Holding Patients and Visitors Accountable For Their Actions

[mackjazz]

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)

[Streamline2010]

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.

LMAO, too! As a customer, we *do* take our business elsewhere. I have deliberately taken my business to "the competing hospital," sometimes even to a hospital in a completely different city, because I don't like the type of clientele and the lax attitude toward security and personnel safety that a particular hospital has a reputation for.

Did Anything-Goes Hospital ever stop to think of that? That they might be losing business?

[Streamline2010]

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.

Agree! Throw the bums out.

[Emergency RN]

i have a bit of a problem with the stated scenario:

...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...

my question is, how would any nurse be able to calm him down, when her first duty should have been to protect herself by exiting the room when confronted by an obvious physically violent patient that is, by his behavior, clearly a danger to her? she should have immediately retreated from the room and pressed whatever panic alarm that all ed's are wired with, and brought security or the police to deal with him.

other than that, i totally agree with the op. patients and visitors tend to get an over abundance of benefit of doubt despite the most egregious of acts. there seems to be a pervasive sentiment of, or perceived feeling of entitlement (by patient's or visitors) simply because of whatever illness process being evident, that is somehow supposed to excuse their bad behaviors. often too, hospitals themselves bear the biggest share of the blame as they tend to bend over backwards in the effort to maintain good customer relations by forgiving transgressions, despite the harm that it does to their staff. are we supposed to take insults, threats, and the occasional fist in order to be good nurses?

no.

the insults i can care less, and maybe even so the threats. but if i get hit, the patient or visitor is leaving the ed in handcuffs, period.

btw: assaulting a nurse in the state of new york is now a felony: new york law makes assaulting a nurse a felony | new jersey nursing news

...the law applies to physical assault, which includes being spit on, bitten, hit or pushed. it does not include verbal assault. nurses can press charges against anyone, including patients who are delirious or mentally ill. the bill, avery explains, covers the basic right to press felony charges. the courts will take it from there.

[Altra, BSN, RN]

LMAO, too! As a customer, we *do* take our business elsewhere. I have deliberately taken my business to "the competing hospital," sometimes even to a hospital in a completely different city, because I don't like the type of clientele and the lax attitude toward security and personnel safety that a particular hospital has a reputation for.

Did Anything-Goes Hospital ever stop to think of that? That they might be losing business?

Oh, you got that right! I have spread the word among family, friends and neighbors to avoid my local *nice* hospital. It is *nice* -- but in my informed opinion (I briefly worked there) you have a considerably higher chance of inadequate care and/or complications than you do in the bigger, less convenient, grittier hospitals in the city. And it's only a matter of time before someone dies in the *nice* ER waiting room.

[Leela81]

Right on! Nurses deserve protection from abuse just as any lay person on the street does. In Massachusetts, USA a new law passed that it's against the law to abuse a health care provider. Now actually up-holding the new law or how exactly it works I don't know. But for sure there have been some patients on our general medical floor that abused physically and verbally the entire nursing staff...we should have called the cops or something! I do believe one particular patient made the list of "No further admittance" to the hospital

[piratern]

I think you are spot on. As an ED manager, I try my best to make sure the staff know that while they are expected to remain professional, workplace violence is NOT to be tolerated. Yes, people respond differently to stress. BUt.... everyone should be accountable for their behavior and threatening or loud behaviors simply shouldn't be tolerated.

[CrunchRN, ADN, RN]

I think you are spot on. As an ED manager, I try my best to make sure the staff know that while they are expected to remain professional, workplace violence is NOT to be tolerated. Yes, people respond differently to stress. BUt.... everyone should be accountable for their behavior and threatening or loud behaviors simply shouldn't be tolerated.

my kind of manager!

[Mbshil]

To KansasNurseD I totally agree with you. It is frustrating that patients and their families are informed of their rights, but we have to endure abuse left and right. Where are our rights? The most obnoxious/rudest and loudest patients are kept apeace to basically "shut them, up" It is a shame that the pleasant ,nice ones sometimes have to get the short end of the stick cause we are busy dealing with the jerks.

