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.
I think it's easy to assume that he wasn't planning on committing suicide because he didn't have anything in his system, but what if his mom caught him with a bunch of pills right before he ingested them? Of course she would still take him to the ER, because she would want to be sure that he didn't take any of them, and he wouldn't be honest with her about that.
Specializes in Cath/EP lab, CCU, Cardiac stepdown.
pockunit said:
Take what? He was talking to his friend and on his phone. It's not like he was trying to assault her. Document the interaction and move on. Try again later, no big deal.
Like you said, not our job to teach manners. I wouldn't even bother with telling him he was being in appropriate because it would not be helpful for this particular interaction. I totally get being wound up by particular patients, but it's OUR job to recognize that and move past it.
Take what? Patients cursing at you, yelling at you, spitting at you, sexually harassing you? Those all things that we, as nurses, do not have to take. Eye rolling? Who's cares, no big deal. But the above is something that I, and no other nurses, or anyone really, should be tolerating.
And by the way, I was referring to a patient being rude and cursing at a nurse, not to the opening post. I don't find anything wrong with informing the patient that he was being inappropriate in an actual inappropriate situation. Think of it like a patient who makes a suggestive remark. What is walking away going to do? You let them know that it's not ok and that you will be back when he is more cooperative. Then you document such.
Am I in any way saying that the op was correct in her behavior? Clearly not as she was judgmental and condescending, and overstepped her boundary as a health care professional.
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.
Ding-ding-ding, we have a winner.
Try to remember that. You're too full of yourself, new grad in the hot-shot ER job; you might get a pass from your management just this once because of your obvious immaturity and lack of experience, but you must treat yourself to a new cruise through your psych text (you didn't just sell it at the end of term, did you?) and perhaps a consult with the psych clinical specialist. Because you blew this big-time and you do not want do do it again. Trust us on this one.
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.
I haven't read the 62 comments which have thus far been posted but here's my response:
You were absolutely in the wrong. It sounds like you went in with a chip on your shoulder and looking to establish dominance.
You were the instigator.
It is the nurse's role to meet the patient where they are and seek to establish a therapeutic relationship. Instead, you demanded that the patient meet you where you are and submit to your authority.
This was going nowhere but bad, right out of the gate.
Let's not attack someone based on one crappy interaction, that she recognized was bad, and asked for help with.
Where did you see that? Going back and rereading, I see the OP posting here to express her surprise that anyone at work thought she was out of line, and asking what we think (but not expressing any thought that she might actually be in the wrong).
I think if I were your manager, I would have concerns about your ability to effectively care for mentally ill patients presenting in an emergency.
What if that patient was triggered, ran off to the bathroom and hung himself by his shoelaces? Looks like you are the one who neglected to care for his mental health and you created an unsafe environment. He was a patient in the ER with suicidal tendency. Doesn't matter what the results were of his drug test. That was the absolute most inappropriate time to tell him how pathetic he is and to grow up.
YOUR behavior was awful and inexcusable for a nursing professional. If you can't keep personal judgments out of your practice, then being an ER nurse isn't the best place for you. You need to do ICU or surgery where personal interactions are limited and it won't compromise the patient.
Actually, we don't even know that. It takes time for ingested substances to show up in urine. The client may have taken an overdose of benzos too recently for them to be registering in his urine yet. I have talked to lots of people over the years who took an overdose, immediately (or, at least, quickly) regretted it, and told a family member or friend or called 911 her/himself. Those people often test negative in the ED, because not enough time has passed for the drugs to show up in a urine drug screen.
Or, as Purple noted, he may have been found and stopped before he actually swallowed the pills. That doesn't make him any less dangerous.
Specializes in Mental Health, Gerontology, Palliative.
FYI, there are a number of drugs that may not show up in a drug screen for benzos, depending on ingestion time, hepatic and renal function may not show up on initial testing. Testing for paracetamol standardly is not done for four hours post ingestion because it takes that time to get an accurate level
I've heard the phrase "oh but they only did it/said it because they were attention seeking"
Which if anyone needs to resort to self harm/suicide attempts to get attention, does it not occur to anyone that something is seriously amiss because there are so many better ways to seek attention.
Let's not attack someone based on one crappy interaction, that she recognized was bad, and asked for help with.
To to me what she wanted was other nurses to back her up. What she did was wrong, and she was not standing up for herself. She personally did not feel this patient was up to her manner standards. That's not for her to decide. Her job was to care for a mentally unstable patient. Instead she felt the need to call him pathetic. How is that ever right? That kid needed help. And yes, I call a twenty year old a kid.
Get the vital signs and the info you need and get out. You don't ever berate a patient like that, ever.
She he felt she was so right, that even the mother would back her, and was upset she didn't. The mother did not need to whip this kid into shape. He was suicidal. And whether or not he actually attempted doesn't matter, he verbalized it.
