Can nurses refuse to care for angry patient?

ERKev · Nov 10, 2003

Originally posted by skybirdrising
Can a nurse refuse care to a patient if they feel threatened? Verbally abusive? Sexually harassed/touched? What if you are already 'enemy' with the patient from a personal experience outside of work?

I'm an agency nurse. I work a lot of different places and the general way of handling this situation is to inform your supervisor and tell them of your concerns. They should accomodate the situation by a different nurse taking the patient. If the problem is with ANY nurse, then if the patient is "stable", they can leave. You do NOT have to work under duress! There's enough stress in this field wiothout having to work in hostile conditions.

Regardless, the problem should be given to supervision (charge nurse, house supervisor, etc).

Town & Country · Nov 10, 2003

Alot of times, people will tell you to "never go in the room alone," but how are you supposed to do that when most places are already short-staffed?

I would just refuse, and see if I could trade assignments, etc.

Gldngrl · Nov 10, 2003

Your work policies may provide you with some guidance on this issue. I refused to care for a verbally abusive/non compliant patient and notified the clinical administrator, med. resident, and wrote up a report for risk management to protect myself. The resident also went in and told the patient that his behaviour wouldn't be tolerated, etc. and the situation improved.

Regarding sexual harassment and the patient: some hospital policies have included patients as "3rd parties" in sexual harassment claims so if this situation applies and you have a policy to cover it, you technically may be able to file a sexual harassment complaint against the patient. Now realistically, the hospital will probably downplay it or attempt to get rid of the complaint altogether. Again, you'd need to check your policies and go through the chain of command and document everything objectively.

Regarding caring for a patient (prior personal abusive relationship): I would establish from the onset not to be assigned to that patient and state that the patient is known to you-that's all unless you wanted to make known the details. If there's a problem, you could discuss it with the supervisor, but most places I've worked made exceptions for situations such as these.

MMB

kids · Nov 10, 2003

Originally posted by skybirdrising
...What if you are already 'enemy' with the patient from a personal experience outside of work?

I have always declined to work with patients that I know privately weather a friend or "enemy". Too much of a potential for being accused of a confidentiality breech or to by "pestered" for advice/information.

rpbear · Nov 11, 2003

I think it depends on your employer. When I worked as a CNA I had a resident that was "sexually inapropriate" with me. The other CNA's just told me that he is confussed and he allways does that but he is harmless. I didn't feel comforatble with him and I reported it to the supervisor. She was very understanding even knowing his past history. I never had him on my assignment again. And would not go in his room alone.

Good Luck.

mspringer · Nov 11, 2003

I heard there is actually a federal law that states nurses can refuse to take care of abusive patients. Anyone familiar with the law. I have heard of this happening and the MD just discharged them because of noncomliance with care and abuse of staff.

montroyal · Nov 24, 2003

Originally posted by skybirdrising
Can a nurse refuse care to a patient if they feel threatened? Verbally abusive? Sexually harassed/touched? What if you are already 'enemy' with the patient from a personal experience outside of work?

Any patient who verbally abuses or threatens you, or sexually harasses or touches you is a criminal! Talk to your supervisor first,but if that does work,call your local police and press charges. Several states now have laws which protect nurses from these criminals.

debRNo1 · Nov 24, 2003

Originally posted by Shezam!
I would just refuse, and see if I could trade assignments, etc.

This weekend I noticed that we had a "frequent flyer" back on our unit. She wasnt in my district so I was glad about that.

I do beleive she is one of these "drug-seeking pts" who may even be "doing" something to herself to cause infections and/or surgeries. I had an unpleasant experience a few months ago with her.............

She was in a private room due to an "infection" SP some minor surgery. She was on every narc in the cabinet. MD writes an order for discharge but she refuses to leave. Cant get daughter on the phone she is giving me phony numbers. Son is "drinking" today and cant pick her up. Has to take a shower before she goes, has to have MORE ms and a valium NOW !!!!! It got to the point where she wouldnt let me in the room and had the door blocked with a chair. This goes on for hours and hours..... Supervisor comes and we have to call security. Shes like a bag lady and has a ton of bags in the room, she is now screaming that we cant touch her stuff. She wont leave till she gets her meds. Shes calling a lawyer, her daughter is a nurse yada yada yada.....We pack her up and she is escorted out of the building.