[Ava.J]

We have exactly the same issues here in the UK, with the 'customer is always right' mentality, to the extent that some days I feel like I am working in a hotel. Patients can be (and frequently are) as aggressive, insulting, sexually suggestive, unreasonable, petty and badly behaved as they like and we are expected to just smile and take it from them, because 'they know their rights' and we wouldn't want to upset the little darlings by laying a few reasonable ground rules.

The year I worked on a High Dependency Unit was the longest year of my life and left me frequently questioning my sanity.

I have to admit that I haven't faced the same level of 'uber-management' in home health/community care and I'm so glad I made the switch. For the most part, my patients are lovely and respectful and I'm able to be the type of nurse I always wanted to be.

I don't feel like I'm constantly trying to juggle being a customer service agent, waitress, cleaner, personal assistant, NATO peacekeeper or lion tamer anymore, I'm a NURSE, which is all I ever wanted to be.

I take my hat off to all of you who work in in-patient, bedside nursing, I hope at least some of your patients appreciate you! :heartbeat

[Silverdragon102, BSN]

We have exactly the same issues here in the UK, with the 'customer is always right' mentality, to the extent that some days I feel like I am working in a hotel. Patients can be (and frequently are) as aggressive, insulting, sexually suggestive, unreasonable, petty and badly behaved as they like and we are expected to just smile and take it from them, because 'they know their rights' and we wouldn't want to upset the little darlings by laying a few reasonable ground rules.

The year I worked on a High Dependency Unit was the longest year of my life and left me frequently questioning my sanity.

I have to admit that I haven't faced the same level of 'uber-management' in home health/community care and I'm so glad I made the switch. For the most part, my patients are lovely and respectful and I'm able to be the type of nurse I always wanted to be.

I don't feel like I'm constantly trying to juggle being a customer service agent, waitress, cleaner, personal assistant, NATO peacekeeper or lion tamer anymore, I'm a NURSE, which is all I ever wanted to be.

I take my hat off to all of you who work in in-patient, bedside nursing, I hope at least some of your patients appreciate you! :heartbeat

This really shouldn't be happening in the UK hospitals as there should be a no tolerance policy. Twice in my last couple years of working in a UK hospital I have seen patients removed for such behaviour.

[Ava.J]

Hi Silverdragon

No, it shouldn't, but I have several colleagues who have either changed to community nursing, retired early or gone off sick with stress because of this issue.

One good friend of mine had a bowl of hot soup thrown in her face by a patient, another has been off sick for 3 months with stress (she works in the A&E) and the staff turn-over on the HDU I worked on was ridiculous. So high in fact, that at one point just before I left, we had 10 new starters all at the same time!

Many of the patients were long term IV drug users, alcoholics etc. and the abuse we'd get from them (and family members) was ridiculous. One of them had launched several law suits against the hospital and every time he was in (he was a VERY frequent flyer) he'd complain over something, whether that be the food, his television, his pain meds... etc., etc. And all of his idiotic complaints were logged and 'investigated'.

My mother has been in community drug and alcohol for many years now and this 'customer service' attitude is incredibly prevalent there too, much to the amusement of the staff. The team leader decided last year to have a 'suggestions' box put in the waiting room. Well, I'm sure you can guess as to some of the suggestions made by their clients! lol

During my training, I was at several trusts and it's been my experience that different ward areas deal very differently to bad behaviour from patients. Whilst I saw one patient's relative escorted from the premises (for drug use in the toilets) and another ward worked very hard to make patients/relatives aware of their 'behaviour policies', at other hospitals their behaviour was tolerated or even worse, they were placated by management.

[Ruby Vee, BSN]

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.

there was a time when i could have/would have agreed with you that anyone who throws a chair into the wall out of frustration has some sort of mental problem. but after living with an abusive spouse for far longer than i should have (longer than one minute!) i've come to the conclusion that people behave that way because they get away with it. tom would knock me into a wall because dinner was late, overcooked, undercooked or not ready when he got home after refusing to tell me when he was getting home. he was sorry, he "lost his temper" or "you just made me mad." only thing was, he never "lost his temper" with his boss, the cop who was writing him a ticket, or with total strangers who disrespected him.

if someone doesn't get it no matter what the consequences, jail is a good place for them. it keeps them from further breeding and the only people they can hurt are those who are also in jail and probably capable of hurting them back.