Disrespectful patient

[hwknrs]

Tonight I got a 20 y.o. pt from the ED who came in saying he tried to harm himself by benzo OD. A&O drug screens neg. I went to his room to check vitals and get his admission history done. He was talking to his friend and did not stop to respond or even acknowledge that I had entered. he complained that he wanted to be released ASAP in the AM and that he didn't even have his cell phone charger with him. When I asked for his emergency contacts he sighed and rolled his eyes at me then went back to talking to friend.

Then mom came in from the hall. Pt then started playing with his cell phone and would not make eye contact. Just incredibly rude and snotty. I asked him to please put his phone down, show some respect and make eye contact so we could get this done He rolled his eyes & sighed ugh fine is that better. At that I told him it looks as though he has a lot of growing up to do and said that this is unacceptable behavior how he is acting towards me. I reminded him that he is here because of a choice he made and not to get smart with me as I'm trying to help and it's not my fault that he's here. His mom then told me that I shouldn't be talking to him that way that he just tried to kill himself (which he really didn't) and I should be more understanding. I said that's what I'm trying to do my job and no matter he still should not be so rude. It's not ok for him to be talking to me like this.

Then pt started screaming at me sayin you ***** you don't know and punching himself in the head. I stood back and watched and said this is pathetic how you are acting this is terrible behavior. Other staff heard him screaming & security was called. I then left the room and family requested another nurse and acted as though I was in the wrong. What do you all think? I just felt that his behavior was awful and inexcusable- needed to be brought to his attention that this is not the way to behave.

[ixchel]

OP, you mocked a mentally ill patient. You also do not know how the mother has handled him in the past. If you spoke that way to my child, my silence would be from surprise (in a terrible way), and requesting someone else would be reasonable and justified.

And before anyone here jumps me saying I must be a parent who coddles poor behavior, my children are disciplined when they are blatantly rude. If I don't feel the need to do that in front of others, you wont see it, nor should you have to. They would apologize appropriately the next time you come in the room.

[LadyFree28, BSN, LPN, RN]

hwknrs said:

I'm not denying that he has a psych problem. I only pointed out the drug screen to show his manipulation. He told a terrible lie to his friends and family in order to get them to run to him and it worked. He also got the attention he wanted from a certain girl. He came to my hospital knowing this and then acted as though I was inconveniencing him by doing my job and that he was angry that he had to be there. This is repeated behavior for him as well. Obviously his mother has never told him this is wrong and I beleive that SOMEBODY needed to let him know this is not right. He should have been admitted to the psych unit as he had no medical problem and that probably won't even happen either since 9/10 OD patients just get d/c home because our psychiatrist won't take them. It's clear that he takes no responsibility for his behavior and then gets angry when the obvious consequences happen. ignoring his rudeness and acting like this is all ok just further implants the idea he has that threatening or attempting suicide and throwing temper tantrums is how to get what you want. When is somebody or anybody going to check what this kid is doing? It's disgusting

Regardless, this person has a psych problem; if you are having issues with responding to someone who is exhibiting this behavior, crack open a mental health nursing book; they have strategies in how to approach people with challenging behaviors; also Google "managing challenging behaviors" and incorporate that into your practice.

"Tough talk" is NOT therapeutic, no matter how you feel about the pt even if this was your family member; if anything it impeded the nurse-pt trust that he needed.

There is still a way to approach anyone with challenging behaviors and moving forward, it would be best to learn how to incorporate the best strategy for your practice.

[bebbercorn]

Wow, for a minute I thought you were joking. You were being authoritative and insensitive, IMHO. Yes, he was being disrespectful, but you can definitely get it through differently! I'm not bashing you, OP, it drives me nuts when people treat me like that. But I might say something like, "If you need to do something on your phone, I'll come back when you have time to discuss your care." While I sympathize with you, OP, I'm going to side with your co-workers. He got under your skin and you let it show.

