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.
Sounds like the OP was assuming this kid was healthy and just being a brat. And maybe the patient expected a healthy minded nurse that was sound enough to do the job? Without taking it personal ?
Folks, this didn't happen in the ED. The OP's specialty is Med/Surg. The OP said (bold is mine):
Lol, I was wondering if anyone else was going to catch that.
Which means if the OP would look at the information coming from ED, she would have found most of the information she needed, and would probably not have gotten upset with the patient in the first place.
Also, if the admit came at the right time, her impatience at the situation could have been a major factor.
The approach was still wrong, but you might want to reflect on what you were feeling before you went into the room, so that next time, you can do better.
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 may be judged up the wazoo for this, but that's ok. If someone is out of their mind with Alzheimer's and/or dementia (or other condition, including extreme pain, that makes them out of their mind), I don't mind if you yell at me, hit at me, etc even though it may suck in the moment.
If you're just being a jackwagon for the hell of it, like this kid was (and his precious mother backing him up) and I've asked a few times to not be yelled at or hit, etc, then I also take my niceness down a couple notches and become just civil. Sometimes barely civil.
Scolding does nothing and won't work, especially if you have an overly dramatic, entitled CHILD like this who has a mother who's this oblivious to his rotten behavior. I always start off as nice as I'd be for anyone else, but make it clear that I deserve the same basic respect that the patient does.
I usually don't have a problem and the three times I've been "fired" from a patient, it was better for both of us. People think that just because we "signed up" for this job we have to take the rudeness and abuse (that would be considered assault if it happened out on the street) that most nurses do. I don't believe that and it's not right.
Like I said, if someone is out of their mind chemically or biologically, that's one thing and I don't mind most anything if a patient has a condition that makes them behave poorly or even abusively because they can't help it.
I've been out of my mind with pain from migraines and the times they've lasted 3 days and I've gone to the ER? I still always say please and thank you because it's automatic and I was taught it. This entitled jerk was made that way by his mommy and you won't turn it around in a single shift so don't bother. Take the resulting "termination", rejoice, and move on to the next patient with a smile.
Save the scolding for a situation where it will be absorbed and learned from. lol
I don't understand why the pt was an admit to med/surg. What was the dx? If anything, a psych facility/unit for the si would've been much more appropriate.
I don't understand why the pt was an admit to med/surg. What was the dx? If anything, a psych facility/unit for the si would've been much more appropriate.
Identified psychiatric clients with possible suicide attempts often get admitted to med-surg beds because they need medical treatment for whatever the suicide attempt was before going to inpatient psych, or because they are in a community hospital without a psych unit and there's no psych bed available in a reasonable geographical range to which the person can be transferred that day, and the individual needs to be kept safe until an attempt can be made the next day to find a psych bed.
I may be judged up the wazoo for this, but that's ok. If someone is out of their mind with Alzheimer's and/or dementia (or other condition, including extreme pain, that makes them out of their mind), I don't mind if you yell at me, hit at me, etc even though it may suck in the moment.
If you're just being a jackwagon for the hell of it, like this kid was (and his precious mother backing him up) and I've asked a few times to not be yelled at or hit, etc, then I also take my niceness down a couple notches and become just civil. Sometimes barely civil.
Scolding does nothing and won't work, especially if you have an overly dramatic, entitled CHILD like this who has a mother who's this oblivious to his rotten behavior. I always start off as nice as I'd be for anyone else, but make it clear that I deserve the same basic respect that the patient does.
I usually don't have a problem and the three times I've been "fired" from a patient, it was better for both of us. People think that just because we "signed up" for this job we have to take the rudeness and abuse (that would be considered assault if it happened out on the street) that most nurses do. I don't believe that and it's not right.
Like I said, if someone is out of their mind chemically or biologically, that's one thing and I don't mind most anything if a patient has a condition that makes them behave poorly or even abusively because they can't help it.
I've been out of my mind with pain from migraines and the times they've lasted 3 days and I've gone to the ER? I still always say please and thank you because it's automatic and I was taught it. This entitled jerk was made that way by his mommy and you won't turn it around in a single shift so don't bother. Take the resulting "termination", rejoice, and move on to the next patient with a smile.
Save the scolding for a situation where it will be absorbed and learned from. lol
So how do you decide (and who put you in charge of deciding) who is "being a jackwagon for the hell of it" or "an entitled jerk" and who "has a condition that makes them behave poorly or even abusively because they can't help it"?
People think that just because we "signed up" for this job we have to take the rudeness and abuse (that would be considered assault if it happened out on the street) that most nurses do.
