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.

[Nascar nurse, ASN, RN]

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 would have calmly and matter of factly stated.. "You can refuse this now and we will notify your Dr. or you can be patient and hold still and I will do my best from there". Balls in his court.

PS - I guess I really don't see this first part of the interaction as verbal abuse - just some guy running off at the mouth. He ain't the first and won't be the last.

[Natkat, BSN, MSN, RN]

I understand you felt intimidated. I'm not a nurse but a dialysis tech, and I have had my share of mouthy patients. This is what I do.

Ignore them.

I just do my job and let them talk. I look at their mouths going "blah blah blah blah blah blah......" and I just do my job.

I once had a situation where I was having trouble getting a patient's bleeding under control. I was getting there but still fumbling around a bit. After a few minutes the patient yelled "go get somebody" and I looked him right in the eye and said "I am somebody" and kept doing what I was doing. He didn't say any more.

[ecugirl]

I am so proud of you! I think you reacted in a most professional and calm manner. It is high time that patients are given the message that they are not allowed to treat health care workers as their punching bags; verbally or physically...this type of behavior from "customers" in any other "business" is not tolerated. A nurse in our ER is actually suing a patient for assault and battery...I hope she wins...even if she doesn't she's getting a message across...and she still has her job!!

[cablern]

i dont agree with ruby vee's reply. there is nothing that states that you must suck it up and take it when dealing with verbally and/or physically abusive patients. i know patients have rights but not more rights than the healthcare professionals that take care of them. i work some of the busiest emergency rooms in san diego and los angeles, and we do not put up with patients that verbally or physically abuse the staff. we are there to take care of the patients, but to a point! this does not mean we are the target of their frustrations or anger or anything else! they need to control there behavior or then can leave! if they continue their abusive behavior, verbally or physically, they will then be escorted out for there safety and own good. this applies to any staff that comes in contact with the patient as well, i will not stand and let ancillary staff absorb the patients idiotic actions as well. that behavior is uncalled for and will not be tolerated in the emergency rooms i've worked in or work at. we are nurses! we will not be treated that way!

i applaud you in the way you handled that situation.

[StNeotser, ASN, RN]

So, can I ask the posters who thought it was OK to have the man refuse (and that is his right) what they thought would happen next?

When we have people like this normally a nurse or someone else will go in with the phlebotomist or attempt to do the draw. If they still behave in the same manner or get more aggressive despite calming techniques we say OK, and chart refused. When you have someone threaten you and you switch assignments with someone else, why is it OK that person gets threatened for the rest of their shift?

I'm not trying to be difficult here, I just want to know how it works where you are.

[MomNRN, BSN, RN]

I would not stew about this. Unfortunately, it does happen and happens often. It is difficult to learn how to handle these types of confrontations. Most of it comes with experience and maturity. It will happen again and you will be prepared.

You did the right thing. If the doc gets pissed regarding the stat nature, he can draw the pt himself. All of our docs would stand up for us and our safety.

If the pt refuses, that is his prerogative. The door swings both ways.

I don't put up with BS attitudes. If you want help, I can help. If you want to be a jerk, I can show you the door.

[cat123]

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.

I'm sorry I must be missing something. at first he just threatened to sue you he didn't threaten you with bodily harm. It seems your reaction is what triggered him with the foul mouth. Maybe you just over reacted a little. People often under stress say things they don't really mean. The verbal abuse shouldn't be tolerated. But, as professionals we should have a little more understanding. just my 2 cents.

[Mary Austin]

Good for you! I AGREE with you all the way. We had a street person who injected meth into his shoulder. He was there for three weeks. He threatened everyone. I called the supervisor and he told me to "make sure the guy did not get between me and the door"! This was nightshift with only three nurses on! When I talked to a state person (Labor and Industries, Workmen's Comp) they wanted to know what hospital, what supervisor, and a full report on what happened. The state (WA) does not like threats made to nurses and they (hospitals) can be reported and cited for putting staff in dangerous situations.

[TazziRN, RN]

So, can I ask the posters who thought it was OK to have the man refuse (and that is his right) what they thought would happen next?

When we have people like this normally a nurse or someone else will go in with the phlebotomist or attempt to do the draw. If they still behave in the same manner or get more aggressive despite calming techniques we say OK, and chart refused. When you have someone threaten you and you switch assignments with someone else, why is it OK that person gets threatened for the rest of their shift?

I'm not trying to be difficult here, I just want to know how it works where you are.

Sometimes it changing assignments with someone else gets the message across to the pt that the behavior was not acceptable and he/she changes for the second nurse. I have actually seen that happen alot.

As for whether or not what the OP's pt said was threatening or not, the opinion of someone else who was not in the room (like all of us here) doesn't really matter. What matters is that the OP felt threatened and scared.

And, BTW, it was highly insulting for the pt to call the OP "little boy", no matter how young he looks. I have enough of a mouth on me that I would have turned around and called the pt "old man" but that's just me.

[vamedic4, EMT-P]

I'm sorry I must be missing something. at first he just threatened to sue you he didn't threaten you with bodily harm. It seems your reaction is what triggered him with the foul mouth. Maybe you just over reacted a little. People often under stress say things they don't really mean. The verbal abuse shouldn't be tolerated. But, as professionals we should have a little more understanding. just my 2 cents.

Have to disagree with cat here...this guy is OBVIOUSLY an agitated moron, less moron, more agitated until proven otherwise. In this case you acted correctly. I deal with family members of children who've been stuck for IVs or labs numerous times and this happens often.

The best course of action (prior to your actual sticking) is to explain everything you're doing, and why you're doing it..if possible. This gives the patient a feeling that they are being cared for and that they are important.

Yes, they're under stress...but there's a limit to what you should and should not have to subject yourself to. You did the right thing. Now fill out an incident report and write down EXACTLY what happened..what was said by both parties, and what was done. CYA in all situations.

What you experienced is completely unacceptable and you did the right thing, short of pulling out the defibrillator and giving him some "accidental shock therapy". That would have shut his mouth

As for looking young...enjoy it while it lasts!!! As a 17 year old nursing student (mannnny years ago) my patients often wondered if I was able to be on the floor without a parent present..much less take care of their nursing needs. Enjoy it while it lasts. Your patient was a bit out of line with his "little boy" comment...but don't take such things personally. If you hold on to every bad thing any patient has ever said about you, you will not last long in this business.

Here's hoping your next shift goes better.

vamedic4

watching Lilo and Stitch with Austin

[goodasitgetts]

I have been a nurse for 16 years and I think that you handled that well! FYI- in the future if you EVER think that you are in danger while dealing with a patient you have the right to stop what you are doing and ask for help. I have seen nurses who were severly injured by patients and I know of an instance where a nurse who was actually raped by a patient during night shift! That is why hospitals have charge nurses and security guards. Your safety is important! One more thing- you should have at minimal documented what occured or requested that it be documented. Patients like that frequently are abusive to many staff but if it isn't documented than if is difficult to prove in case an incident occurs. Best wishes!

[redding-er-rn]

No one deserves to be verbally abused by anyone including patients. I think you handled the situation in a professional manner.