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.
You did right, OP. I wouldn't have put up with it - we aren't paid enough to deal with hostility. That sort of situation is just not therapeutic. Finding another nurse was the right thing to do.
You did right, OP. I wouldn't have put up with it - we aren't paid enough to deal with hostility. That sort of situation is just not therapeutic. Finding another nurse was the right thing to do.
You are exactly right! It wasn't therapeutic at all. The OP should never have talked to the patient that way.
You did right, OP. I wouldn't have put up with it - we aren't paid enough to deal with hostility. That sort of situation is just not therapeutic. Finding another nurse was the right thing to do.
It's not a patient's job to provide a therapeutic environment for the nurse.
This is a big reason why I am leaving teaching for nursing. I'm tired of being expected to tell students their behavior is inappropriate when, really, it's an ENTIRELY appropriate response based on their mental and emotional state and history and biology. You're acting out because you didn't study for the test? Go to in-school. Never mind that you didn't study because you're 15 and taking care of your sick grandma who's your only guardian. You skipped study hall? Get a discipline referral. Never mind that you're 17 and it's your best friend's lunch period, and, like I said, you're 17.
I've decided that I need a career that allows me to be more holistic and nurturing, where I'm not expected to be constantly punishing adolescents for non-lockstep behavior. Maybe OP would be more comfortable as a high school teacher?
I understand -- REALLY! -- how frustrating it is to be charged with improving a person's situation when they don't want to help themselves. But punishment and belittlement is not the way to get through to someone who is already punishing and belittling himself.
You know another thing that bothers me about this (sorry, I know--this thread has already gone on long enough): it isn't ok to judge the mom in this scenario either. I've met moms of suicidal kids, and they're practically tip toeing on egg shells. She's fearing for her son's life. Do you really think her focus, in that point in time, will be (or should be) on manners?
Since everything has already been said, I am wondering about the OP's state laws regarding suicide attempts or ideation. I know that Florida has the Baker Act and Louisiana has PEC, both of which call for 72 hours of involuntary psych care. If admitted to the hospital, they would have a sitter to watch them. They would not have their phones (definitely not a charger!) and visitors would be limited to immediate family if any.
That's actually really interesting. I have never considered whether the place I'm working has specific laws regarding suicide attempts/ideation. As far as my experience goes, we were usually told that the patient has a 1:1 sitter for the 72hr hold but basically does whatever they like in the mean time.
I wanted to add to those who already added great suggestions that you made this about you. Why was this kid getting under your skin so bad? Don't make this personal.
hwknrse now that you've read what a lot of people had to say on the subject do you still feel the way you did when you first posted or have you changed your mind about how the situation could have been better handled? Would you do it differently now that you know the opinions of the many who wrote to you or would you still do it the same way? What do you think about it all now that some time's gone by and you had a chance to think about it some more?
I think a better approach would have been to acknowledge him or ask an open ended question. I don't remember reading anything that suggested you did an assessment of him, instead you made it about you and your feelings. You demanded him do something for you, when really, you should have done something for him. You could have said something like "It seems like you don't want to talk" or it could have been as simple as introducing yourself to him and his mother and asking a question like "So what is going on?" It seems like you were in a rush to just get the assessment done, and I completely believe that you were busy! But, you do have time to properly introduce yourself and acknowledge the patient and his mother in a therapeutic manner.
It would also be inviting conversation and showing the patient that you are ready to listen if you take a seat in front of them in a therapeutic manner. I mean leave enough space between you and the patient and his mother and also leave the door way free. Don't cross your arms, don't be preoccupied (with your tasks or your emotions), don't multitask. This will make the patient feel more comfortable. Talking about whatever issue he had in his life is going to be hard, it is probably something bottled up, and it is important to tell him that he did the right thing by coming to the ER. Praise him for what good he has done in this, ignore the way he makes you feel, sorry, but sometimes it IS about the patient and not about you.
There are also reasons behind why he would not make eye contact. Some other posters said it could be shame or embarassment, or maybe he felt like he was going to be judged. OR maybe he has attempted suicide before and he has bad experience in the past. You don't know. And you don't get anywhere by reacting to it.
But he didn't try to commit suicide, he just said he did. He wanted the attention and he obviously has issues. Just because you are a patient does not give you the right to act like an animal and treat people who are trying to help you with disrespect.
Well some benzos don't show up in a uds, klonopin is notorious for that. Also depending on the time between consumption and the uds it may not show up
Specializes in Critical Care; Cardiac; Professional Development.
I didn't read all the responses, but I am pretty incensed by how you treated this patient. His behavior toward you at this point was nothing short of part of your assessment. Lack of eye contact and hitting himself in the head when upset can be a trademark for any number of disorders, including autism. You were so out of line I am having trouble expressing myself.
You should have charted his behavior. If he refused to answer your questions, you should have made THAT part of your assessment. Nobody is required to talk to you. Period. And he wasn't a kid, he was 20. His mother was stressed because her child decided he was hurting enough to want to die....or even just enough to want people to think he wants to die. Obviously there were psyche issues and obviously this guy and his mother were having a pretty rough day. You failed your patient. There was nothing therapeutic in your actions and it upsets me just reading it. You don't shame a patient. Ever.
RNdynamic
528 Posts
You did right, OP. I wouldn't have put up with it - we aren't paid enough to deal with hostility. That sort of situation is just not therapeutic. Finding another nurse was the right thing to do.