[nurseinthezoo]

I would have documented his behavior, deferred the admission history, assessed him and moved on. Remarking that he's got a lot of growing up to do, especially in front of his mother was a sure fire way of ramping him and the mother up.

[BuckyBadgerRN, ASN, RN]

Wow. My advice is to grow a filter and grow it fast. Of course the mother wasn't going to side with you. Any snot-nosed punk who would DARE act like that in front of his mother is not going to hear him Mom go "against" him. Mentally, I agree with what you said, but it was NOT your place to SAY it. Expect an HR contact in your future!

hwknrs said:

I was hoping the mom would back me up and help remind him of basic manners. This has worked in the past but not this time. I know if my child was acting this way I would be embarrassed and definitely tell them to knock it off.

[NutmeggeRN, BSN]

hwknrs said:

Tonight I got a 20 y.o. pt from the ED who came in saying he tried to harm himself by benzo OD. A&O drug screens neg. I went to his room to check vitals and get his admission history done. He was talking to his friend and did not stop to respond or even acknowledge that I had entered. he complained that he wanted to be released ASAP in the AM and that he didn't even have his cell phone charger with him. When I asked for his emergency contacts he sighed and rolled his eyes at me then went back to talking to friend. Then mom came in from the hall. Pt then started playing with his cell phone and would not make eye contact. Just incredibly rude and snotty. I asked him to please put his phone down, show some respect and make eye contact so we could get this done He rolled his eyes & sighed ugh fine is that better. At that I told him it looks as though he has a lot of growing up to do and said that this is unacceptable behavior how he is acting towards me. I reminded him that he is here because of a choice he made and not to get smart with me as I'm trying to help and it's not my fault that he's here. His mom then told me that I shouldn't be talking to him that way that he just tried to kill himself (which he really didn't) and I should be more understanding. I said that's what I'm trying to do my job and no matter he still should not be so rude. It's not ok for him to be talking to me like this. Then pt started screaming at me sayin you ***** you don't know and punching himself in the head. I stood back and watched and said this is pathetic how you are acting this is terrible behavior. Other staff heard him screaming & security was called. I then left the room and family requested another nurse and acted as though I was in the wrong. What do you all think? I just felt that his behavior was awful and inexcusable- needed to be brought to his attention that this is not the way to behave.

Bolding is mine...

Judgmental much? Sorry, wrong approach/response. Telling someone their behavior is unacceptable is one thing (I have done that), telling them they need to grow up, not cool.

Whether or not he was acting pathetic, not your place to label his behavior.

I have walked away or simply stopped talking until I get their attention.

You will be lucky to not be reprimanded. Maybe it was horrible night for you, or maybe the ER is not for you. But you need to reflect on YOUR behavior.

People act how they will, you have no control.

How you respond is totally within your control.

[nursmimi, BSN, RN]

You are there to be his nurse. Nurses are there to help, whether they want it or not. He was not physical with you, why would you antagonize him like that? No, he should not have been acting that way, but IMHO you acted worse and actually escalated a problem. You might as well have just gotten up in the mom's face and told her what a crappy kid she raised and how much of a bad mom she is...

[macawake, MSN]

hwknrs said:

Tonight I got a 20 y.o. pt from the ED who came in saying he tried to harm himself by benzo OD.

Quote

He was talking to his friend and did not stop to respond or even acknowledge that I had entered.

Quote

Pt then started playing with his cell phone and would not make eye contact. Just incredibly rude and snotty. I asked him to please put his phone down, show some respect and make eye contact so we could get this done He rolled his eyes & sighed ugh fine is that better.

Quote

At that I told him it looks as though he has a lot of growing up to do and said that this is unacceptable behavior how he is acting towards me.

Quote

I reminded him that he is here because of a choice he made and not to get smart with me as I'm trying to help and it's not my fault that he's here.

Quote

I said that's what I'm trying to do my job and no matter he still should not be so rude. It's not ok for him to be talking to me like this.

