going to knowingly compromise a patient or do something unethical and jeopardize my license. That makes me no better than them. I've asked to start a staff safety committee and I'm going to try through that route to change things. I'm also carefully documenting any problem encounters with patients. The other providers are on board with banding together to press our concerns. Meanwhile, I keep my eyes and ears open and always look behind me.

[delphiniumRN]

maybe someone should remind the social worker what happened at the MGH bipolar clinic with the pdoc being attacked. That patient hadn't even shown agression prior.

[traumaRUs, MSN, APRN]

BCGradnurse - you are handling things the most appropriately that you can do under the circumstances. I work in a similar setting where we NEVER EVER EVER discharge a pt.

Its hard.