Just to be clear, nothing this young adult did came even close to fulfilling the legal definition of the crime assault. It's also highly debatable whether he would have escalated in the first place, had it not been for having his buttons pushed repeatedly by a relentless Ms Manners, topped off with the humiliation and provocation of being called pathetic.
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If you're just being a jackwagon for the hell of it, like this kid was (and his precious mother backing him up) and I've asked a few times to not be yelled at or hit, etc,
How on earth can you be sure about this? Can you diagnose a person without having ever laid eyes on them? Personally I think that a suicide attempt alone or even if a person just expresses the desire to commit suicide, is enough to conclude that some sort of mental instability is present and that the person needs medical care/attention.
Your sarcasm directed at the young man's mother is in my opinion highly inappropiate. You have no idea of their history or what struggles either of them face and have faced. Even if this had been a case of a parent not succeeding in teaching her child basic manners, why would any thinking nurse expect that pointing that out in the midst of a very high-stress situation, would yield a favorable outcome? That's in my opinion an unrealistic expectation and shows a lack of insight into the human psyche.
Yes, there are times when nurses and other healthcare professionals are treated in a way that isn't acceptable by individuals who are actually in control of what they say and do, and are being purposefully obnoxious. In those situations I think that it's perfectly acceptable to let them know that their behavior needs to change. This just clearly wasn't one of those situations.
Identified psychiatric clients with possible suicide attempts often get admitted to med-surg beds because they need medical treatment for whatever the suicide attempt was before going to inpatient psych, or because they are in a community hospital without a psych unit and there's no psych bed available in a reasonable geographical range to which the person can be transferred that day, and the individual needs to be kept safe until an attempt can be made the next day to find a psych bed.
I get that, we admit all the time to manage ods. but if his uds was clean and he was asymptomatic for a benzo od (which he seemed to be judging from the behavior described), then medical clear in the ed, psych screen, vol or invol commit & out to appropriate facility.
I guess i'm spoiled too. My facility has a dedicated psych screening area within the ed. The 24x7 screeners & psychiatrist do all the placement work. And yeah, we can hold them for a few days before a bed is available.
Specializes in EMT since 92, Paramedic since 97, RN and PHRN 2021.
One thing I have learned from my time on the ambulance and interactions with police with different patients is certain phrases to give the patient the control (or appearance of) the tone of the conversation.
The old " you'll be treated the way you treat us" will usually have someone stop and think about their attitude.
While it's not appropriate in all situations it may work in some of them.
Identified psychiatric clients with possible suicide attempts often get admitted to med-surg beds because they need medical treatment for whatever the suicide attempt was before going to inpatient psych, or because they are in a community hospital without a psych unit and there's no psych bed available in a reasonable geographical range to which the person can be transferred that day, and the individual needs to be kept safe until an attempt can be made the next day to find a psych bed.
Huh. Looks like it depends on where you work.
Where I work, if the county MH person can not make it to assess them at that time, usually over 5 hours wait time, the patient is admitted to ICU. But, our hospital is a small, rural hospital. They would never admit someone who is a suspected OD to the med/surg floor.
BTW, I am actually surprised the patient didn't knock you out, OP.
Where I work, if the county MH person can not make it to assess them at that time, usually over 5 hours wait time, the patient is admitted to ICU. But, our hospital is a small, rural hospital. They would never admit someone who is a suspected OD to the med/surg floor.
BTW, I am actually surprised the patient didn't knock you out, OP.
Most things in nursing "depend(s) on where you work."
At the risk of seeming snarky, why should that make any difference? It was not a helpful way to manage the situation regardless of where the patient was located.
Because some of the responses I was reading had the appearance of making the assumption that this happened in the ED.
While the OP's behavior would be inappropriate in any setting, ED RNs usually receive training in caring for the patient experiencing a psychiatric emergency, while RNs on the inpatient unit often do not. That has been my experience, anyway. The U.S. State in which I practice has a requirement for all staff who work in the Emergency setting to receive this training on a yearly basis.
When I worked the inpatient telemetry unit, prior to transferring to the ED, we cared for patients who had overdosed or who had severe psychiatric issues, and did not receive any education or training (other than what we had been exposed to in nursing school) in caring for this patient population. Inpatient RNs can be very ill-prepared for caring for patients with behavioral health symptoms.
That's why I felt it important to point out the setting. No snark inferred, your question was legitimate.
LwardRN
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Sounds like the OP was assuming this kid was healthy and just being a brat. And maybe the patient expected a healthy minded nurse that was sound enough to do the job? Without taking it personal ?