Antagonizing patients--just a vent

Specialties Psychiatric

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I have been in psych now about 7months. I am very disturbed at some of the behaviors exhibited by experienced nursing. Why do some nurses antagonize these patients. Patients are there for a reason, is it really necessary to be sarcastic and use foul language with these patients? could this behavior happen or even be tolerated on any other type of unit?? why is this okay for psych patients? I cant stand it. One of the off-going nurses got in the patients face demanding that he go to his room. The patient back talked, but really he is very psychotic. He went to the doorway and stood in the doorway. That wasn't good enough for the nurse. The nurse got right up in his face, I mean nose to nose, and screamed you better get in that room right now, Im not playing with you... it was just so unnecessary and demeaning to the patient. The nurses posturing was a scary. Granted these patients can be trying, but again that's why there are in the hospital. If your burnt out please allow another nurse to take over, and stop personalizing their behaviors. I really want to report this to the NM, but its such a difficult situation being the new one, complaining about the seasoned one.. ughgh... its just sickening sometimes... very un-therapeutic and sad

Specializes in Neuro ICU and Med Surg.

I have no patience to work psych, however, I know behavior like this will get a psych pt to smack you fast. CPI is a great class. I really try to take other approaches to getting them to calm down. I am not one to jump to restraints unless it is to protect a drain or ET tube or other healing device.

Specializes in Med-Surg/Neuro/Oncology floor nursing..

It's really sad because if a mentally ill person reports being treated unfairly chances they won't be believed because when you are in the middle of a psychotic break they aren't in line for the credibility award. Psych patients all the time are claiming being harmed by people all the time..especially the paranoid ones. I haven't worked in psych but my sister(a social worker in a hospital in Chicago does) and she tells me stories all the time...patients claiming people in the CIA, FBI, Police Departments, Hospital CEO's, Terrorists, The secret service, their parents(when their parents have been dead for decades) all tried to strangle, beat, shoot, attack and or rape them. So since a lot of these patients have a small chance of being believed then you have to speak up for them and report them.

It's kind of like in prison environment and jail..the CO's getting in the prisoners faces and antagonizing them sometimes for no reason(sometimes for VERY good reasons minus the antagonizing part...I would never antagonize a convicted murderer). While a psych unit in a hospital is different from a prison, I am guessing some of the patients have been in jail and or prison, sometimes for violent crimes so the chance for violence is VERY real. As a last resort if a patient is exhibiting behavior that is harmful to other people(or themselves) then you have no choice but to restrain and or sedate them...obviously with a doctors permission and ALWAYS with respect and dignity and with the least amount of force necessary. Sometimes putting them down for a "timeout" is the best option...certainly better then getting into a patients face and screaming at them for 20 minutes! You can't reason with a two year old...just not going to happen and the same rings true with people acting like two year old.

Specializes in Psych.
I think that sums it up quite well. Type A people who are control freaks shouldn't even dream of working in this field. I am considered by my peers to be a kind, compassionate, empathetic listening type of person who cuts sick people slack for being in a hospital, and even I wouldn't consider trying to be a psych nurse.

Im a very Type A personality and I love working psych. Do I call patients out on their behaviors, yes. Have I said things in the heat of the moment that were inappropriate, yes, and I reported myself for it. However, the patients know that I will go to bat for them if need be, will stay late to listen to them if I am the only one there that they feel comfortable talking to. They also know that I am willing to do things that other nurses will not do, for fear of management. We are a caffeine free unit, if we have a patient who drinks insane amounts every day and will be getting the caffeine headache, I will get an order for a regular cup of coffee from the doc.

Im a very Type A personality and I love working psych. Do I call patients out on their behaviors, yes. Have I said things in the heat of the moment that were inappropriate, yes, and I reported myself for it. However, the patients know that I will go to bat for them if need be, will stay late to listen to them if I am the only one there that they feel comfortable talking to. They also know that I am willing to do things that other nurses will not do, for fear of management. We are a caffeine free unit, if we have a patient who drinks insane amounts every day and will be getting the caffeine headache, I will get an order for a regular cup of coffee from the doc.

What does that mean - caffeine free unit? For staff, patients, or both? What's the purpose of it?

Same reason parents yell at children for things they don't understand.

Frustration boils over.

Psych patients seem to listen more if you're aggressive and upfront VS the timid, overly polite nurse (So ive been told).

Is there a line? Of course there is.

Same reason parents yell at children for things they don't understand.

Frustration boils over.

Psych patients seem to listen more if you're aggressive and upfront VS the timid, overly polite nurse (So ive been told).

Is there a line? Of course there is.

IMHO neither one would be good. Yes you cannot let patients walk all over you = they must be aware there are rules. But you don't want to set them off either. I was in hospital security for a while before nursing school and I have CPI training - I believe someone here mentioned CPI earlier - and I've found it to be very practical and helpful in de-escalating situations. I would not yell at psych patients not because I would have any real fear of them but because I wouldn't feel like having to deal with the aftermath of a big blowup. One reason why psych as a field doesn't interest me is that most of these people you cannot reason with or get them to see what most people would consider to be logical or sensible. That part of them is damaged, sometimes irretrievably. It's easier to deal with people who may be physically sick but are still "normal" mentally, and are just going through the normal moods and emotions that sick people go through in the hospital.

