How far can a patient go?

[junebride]

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.

[diane227, LPN, RN]

First of all, on my floor they DON'T get away with this kind of behavior. I make it my mission to go in and tell them that we are not going to put up with that kind of behavior. I let them know what we will do and want we won't do. I tell them that I will not put up with disrespectful behavior under any circumstances. I ask them what need they have that is not being met. If the patient is ambulatory, I tell them what they can and cannot do. I tell them that if they can't behave themselves that we will discharge them from the hospital. If the family members are disruptive I let them know that if they cannot act in a polite manner that they will be escorted out of the room and the patient will no longer be allowed to have visitors. If they are still angry, I give them the number to the Washington Department of Health so they can make their complaint. If they say they are going to call their lawyer, I hand them the phone. I just won't put up with this stuff. Works every time. I am blessed with a LOUD Texas accent and that helps.

[cookienurseRN]

to WYDiceDancer,

If you read the rest of my post, you would have seen that I do not let the patient's illness become the excuse. I manage their behavior in a professional way by telling them that I don't appreciate the way they treat me and expect better treatment from them.

[Cindy_A]

You are also blessed with management that backs you up, some nurses aren't as lucky. I'm glad you do what you do, keep it up! :yeah:

First of all, on my floor they DON'T get away with this kind of behavior. I make it my mission to go in and tell them that we are not going to put up with that kind of behavior. I let them know what we will do and want we won't do. I tell them that I will not put up with disrespectful behavior under any circumstances. I ask them what need they have that is not being met. If the patient is ambulatory, I tell them what they can and cannot do. I tell them that if they can't behave themselves that we will discharge them from the hospital. If the family members are disruptive I let them know that if they cannot act in a polite manner that they will be escorted out of the room and the patient will no longer be allowed to have visitors. If they are still angry, I give them the number to the Washington Department of Health so they can make their complaint. If they say they are going to call their lawyer, I hand them the phone. I just won't put up with this stuff. Works every time. I am blessed with a LOUD Texas accent and that helps.

[flightnurse2b, LPN]

we have this thing in our hospital called a "code gray".

if at any time, ANY member of the staff feels they are being emotionally/verbally abused or are in danger of physical harm r/t a situation escalating, you call a "code gray".

all available men in the hospital show up to the area where the situation is going on. if the patient is alert and oriented, they will more times than not back down and not behave like that again... unless they want 40 men to show up in their room.

sorry your patient is so difficult.

[canoehead, BSN, RN]

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....

Why in the world would you give her any prn meds if she's abusing you. She can clean up the spit, and her language, and get the meds per policy, or not get them at all. She chooses what happens, not you, and make sure she understands it. If you must give prns a 50cc bag piggyback won't hurt her, or you. Bet her behavior improves. Maybe she'll refuse you as a nurse again (darnnit!)

[yetanotheramanda]

we have this thing in our hospital called a "code gray".

if at any time, ANY member of the staff feels they are being emotionally/verbally abused or are in danger of physical harm r/t a situation escalating, you call a "code gray".

all available men in the hospital show up to the area where the situation is going on. if the patient is alert and oriented, they will more times than not back down and not behave like that again... unless they want 40 men to show up in their room.

sorry your patient is so difficult.

you must work for an amazing hospital!

[ksrose1]

We have code grays at our hospital also, but is only used for situations that can no longer be controlled by the staff on the floor alone. If we called a code gray everytime a patient on our floor was verbally abusive or threatening, we would be in trouble.....I work at a county hospital, so we have to take everyone.

[Ruby Vee, BSN]

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.

being sick, scared or hurt is not a license to abuse those who are trying to help. this line of thinking is why nurses are continually abused not only by our patients but by their families (oh, they're under a lot of stress because grandpa is so sick!) and by our managers (i know that family member threatened you with bodily harm, but if you kill them with kindness, they'll be nicer to you.) you sound like a manager or, worse yet, a social worker.

[ChristaRN]

Isn't this something that probably every nurse has wondered on occasion? First in med-surg it was some of the walkie talkies who acted like they were the sickest patient on the floor and now in Pediatrics its some of the parents who act like every time we give their child an IV we are purposely hurting their child. It's the part of the job I hate the most. The parents are often easier to appease by soothing them and acknowledging that we know how frightened they are, this is their baby etc.... I remember one particular patient on med-surg when I was a relatively new nurse who was downright verbally abusive to the staff, not suffering from dementia or anything that would alter her personality and it took three doctors over a period of roughly half a year to end up writing her official letters to state that because she was so uncooperative with her care and the people providing it they felt that they could no longer care for her, then she went off to another hospital and more doctors. I guess the moral is that nothing will ever really stop them! But we did have one patient back when I worked med-surg who was hiding a sharpened pencil under his covers and when a nurse was starting an IV on him (because he ripped out the last one) he swung his arm out and stabbed her just above the eye. That man was arraigned right in his hospital room next to the nurses station but the DA and was removed to prison immediately when cleared for discharge. Too bad it had to come to that!

[Valerie Salva, BSN, RN]

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.

I don't agree- most people treat others badly because they are jerks- and these type of people have always had a sense of entitlement and treated others poorly- even when they were in perfect health.

I recently cared for a very non-compliant- and well, frankly, dumb pt. I bent over backwards for this woman. After a long day of running around doing for her, tons of pt teaching, and so on, her daughter called and started cussing me out over the phone. I said "I will not be spoken to like that." and I hung up on her.

Boy, did that feel good. I kept expecting to get in trouble over it, but nothing was said to me.

[AshiPanda]

I don't know, lol. I work with a nurse who yells at the patient when they start acting up and they listen to her.

[cherrybreeze, ADN, RN]

Why in the world would you give her any prn meds if she's abusing you. She can clean up the spit, and her language, and get the meds per policy, or not get them at all. She chooses what happens, not you, and make sure she understands it. If you must give prns a 50cc bag piggyback won't hurt her, or you. Bet her behavior improves. Maybe she'll refuse you as a nurse again (darnnit!)

I hope the sentence I bolded is a joke (I can't tell by reading the post, and I know that since inflection doesn't come across in the typed word, things can be misinterpreted). I also haven't been here long enough to know other members' senses of humor yet.

Obviously, you wouldn't be giving this lady (or anyone else) a "fast push." Desirable as it may be, I know where I work I couldn't take that prn and put it in a mini bag; we don't mix meds on our floor and there's no written policy for doing so, so I would actually get in trouble for it. My only choice is to give the med push, and over the time recommended (also, and this is a serious question: if a PRN order states "IV push," can you truly give it in a minibag? Doesn't that change the route from IVP to IVPB?...I know it's still IV, and that's why I'm not clear on it).

Let me restate, I am taking the quoted post's first sentence as a joke, but I DO honestly hope that someone wouldn't use their power and withhold a PRN med that the person could otherwise get, due to their behavior. It certainly would be tempting, and something that you would mutter to yourself as you drew it up, but you wouldn't actually abuse your role and not give it.....right?