Feeling threatened by your patients

  1. I am a new nurse who started working in a large teaching hospital on a med/surg floor almost a year ago. It's been hard enough adjusting to being a "real" nurse, but we get a lot of patients that are not exactly, for lack of a better term, "nice."

    I am constantly stressed at work because it is very frequent that I feel threatened by one (or more) of my patients. Today I had a woman literally scream at me and lurch toward me while screaming "Ask me that <insert profanity here> question again, go ahead, ask me that <and here> question again!" Luckily I was by the door and able to make a quick escape.

    This just got me thinking how often this happens. I have to deal with so many innapropriate people it is just making me sick. And there is no reasoning with these people because they have no morals/values/conscience. I just don't think I deal with it much longer without going nuts.

    Does anyone else have any similar experiences? I could never imagine that as a NURSE I would have to fear for my own safety... that is one reason I chose not to work on psych.

    Thanks for letting me vent- this is wearing me out!
  2. Visit rachel h profile page

    About rachel h

    Joined: Nov '01; Posts: 189; Likes: 12
    med/surg RN- mostly med


  3. by   Diana in Sweden
    I am so sorry you feel unsafe... I have had many similar experiences but I was in psych .. all I can say is don't go in alone if there is a problem and don't get the patient between you and the exit...
    do vent with others at work... kind of like on the job debriefing

    I doubt this is much help... but do know that you are not alone and I know how tough it is
  4. by   tattooednursie
    I work in LTC and i have felt threatened. Once I litterally had the tar beaten out of my by a little old lady.
  5. by   ShortFuse_LPN
    I have learned that some of these pts just want to see who they can intimidate. But you never know who is bluffing and who will hurt you.

    I agree that if a pt is aggressive, take someone in with you! And don't forget about the security guards.

    And, if a pt actually hits you, by all means don't hesitate to call the police!
  6. by   leeca
    l work in a nursing home, l've been screamed at, hit, punched, scratched and nearly got a kick in the head. l've also put up with verbal abuse.

    l treat my clients with dignity and respect so l feel l should not have to put up with this behaviour. The powers that be just say put up with it.

    Whats worse is l've only been working as a nurse for 4 months, no wonder nurses leave, as no one is willing to do something about it, but l'm not going to let it get me down as l want to make a career out of nursing.

    But with this sort of abuse you really don't look forward to going to work.
  7. by   Nurse Ratched
    There are two kinds of threatening patients: those who know what they are doing and are just miserable human beings, and those who are out of their minds for whatever reason and don't necessarily have control.

    The latter kind need to be placed on a locked psych wing so those who deal with that daily can handle them (that's our job! ) The former kind need to understand that you *will not* be treated in that manner, and the fact that they are in a hospital bed does not give them special privileges to do or say things to you that they wouldn't do or say out on the street to a stranger.

    Scenario: You walk into room to do your initial assessment on Mr. Patient and are greeted with, "What the (blank) do you want? Get the (blank) out of my room." You: (standing your ground)

    "You've clearly mistaken me for someone you're angry at, because we've never met before and I'm very sure I've done nothing to you to deserve that kind of talk."

    That particular line has shut down many an ornery patient in my experience.

    If you get something along the lines of, "I don't need you checking on me," a good response is sometimes, "I'm very happy you're feeling well enough that you feel you no longer need our care. You should talk with your doctor about going home if that's the case. In the meantime, while you're here, I am obliged to monitor your condition."

    Good luck - you'll find your own style. Always be safe, but understand that a lot of people are just blustering. Knowing that may happen and having a stock answer ready may help you defuse the situation.
  8. by   jenac
    I have encountered a few down-right nasty patients in LTC. Some are confused-and don't understand wht you are trying to do-some are just nasty, mean people by nature. You can do one of two things- firmly remind them that it is inappropriate and that it is offensive to you, but stand your ground (in the event of verbal abuse) Or you can take someone with you (in the event of physical violence). Never let them back you into a corner-or get between you and the door. I've blocked a few swings at my chin and reminded people that it is unnecessary and inappropriate to hit people. Not giving them care is not in either option. Remind them that the sooner they cooperate with you-the sooner you can leave them alone again. I've had many people do things just so that I would go away!
    Finally, if you are that unhappy with your job as it is, and don't feel it will change-how about changing jobs? You will encounter nasty people everywhere you go, but if you feel threatened all the time, why not go elsewhere?

