Anyone know what rights we have on a federal level regarding being abused by patients?

[TonnyaLPN]

Ugggghhh...

So I work in long term care. We have a patient who was previously homeless, and is so incredibly abusive to staff and other residents, but absolutely nothing is being done about it. Our NHA and DON have said on multiple occasions "well, sorry....you just have to deal with it." Which of course was met with nothing but "Are you kidding me?!"-s from staff.

This resident will fly off the handle if you ask him any kind of probing question. How he is, what he's up to, that kind of thing.

Some such incident happened this evening, he came to my unit from his across the building and was obviously looking down my hallway, as if looking for someone. About a week ago, he had a confrontation with another resident (who has been here for yeeears) and who, by the end, was the one that was removed from his home to my unit. Knowing the aggressors temperment, and in an effort to protect my patients, I asked him what it was he needed. Very politely. To which he responded "what the **** do you care?" I explained that It was my job to make sure that anyone needing something found help in doing so, and that I was a nice person." Among the condescension I was ignoring and him rolling away from the desk (after not seeing the person he was hoping to see) I picked up my phone and called his unit nurse. I let her know that he was over here, and it appeared he was looking for the patient he had had the confrontation with. She relayed to him that it was inappropriate for him to be seeking this patient out and went along her day. Not 10 minutes after she told him that, he came back to my desk screaming at me stating "WHAT THE ****! So you call my nurse telling her Im over here looking for {name}!?" I stated "No, What I told her was that it LOOKED like you were, and I am not engaging you, so please remove yourself from my desk" He then proceeded to scream and holler, calling me a stupid fat *****, and an idiot and probably 100 other things I couldn't here" I finally got so fed up that I just blurted out "Shut up and go away." (after which I promptly pissed my pants because I realized my RN manager was sitting not 10 feet away in her office and heard the entire interaction)

But for crying out loud! This patient has and will verbally assault anyone that he feels he needs to, and management wont do anything about it. In fact, I have heard several times from both my NHA and my DON that as nurses, even from a patient who is A&Ox3 as he is, that we can do nothing about it. We just have to deal with it, because "this is their home" and they have the right to say whatever they want. Im sorry, but even if I was in that man's private residence, I would never allow him to speak to me in that manner, and there isn't anything anyone can say or do to make me feel otherwise.

What I am asking is this; There are a million and one federal rules about nurses abusing patients. Obviously. However, I am having trouble finding out what kind of rights we as nurses have on a federal level, or even just a legal level,when we feel abused? Is my management team right? Do we just have to endure?...or just stare at them...or ignore them? or is there something we can do to make management protect us from ass-hat patients like this bozo?

[KatieMI, BSN, MSN, RN]

There is one, although not "federal" rule. It is named "voting with your feet". When nurses quit their jobs en masse AND let the Powers know why, AND spread the information about intolerable working conditions locally (NOT through social networks!) then the Powers eventually come up toward the reality.

P.S. you have right, just like every other human being in this country, to call police, go to police station and press charges against anyone, etc. There were precedents of health care workers suing patients for things like assault and winning. But, honestly, I kinda feel for that fellow, even if just for so little. It is not a nice feeling when people speak behind your back that you "might looking like" up to no good while you just happened to be within their view's range. And the man very well may not even be able to understand your "please remove yourself from here", as everything he ever knew all his life was that "shut up and get outta 'here".

I work with such folks pretty regularly and it is challenging, no questions. Especially for me because I am an immigrant and most of them are openly xenophobic. But once you find a way to get them trusting you, the results are frequently nothing short of amazing. It takes time, concerted efforts of a whole team and even playing around the rules - like, if the patient openly hates the common social niceties of "how are you doing" and such (many of them count social graces as lies) then nobody can use these expressions when addressing the patient, doesn't matter what. But the end result really makes life easier for everyone, especially long-term.

