getting walked on

[UtErRnEmt]

after having a pt curse me out and than losing my temper, which i'll probably get pulled into the office over, i was wondering how management at other hospitals react in this type of situation. do your supervisors allow the staff to be verbally abused?

[tyvin, BSN, RN]

Absolutely in no terms for any reason. I've seen a nurse dismissed after a few people heard her speaking harshly to a patient. It all depends where you are working and to what extent was the abuse and is the patient complaining.

We have to be able to control ourselves; that's the bottom line. Good luck.

[UtErRnEmt]

even if the person threatens to come after you physically?

[EMM2erl]

Funny u should bring this topic up. I just finished a mandatory course "Managing a difficult patient" Very enlightening. Don't fight fire with fire. When a patient starts to curse and u can't get ratiionalize with them. I would have sought the help of my charge nurse or supervisor. When the patient gets physical we call security. Being verbally abusive is a no-no. Being physical with a patient is a last resort not unless he is trying to hurt you. We have been taught how to subdue a patient if need be. At times i would have a co-worker to acompany me to serve as a witness. Hope goes well.

[RNvocalist]

Get used to it. Bottom of the food chain...

[tyvin, BSN, RN]

even if the person threatens to come after you physically?

A person can threaten bodily harm but it's a different thing then it actually happening. I can only go on the experience where I've worked and verbal abuse of any kind is not tolerated.

Has your place had any kind of in-service on this subject? That's how I would go with it when and if they call you in. Don't try to justify your actions just go with the "it took you by surprise", may I apologize etc... Ask for an in-service on the subject or if you can attend a conference coming up with this type of theme.

I hope everything works out. Head up and smile. Actually I wouldn't wait for them to call me in I would go in a little early and give a report on what happened with the intent of wanting to learn more about how to handle such situations.

[Larry77, RN]

I would be honest and admit that you lost "your cool" then explain to them what you will do when faced with the same situation again. If you go into the conversation with the attitude that patients shouldn't be "allowed" to verbally abuse staff you may have a harder time because management will see you as a liability.

If we are threatened we need to document the threat, if we are assaulted physically we need to press charges, but we can NOT lose control of our own emotions...we have to be the sober one, the mature one, and the professional one.

So much easier said than done...trust me I worked inpatient psych for 4 years!

[GreyGull]

Don't make their problem become your problem. The patients don't know you and whatever they yell at you should not be taken personally.

Maintain a professional attitude until it is determined if their behavior is something related to a medical condition that can be treated or if it is their normal personality with issues that can not be fixed or even addressed to any extent in the short time they might be with you. And don't let their behavior cloud your judgement for assessing this person as a patient.

However, document the person's actions because that can also be part of the assessment for medical issues as well as making a note to initiate a paper trail to show the patient's violent behavior to justify the next level of security or restraint. In some places that can mean placing the patient into the custody of the PD and transferring them to a locked medical unit to continue their treatment.

For this situation I agree with "it took you by surprise, may I apologize" advice that tyvin posted.

[PostOpPrincess, BSN, RN]

I immediately set limits on what's allowed and not allowed. No one is allowed to curse at me, threaten me, etc.,

Now what they actually do or say is a different story, but my goal is to let them know that they're crossing the line.

As for talking back to them, a stern "I don't think so" seems to work well. Especially if you throw in a couple of big words. I do not, however, allow myself to get annoyed to the point where they get to me personally. It's not worth the energy expenditure.

J

[casper1]

Patient's , Co-workers no one has the right to verbally abuse you. I don;t yell back but I do defend myself and tell them that the behavior is unexceptabe. If the patient is not at risk of hurting themselves or others, I excuse myself and tell them I will return when they gain control.

[GreyGull]

Telling someone not to yell may work well if the patient has some capacity for reasoning or rational behavior. However, many of the patients we see may not be on their psych meds or should be on psych meds. The others may have some medical condition yet to be discovered that is causing irrational behavior. We also are seeing patients at younger ages having dementia. I only wish it was so easy as telling everyone to just behave themselves.

[JD228]

Yelling back may make you feel better in the short term, it isn't worth the long term consequences. We have police in our ED that are great about intervening as needed. Also, our physicians will step in and tell them that they can not treat our staff that way. Support from others usually helps. If it just seems like a personality conflict, sometimes switching with another nurse is the way to go.

Unfortunately, a lot of our patients don't have good coping skills and it is easier for them to take out their frustrations on us than on dealing with the real problem (s).