Saturday low and behold who has been moved to the empty private room in my district !!?? So I bite the bullet and go in cause her bell is lit. I introduce myself and ask what she needs and the argument begins~the bell isnt lit~YES it is~what do you need~the nursing supervisor~what is wrong~what do YOU think~YOU kicked me out and wouldnt give me my meds last time I was here, I dont think your my nurse today.................. GET OUT !!!

So I go call Sup and tell her, think shes heard enough about this woman, who caused such a fuss they put her in that room. I traded with another (float) nurse who had the time of her life that day. Roaming the halls following the nurse BEGGING for meds, sneaking out to smoke, pulling out her IV, she had a list of meds for doc and he refused to order them. Shes dressed to kill wearing tight jeans, big shoes and lifting up her shirt so everyone can see just how red her belly is. Funny thing is there is no psych hx documented on this woman !!??

At first I felt a little insulted, Ive never ever had anyone refuse me as a nurse~ this is a first. BUT Im glad though because I wont ever have to deal with this woman again.

I documented word for word what she said and that sup was aware. I just hope shes gone by WED so I wont have to witness her being escorted out again.

Too bad for her because Im the smoker who will take the smoking pts out and I REFUSED to take her out with me. Sorry but Im not getting involved and taking her out when she already had a valium and 10 mg of MS.....................no thanks I can refuse too.

I just hope they "escort" her out before I go back on WED.

:eek:

chris_at_lucas_RN, RN · Nov 24, 2003

I wouldn't take care of someone I knew from "outside" either. As a licensed psychotherapist, that would be a no-no--so I'm already in that good habit. (If I was the patient, I probably wouldn't want my neighbor, for example, taking care of me!)

I'm surprised this last patient wasn't referred to psych?????

Sounds delusional and self-destructive. Can't get the family on the phone? Call welfare (adult protective services, etc.).

Son is drinking and can't come? Call AA--see if they'll send someone out there.

Who's the next of kin? there should be phone numbers on the admit sheet--

There are all kinds of things--productive or not--that could be done.

But my first vote is for psych. Also, if the docs d/c her pain med orders in favor of a paper scrip, I'll bet she finds a way home!

Makes me want to reeeaaaaallllyyyy consider what area I want to work in when the time comes (6 months and counting).

imenid37 · Nov 24, 2003

I once did a postpartum home visit on a lady who had the last name of one of my old boyfriends who was some- what "psychotic." I asked the homecare co-ordinator what pt's hubby's first name was. She told me it was"Michael." Ok, I thought. It's not him. His middle name was Michael, but he went by his first name "Paul." I said to her, it's definitely not "Paul". No it's not. I go to the house and gee guess who answers the door. It's Mr. Kooky himself. Well, he left the house thankfully. I offerred to call the agency and send someone else, but his wife said it was o.k. w/ her for me to do the visit. She was very nice. Just before I left, he returned and stated he'd be back in 20 minutes and I'd better be gone. I told him that was no problem. He had been such a creep. He broke my car windows when we broke up. I called the home care agency and told them that it was the guy I was trying to avoid. I thought he'd complain about me, but he said nothing. What a weird experience! i was really mad at the agency. I would've never put myself in that position voluntarily.

Nurse Ratched, RN · Nov 24, 2003

The lady who refused to be discharged definitely sends my "borderline personality" radar to humming!

As far as caring for abusive patients, I am no more obligated to tolerate physical abuse at work than I would be walking the street. Any pt who gets physical with me would discover that it's illegal to assault someone regardless of the setting.

Pt's who are verbally abusive come to an understanding with me that they will be cared for and I will be treated with respect. That's the tradeoff.

The only time I have traded an assignment is when I have known the pt on a personal level. Ethics plus good old common sense demands you not care for someone with whom you have a close personal relationship. It can impede your judgement and put you and/or the patient at risk.