How to deal with abusive family members

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I had a pt the other day whose baby had lost to much weight. I told her the pediatrician would not release the baby and the father snapped and became very verbally abusive to me. He started yelling and swearing that I was not going to keep his baby. Explaining that it was not my decision did no good and he was going AMA. I said that was his right but nothing worked and he kept screaming at me thatI knew nothing about his baby. I was so upset I left the room and cried. I was in no way unprofessional and had the best interests of his baby in mind.

I mean I've had patients upset they couldn't leave and those that have gone AMA but I have never seen this kind of response with someone who just couldn't see reason.

How do you deal with these kinds of people?

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Specializes in Telemetry.

call security to deal with them!

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They left before security could get there.

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Specializes in PEDS/NSY/L&D/med-surg.

How on earth did the baby get out the door AMA w/a security band on??

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Document, document, document. Make sure you accomplish an incident/occurent report and discuss this with risk management and your unit manager. And I am sorry this happened to you. It sounds like you had a horrible time. You will learn in time, how to deal with people like this. Make sure, in times like these, you stay calm and involve/activate your chain of command, starting with your charge nurse, all the way up as needed.

Don't beat yourself up. We've all been there. Just try to learn from this.

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We don't have alarms on the baby bracelets and legally we can't keep them there. I did document, I practically wrote a novel so at least I did that and my licence is covered.

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Specializes in Emergency.

First of all, you shouldn't be telling the parents that the doc won't release the baby; the doc should be the one giving this info (make them do their own dirty work; personally, I hate it when doctors treat me like their "errand" girl). Now, was this a newborn/young infant and the doc wanted to keep the baby a bit longer in the hospital to monitor them, or was it a potential abuse situation and the parents were suspected of neglect/maltreatment? I'm going to assume that it was just a "monitor the baby" issue - if it were the second scenario, you need to have security present and make sure you are following P&P of your facility (and perhaps have the police involved, as well as social services and whatever gov agency that governs child abuse in your area).

To handle these types of patients/family members:

1. NEVER let the patient/family member get between you and the door.

2. Talk calm, but firm - state "sir/ma'am, please stop yelling at me"; then proceed to "sir/ma'am, you CANNOT yell at me" if it continues.

3. Use empathy! Say things like:

  • "I realize you are upset"


  • "You seem angry"


  • "I am trying to help you"


  • "Please, let me help you"


  • "I can only imagine how frustrating this must be for you"


  • "I'm not in your shoes and I'm not going to pretend to know where you're coming from, because I'm not YOU - but, I DO want to understand where you are coming from and I truly want to help not just you, but I want to help your baby as well"


4. Let them know that you hear what they are saying, and try to turn the situation around so it benefits them. Say something like "Sir, you are right - I know very little about your baby. But I do know that babies who lose weight can become very ill very quickly. I have seen babies look well one minute, and the next minute they are critically ill. This hospital stay is an opportunity to give your baby a nutritional "boost" that can only be given in a hospital setting using special equipment. This will help your child fight infection, prevent dehydration, and help their brain to develop properly. We can also evaluate your baby to make sure there isn't an underlying cause for their weight loss, because it's very possible they may have some type of food allergy that is causing their body to absorb less nutrients. Today is the perfect opportunity to make sure that your baby is digesting nutrients normally, and both you and your wife are welcome to stay 24/7 with your child. This is also an opportunity for you and your wife to get some rest, because after the day's ended and you've given all you can to care for a baby, there's little left over for yourself. We absolutely in no way are trying to take your child from you, and you obviously love your baby because you brought them here today. I'm being honest with you and I'm not trying to scare you - but I've cared children in the past who became very ill and it could have been prevented; and I wish that I would have been more forthcoming with the parents about why their child needed to be admitted. Since then, I've promised myself to do everything I can to prevent another child from becoming ill and dying from something that we can prevent - so please, let me help your child".

5. Flat out ask "Is there a reason why you are yelling at me", and "Is there a reason why don't you want your child to stay".

6. Like others have said, document away!

Some people may disagree, but I at times will overexaggerate a patients condition to help them comprehend the severity of their situation. In the ED, I've really only got one opportunity to help a patient understand the seriousness of their illness. For example, I've told alcoholic GI bleed patients that they need to stop drinking because it is killing them, and I've flat out said to GI bleed patients (who are peeved because they can't drink water, and who are upset that we won't let them watch TV - meanwhile, we're running around trying to stabalize them) "You are very sick, and people can die VERY QUICKLY from a GI bleed - so my job is to prevent that from happening, which is why there are 3 nurses in the room and why we are putting in so many IV's which help us give you fluid and medications". Is it likely that that specific patient will crash and die before my eyes? No. Have I seen it happen? YES; and it is awful. I myself have seen infants awake one minute - next minute, their lips are blue and we're trying to stabalize them (one patient specifically was 10 days old, and we shipped them to another facility for emergency cardiopulmonary surgery, of which they ended up on ECMO and a chest that couldn't be closed due to swelling...and sadly, I highly doubt they survived). So, if I need to be frank with patients to help them understand how serious their condition is, I totally will. Its not about shock/scare tactics, its about truthfullness and speaking in words that get through to the patient. If "serious", "deadly", "critical", and "ICU" help convey the reality of a patients condition, then I'll use those words - and I do so respectfully.

Dealing with verbally abusive family members can be very hard, especially when little ones are involved - and what makes it worse is that these children can't speak to tell us what's wrong, and can't ask for what they need.

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Specializes in Cardiac, stroke, telemetry,Med-surgical.

"I said that was his right but nothing worked and he kept screaming at me thatI knew nothing about his baby. I was so upset I left the room and cried. I was in no way unprofessional and had the best interests of his baby in mind."

Eden, what is the cost of staying one day in your hospital?

I think, this aggressive outburst had an underlying reason. It wasn't about you at all.

I am sorry you had to take it on yourself.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

You are right; it's rarely about us. I like the above post about how to handle such outbursts specifically---the words to use and the fact we should not let escalating, angry people get between us and the door; EXCELLENT advice. It's not about us----but that does not make it any easier to deal in the heat of the moment. To defuse the situation takes practice and tact ------and a lot of calm. And help. I would not try to do it alone, if things further escalated.

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Thanks for your responses.

Moonshine, I work in an LDRP where the doctors are not on the floor all day. It is well within our scope of practice to tell the patients what the routine practice of the pediatricians are so I don't blame the doctor for not coming in.

Romantic, there is no cost to the patient to stay another day, we have universal healthcare here.

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Specializes in OB.

Eden - it sounds as though you did all the right things. Sometimes people have underlying reasons for their reactions and sometimes they are just jerks, If they are just a bully then all the "theraputic communication" in the world won't help. I think to that sort it sounds like appeasement and just reinforces their behavior.

The only other thing I might have done in this case would be to offer "I'd be glad to call the physician for you and let you discuss it with him". Then get the phone, call the doc and hand the phone over.

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Sorry you had such a bad experience! It sound like you did the right things. The person at fault here (bedsides the ignorant father) is the pediatrician who gave the order to keep the baby--he/she should have initated a dialogue with the family directly and explained what is the problem and why--not just dump it on the nurse. Families naturally would be upset and would like to ask the doctor questions. We as nurses must insist that the doctor contact the family immediately. I would bring this up with your nurse manager and see if a policy could be put in place about that. Take care :)

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