Aggressive family member

[Jerez]

So I was placing an IV in a pediatric pt about 6mo and she was of course not happy. She was crying and the mother was comforting her the best she could. As I was placing the IV though, the dad reached across the bed while I had the needle in the child's arm and literally pushed my hands away and told me to stop & get another nurse. I was shocked that someone would do that and was taken completely off guard. The wife had jumped when he did it too and almost intervened but stopped herself. Anyways, I became angry and flustered over the whole ordeal as the doctor had explained in great detail what to expect and gave them the option of PO fluids & meds vs IV. I pulled the needle out and wrapped the child's arm, apologized, and told them I would send in another RN. I spoke to my charge RN about the situation and decided to transfer the child's care to another RN because I felt very uncomfortable at this point. I couldn't help but ask myself over and over what I did to set this man off but at the same time don't think any pt or family member has a right to lay their hands on any staff especially during a procedure. A simple "stop" would have worked just as well. Also, I do understand the frustration of having a sick child that ends up going through painful procedures in order to help them get better so I know that plays a part. I guess I just need to suck it up as part of the job. I just wonder as nurses, should we expect to be abused, whether physically or verbally? Or should I have said something about the inappropriateness of what happened right then & there? I'm not sure what was the most professional thing to do but I did not want to escalate the situation any further but at the same time I wanted to let him know that touching me or any other staff member in an aggressive manner would not be allowed.

[MunoRN, RN]

1. Moving a 5 year old's hand away from a knife

2. Pushing a nurse's hand that is holding a needle that has just been inserted into a child's vein

How are these 2 things remotely alike?

I think I explained how they are alike, maybe you could be more specific on how they have nothing at all do with each other.

Both involve sharp objects where you want the person manipulating the sharp objects to immediately stop and don't want to startle the person by blurting out the verbal freak-out that's going on in your head since that potentially has more likelihood of startling the person than getting their attention by putting your hand on theirs.

[MunoRN, RN]

The supermarket/open checkstand tap is, at its core, an attempt to get someone's attention to offer or demonstrate courtesy/fairness.

I'm really not a fan of using hyperbole as a tool ("lateral violence" being the obvious example) but the action in the OP is much more of the "I don't like this and you're gonna pay!" variety than the "Hey, mate - there's another lane open" variety. This wasn't to get anyone's attention for the sake of courtesy. Stories like the OP can be associated with folks whose MO is generally abusive; they lash out at whomever is near-by whenever life doesn't suit their wholly irrational sensibilities. And it is 100% irrational to push the hand of someone who, for pre-planned therapeutic purposes, is holding a sharp object inserted into one's child. Meanwhile, 2- and 3-year olds can successfully learn to "use your words."

In lieu of hyperbole, I would be quite in favor of an authority figure addressing the issue by saying, "Your child's crying is neither indication nor proof of any wrongdoing or actual harm. We will be happy to talk through your concerns, but you will be removed from the property if at any point you purposely touch another employee."

Forget worrying about correct use of the terms assault, battery, felony, push, tap, abuse. The above works just fine for me.

I completely agree with telling the dad that wasn't appropriate as I stated earlier, what I don't agree with is the idea that this is worthy of criminal charges and CPS involvement.

[broughden]

I completely agree with telling the dad that wasn't appropriate as I stated earlier, what I don't agree with is the idea that this is worthy of criminal charges and CPS involvement.

And that's your right. Next time someone shoves you, you are welcome to ignore it.

They shove me? Especially when I am in the middle of a procedure with a patient?

They are leaving in the back of an officer's car.

[MunoRN, RN]

And that's your right. Next time someone shoves you, you are welcome to ignore it.

They shove me? Especially when I am in the middle of a procedure with a patient?

They are leaving in the back of an officer's car.

Had someone been 'shoved' in the OP's scenario I'd completely agree with you.

[brownbook]

I am a pediatric nurse in a large children's hospital... and I'm trying to decide how I would react in this situation. I will say - working in pediatrics, you really do take care of the whole family unit, not just the child. It is a struggle at the best of times. Security is our best friend... because in this situation, where emotions are high, and there is that feeling of a loss of control and fear.... people tend to do stupid stuff. I have called security for a myriad of reasons.... a 9 year old threatening to kill me and himself, parents raising their voices at each other - you get the drift. But I am not sure in this situation, I would have called security. In my time as a pediatric nurse (which is what I am, all I have ever been or will be, adults are gross. LOL), I have gotten very good at using my assertiveness and putting people back in their place. Sometimes, a parent needs that kind of swift reminder that hey: I am here to help your child. They get caught up in this fear cycle. They have no control over this terrible situation that their child is in, so sometimes that gets taken out on me.

Now, putting your hands on my with a violent or sexual intent is an entirely different ballgame. I will have you arrested in a millisecond. But that doesn't seem to be the case from what I am reading from the OP. Sure, this wasn't the brightest or safest reaction from Dad, but you have to remember: these people aren't medical people. He didn't have the intent of causing a needle stick or hurting the nurse or anything else. Nor did he realize what risks his behavior carried. He had the intent to protect his child from what he saw as unnecessary pain.

I think in this situation, I would have looked that parent in the eye and told him point blank... Sir, do not touch me. This IV is necessary for XYZ. It is your right as a parent to refuse this procedure. But please understand that I am here to do my job, and that job is to care for your child.

