How far can a patient go?

Nurses General Nursing

Published

So after dealing with an extremely demanding, non-compliant patient on our telemetry unit for a combined couple of weeks now, I am curious: How far does a patient have to go in abusing staff to be removed from the unit? This patient has managed to verbally and emotionally abuse every member of the staff, and demands a huge amount of our time, usually to the detriment of other more needy patients. (this patient is completely ambulatory and is not a fall risk, and does not receive psych treatment) They have threatened to report almost every caregiver assigned to her and leaves every single staff member at their breaking point by the end of the shift, including tears.

So what does it take? Attempted murder? Rape? I'd be interested in hearing any stories you all might want to share of any actual patients being removed from a unit for bad behavior.

Specializes in ICU/Critical Care.

You need to set limits. I have told patients that they will not speak to me in a disrespectful manner and that I will do what I can to meet their needs and that I cannont guarantee that I will be able to get everything they demand.

Up Vote Up Vote ×
Specializes in neurotrauma ICU.
You need to set limits. I have told patients that they will not speak to me in a disrespectful manner and that I will do what I can to meet their needs and that I cannont guarantee that I will be able to get everything they demand.

That is a skill I am soooo trying to develop! I truly admire nurses who can do this and come across as assertive instead of b*tchy.

Up Vote Up Vote ×
Specializes in ICU, Telemetry.

I had one over the weekend -- HIV positive, likes to spit at the staff, spit in her hand and wipe it all over anything the nurses touch, tries to make you stick yourself when you have to restart an IV or give her an insulin injection. On the callbell q2h for morphine/demerol for "pancreatitis" -- sorry, I saw the labs/ct/MRI, and her pancreas is fine. I understand all the psych stuff about her being upset about having HIV, but my sympathy stops at her trying to give me HIV.

I went in, tried to do my assessment, and couldn't get very far. She yelled a bunch of nasty things, and then demanded I do a "fast push" on the morphine/phenerghan she was getting. I pushed it over 2 minutes, just like the procedure manual says, and when she started screaming that I wasn't treating her like the rest were, I told her she would only get the push per my procedure manual. (this person also told me she can only have IV morphine, she's "allergic" to PO).

I told my charge that I'd done my 12 with her, and didn't want her back, but she AMA'd out when the doc DC'd the morphine....

Up Vote Up Vote ×
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

i don't think there's a limit to how far a patient can go . . . the patient who shot my friend bert in the buttocks (with a real handgun his family brought in for him) got to stay; bert quit. the family member who threatened to shoot (in no particular order) his wife, his wife's doctor and his wife's nurse was arrested at midnight and was back in to visit by 6am. (the police did, however, confiscate the handgun he was waving around. however he still had a plethora of other weapons in his truck.) the patient who sent several nurses to the er with injuries remained on the unit until long after the nurses' medical leaves were over.

in short, i don't think management gives a flying fig about safety of their staff. it's all about those press-gainey scores!

Up Vote Up Vote ×
Specializes in ICU/Critical Care.

Couldn't your friend press charges against the patient who shot him?

Up Vote Up Vote ×

I've seen patients that have been d/cd to a psych facility. I've also seen a family member who threatened not the nurse but the nurses child be banned - (we have a day care on site)

Up Vote Up Vote ×

For physical abuse or like what the HIV + patient was doing charges can be pressed by the nurse on the paient. Most physical abuse on staff where I work is by elderly patients with dementia who think we are breaking into their home etc. I'd had trouble pressing charges for those patients.

Emotional and verbal abuse is a different story. It takes it toll on all staff. Rotating staff is the best for the staff but actually doesn't always help the patients negative behavior. Just when a patient know he can't get away with xyz when Nurse Jane is on then he gets Nurse Tom so he pulls his bad behavior again. I always like the statement " Well the other nurse let me do it" My reply " Well I am your nurse now and that is not allowed"

Up Vote Up Vote ×

If a patient of sound mind threatens or hits me I call the police. That is a police issue not a hospital one. All healthcare workers should do the same. Our job doesn't include threats and physical abuse. Threaten or hit me and police will be in your room shortly. Period.

It's all about boundaries done in a polite but firm way. "Pls don't speak to me that way. I can leave until you calm down or we can start fresh and move on." Another could be, "I understand you aren't feeling well but we are on the same side. If we work together we can get you on the road to recovery much sooner." Put it on them. It gives them some control to decide and move forward.

I also think in a lot of cases a psych consult is a good thing. I wouldn't be afraid to ask for one if you think it is needed and will help. Some are leery about doing it but it's our job to help them and psychological help is included in that.

Up Vote Up Vote ×
Specializes in CVICU.

We did have nurses in our ER who had the "fool me once" mentality... if a patient spit on them the first time, they got a warning. Subsequent spiting, punching, kicking, or threatening resulted in a call to the cops. We got tired of being bombarded by these jerks. Since ER nurses and cops are a pretty close-knit group, even cops who weren't there for that particular patient wouldn't mind stepping in and saying something. That usually made the patient stop. We even had one nurse file assault charges, and the patient was banned and barred from our facility.

Up Vote Up Vote ×
Specializes in LTC, hospitals and correctional settings.
When patients act out like this, it is usually because they fear loss of control, or worse, death. In my experience, when I've spoken up and basically told the patient not to talk to me or treat me that way, they back off. Sometimes you have to tell them their behavior doesn't help nurses who are trying to help them..in these instances, patients had no idea how they were coming across. Perhaps a social worker or physician can lay it on the line for them if nursing is not able to do this.

This thinking is why nurses are treated badly today. Being sick is not a license to bully others. It's high time nurses expect professional treatment and quit letting docs, patients and the general public walk all over us.

Up Vote Up Vote ×
Specializes in Flight, ER, Transport, ICU/Critical Care.

Batman24 gives good advice with making it a police action. You are a citizen and you have the rights of any citizen. Being in the hospital neither takes away your basic rights (RN) - not gives you carte blanche to do whatever you want (being above the law as a patient). Assault me, threaten me or engage in some other ILLEGAL activity and I think you can recover in the court system. I hear that some jails even have nurses!

Seriously - I wonder if a NURSE filing a WORKERS COMP action due to the stress of being VICTIMIZED would get this PROBLEM the attention it DESERVES. I mean what we are all doing - while being treated in disrespectful and often abusive ways IS NOT getting any better and NOTHING is being done - well, customer service classes have been held. Yep, that will fix it!

I have been sick over the the way some patients (and administrations) have treated me. I would love to go back to being an ER/ICU nurse - but, I know that it would kill everything that is good in my soul. I am just not that tolerant or patient. (And I think I have PTSD from all the "healing" I have been a part of).

Good Luck.

Up Vote Up Vote ×
Specializes in Community Health, Med-Surg, Home Health.
You need to set limits. I have told patients that they will not speak to me in a disrespectful manner and that I will do what I can to meet their needs and that I cannont guarantee that I will be able to get everything they demand.

I am finding more and more creative ways to demand the respect I need without making a scene...in fact, the patient can go report it, I can admit to it, but it can't be proven that I was disrespectful towards them (usually). Then, there are the ones where I have to make sure no one is around when I tell them to cut the crap.

Up Vote Up Vote ×
+ Add a Comment