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.

[beth50lpn]

I agree with the majority on this one. How are you supposed to do a procedure correctly when you are being threatened before you even begin? That would make me nervous, & I would be sure to miss the vein! If the dr. wants it STAT, maybe he should attempt the draw. I wager the pt. would not be so abusive to the doc! I work with the elderly & many have dementia, & I get threatened & even assaulted on a daily basis. I can excuse this behavior in a dementia pt., but not in an alert & oriented individual.

[MichaelLooney]

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!

since this has been stated, i'll post what happened to me reguarding an abusive patient.

i not only was verbally abused by a patient, but physcially. and she was one of those 'grandmotherly'-types, so she looks all harmless until she's angry. now, they tell me i can't refuse her any care under any curcumstances, then fired me the second time she hit me, claiming i was abusing her.

(now, i'm the one with the broken glasses, the bruses on my thigh, and the fracture in my wrist, while she comes out of it happy as a daisy and sparkeling as a diamond, and _i_'m the one abusing her.)

i think it really depends on the place you're working on, and their views on everything. the place i worked assumed that every time a patient became combative it was automatically the cna or nurse's fault, and they were consequently blaimed for the entire fiasco.

[beth50lpn]

I understand completely. Was it in a hospital or nursing home? In a nursing home, those residents with a history of dementia & combative behavior are known to administration, as we are encouraged to document every instance in the nurses' notes. Now, if a family member of one of those folks were to launch an abuse complaint, it would be investigated as any other, but the residents are not generally able to lodge complaints themsleves. I know of only 1 STNA who was fired over an allegation of abuse, & that was a set-up job. Another employee had a reason to want to make trouble for her, & so filed a complaint with administration, alleging they had witnessed abuse.No abuse ever took place, but the facility fired her as they didn't want even a hint of scandal. That's sad, as she was an excellent aide. I have a resident that's mean as a snake & I have to do blood sugars & insulin on her daily. I have been hit, clawed, spit on, kicked, elbowed in the stomach, & called everything but a nice person by her. It will happen again tonight. She makes me angry, but I have to remember she is not wholly responsible for her behavior. When it gets to be too much, I just walk away.

[bradleau]

I am a RN and only once, in my doctors office told the lady ATTEMPTING to take my blood to STOP. When she refused and said "I know what I am doing" , I walked out. Got my doctor to send in someone else. This one did do it right. The other one did not have a clue, nor did she listen to me. I told her I was a nurse, and offered to assist her in her attempt at getting my blood. No it is not difficult unless you are trying to get blood from my tendon instead of vein.

[Trauma_Team_1]

That you for all the replies the advice has been great ( I have updated that main part of the question btw)

[Warpster]

If you feel unsafe, the best thing to do is leave the area. An injured health care worker is going to help no one. After you assure your own safety, get help in approaching the patient to do your job.

If a patient is out of control to the point that other patients are threatened, get them out of the area, as well. That's your job, too.

Assault is a fact in hospital situations. Hospital security people are paid to insure safety for health care workers who have to deal with patients who are violent. Experiece will teach you how to defuse many potentially violent situations. There will always be some you will have to physically leave and get help to deal with.

You'd be surprised how sweet some of these bruisers get when you return wth two burly cops to stand by while you draw that blood.

[kadokin, ASN, RN]

I agree with Ruby on this. Where is the above statement did he threaten anything physical? It was only after your reply to his statement that he verbally abused you.

Heck, another nurse and I were taking care of an elderly patient the other day that SPIT on her, then turned to me and said, "You're next!!". After telling him "I don't think so.", we simply put a mask on him and continued with our care.

U R so FUNNY!!! "I don't think so". Also love the tag line @ the bottom of your post. Funny people make my day.

[sprout]

I was a phleb before I was a nurse and I got spit on, threatened, hit, called names etc. and the patients that were "experts" (you get one try, or you can only poke me in this vein with a butterfly (and they have garden hoses!) You may look young, but many people do. Just be confident in your skill and show that confidence! As a nurse you will be dealing with patients just like this. Be direct, confident and do not allow them to bully you - you did handle it well. I've had security accompany me with psych and combative patients - sometimes they've even held an arm so I wouldn't miss. Their presence or even the nurse's presence made all the difference. Don't let those people ruin your day. As frustrating as it is because we're all in this to help people, some people are just a*****. Let the doctor know why this patients labs aren't done. I've had doctors back me up and tell the patients that it is not acceptable to abuse the staff and they are welcome to go somewhere else.

[Trauma_Team_1]

Should phleb's carry MP ins?

[IMustBeCrazy]

Always be aware of that little voice inside you. If you get "that feeling" then GET OUT. NEVER EVER compromise your own safety.

[i_am_acat]

I agree with Ruby as well. It's inevitable to meet patients like that in the future: anxious, stressed etc... Im a first year student nurse and I havn't done duties before, but head on, my school teaches us how to deal with those kinds of patients.

[DarlinNurseRed]

I have no desire to be injured while helping someone. I think it is always best to punt if there is no other way. The other workers would rather attempt a stick for you than have to pull this big guy off you in a fight. If it was my patient, I would have said, "you did the best thing" and I would have taken care of it.