How to deal with litigious patients?

Thunderwolf, MSN, RN · Sep 2, 2005

Be polite and business like.

Do not enter into arguements or provide remarks that marr your professionalism.

Document objectively the patient/visitor/family behavior as well as your own actions.

No subjective charting.

HIPPA.

caroladybelle, BSN, RN · Sep 2, 2005

Document, Document, Document.

**canoehead, BSN, RN** · Sep 2, 2005

If anyone threatens me with a suit, or with calling management I have a stock response that hasn't failed me yet. I just tell them I would welcome the chance to tell a judge (or whoever) exactly what has happened. Make sure you use the emphasis, and say it confidently. A follow up would include saying that the chart will reflect exactly what happened, in detail. No one has called my bluff, but then again it's the real turkeys that threaten the nurse to her face, and they back off quickly.

When called into management you should have the standards of care for your specialty in hand, or for the hospital. I have also been in that situation, and it doesn't matter who got bent out of shape, if you are polite (though simmering underneath) and you follow the standards and can document it point by point, you are golden.

Of course in some areas the hospital can discipline you for the color of your chewing gum, but they will look really dumb. Sometimes thats all the consolation you are going to get. If you did right hold your head high.

Cute_CNA, CNA · Sep 2, 2005

Try to find an area you agree upon, no matter how small. You don't have to agree with their whole argument to find common ground.

Rephrase what they just said to you, to show that you're listening. Say stuff like, "I understand you're upset right now. It sounds like x, y, and z are bothering you."

When they are agitated, stay calm. Hopefully it will rub off onto them.

USA987, MSN, RN, NP · Sep 2, 2005

No one has called my bluff, but then again it's the real turkeys that threaten the nurse to her face, and they back off quickly.

That is so true!!!

DusktilDawn · Sep 2, 2005

Alot of good suggestions from the other posters. I definately like Canoehead's style.

When it comes to documentation I would like to add that statements such as "noncompliant", "uncooperative", "hostile", etc sound like personal judgments you've made against the person. If your documentation comes across as if you didn't like the person, it is not a far leap for someone to conclude that if you didn't like the person then you probably didn't provide them with good care. Be explicit and as objective as possible. For instance if the patient refuses to listen to health teaching, "pt stated 'You are an idiot and don't know what your talking about.' Pt then turned the volume up loudly on TV and turned his face away."

Avoid any action that makes you look unprofessional. Never stoop to their level. Once you succumb to anger, you've already lost control of the situation.

rn/writer, RN · Sep 2, 2005

Document, Document, Document.

This is sooo important. I would also encourage you to keep your own private account of anything dicey. In your own notes, you can add references and info that you would NEVER put in a chart.

Miranda

SmilingBluEyes · Sep 2, 2005

Be polite and business like.
Do not enter into arguements or provide remarks that marr your professionalism.
Document objectively the patient/visitor/family behavior as well as your own actions.
No subjective charting.
HIPPA.

excellent advice.

hrtprncss · Sep 2, 2005

You can always look forward to the end of your shift, and when you're done you can request not to have the same patient the next day. Most charge nurses and fellow nurses would understand. Some patients just responds better to other nurses.

IMustBeCrazy · Sep 2, 2005

Great advice all, thanks! I like Canoehead's direct and honest style. I need to incorporate that line in these situations.

Comment on keeping a personal diary, I was taught *never* to do that and to chart it all (objectively) in the chart. Even if the diary is kept under lock and key in your work locker and never leaves the institution, legal nurse consultants have stated that any discrepancies between your diary and what is in the chart can raise reasonable doubt in a court trial.

:)

IMBC

rn/writer, RN · Sep 3, 2005

Great advice all, thanks! I like Canoehead's direct and honest style. I need to incorporate that line in these situations.
Comment on keeping a personal diary, I was taught *never* to do that and to chart it all (objectively) in the chart. Even if the diary is kept under lock and key in your work locker and never leaves the institution, legal nurse consultants have stated that any discrepancies between your diary and what is in the chart can raise reasonable doubt in a court trial. IMBC

Oh my gosh, You don't keep a personal diary anywhere near work! You keep it well-hidden at home for your own private use. Because of HIPPA, you don't use names but with dates and detailed descriptions, you should be able to identify anyone who came after you legally. This is not something you tell people about. If a defense attorney knew it existed, he could get a subpeona for it.

So why keep such a journal? Because charts take time to resurrect and may not jog your memory the way your own personal notes would.

I learned to do this as an EMT and, while I personally have never been to court over a past call, I know others who have. We've been encouraged to go home and immediately write down anything we can remember about those calls that felt funny or had some unusual character to them, and to add details as they came back to us. My colleagues who have been summoned as either witnesses or defendants have been so glad they had these notes to refer to. Run sheets (the EMS version of charting) can be kind of bloodless (pardon the pun), but personal notes have a way of putting you back in the moment. Oh yeah, this was the guy who smelled like garlic and kept cussing out his wife on the way to the hospital. A few well-chosen words can bring it all back.

Miranda