Patient's "right" to abuse nurses...I need your opinion

[MsNewbee]

Hi, everyone. I'm a year out from graduation and have been working my job so I haven't posted or been on in a while, but a topic came up on the job and it just rubbed me the wrong way. I didn't want to ruffle feathers at the hospital so I decided to turn to my peers on allnurses for guidance.

I recently had a patient that really tried my nerves. I'm a super patient person and she made me question why I chose nursing (which I thought would never happen!). She would ask me for pain medication and as soon as I would leave her room she would be on her light again asking for the same thing. She literally rang her light 15 times in 10 minutes. I counted because I would answer her. She did this everyday for at least 3 hours every morning for the 5 straight days that I had her. She was cognitively intact. She wanted to go smoke outside, but needed staff with her and no sooner that she went outside by herself (while I was with another patient) she broke her wheelchair then demanded that I go with her. I only had 8 other patients to take care of, no big deal right? She complained about everything from the food, to the other staff, to the other patients. Her room was next to the nursing station and she would scream my name down the hall while I was charting because I was in her line of sight. I started hating my name just because of the shrill way she would scream it and she did this constantly. If I left to tend to another patient she would scream my name louder. I could hear her screaming for me while I took lunch breaks. She yelled at other patient's family members as they would passed by her room. I got so frustrated I told her we were human beings that should be treated the way she herself would want to be treated and her behavior was not acceptable. I didn't know what else to do or say to her. Eventually, she hit my tech and started smoking in the room and that's when administration said she had to go on the 5th day with me.

I made a sarcastic comment and said, "Can someone take the light and just put it somewhere, she knows I'm coming." The nurse supervisor who was getting off of work said, "it is her right to abuse you." I just looked at her back as she sauntered off to the elevator with my mouth open because I couldn't believe what she just said. I thought a better response would have been, "she needs to have her call light in case she has a need that hasn't been addressed." or something along those lines, but she was serious. I determined at that moment I would not pick up any more shifts because I was begged to come in that day and that was what I got. I felt like the "higher ups" really didn't care about me or my mental well being.

My question is do patient's have the right to abuse us? Am I just being a baby and should suck it up because this is my life/job now? I am really dreading going in tomorrow. I loved my job until I had this one crummy patient. I woke up crying in the middle of the night on my third day with her because I knew she was going to do this every time I showed up. I was fighting back tears for those 5 days at work and I cried once in my car on my lunch break. How do ya'll keep the fire that inspired you to go into nursing from going out?

Please help, I'm feeling sooooo helpless and drained .

[Froggybelly]

It's is absolutely not your job to be treated that way, and honestly, if you have an internal reporting system, I would write up that other nurse's behavior. Putting that patient with you, a new nurse, day after day, despite the obvious detrimental effects you were experiencing, is inappropriate. It kind of sounds like that patient was detoxing from something, but that's no excuse to abuse the nurse. If this slides, it will just happen again and again. I'm sorry.

[oldpsychnurse]

This is the kind of patient the docs will medically clear (even if they have a tube sticking into and out of every available orifice) in order to send them to us, your friendly psych unit!

[jag nurse, RN]

I have had numerous patients like this, and like others have said, you need to put your foot down. Everyone needs to share the wealth. In other words, you don't need to take someone like that for five days in a row. Unfortunately, the pendulum has and will continue to swing far, in the direction of patient satisfaction. We should satisfy our patients and try to make them comfortable; that's our job. But the whole "we don't get paid if the pt isn't happy" is a political snowball that is becoming its own monster, to the point that we can't properly take care of the rest of our pts, when we have someone like that woman.

I didn't read all the replies, so maybe you've already addressed this, but is this a for-profit facility? I've worked for both profit and not-for-profit. Pt satisfaction surveys and reimbursement criteria are at all of them, but from my experience, the for-profits are worse, in both the abuse they expect the nurse to take, as well as the nurse-to-pt ratio.

[AmyLynnTesch]

I'm sorry you are going through this. As an agency nurse abuse comes from both the patient/family, and staff. It didn't last long with staff as they saw my performance with various situations. Patients thought they could get the best of me, that is until I stood my ground, and called a couple of them out for their behavior.

The best example was a patient who felt I wasn't tending to her fast enough, and proceeded to verbally assault me. I apologized (even though there was nothing to apologize for), and stated that I had her medication. She berated me stating she took her pills at this time and it was too early. I told her that they were scheduled to be given at this time. "Well I don't want them now! I want them at ‘X' time!"

My response was so awesome that I got high fives from the other staff members because she had been hell towards them too. "You have two choices. Either take them now when they have been ordered, or I will waste them and put you down, and chart you as a refusal! I have other patients that need my attention just as much, if not more than you. Also if you think that berating me will get you service, you have another think coming! I get paid whether you take your medication or not, so you aren't hurting anyone but yourself!" I turned to walk out and she told me with a grunt she would take her medications. She hasn't bothered me since. She realized that she couldn't play her games with me. An aide reported when she went in to do her HS care, the look on her face was priceless! She asked, that nurse is mad at me isn't she." The aide backed me up and told her that I wasn't, but just because she was a patient did not give her the right to treat people like crap.

