Dealing with a patient who verbally threatens you

susieqlvn · Aug 20, 2006

What the a**hole patient wanted to do was intimidate you. I don't blame you for being nervous and withdrawing from the situation, but from an old granny nurse, if you are ever intimidated like that again, you could casually reply that he is free to sue anyone he wants, that you are covered under the hospital umbrella, and that no matter what, your paycheck will be the same whether you draw his blood or not. You could also mention that he scared everyone else and so they called you to do the blood draw because you are the resident expert, anyone else who comes behind you is not so skilled and will likely miss his vein even worse.

Kim O'Therapy, BSN, RN · Aug 20, 2006

I don't really think it matters how this patient was feeling emotionally - he was verbally abusive and trying to intimidate a staff member. If we just let that slide and say "now how does that make you feeeeel" I think we perpetuate the behavior and tell him that it is okay to treat staff in that manner.
I think the OP handled himself well. When I have patients that respond like that, I say "I'm sorry you feel that way. I will not force this on you, but I will also not return to your room until you are speaking more respectfully. I do need to tell you though that this is a stat CBC and these are the reasons you need it." I think it is important to assert yourself - with the birth of patients as customers (gag) and the wonderful survey scores, everyone is afraid to put the customer in his place - but at the same time he needs to be told the consequenes of his actions. If my patient is going to be an ass, he will be an informed ass.

:yeahthat: :yelclap: :yeahthat: :yelclap: :yeahthat:

htrn · Aug 20, 2006

I agree and disagree with the OP. I certainly understand the need to protect yourself from an abusive or threatening patient, but I also see that this patient was scared and acting out. I had a 19 yo pt having pre-term contractions. MD ordered SQ injection, IV fluids and IVP meds. She told me forget it, she was walking out. I spent about 30 minutes explaining the hard realities of pre-term delivery and told her that if she refused tx she put her baby at serious risks (i.e. "you've seen the commercials with pictures of those little teeny babies with IVs in their heads and tubes sticking out everywhere?"). Her SO convinced her to accept tx after I left the room.

She then told me she gave the last person that started her IV a black eye and he forgave her. I told her that was actually assault, got another nurse to hold her arm down and stuck it in.

Funny thing, when she was due she got mouthy enuf with MD to get INDUCED - volunteered for an IV :uhoh3: Then ended up, you guessed it, C-section!!

Kev702 · Aug 20, 2006

Hey T_T_1...

I haven't read your other replies because your post reminded me of my first days in ER. I've been doing ER for a long time and my experience started out similarly.

Within my first 6 mos of working ER as a new grad I was wisked out of an exam room by security (guns drawn) after the pt I was alone behind closed doors with was ID'd as the same guy that had pulled an armed robbery for drugs at a rural ER not too far away from the one I worked in.

Since then I have worked in some of the worst inner city ERs that there are. But, it all comes down to the same thing to me: there aren't many who will work in these places, so just keeping your cool, staying watchfull and being courteous to people can not only bring you some of the most rewarding experiences you can possibly imagine, but some stories that will blow most people away...

Good nurses are needed in these ERs. People that end up in these ERs appreciate (more than most!) being taken care of by some one that doesn't look down their nose at them and more often than not, just cool, common sense will diffuse many dangerous scenarios.

Kev

Agnus · Aug 20, 2006

I back off as well. A threat should be taken seriously. Yes indeed this was abusive behavior on the part of the patient. Being ill, injured, in pain does not give anyone the right to abuse the very person who is there to help.

I have let patients know that I will not accept abuse nor will I allow them to abuse anyone else in my presence or while under my care. If they choose to then I an who ever else they abuse will walk out of the room and they will be without care. If they are sane and not on drugs this usually works.

However, in this case this person was not sane or acting sane in any way so the only think I would do is back off.

As far as someone having to do it. Well the person MD or what ever who ordered it ultamately has the responsibility. So if the MD insist despite the pt. objection/threats/behavior then the MD will can order restraints mechanical or chemical, and security should always be called in these situations. Some times the mere presence of a couple or more security guards is enough to make the pt. behave.

You can not be required to treat a patient who threatens you. The hospital has a responsiblity to provide a safe work enviorment. If you find your hospital unsupportive to you it is time to move on.

swatch007 · Aug 21, 2006

Wishing that I don't have to deal with a violent pt.

because I'm afraid more on the damage I could do, though not intentional I have to re- train myself to suppress my tendency (reflex) to punch and kick when I'm being attacked.

I'm learning too from responses of fellow nurses here.

casi, ASN, RN · Aug 21, 2006

You should talk to whoever is in charge of your department to find out how you can handle combative patients. Ask about tips and tricks, brushing them all off on the nursing department isn't going to teach you anything. You shouldn't have to take abuse, but if you work in health care there is good chance you'll end up having to deal with it.

For your new example on 8/16 you were upset you weren't told that this person was a drug user. My guess is that HIPAA would restrict others from telling you this. His drug use really doesn't effect you drawing blood off of him. You were also upset that no one told you he was combative. Did other staff know that he was combative at this point? Someone has to find out a patient is combative the hard way first. Maybe it was your lucky day to make this discovery.

When you know a patient is combative, find a big intimidating looking staff member and have them stand in the room with you. This can sometimes help.

twotrees2 · Aug 31, 2006

So, can I ask the posters who thought it was OK to have the man refuse (and that is his right) what they thought would happen next?
When we have people like this normally a nurse or someone else will go in with the phlebotomist or attempt to do the draw. If they still behave in the same manner or get more aggressive despite calming techniques we say OK, and chart refused. When you have someone threaten you and you switch assignments with someone else, why is it OK that person gets threatened for the rest of their shift?
I'm not trying to be difficult here, I just want to know how it works where you are.

dependent on the situation ( this guy does NOT sound like he meets the criteria ) such as an alzheimer's patient or other psych disorder - sometimes it can make a big difference in changing staff and the other staff would not be yelled at etc - many times on my alzheimer's resident we have to do this - kinda a good guy bad guy type scenario - the resident doesn't realize we know the other person isn't bad but they will do as we ask cause they think we are saving them from whatever their mind has drawn up about the other staff member. just a thought on it - though it di not sound like this man qualified for that as it sounds like he was of sound mind and body but a jerk - as the poster did - so would i - chart it as refused and not look back