Verbal abuse ... what are my rights?

  1. So, I work in a facility where it's not uncommon to have patients who are confused and aggressive - out of psych issues or other diagnoses where aggression is an expected stage of their disease process. Sometimes, they're cranky or aggressive because they're seekers and you're not getting them their much needed "pain" med.

    However, this latest patient is a whole new ballgame for many of us on the unit. Quadriplegic - so completely dependent for all activities of daily care. BUT, he is verbally abusive ... you F'n nurse, hurry your F'n ass in here when I call, F you! (racial slur here and there), and he goes on for 45 minutes that he eats up of your time "fixing" his position because he dictates every minute detail. I'm at a loss as to how to deal with this .. if it's coming from a confused patient, that's one thing but this is draining when it is coming from someone who is completely oriented and knows exactly what he is doing! 45 minutes each time repositioning is required is also a problem because it takes me away from my other patients who can go downhill very quickly but I wouldn't know it.

    The charges, nurse manager, supervisors, head nursing office, all know about this patient because he calls them incessantly when things don't go his way. BUT he is allowed to continue this behavior. I'm dreading the next time I go in and find that I'm assigned to him!
    •  
  2. Visit bratty477 profile page

    About bratty477

    Joined: Sep '10; Posts: 87; Likes: 47

    77 Comments

  3. by   bjwojcik
    I'm not a nurse, but maybe a sock and duct tape would do the trick.
  4. by   QuietIsntAWord
    Where I work if we have issues like this we call upon social workers. They will often speak with the patient and let them know that behavior is not acceptable. In most cases it works.
  5. by   NurseCard
    Not really behavior that you should be expected to just accept and move on...
    However, if all of your higher-ups know about the behavior and have chosen
    to do nothing... then about all you can do I'm afraid, is pray for the day
    when this lovely gentleman gets sent back to from whence he came.

    This is an acute care setting? I hope?
  6. by   NurseCard
    Quote from QuietIsntAWord
    Where I work if we have issues like this we call upon social workers. They will often speak with the patient and let them know that behavior is not acceptable. In most cases it works.
    Yeah, that too.
  7. by   bugya90
    Document document document. Point blank tell him that his language/behavior is not appropriate and you will not tolerate it and that you will return when he has a more appropriate attitude and then walk out. Document word for word what was said. Go back in a little while later to check on him and be nice but firm. If he is still acting like that, repeat again and walk out. Continue doing this. Either he will figure it out and stop or you will only have to spend about 5 minutes with him each time instead of 45 before you walk out.
  8. by   QuietIsntAWord
    Quote from bugya90
    Document document document. Point blank tell him that his language/behavior is not appropriate and you will not tolerate it and that you will return when he has a more appropriate attitude and then walk out. Document word for word what was said. Go back in a little while later to check on him and be nice but firm. If he is still acting like that, repeat again and walk out. Continue doing this. Either he will figure it out and stop or you will only have to spend about 5 minutes with him each time instead of 45 before you walk out.
    You just went all psychology on us, negative reinforcement. And who said pre-req's weren't important?

    Added: If above works, then when he responds in a good way then you go out of your way to be super nice despite his past... it's a transition into positive reinforcement
    Last edit by QuietIsntAWord on Mar 7
  9. by   bratty477
    Quote from QuietIsntAWord
    Where I work if we have issues like this we call upon social workers. They will often speak with the patient and let them know that behavior is not acceptable. In most cases it works.
    I work night shift and social workers have all gone home but I know everyone has tried talking to him, only to find that he quickly reverts back to that behavior.
  10. by   bratty477
    Quote from NurseCard
    Not really behavior that you should be expected to just accept and move on...
    However, if all of your higher-ups know about the behavior and have chosen
    to do nothing... then about all you can do I'm afraid, is pray for the day
    when this lovely gentleman gets sent back to from whence he came.

    This is an acute care setting? I hope?
    Yes, acute care.
  11. by   bratty477
    Quote from bugya90
    Document document document. Point blank tell him that his language/behavior is not appropriate and you will not tolerate it and that you will return when he has a more appropriate attitude and then walk out. Document word for word what was said. Go back in a little while later to check on him and be nice but firm. If he is still acting like that, repeat again and walk out. Continue doing this. Either he will figure it out and stop or you will only have to spend about 5 minutes with him each time instead of 45 before you walk out.
    This is exactly what I have done and what all the others have done too but it doesn't stick..and yes, I document everything!
  12. by   bratty477
    Quote from QuietIsntAWord
    You just went all psychology on us, negative reinforcement. And who said pre-req's weren't important?

    Added: If above works, then when he responds in a good way then you go out of your way to be super nice despite his past... it's a transition into positive reinforcement
    Again, positive reinforcement doesn't stick ... negative reinforcement has produced more results so we are sticking with that until he calms down ... then we go in and do what he asks.
  13. by   OldDude
    Maybe try water boarding...of course I'm kidding but you gotta admit you did chuckle a little.
  14. by   JKL33
    This patient doesn't have any TBI or right brain additional neurologic injury that could explain any of this? Perhaps contributing to the reason that 1) he does this and 2) it almost sounds like he can't help reverting back to it?

    I'm trying to think...I just can't recall many (if any) situations where the patient was perfectly fine cognitively and did this kind of thing. At the very least he's fried some social and verbal filters (< that's a bona fide medical dx, by the way )

    I promise I'm not so much of a bleeding heart that I make excuses for anything and everything any patient does. This just doesn't completely sound like he's in control...and somehow for me personally that usually makes things a little more tolerable.

    I hope you have the support and backing of your NM and others; I know it can't be pleasant. I hope limit-setting is allowed.

    I actually think something akin to an old-fashioned care plan is in order. Or perhaps your EMR has an appropriate one built-in somewhere that can be activated and customized. That will keep everyone on the same page, help maintain his safety, define reasonable effort to be applied toward making him as comfortable as possible, and help define/identify therapeutic interventions that may be appropriate related to his behavior.

    Hopefully our peers from neuro and psych will weigh in!

    (hugs)

close