[crazin01]

I agree with PP, if there is any type of physical contact to file a report with the police/sheriff whomever resides in your area. If an officer came to take a statement, maybe seeing a cop would make him realize your not going to take it any longer. OR, a 'show of force', with multiple staff members (charge nurse, security guards, if they are present at your facility) could have the opposite affect and he could grown even more agitated.

Sounds like he doesn't like being told how to live (where/when to sleep, eat, shower, etc) after so long of him being his own boss. And that he has control over very few aspects of his life now, and wants to maintain some control over some aspect of his life.

I'm sure you and other staff have tried to 'kill him with kindness' many times over at this point, with explaining his care/stay at facility. And of course removing yourself from his company, and explaining you will not take his attitude/verbal abuse any longer. He can choose to come find you/his nurse when he is ready to be nice.

What about documenting his behavior, when he's difficult and maybe something along the lines of a behavioral contract from management? Of course, management would have to be on your side, which seems to be a problem. And I don't know if his behavior would warrant an incident report (or whatever they are called). Med error, patient fall, just not sure this would fit that bill.

I may be way of base with this, but: as nurses, we have a responsibility to notify authorities of suspected elder abuse. Has he ever tried to physically hurt another resident? (I know it sounds mean, when he is the one being a jerk). But I think he'll continue to act out until he realizes it will not be tolerated...

Sorry, i have no real answers. Good luck to you & colleagues dealing with this gentleman.

[Esme12, ASN, BSN, RN]

No....there are no laws to protect hospital personnel against verbal abuse. There has been some headway about workplace violence and suggestions from the Joint Commission and the ANA . Each state has different laws against physical violence and most of them pertain to EMT's and some emergency department staff.

https://www.ena.org/government/State/Documents/StateLawsWorkplaceViolenceSheet.pdf

Workplace Violence

[amoLucia]

You have the 'RIGHT to NOT work there. (Note: Am not trying to be a smarty!)

No, seriously. There isn't much that can be done although you do have rights just like any other citizen in any other job in any other place.

If a grocery store clerk gets NASTY mouthy with you, you can just walk away. You can report the clerk to the store's admin. You can change where you shop. You could become mouthy back and engage in a war of words with the clerk whereby the situation might just escalate into a heated, and possibly dangerous 'RAGING" situation.

Pretty much the same if you run into some ignoramus on a bus, at the bank, a kid's football game, etc. But just being mouthy doesn't mean someone broke a law, nor is it always considered ABUSE. Now if you're verbally threatened or physically assaulted, you can call the police and press charges. And you'll go through the legal process whereby your claims will be investigated and determined by others. That's your rights just like any other US citizen.

But there are folk who are PROTECTED because of who, or where or what they are, meaning your pts because they are considered at risk or vulnerable and are institutionalized. There's where you walk the fine line to determine your response. You've done all you could with your admin.

Yes, you should feel safe and NOT exploited or abused in your workplace. I think of clerks on the NOC at the local 24 hour WaWa or gas jockeys at the local gas station. They should feel safe too. But the nature of their job does put them at risk. Police & fire rescue come to mind also. It's all one big calculated risk where one works. A suicidal bomber could show up at a Sunday church service and the minister and choir are now jeopardized. A pt's crazy ex-husband shows up with a gun and opens fire thus killing 8 people in the Planned Parenthood parking lot. Those folk all have the right to choose where they opt to work. Their CHOICE, like yours.

Unions have long fought for safe workplace standards. Staffing, training, equipment, monitoring etc have all been provided. But the unexpected is still possible at any job. And that's what happens in healthcare. PP Esme12 points out that there are some state laws in place that protects workers from abuse during the performance of their jobs. (Just FYI - New Jersey expanded its laws a few years ago.)

If this guy can be determined to be a 'risk to others' as in other 'protected' residents, then this most rightly becomes a DOH or Ombudsman referral. It may be the best way to pull some official attention to the guy. Your admin would then have to take some steps to address the situation.

I've been in situations like yours. No easy answers.