Worst night in history

Nurses General Nursing

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Specializes in ICU.

Im a GN but still working as an ACP till I pass NCLEX. Last night I was assigned to be a patient sitter to a schizophrenic. He was alert and oriented to time, place, person and situation and ambulatory with minimal assist.

At first, everything seemed to be going fine. Made casual conversation with the patient, everything was calm. It all started when he told me he was going to crap and pee in the bed, and I told him that wasn't nessesary as we could get him to the toilet. He tells me he will do whatever he wants, and when I told him we would have to get him up to change the sheets anyways so he may as well use the toilet, he called me a dip****. Long story short, the next 7 hours consisted of him screaming at me at the top of his lungs, and insulting me with very personal insults. Im stupid, I have a measly pea brain, Im slow and don't know what Im doing, I'll never make it as a nurse and Im not even fit to clean up garbage, sit down and shut the **** up, I'll never make it in life cause I can't follow directions, he gives the orders and I have to do what he says, he knows everything about hospitals cause he's been in them before, don't try to hold my crappy education up to his cause it isn't s***....and the list goes on and on. Other patients were coming into the hallway to look and one even said she was calling the police. He also kept belting out insults and racial comments to visitors and housekeeping in the hallway, telling them they were fat, and calling them things like "smell puerto rican". Though it was extremly hard, I was not arguing back in any way shape or form. The only thing I did was tell him to please not yell, and to be nice. His nurse said I was not to repond to him in any way and just do what he asks because you can't reason with a mental illness. So the rest of the night was spent just sitting there while he called me every name in the book, told me how stupid i was, and ordered me around. Later that night, the ANM finally came in and told him to stop being rude and insulting me and people in the hall, and he told her all these hurtful lies about me, including that I was trying to make a pass at him and he doesnt involve himslef with married women.

Im trying to remember that he has a mental illness, but at what point has it gone far enough? Where is the line between the mental illness and just being plain hateful? I was so humiliated and degraded. The happiest moment of my life was when my shift was over

Familiarize yourself with schizophrenia. Seven hours of verbal abuse will make anyone feel degraded.

The nurse was not handling the behavior! There is no way in h*ll you should have been put through this!

He was also disrupting the entire unit. Medication, the quiet room, security intervention all should have been done within the first. hour.

You need to make the NM aware that the nurse cannot handle psych patients and put you in jeopardy.

Why did you engage him in conversation and tell him anything about you? I don't know what the rules for sitters are at your facility, but where I work, whether a tech or not, a sitter cannot assist a patient with ADLs, cannot engage a pt in conversation, they are there to sit and make sure the 1013 patient remains under constant watch. I understand that it hurt your feelings and bothered you, but considering that one day you will likely be taking care of a patient with psych issues, you probably need a little thicker skin. People, 1013/psych or not, are going to say mean things, especially when they aren't getting their way.

This patient's disruptive behavior should not have been allowed to continue. He needed firm limit setting, clear boundaries, and enforceable consequences should the behavior continue or escalate. None of those things are your job. The nurse failed you, the patient, and the rest of the patients and staff on that unit by failing to act. I'm sorry that happened to you.

Why did you engage him in conversation and tell him anything about you? I don't know what the rules for sitters are at your facility, but where I work, whether a tech or not, a sitter cannot assist a patient with ADLs, cannot engage a pt in conversation, they are there to sit and make sure the 1013 patient remains under constant watch.

I don't think the OP did anything wrong by making casual conversation with the patient that she was about to spend the next eight hours with. I would have done the same thing.

Policies vary from facility to facility, and of course from situation to situation. Whenever I worked as a sitter, it was not against policy to engage in conversation, nor assist with ADLs, so long as the patient was cooperative and not considered a threat to themselves or others. If the possibility that the patient would become agitated and therefore potentially dangerous was reasonably foreseeable, then the sitter would be stationed just outside the doorway to the room so that they could keep the patient in their field of vision at all times without being inside the room.

Specializes in ICU.

Its not like I gave him my address and SS#, we were just talking about generic things (where went went to school, the weather, did we grow up here in town, ect) and there is no policy that states that we can't talk to our patients...

As CNA's we are required to handle all ADL's and patient care within our scope of practice when we are sitters

I dont think telling me to grow thicker skin is very fair. Ive been a CNA and a sitter for many years, and went through 2 years of nursing school and that's the 1st time anything like this has ever happened. Ive never been treated like this before and it isnt something I expect to become the norm

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Specializes in ER, progressive care.
Its not like I gave him my address and SS#, we were just talking about generic things (where went went to school, the weather, did we grow up here in town, ect) and there is no policy that states that we can't talk to our patients...

