Patient hostility...HELP!

  1. I have just returned to work in a dialysis clinic that I left 3 years ago. (I left to go to RN school and spent a year in the hospital) I had been there 5 years prior and I love dialysis and the close relationship you form with your patients. It is a small clinic with a patient census of 40. There are a total of 3 nurses (counting me) and 5 PCTs. I have really enjoyed returning to this clinic, with the exception of one pt., and because of him I am thinking about quitting. He is ~45yo, and mad at the world. I think he has been on dialysis about 6 months. He is completely noncompliant. He misses tx., he ends his tx. early, he has a beautiful fistula that he won't let us even touch so we continue to use his infected catheter that he refuses to have removed. He cusses me and the other staff, he has called me a liar (I am his primary nurse)...it is GD this and GD that. He is offensive to the other patients and I feel like there is nothing I can do about him. He is young, and he does have a sick wife at home he is taking care of...and I understand his anger...but I am sick of the harassment. I have talked to my NM and she has tried to have the MD send him to another clinic, but the MD refuses. I love my job, but I dread dealling with him so much...Please help!
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    About shannon8282

    Joined: Oct '03; Posts: 15

    9 Comments

  3. by   Juanay
    shannon8232
    Sounds like this pt needs to be on a behavior contract. If he refuses to comply with the contract he should be discharged as a pt from your facility. Unfortunately in the times we live in we should take all verbal abuse as assault and not allow these behaviors to continue. You never know when one will snap. Maybe all the staff should sign a complaint and send it up the chain of command until something is done. This type of behavior should not be tolerated.
  4. by   wordsmith
    I agree with the other poster--this kind of behavior can't be tolerated; it's abuse. You've probably thought of all this, but I'll suggest the following, for what it's worth. Since the MD refuses to transfer the patient to another clinic (he may not like conflict and doesn't want to deal with the patient himself), another alternative may be calling a conference with all of you: MD, RN, NM and the patient, if possible. Your clinic has a social worker, right? What involvement has the social worker had with this patient, and what recommendations has the SW made? Is your NM and the administrator one and the same? If not, this may be time for the administrator to get involved as well.

    You can't do anything about him ending tx early or missing tx except documenting them. I'm assuming everyone's talked to him about what choices he does permit, which is why he's only allowing the infected catheter to be used instead of the fistula. He can make choices, even if everyone thinks they're poor ones (we have an angry patient in our clinic, too, and she's not quite as verbal as your guy, but if she gets a little irritated she goes off like a rocket).

    Is your clinic set up so this patient can be located a little further away from the other patients? Our clinic has one "isolation" room for MRSA/VRE patients and that's where our anger management patient goes when she's having a bad day.

    I don't know if this will help at all, but more than likely it's not you personally. It's directed at you because you're there and a convenient target. Sometimes it's really difficult to separate what feels like a personal attack and realize that it may not be that, but circumstantial. Most of the time it isn't personal with an angry patient. They're just p.o.'d with *everything*.

    Best of luck.
  5. by   Mudwoman
    I had a patient in dialysis hit me and knock me out. The management and doctor made him sign a contract stating that he understood that a certain level of behavior was expected and that if he chose to act out again, he would have to find another dialysis unit. He signed it and we never had any trouble with him again.

    Your patient is getting away with bad behavior. Tell the doctor that until some type of agreement is reached with the patient, you will not be his nurse. When everyone refuses to care for him, either he or the doctor will get the message.
  6. by   Farkinott
    Thankfully my facility has a zero violence policy. Crap is just not tolerated and the higher ups (by law) have to enforce this policy. As for the infected catheter. That guy will just get sicker and sicker until it is removed. Why don't you just refuse to use it as it is poor practice to continue using an infected catheter especially as the guy has a good AVF. Your medical staff need to grow some balls!
  7. by   traumaRUs
    I have to start in the middle - Mudwoman - that pt would be in jail. In IL there is zero tolerance for violence to healthcare workers. No one should ever tolerate such nonsense.

    I work as an APN in a very large unit (160 pts) and we have several patients like the one you describe: verbally abusive. However, EVERYONE signs a behavior contract. If someone violates this by swearing or being aggressive, they are immediately pulled off the machine and shown to the door. As to the infected catheter, we would not stick that because it is a care deficit issue.

    Dialysis patients have a tough life. It is a restrictive lifestyle. However, the way to get things together is to set forth rules and everyone follows them.

    Consistency is the way to go.
  8. by   urrRN
    I don't know what ESRD Network area you're in, but I'm sure your network has pretty much the same manual and tools as Network 13. Look in the manual or on the CD for the Provider Conflict Tool Kit. It's pretty helpful.
  9. by   mmurphy
    You don't "stick" dialysis catheters.


    Quote from traumaRUs
    I have to start in the middle - Mudwoman - that pt would be in jail. In IL there is zero tolerance for violence to healthcare workers. No one should ever tolerate such nonsense.

    I work as an APN in a very large unit (160 pts) and we have several patients like the one you describe: verbally abusive. However, EVERYONE signs a behavior contract. If someone violates this by swearing or being aggressive, they are immediately pulled off the machine and shown to the door. As to the infected catheter, we would not stick that because it is a care deficit issue.

    Dialysis patients have a tough life. It is a restrictive lifestyle. However, the way to get things together is to set forth rules and everyone follows them.

    Consistency is the way to go.
  10. by   lovingtheunloved
    So if he's such a royal PIA and disruptive to other patients, why is he still there?
  11. by   traumaRUs
    Oops - should have said accessed the catheter. However, the thought is still the same, we would NOT access an obviously infected catheter.

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