OP will be very lucky if family does not report this and she does not get disciplined. A person on their phone happens all the time. This isn't tit for tat, where she thinks he was disrespectful so she is within her right to do it back. She needs to uphold professionalism at all times. She ended up stooping to the level of the patient. Nursing is a profession.
FYI, there are a number of drugs that may not show up in a drug screen for benzos, depending on ingestion time, hepatic and renal function may not show up on initial testing. Testing for paracetamol standardly is not done for four hours post ingestion because it takes that time to get an accurate level
I've heard the phrase "oh but they only did it/said it because they were attention seeking"
Which if anyone needs to resort to self harm/suicide attempts to get attention, does it not occur to anyone that something is seriously amiss because there are so many better ways to seek attention.
Exactly...
I have seen many ODs where patients were negative for the ingested substance. I have also known people who take opiates or ADHD meds daily and are negative on tox screens.
Are you serious? lol. Your responses to him are similar to telling an irate or upset person to "just calm down". ie, you only further riled him up and made it into a huge issue in the end when it did not have to be. I am not trying to say everything was fully your fault, but you are the professional and you need to treat patients where they're at, not try to "teach them respect" or anything like that. If a patient is being verbally abusive, aggressive etc then yes something needs to happen with security, supervisor etc, but even (or in fact ESPECIALLY then- not the time to "teach respect") Because he was on his phone and avoiding eye contact is not something you should've gotten so offended at.
Probably a more effective approach would've been starting out saying "I'm sorry to interrupt your conversation, but I have a few questions we have to go through with all patients. Some people prefer to speak in private about that, is it okay for your friend to be here?" Seems he became more avoidant and using the phone when his mother came in. Perhaps he wasn't comfortable having her in there at that time? You could've clarified this with him before treating him like a naughty 2 year old. Clearly you felt he did not try to kill himself and therefore had no issues? Because you do NOT address a probable psych patient by saying "you are here because of a choice you made" ??! Really??? And saying it is not your fault he is here?? You made this whole situation all about you. I am not trying to be harsh but I'm honestly rather appalled at your reactions, your comments and overall your response. In fact, I half wondered if this was a joke as you seemed so oblivious that you were so inappropriate!
I am not denying he may have came across rude at times initially or even been rude initially, but part of our job as nurses is to think about WHY someone may come across that way. For example, when he was talking to his friend, perhaps he was sharing something about his recent issues or a trauma or something important to him so he didn't immediately stop and notice you? The way you typed this and described the situation, seems as though you went in with an attitude from the start as soon as the pt didn't immediately acknowledge you, or perhaps even before that when you saw the neg. drug screen... Patient's can sense this attitude, and teens/early 20's especially are quickly put off by that and get into the eye rolling and sarcastic ness if they feel a "grown up" is looking down on them.
I was not there, I can't say for certain what was going on with this patient, all I know is that your behaviour and wording was very inappropriate and if that was my son/family member/friend, ETC, I would've been very annoyed with you as well. This especially "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" Just wow.
I feel this situation would have never ever escalated to him screaming and punching himself except for due to your way of "handling" him.
You then said "this is pathetic how you are acting this is terrible behavior" Like seriously? You thought that was the way to de-escalate the situation? That's a great way to get yourself confronted aggressively or even hit, even in an average patient.
Think about that. You told him he needed to grow up, and that he was here because of choices he made. When he got upset (which your comments were egging him to do basically, especially for someone coming in with ?suicidal ideation) and began attempting to harm himself you said he was pathetic(?!?!) and having terrible behaviour?? What would ever make you think that would be a helpful way to handle that situation.??
To top it off, you show basically zero self awareness of the huge role you played in this situation by saying the family requested another nurse and "acted as though I was in the wrong" as if you think you were not?
Honestly, I am stunned and half hope this is a troll post because I find it quite shocking that someone with supposedly 14 years of experience shows such little knowledge of how to communicate with a patient.
Specializes in Psych, Addictions, SOL (Student of Life).
I agree that some of could of been a bit nicer to the OP who BTW hasn't been back since the responses were mostly negative. Still it's important in any situation that once it has escalated to a power struggle you have already lost the battle. After that you either fight on or give in. Though most psych patients are harmless for the most part they can be downright dangerous when agitated. Best not to go that route whenever possible. No matter how we may feel about someone's attention seeking behavior we should not let our ego or opinion into the treatment we give. Think always of the patient first.
Purple_roses
1,763 Posts
I think it's easy to assume that he wasn't planning on committing suicide because he didn't have anything in his system, but what if his mom caught him with a bunch of pills right before he ingested them? Of course she would still take him to the ER, because she would want to be sure that he didn't take any of them, and he wouldn't be honest with her about that.