As CNA's we are required to handle all ADL's and patient care within our scope of practice when we are sitters

I dont think telling me to grow thicker skin is very fair. Ive been a CNA and a sitter for many years, and went through 2 years of nursing school and that's the 1st time anything like this has ever happened. Ive never been treated like this before and it isnt something I expect to become the norm

But in this field, you really need to, especially with psych patients. And you will see mental illnesses everywhere you go, not just on a psych unit. It's hard at times but that's what you have to do. There is a first time for everything.

I'm sorry that you had to experience that. I agree, the RN taking care of that patient should have intervened instead letting you deal with that for 7 hours straight.

And where I work, whether the sitter is a CNA or monitor tech, they can talk to the patient and do ADLs while at the same time watching the patient and make sure they are safe and not pulling out any tubes/lines, etc.

And totally off topic, but it really annoys me when a patient loses their IV site when they have a sitter...

Specializes in Hospice, corrections, psychiatry, rehab, LTC.
Its not like I gave him my address and SS#, we were just talking about generic things (where went went to school, the weather, did we grow up here in town, ect) and there is no policy that states that we can't talk to our patients.

You absolultely should talk to your patients. Just don't tell them anything about your personal life or background. The patient can already read your name off your badge. If you give the patient any personal information (former school, home town, neighborhood you live in, etc.), with all the internet tools available it wouldn't be long before that person could have all sorts of additional information about you that you didn't give them. This is doubly dangerous when the patient has a mental illness. This is why a lot of hospitals allow nurses in ER and on mental health units to cover up their last names on their ID badges, or omit them from the badge altogether. Best to be cautious.

Specializes in Emergency/Trauma/Critical Care Nursing.

I disagree w/the post saying you shouldn't talk to pts as a sitter, if anything having someone to talk to may keep a patient calm, or occupied if they like to pull at things. Besides, how uncomfortable would it be to be a patient and have some stranger sitting by your bed watching you but won't talk to you? ESPECIALLY in paranoid schizophrenic pts who may interpret you as one of his hallucinations as they frequently feel like they are "being watched".

Now as for the nurse assigned to this pt, her behavior and lack of intervention was completely inappropriate. This pts disruptive and offensive behavior should have been addressed immediately and I assume the supervisor that came later has made sure that nurse won't do it again, its pretty bad when your supervisor has to come do your work for you lol.

As a newer nurse, I understand that you haven't had time to develop the thick skin that comes w/years of dealing w/abusive behavior. It will take you time, but eventually you will find your own coping mechanism. My response to these situations is to never personalize it and find the humor in it. If I had been sitting w/your patient instead, the minute he threatened to purposely be incontinent, I would have looked him straight in the eye and said "well that's entirely up to you, but when your done you will have 2 options.. 1. you can get up and go clean yourself in the bathroom and then clean up the mess you made b/c we both know you are very capable of doing so. Or 2. You can sit in a bed full of your own feces and urine for however long it takes you to change your mind and go with the 1st option.

You have to be firm and assertive with any patient/visitor etc who is yelling at you. If they can see that they are getting to you it only feeds into their behavior. If you make it clear that you will not tolerate inappropriate behavior and will try to assist them as needed once they act appropriately.

Also, I noticed that you said he was yelling "personal insults toward you". Then proceeded to call you a pea brain, slow, etc. So let me ask you this.. ARE you a pea brain or slow?? I doubt it very much.. he was just yelling any insult that came to mind and you happened to be in the line of fire. Try to think of it that way vs internalizing it and letting it hurt your feelings.

I'm sorry to say that this will definately not be the "worst day in history" after you get a few years under your belt. Just remember.. sticks and stones may break my bones but words will never hurt me. :)

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But in this field, you really need to, especially with psych patients. And you will see mental illnesses everywhere you go, not just on a psych unit. It's hard at times but that's what you have to do. There is a first time for everything.

Agreed.

My question/thought...the nurse that came in and basically told him to behave himself seems completely unfamiliar with psych nursing. 7 hours - the man needed a prn.

This is ridiculous. Not only was he disruptive he was verbally abusive. There is some consideration that can be taken when someone has a mental illness, but that does not give them an excuse for all outrageous behaviors. The nurse should have provided some sort of intervention to address this behavior.

Specializes in ICU.

We get psych patients all the time. If they have a medical condition that warrants them being admitted to us, then we treat them. No, you cannot argue with mental illness~ you are just wasting your breath. What would the nurse do to "intervene?" Knock him out? If he was physically violent, that's a different thing altogether. You do need to just "grow a thicker skin" with verbal abuse. A schizophrenic patient usually gets worse because they stop taking their meds. Maybe his particular medical condition caused his schizophrenia to worsen, or his meds to not work properly. And some drugs make them nuttier. (Ever given ativan and had it backfire on you?)

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