Specializes in LTC, assisted living, med-surg, psych.
What does that mean - caffeine free unit? For staff, patients, or both? What's the purpose of it?

From what I understand, some psych hospitals don't allow caffeinated substances for patients on the unit because it tends to exacerbate some conditions, especially mania.

Not everyone is affected similarly, and in a normal mood caffeine may not bother someone at all, even though many psychiatrists recommend that patients with certain conditions should give it up. (I know that when I'm in a manic state, coffee makes it even worse.....of course, that's when I crave it the most. Go figure.:rolleyes:) I would hope that a psych unit would carry lots of Excedrin for the caffeine-withdrawal headache, though......imagine coping with a thunderstorm in your head while trying to recover from a severe episode of mental illness. That's just cruel IMHO, but then, I drink an insane amount of caffeinated beverages daily and would be in a world of hurt if I got cut off!

Specializes in Mental Health Nursing.

I've been experiencing problems like this at my facility as well. I've tried reporting situations like this to management, but I've been told to look the other way. Here is how my superiors put it... "You don't really want to go against other staff when it comes to abuse because they're going to protect themselves the best way they can; and eventually they might start finding and reporting every single thing you do to make work hell for you." And other nurses have even commented negatively, stating that I might as well go along with how things are because it'll only make work harder for me to complain. The bottom-line in a general sense is that patients are being mistreated at times and there's too much covering up going on. Welcome to psychiatric nursing sighs.

Specializes in Mental Health Nursing.
I think that sums it up quite well. Type A people who are control freaks shouldn't even dream of working in this field. I am considered by my peers to be a kind, compassionate, empathetic listening type of person who cuts sick people slack for being in a hospital, and even I wouldn't consider trying to be a psych nurse.

This!! I'm finding that a lot of the individuals who work at my facility do so because they love having authority over patients. They tell their control-freak friends about the job and help them to get hired. I work at a state hospital and my patient population consists of mentally-ill criminals. I understand how its easy for some to treat this patient population differently; however they are still patients and most of all they are PEOPLE.

Specializes in Psych.

I, too, work in a state hospital - but my experience is nothing like what you're describing. Trauma informed care, social learning programs - those are the reigning powers at our hospital.

That's not to say that a patient has never been antagonized - frequently, the doctor and/or professional staff have called a patient on their crap - but only in a way that has been quite directed by the treatment team as having a beneficial value to the patient.

No one is poked for the fun of it - and if they were, APS would be my first phone call. Nurses are mandatory reporters and failure to report abuse/neglect is acting as an accessory after the fact.

Specializes in geriatrics & profound/mulitp. disability.

What about an ombudsman? I have worked in a toxic environment and in that type of environment it is true your co-workers will turn on you and make your life a nightmare at work. I was working the night shift one night long ago with an older gruff former army nurse. She tended to think she knew it all and if one of the aids or myself went to her with something she tended to minimize it and brush us off. On this particular night one of our patients (LTC for profoundly physically and mentally disabled) was taking a turn for the worse. When the Aid reported the situation to her she told the aid to stop being so dramatic and to stop babying the patient. Said Aid caught me in one of the back halls and begged me to come take a look @ the patient which I did. She was indeed in trouble so I went to this nurse and explained what I had assessed. She became angry with me for " sticking my nose where it did not belong" being fairly new and insecure myself I backed down. Instead of confronting the situation with her head on I went behind her back and administered nursing care to the best of my ability for the rest of the night all the while praying that the patient would be okay until management arrived in the a.m. and that she would not catch me touching her patient. I am ashamed to say I was a coward, and a bad nurse that night. I did my best behind her back to keep the patient stable until first shift arrived and explained the situation, again behind said nurses back, to the on coming nurse. The Aid supervisor for nights who happened to be a friend of mine assisted me. I stayed and helped the first shift nurse get the patient transferred out. She was out of the facility in ICU for several weeks but she did survive Thank God. I caved under pressure and did not report her but my Aid Supervisor had courage and integrity and did. I was called in and interviewed but not reprimanded other than to never fear retribution from anyone when it comes to advocating for a patient. The gruff dismissive nurse was suspended. I have always felt and still do that I was just as guilty. I knew the situation was beyond what I could handle yet I put the patient at risk by trying to handle it myself for several hours before first shift arrived. I should have advocated for the patient with her nurse and if I still could not get her to listen to reason I should have called my supervisor in. It was a very hard lesson to learn but now I am a mama bear protecting her cubs when it comes to my patients or any other patients that need an advocate. You can do this, you must. Don't allow fear to stop you from doing your job report the abuse to management all the way to the top and beyond if you have too. You don't want to live with the guilt and regret should something happen that you could have prevented. JMHO

caffeine is a psychoactive drug. antidepressant.

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