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Then pt started screaming at me sayin you ***** you don't know and punching himself in the head.

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I stood back and watched and said this is pathetic how you are acting this is terrible behavior.

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Other staff heard him screaming & security was called. I then left the room and family requested another nurse and acted as though I was in the wrong.

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I just felt that his behavior was awful and inexcusable- needed to be brought to his attention that this is not the way to behave.

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At the time I felt that holding my tongue would be a disservice to him and reinforce that he act this way again in the future.

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What do you all think?

What do I think? I think that the way you handled this leaves a lot to be desired. I'm former law enforcement. I am very accustomed to lecturing/disciplining adults who exhibit undesirable or illegal behavior. I learned quickly that if I wanted to get my point through, but not escalate the situation, it's best to be factual and simply point out which behavior is unacceptable. Unless I was itching for a conflict I'd never attack personal shortcomings or try to demean/belittle the other person.

Honestly, what did you think would be the result of your admonitions? Telling someone that their behavior is unacceptable is fine, telling them they're behaving like a baby isn't. (That's exactly what you're implying when you tell an adult that they have a lot of growing up to do).

Why would you demand that your patient look you in the eye when they talk to you? That's only your own preference and you're not your patient's parent. You are in my opinion making this about you, when it should be about your patient. There are many reasons other than lack of respect why a person (with or without mental health issues) won't look you straight in the eye.

You say that you felt that his behavior was awful and inexcusable and that that you felt that it was up to you to bring this to his attention. I've bolded all the times you brought it to his attention. You told him over and over again without accomplishing your desired effect. How can you be surprised that it was concluded that you were a part of the problem and that your approach simply wasn't working?

If a person who has come to your ER seeking help for some type of mental health issue, why would you tell them when they've reached a point when they're punching themselves in the head (!), that their behavior is pathetic? Try to imagine yourself in such a state of agitation or frustration that you are delivering punches to your own head, and ask yourself how you would have responded to such a comment. From my experience you're lucky that your patient didn't turn his aggression onto you instead of himself. You didn't handle a clearly emotionally volatile patient in the safest way.

I wish I could be more supportive, but in this case I'm finding it difficult to be. I think that the way you chose to handle this situation is likely the reason this situation escalated in the first place.

(Please note that I said that the way "you chose to handle the situation" was less than optimal, not that you are useless at dealing with your patients. There is a lesson in that. Don't make a personal attack that is bound to evoke defensiveness, focus instead on behavior that can be changed).

[Cultmember]

I could not believe what I was reading---that you, the nurse, actually proceeded to chastise your patient for not cooperating when you wanted to get your vital signs. Excuse me, dear nurse, but the patient has a right to refuse having his/her vitals taken. Even in the case of a certification/involuntary status, the nurse must obtain at the very least implied consent to touch a patient's body, otherwise is constitutes assault.

You should have walked out of the room when the patient was showing no interest in cooperating with you and your desired intervention. Documenting your first attempt at an interview.

Next, the fact that you are judging an individual who has presented para-suicidal tendencies indicates to me that you are not fit to work with patients in general.

If I were your manager, you would be forced to an ethics class.

I know you felt disrespected but at no point are we allowed to retaliate, which is mainly due to the power dynamic between you and the patient. Your patient represented a vulnerable individual and you represented the authority in the situation.

[elkpark]

Really, OP? You're working in an ED, not an etiquette school. If you spoke to any family member of mine, regardless of the situation or the family member's behavior toward you, the way you describe, I'd be complaining to the administration about how inappropriate you had been. It almost sounds like you were intentionally trying to make the situation worse.

[bsyrn, ASN, RN]

Never take how a patient acts personally. This was all about what he was going through and really had nothing to do with you. This definitely could have, and should have been handled better. Live and learn.

[needlesmcgeeRN, ASN, RN]

Did you miss your rotation in psych nursing???

Not saying I approve of the patient's behavior, but your response was not appropriate.