Then I would pass the info on to the charge RN, who would follow up and give some stern reminders to this dad and then together we would figure out a plan. Let's be honest, if he was this pissed at my IV starting skills, he is going to be just as pissed at the next RN who comes in behind me.

I want to know why, if given the option between PO push fluids and PO meds and IVF and meds - WHY did these parents choose the invasive option in the first place? And why did the RN lay it out as a choice? As an RN, if the child doesn't NEED IVF and meds and can easily tolerate PO - I am going to advocate for THAT, because it is in the best interests of my patient. No one wants to poke a 6 month old baby if they don't need to. I'd have been on the phone with the physicians before ever attempting that IV. If a child's condition is compatible with PO fluids and meds, there is zero need for an IV.

Thank you. Your post needs to be read, and reread, several times by most respondents. It's what Munro, (if I can speak for him), and I have been trying to say from the start.

[Kooky Korky, BSN, RN]

so when I was in nursing school, my child ended up having to have surgery at the childrens hospital. It was a stressful time as I was an intense program with two kids under two. We ended up having to go to ER after he had urinary retention for over 16 hours after having some diagnostics done the previous day. My husband is a big guy and we were not really impressed with his care by the nursing staff. But by no means did we physically act out. They wanted a urine sample but he was too dehydrated and nothing was working. Anyways, I think it is good you transferred care. However, I do think an incident report needed to be filled out as that is workplace violence and needs to be documented. I also think security or the doctor needed to come in and speak about his behavior and try to help with deescalation in the situation. Also was there any assessment for possible physical abuse?

Great. The kid is there for not being able to pee, he is dehydrated, and they want a urine sample. Gotta laugh. Yeah, I know, not an unreasonable thing to want a sample, just read funny.

For OP - The doctor and Security and OP's boss all need to let the father know that he is not allowed to ever touch staff in an angry, aggressive manner ever again.

I understand Dad's stress, too. Kids get sick, needles hurt, kids cry and adults want to protect their children from pain and their hearts are breaking. Dad needs to either super chill out or stay away when hands-on procedures might cause pain. And if Dad is not happy with the way things are going, he needs to say his safe word - like "No, stop, no, stop" and staff must stop immediately. Let Dad and the Doc figure it out.

OP, do not go near this parent again - at least, until he truly apologizes to you.

[Kooky Korky, BSN, RN]

1000% not okay. You are stripping away the comfort and security of that child. Unless the child is of the age they can make the decision if they want the parent in the room or not, the parent stays. You can use positions of comfort and distraction to occupy the parents with a task. Separating a child from a parent during a traumatic procedure, guaranteeing is harming a child (even the tiniest of humans). Trust issues, anxiety and even PTSD can happen to children while in the hospital if they are not made to feel loved and safe even through the scary stuff.

The separation of parents from their children with minor trauma that took place in our ER many moons ago, plus the trauma of having no parents on the ward after visiting hours in even earlier decades must be what messed us all, of a certain age, up. I am only half joking. Lack of breastfeeding and good old-fashioned physical correction (not brutal beatings) did the rest. Yet, we still have produced John McCains and other heroes too numerous to mention.

[angel337, MSN, RN]

Was this the first stick? I didn't read all the comments yet. I only ask because as someone else suggested it's good to have another person with you if possible ..tech or another nurse for support. So just in case you do have to attempt a second time, people are less likely to behave this way.

I speak from experience. Alone with parents and a baby that needs an invasive task done ( straight cath etc) gives parents more power over the environment.

[TriciaJ, RN]

I think I explained how they are alike, maybe you could be more specific on how they have nothing at all do with each other.

Both involve sharp objects where you want the person manipulating the sharp objects to immediately stop and don't want to startle the person by blurting out the verbal freak-out that's going on in your head since that potentially has more likelihood of startling the person than getting their attention by putting your hand on theirs.

A hand has just inserted a needle into a child's vein and is still holding the needle. If the hand is pushed at this point the needle will dislodge, causing additional injury and pain to the child. It will also cause the nurse to have a needle stick. Most of us don't like to be stuck with needles that have already been in other people.

If one moves a child's hand away from a knife before it actually touches the knife, then possible injury is prevented. We won't get into the dubious wisdom of teaching a five year old to cut tomatoes.

[morte, LPN, LVN]

Battery would require the intention of physical harm which clearly wasn't the intent or the result in this case, it's not the appropriate way to do it, but the intent was to decline the continuation of a procedure, which is an important parental right for the nurse to recognize, recognizing it as something it's not isn't helpful.

I completely agree that we shouldn't be downplaying acts of aggression or violence, but that's exactly what we're doing when we call things aggression or violence when they aren't.

In Mass, that would assault AND battery..

[Medic_Murse, BSN, RN, EMT-P]

Had you just inserted the needle when the dad stopped you or were you digging around for a little bit?

What difference does it make? She had a needle in the kid, when the Dad grabbed her...with a needle in the kid.

Quite frankly, when I worked in the ER, I hated peds, not because of the kids but because of the parents. I had some I threw out into the lobby, other I told to be an actual parent, get their kid under control, and to get off their damn phones. It honestly worries me that the future is being raised by a bunch of door knobs (the parents I've dealt with, that is).

[humerusRN, BSN]

Parents are definitely the most challenging part of working in pediatrics.