This may or may not help you, but I'm just sharing my experience and advising that sometimes you have to stand up for yourself professionally otherwise you will always be a mark! It's sad to see nurses eating their young. (Being assigned the same patients day after day can also constitute abuse as well).

Finally, don't be afraid to look for another job. If you do not have supervisory/managerial support. Time to fly!

[mbarthold]

No.

Just no.

That's workplace violence. No one - patient, staff, physician, visitor ---NO ONE has a right to abuse anyone. And your supervisors/charge nurse/nurse manager shouldn't have waited 5 days to address the issue. Two hours of that behavior would be enough to have administration - not you - administration address the patient's behavior.

I do hope your supervisor was being sarcastic. To be honest, if I were being sarcastic with a comment like that, I would make it VERY clear that it was sarcasm.

If this ever happens again, please don't wait to ask for help. You should never have to put up with anything like this. And if your immediate supervisor isn't helpful, keep going up the chain of command until you reach someone that will help -- even if it's the CNO or CEO.

(Think of the headline........)

'Hospital X Tells Staff that Patients' Abuse of Staff is OK!!'

Melissa

[kiakia122002]

Sorry to hear that, I don't know when the abuse of nurses by patients is ever going to stop, they treat us like we are servants, and the more I work in nursing homes the more I question why I even became a nurse, more and more we have drug addicts that are admitted and catered to instead of trying to help with the problem let's just prescribe them anything they want, and of course let's have a cna take a patient out to smoke, on an already short staffed unit, but patients demand it, I think if these people are with it and cause issues with staff need to be discharged home, but the hospitals and nursing homes won't do that because they want that money coming in, it doesn't matter how we are treated. I'm feeling drained and abused also, so I know how you are feeling.

[Roz, RN, BSN, RN]

Once, I was assigned 8 patients on a PCU with no tech. One patient, who had already had an ugly confrontation with the hospitalist, demanded that I bring him some coffee. I explained that there was no coffee on the unit and I did not have time to make any right then. He replied " Well you're a damn sorry Nurse.". As I walked out of his room, I told him that his comment would add two hours to his wait for coffee!

Set limits with your difficult patients. For those who think the call bell is a Nintendo controller, explain that someone will check on them every hour. Keep a list of all requests and take everything requested with you when you go to the patient's room. Before you leave the room, ask if there is anything else the patient needs. I know it's time consuming, but document everything.

Explain to your manager how difficult this patient is. If you don't speak up, you will get dumped on.

If the patient violates hospital policy, report it and document it. If the patient gets discharged because she was smoking in her room, it's on her and not you. Better she get sent home than to have that cigarette come in contact with oxygen and blow up that part of the hospital!

[Medic/Nurse, BSN, RN]

OMG. No. Just no. Abuse is not an expectation of any nursing job. Assault will get a patient (that is intact) criminally charged regardless of how the facility feels about it.

I think you did most awesome.

In your case, there was true patient pathology. And she may have been testing you. Some patients can be very manipulative creatures. And I would have just not taken that patient for the 5th day. No going out smoking ever with a patient. Live and learn.

You are a better nurse than I am.

:angel:

But, I've been there. Minus the patient that did the smoking. Now, I don't smoke, but worked contract in an ICU where every other RN smoked (so all they went out on the hour – mostly together). Also I got the isolation and tough cases - including the SCREAMER!!!

My SCREAMER was a 50ish terminal 400# patient that had anxiety, just needed reassurance and was an ICU admit for monitoring due to prior history of respiratory arrest and would scream NURSE at the FULL PITCH every 5 minutes. Inconvenient? You bet. I'm covering the ENTIRE UNIT for 15 minutes every hour. Not even kidding.

Was anything wrong? Nope. Never.

Finally, I had to throw down and have THE TALK. Please stop SCREAMING "NURSE!" For NO DAMN GOOD REASON, PLEASE. Now, only SCREAM if SOMETHING is WRONG!

I finally bribed the PATIENT. I lined up HERSHEY KISSES on the overbed table and told them for every hour they DID NOT SCREAM for NO REASON I would come in and FEED them a Hershey Kiss.

The patient seemed delighted that I could really do this. Are you allowed? "They won't give me chocolate at the nursing home? I've wanted some for so long".

I assured them, I was a special nurse and as long as we kept it our secret we could do it.

I figured so what, emotionally this could be a good thing. Yep, I've got an order for sliding scale and I can cover any rise in blood sugar, I literally have to actually feed this patient (cut up food and feed them). They are terminal and have decub the size of my head. So what, Big deal.

The pointless screaming stopped. Patient cooperation is a beautiful thing.

My nurse colleagues were amazed that the screaming had ceased. On my days off the screaming banshee was back!!!

