Holding Patients and Visitors Accountable For Their Actions

I am an ER RN, and for the most part enjoy my job. Today I had to attend a class that struck a nerve. A big nerve actually, that has led me to organize my thoughts about it. The class was about preventing/managing a patient or visitor that is 'escalating' to the point of verbal and physical abuse. Nurses General Nursing Article


Holding Patients and Visitors Accountable For Their Actions

We were all trained on how to recognize anxious behavior that may lead to violence, and 'deescalate' the 'crisis'. For example, lets say that a man(free of mental illness) that has a painful toe begins shouting about the wait time and throws a chair against the wall cracking a picture frame. The nurse was then able to calm him down. The man gained control of himself and become very very very sorry for his behavior, and the nurse said 'ohhhh, thats ok.'

We all then discussed that maybe he doesn't like hospitals, he had a bad day, maybe he lost his job, maybe someone stole his parking spot, maybe he has to be somewhere important, maybe hes getting a divorce, maybe its the economy, maybe he was abused as a child, and maybe we should all be sensitive to whatever the patient is going through.... The whole time I was thinking MAYBE he should have controlled himself in the first place, MAYBE he should have been arrested for destruction of property and risking the safety of the nurse and others in the waiting room, and MAYBE he should be accountable for his actions.

I spoke up and expressed my opinion which pissed off some and amused others. A social worker had the exact opposite opinion stating "Sometimes people have difficulty controlling themselves when they have a crisis, sometimes we don't know what they are going through."

So, whoever said that is is OK to mistreat/abuse others when they are going through a hard time?

I replied that I am completely empathetic to those that have a crisis/bad day/whatever their problem, but that does not excuse abusive behavior.

This social worker went on and on defending her opinion in various ways while others simply laughed at my opinion. They said "Yeah, wouldn't that be nice if everyone was accountable for they're actions, hahahaha"

I couldn't believe it!

Of course everyone needed to be accountable for their actions, I don't care what anyone's excuse is, because it does not matter!

You cant tell a cop "I know I'm drunk driving and a safety hazard to everyone on the road, but I lost my job and got in an argument with my son earlier today."

Your still going to jail, right?

Same consequences should occur in a hospital as well....

"Sir, I'm sorry you lost your job and got in an argument with your son, but that is beside the point. You are NOT ever aloud to throw chairs or yell/threaten anyone for ANY reason.

And now you are sorry?

That's great but you will still have to pay the consequences!"

Healthcare workers are told to leave their problems at the door, to take a walk or talk to someone if they are having a difficult time.

Why aren't these standards held on everyone?

I plan to hold each and every person accountable for their actions. We need to change our culture to this thought, especially in hospitals. This, I believe, is the best prevention.

(my opinion does not apply to anyone with a physiological/psychological illness)

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Specializes in Transgender Medicine.

I can only stand up and applaud you. This runs along the same reasons why people come to my ER for runny noses and other such nonsense. No one has ever stood up to them and said, "Hey, this is the EMERGENCY room you idiot! You can't just come in here for every little thing that could be more easily handled at an urgent care or PCP's office." Of course, then they'd actually have to PAY for the service (and wouldn't that be the end of civilization as we know it.) You can't go to a gas station, punch the clerk, and get gas without paying - So why is it that people can be physically/verbally abusive in the hospital and also never even attempt to pay their bill and nothing is ever done to chastise or correct them? Makes me sick every day. And administration cares not a whit! Just as long as that psycho pt sends in a satisfactory survey result. Makes me wanna strangle myself with fishnet stockings and call it a day. Thanks for the rant! :smokin:

gonzo1, ASN, RN

1,739 Posts

Specializes in ED, ICU, PSYCH, PP, CEN.

I agree with you. This is one of the big problems with society today. People are let off the hook for unacceptable behavior far too easily. People are not taught to take responsibility for their actions.

Orange Tree

728 Posts

Specializes in Medical Surgical Orthopedic.

I agree with you 50%, but the other 50% of me says that anyone who would throw a chair into a wall out of frustration has some sort of mental problem. Maybe it's psychological and they were never taught how to deal with their emotions appropriately, or maybe they're just not very smart....

In any case, there will always be people who just don't "get it" no matter what the consequences are. And while I used to want to lock them all up or at least keep them from breeding, I am now just happy not to be one of them.

tablefor9, RN

299 Posts

Specializes in ICU, Home Health, Camp, Travel, L&D.

We have whole generations of people with a laundry list of excuses for unacceptable behavior. Too many people play the "poor me" ticket to get by, having no concept of personal responsibility. Drives me crazy...but not enough to throw a chair.

