Dealing with a patient who verbally threatens you

[Trauma_Team_1]

Im not a nurse (yet), but I work as a phlebotomist, and I only have about 3 weeks TOTAL experience working in a hospital. Im 24/m and I look 16 ( in the face and in the body 6'0'’ 150 lbs) and it seems that I am having trouble having P.T’s treating me like an adult and not someone who is out of H.S. I really do believe its because I look so young so its not really all their fault for that I guess. Anyways today I had a STAT C.B. for a P.T. that was about to be discharge, but he started spiking a fever so the STAT was ordered. The guy was prob 6'5'’ 300lb football player looking guy and just seeing him scared me to death lol. As I was drawing him he told me " if you miss my vein im going to sue you little boy" ( he did this in a cruel way not a playful way) I immediately stopped the procedure ( and I did miss his vein, but he didnt know that) and told him "if you threaten me like that again I will stop this procedure all together, and this will cause you to stay longer because I will not draw you, and will alert your nurse about this incidents" I said this as politely as I could ( but I was visibly shaken I am not a confrontational person at all by nature) he then SCREAMED "F*** Y** you skinny rail mother ****** ill sue you’re a** off b****" I said nothing just took my gear and left told the nurse that I refuse to draw this guy ( it was a STAT so I was ticked off that I had to make the doctor wait, but im not drawing someone like that) It basically ruined my day , but is that the best way for me to handle that? Any advise from nurses who have experience with difficult P.T.’s would help me a lot. Thanks.

******************************************UPDATE 8/16/06******************************************

First I want to thank all of you that have responded to my question the advise is valuable. Today 8/16/06 I was called for another STAT draw on a pt who was a drug user. ( I did not know that until AFTER what im about to say happened) The pt was down in CDU laying in one of the beds in a bay. He seemed to be totally aware that i was there to draw blood on him. So as i go to tie the tunicate on him I was about 6 inches from his arm when he SWINGS at me with his free arm..not once but 2x. He missed both times but i had to pull some rocky moves to dodge both swings ( thank god im flexible lol) He then tried to run out of CDU until half of the nursing stuff jumped on him. I almost feel like im more a cop then a healthcare worker at this point. I was really kind of teed that no one informed me this guy was a massive drug user and could be dangerous until AFTER this happened ( BUT its my fult as well as i should NEVER let my guard down). But this is only my 1st month working in a hospital environment so i really am ignorant to the dangers i guess. Anyway I thought this would be an interesting follow up to my first part of the post. I think I need to join the police academy before i go into any more rooms lol.

[TazziRN, RN]

Yes, I think you handled the situation well. As for your appearance, sometimes a change in hairstyle can help with the age problem.

[CHATSDALE]

not all nuts are all mouth don't take any chances you did the right thing back off and let someone else step in you will have a chance to pay back the coworker some time when they need you

[veronica butterfly, ADN, RN]

You did completely the RIGHT thing, good for you!! The next time it happens, it won't be as scarey, haha!

[CaseManager1947]

You absolutely acted correctly-- no one deserves to be treated with abuse. I'm sure that you weren't the only phlebotomost in the house that night. Right On!!

[Ruby Vee, BSN]

i'm going to disagree with the previous posters. the blood draw was a stat, and someone had to draw the blood. patients like that probably aren't going to be any more pleasant to the next person to attempt, so the next person is going to have to complete an assignment that you were given. and that person probably isn't going to want to do it, either.

when you work in a hospital, you get to take care of verbally and sometimes physically abusive patients. someone has to take care of them. sometimes, that "someone" is going to be you. talk to your boss or a nursing instructor and get some help figuring out how to better handle patients like this without turfing your assignment to someone else. if you learn this lesson now, it's going to make the rest of your clinical experiences go so much more smoothly!

good luck with nursing school. i hope you find your niche in nursing.

(by the way -- p.t. means physical therapist.)

[snowfreeze, BSN, RN]

I am impressed with how you dealt with this patient. I hope you get to know the nurses so you can approach them and ask for some insight on patients mindset. As a young person you are going to deal with a lot of oldsters who dont like young people. Get the nurse to help you with blood draws while you establish your comfort zone. Good luck!

[MajorAl]

I'm going to agree with the majority and disagree with Ruby Vee. I've worked in mental health for the past 14 years consecutively and off and on for the 17years prior to that. One of the hardest things to teach new employees (Nurses, CNAs, Social Workers, Psychologists, etc) in mental health is that sometimes it is best to disengage and let someone else handle the situation. Too many people think that they have to complete what they are doing even if they are verbally or physically threatened. Now a piece of information I picked up back in the late 60's. Some of the biggest guys in the world are frightened to death of a itsy bitsy needle. It sounds to me like your pt is/was one of these guys and the way they handle this fear is to threaten you. If it ever happens again, before you insert the needle for the first time, tell him (always has been a him in my experience) that he has good veins and with your experience you should have no trouble with a simple stick. Good luck. Alan

[firstyearstudent]

I'm not a nurse, but I think you did the right thing and handled it well. You were assertive and also aware of your own limitations. Both are commendable. I suspect that wrangling difficult patients is a skill that is learned over the course of years and not in three weeks.

[TazziRN, RN]

I agree with many of Ruby's posts but not this one. When one is threatened one has the right to protect oneself, even when in the position of caregiver. Yes, by doing this he left the job for someone else to do, but perhaps the pt learned that such behavior isn't tolerated and was more pleasant with the next phleb.

[LeahJet, ASN, RN]

It depends on the situation. If I really felt physically threatened, then I would refuse, as the OP did. Now, if it's just some mouthy jerk that's out to hurt only my feelings....ppffttt...whatEVER. I just get this flat affect and monotone voice and do what needs to be done.

[LoriAlabamaRN]

I think this is the first time that I have ever disagreed with Ruby... but I think the op did exactly right. Noone deserves to be treated that way. How terrifying to have someone that large screaming and cursing in a threatening way toward you. I give you props for keeping your cool and handling the situation professionally. If any of my nurses were to find themselves in that sort of position, I would expect them to do the same thing. I realize the draw was a stat, but that does not mean that we need to put ourselves in a dangerous position. I would have gone in to take the blood myself (after introducing myself as the facility supervisor) and would have had at least one if not two of my large male staff members with me just in case he became violent. I speak from experience, I once had to draw a stat potassium on a very violent man, he muttered and cursed but let me slip the needle in his vein, then as the blood started to come up toward the tube, he suddenly ripped the needle from his arm and threw the entire works at my head. If I hadn't ducked I would have received a bloody needle in the face. You did good, OP. I'm sorry you were put in that situation, but you handled it well.