    Whatever you do- take care of yourself. And good luck! Our thoughts are with you.
  9. by   gwenith
    I was going to say repeat this mantra "Be like nurse Rachet. Be like Nurse Rachet" but she beat me to it

    No kidding, get out "One Flew over teh Cuckoo's Nest" and watch louise Fletcher - copy THAT look. It is called "the look"- cool completely closed down and NONREACTIVE.

    Lesson 1 Rabid patients are not really different from rabid dogs - (Well - you can shoot the dogs) . Moral - you cannot show your fear.

    If they come at you like that (assuming there is no psychiatric reason for the behaviour) straighten up cross your arms and look intmidating.

    I am truly sorry you had this experience - I remember another thread about impossbile patients (called Is it legal to kill a patient) where I gave similar advice and had to eat my words as I met an uncontrollable patient.

    We have all been there and this is not a situation that is covered in the nursing books - it should be but it isn't.

    It might help you to get more self-confidence by doing a self defence/Judo class. It will help you to think "this person can only yell at me - words can't hurt me."

    Oh Yes! and document document, document. If you are really concernd about one of these bullies trying to take you to court then start carrying a tape deck like the Police do. If nothing else maybe you can play the tape for some of your superiors :kiss
    Last edit by gwenith on May 6, '03
  10. by   yannadey
    Working in LTC you do get abuse by the residents whether physical or verbal.
    I usually deal with them in a calm firm manner it usually works for me although I had one resident who was not only verbal but also physicial abusive to staff & resident, this behavior had been going on for awhile he refuses to take any meds that may have help cam him down, that day at work I've had enough I call 911 when the police came & he realize how serious we all were he became the sweetest person around up to this day whenever anyone start acting up he always tell them to settle down or they'll call the coppers on you
    & what Gwenith said always document whether verbal or physicial abuse no matter how insignificant it may seem to others you document.
    Good luck & stand firm remember its not really you they are angry with its their illness, loss of independence & being in the hospital environment that may cause them to act that way (on the other hand some may just be plain mean)
  11. by   bklynborn
    RACHEL.....................?????? What was the question you asked???? (Just curious?????) and I agree with everything that has been said here so far.
  12. by   nimbex
    yes, been there too! How scary and frustrating for you.

    Worked psyc. where 70 yr. old little ladies would kick my butt, needing 4-5 of us to "take them down" and medicate them.

    Have been in charge when one of my nurses had been verbally threatened, with a fist flying near her face, this person had her mental faculties. For her, I called the sheriff, with this nurses insistance, he came up from the ER, explained to her VERY plainly that one more threat from her would equal charges filed by the nurse, AND she would have a warrent for her arrest in place PRIOR to leaving the hospital.

    That straightened her ugly demeanor out FAST!!!!! Management hinted that this approach was a bit strong, and I reminded them of this law called work place harrassment, management being required to protect their employees. Patient sang a different tune, and all was dropped.

    Bottom line, your management is required, by law, to protect you from patiets who are oriented from harming you. If the patient is confused, it is the MD's responsibility to protect you and the patient from harm by either medicating them or medicating them AND restraining them.

    If the MD refused, immediately contact the supervisor and tell the MD and supervisor that you are documenting responses in the medical record. Follow through!!! We had a nurse not too long ago that was punched in the face, MD and family refused to medicate or restrain.... nursing staff documented this and refused the assignment, called risk management at home.... risk management spoke with MD and supervisor... the family was given the choice to comply with care which equaled meds and restriants or sign out AMA.

    You DON'T have to tolerate this..... I'm thinking of you, having been there, it's very tough when all you're trying to do is CARE for your patients.
  13. by   purplemania
    A lot has to do with self confidence. Young, novice nurses get abused verbally because the mean pt. thinks he/she can get away with it. I am no pushover, but I have experienced what you claim, although it gets more rare the older I get and the more I stand my ground. Call in security, other nurses, house supervisor at the FIRST HINT of abuse and DOCUMENT carefully. I have sent visitors home that did not know how to act in public.
  14. by   rachel h
    Thanks for all the feedback. I think part of it does have to do with the fact that I am young. And I just want to clarify that these patients who have threatened me have all their faculties- they are A&O- I would never let it get to me if the patient was confused or had legitimate psych issues.

    I don't know if it's my personality or what, but I can never seem to diffuse a situation. Everything I say or try to explain seems to make the person angrier... never was good at that therapeutic communication.

    I know I can't stand it much longer- I have been checking out the employment section in the paper every week...