OP, you would have shut the SW up fast if you'd thrown a chair in her direction. It's always easy to theorize, easy to be understanding when the missiles aren't flying at you. It's quite different when the bad thing happens to you or someone you love.

I was always empathetic toward criminals - oh, his daddy was not part of his life; oh, she was raped, so it's ok for her to be angry and mean to everyone all the time (I hope I'm not stepping on too many toes too heavily with this scenario). Until my loved one was a crime victim. Then, all the theory and mushy feelings went trotting down the road. Funny how that happens.

Altra, BSN, RN

6,255 Posts

Specializes in Emergency & Trauma/Adult ICU.

Absolutely right. This is a problem of our culture, not of the emergency department. (though some days it seems particularly acute there ... :uhoh3: )

Training in self-control used to be a standard part of parenting beginning around age 2. The basics: the ability to sit quietly, keep hands to self, to use "indoor voice" :D , and to recognize that some times you're not going to get your way. Current popular culture almost totally disassociates itself from that, then wonders why there is a problem in older children/teens/adults. Go figure.


18 Posts

Specializes in Emergency, Corrections, Adv Practice.

This is the reason I am SOOOO frustrated with hospital medicine. It has become about patient satisfaction and not patient care. I completely agree with you that people should be held accountable, but unfortunately hospitals consider patients to be "customers" not patients. Apparently your hospital like so many others, including my own, believes the old adage "the customer is always right."


547 Posts

Specializes in ED/trauma.

This is very true, esp in the ER. I think when people enter the hospital, we automatically put the, "Oh, they're suffering" veil over them -- similar to nurses who are battered in the workplace and don't file charges. Why the hell not?! Often, it's management that won't do anything. (They wouldn't press charges against this man because it would ruin their image, he won't come back, the news will eat them alive -- anything that will damage their bottom line.)

I think we, as nurses, have to stand up to behavior like this though.

In my ER, we were filled with hall pts one day. This one pt (total BS issues imho) starts yelling at their mother-in-law over the phone. Everyone is staring at the pt -- patients/family standing out of rooms. The thing that got me most, though, was my co-workers, even the pt's own nurse. Everyone just staring at her! I came from a very different sort of ER... so I walked up to the pt and with a slightly raised voice informed the pt that it wasn't appropriate to be yelling on the phone like that. (I forget my exact words, but you get the point.) The pt carried on a bit, but I continued on. I eventually got on the phone, cleared up the issue, and reiterated that it wasn't appropriate to act that in this ER. The pt eventually calmed down, and it didn't happen again.

In another example, a pt presented with stroke-like symptoms (and an extensive pysch history...). Pt kept yelling at spouse, saying pt didn't need another damn MRI, pt just wanted to go home, etc. I marched in their with an AMA form and told pt to sign. Pt started hedging a bit but still trying to yell at me. I told pt we had a waiting room full of people and plenty in the hall who would love this room. If pt didn't want to be here then pt could sign and leave immediately. Pt calmed down pretty quick, and apologized (citing hormonal changes as the cause of pt's behavior...) Pt didn't give me and more guff the rest of the night.

I truly think people throw out some of their inhibitions when at the hospital, esp the ER! They think their frustration excuses their behavior. But, perhaps more importantly, just like children, they test their boundaries. If WE allow them to "escalate" until a chair is thrown, for example, we may not be to blame, but we do have the power to intervene. I say F that non-sense about excusing their behavior. If people are too stupid to know what behavior is/isn't appropriate in a hospital, then I will be happy to show them.

OP - thanks for the post.

suni, BSN, RN

477 Posts

Specializes in med surg.

I agree with you but we are constantly being told that health care is a business and patients are customers who can take their business elsewhere. It seems like the nurse is always wrong , I would like to see upper administration take the crap we take with a smile and their scripted responses: I am so sorry this happened to you, what can I do right now to make it better?


1,046 Posts

Specializes in Corrections, Cardiac, Hospice.
I agree with you but we are constantly being told that health care is a business and patients are customers who can take their business elsewhere. quote]

There are MANY times where I would be happy to point the "customer" in the direction of the competing hospital, LMAO.

CrunchRN, ADN, RN

4,498 Posts

Specializes in Clinical Research, Outpt Women's Health.

It can be understood when young children have poor impulse control, but adults should be held to a higher standard don't you think?

A family crisis is still NO excuse for cussing out employees, throwing furniture, or any other unacceptable behavior.

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