I'd go in and check on my "star" patient - feed them a HERSHEYS KISS. The blood sugars only varied +/- 5 points in the 4 hours checks over the days I cared for them. So, I also went to Wendy's and got them a Burger, Fries & Frosty. Cause why not. Remember patient was TERMINAL.

I am a terrible nurse.

I never told anyone my chocolate secret either.

[PANYNP]

COB here. So very sorry that you experienced such a challenging and frustrating patient care situation that was exacerbated by what appeared to be a lack of support by an unsympathetic and unhelpful middle manager (nursing supervisor). I agree with others who recommended that you follow through with a request for clarification of the meaning and intent behind this nursing supervisor's remark. Her role ideally should encompass not only monitoring of functioning of patient care areas and patients' condition by assessment of nursing work conditions, but also supporting staff who are challenged by difficult and/or disruptive patient care situations.

Although daily rotation of nurse caregivers disrupts continuity for patients, and may contribute to their increased anxiety while hospitalized, nurse caregivers' level of anxiety and risk for disengagement and development of compassion fatigue also are factors that must be acknowledged in order to maintain a healthy workforce of nurses who actually want to work as nurses.

Recently a master's student who works as a staff nurse in long-term care related to me that her administrator told her that "residents have a right to fall". When I looked in the literature for a rationale for this statement, very limited anecdotal evidence was available that seemed to indicate that a failure to implement fall precautions was acceptable in that these precautions impinged on an individual's free will or "right to fall" (injury and liability notwithstanding).

I wonder if the nursing supervisor's observation that "it is her right to abuse you" comes from a place of similar sideways thinking.

In any event, an academic medical center in Western New York, where I spent many years in practice, has a MIPS service - Medicine in Psychiatry - that includes a 20-bed inpatient unit for patients with mental health diagnoses who also require inpatient hospitalization. In an ideal world, this setting may have been the right type of placement for your challenging patient.

In the less than ideal world in which most of us live, I encourage you to continue to question and assess your patient care environment for safety and comfort (both patients' and your own), analyze your own responses to your daily experiences, and reach out to the community of nurses, both locally and globally, as you've done here, for solutions based in both practice and science. We're counting on you, as a young nurse, to maintain your passion for providing mindful patient care.

Typically I don't say "namaste", but it seems to fit here. Namaste.

[GitanoRN, BSN, MSN, RN]

First of all, I'm so sorry that you have to go through this without the support of your superiors. Furthermore, in the facility where I work we have ZERO TOLERANCE when it comes to staff abuse of any kind from any patient, family member, or any staff. With that being said, this includes verbal, or physical abuse. Moreover, when our patients go through the admissions dept. they have to sign the literature regarding this issue with no exceptions.

Unquestionably, my staff is there to serve the highest caliber of patient care however, this doesn't mean that the patient can abuse the nurse in any kind of way. Needless to say, I'm very surprise that a manager or supervisor would state the following "The nurse supervisor who was getting off of work said, "it is her right to abuse you." this doesn't sit well with me at all. Undoubtedly, every facility has different ways in managing these kinds of situations, and one most abbey by their rules and regulations. However, I just can't see any management allowing any patient, family member, or staff, harass or abuse any medical staff, for the sake of getting good patient satisfaction; at least NOT under my supervision. Wishing you the very best in all of you future endeavors... Aloha~

[3ringnursing, BSN]

Some patients have behavioral health disorders that give impetus to some truly horrible behavior. A patient may appear cognitively intact, but could have little to no empathy for others (a personality disorder). When one pops up your happiness on the job is forfeit. They do things that they themselves would positively howl over if they had to endure the same behavior from someone else, especially for an extended period of time. I truly know and feel your pain.

That being said, I've run into the very same attitude from higher up's - possibly because they themselves do not have to endure this type of behavior being one removed in the chain of patient care. It's easy to tell someone to suck it up if you don't have to endure it yourself.

This type of thinking decreases staff moral, contributes to loss of staff, and the unit operating short. Who enjoys being a whipping post?

This is my primary objection in nursing. Nurses can be treated as if they aren't human - I can't count the number of times I've had a patient not even try to avoid coughing, or sneezing right in my face, as if I had been a nonentity. This surprised me the most as a new grad. Nurses can be subject to physical, psychological, and emotional abuse from patients, and treated unkindly by providers, but it has been rare I've seen any corrective action until things have gotten way too far out of hand.

Perhaps one day as group we will stand up and say "No more".

[allywally]

Sounds like this "nurse supervisor" needs to be reported to his/her own "higher ups". It is unacceptable for us to be treated as slaves and subservients. Sounds like this may be a toxic place to be working and may contribute to some serious burnout. Abuse in the workplace should not be the cause of your crying on the job or at the end of your shift!! This makes me so angry. I've had patients like that and as soon as I get the sense that they think they can abuse nurses, I set the tone to ensure they know I will not put up with nonsense.