How to set limits on inappropriate pt behaviors

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Specializes in Tele, ED/Pediatrics, CCU/MICU.

Today was a rough day, I'll admit it. Long waits, sick people, 'lotta crap in the waiting room.

The shift ended with three back to back discharges.

As I was in room A helping elderly patient A into a wheelchair, patient B came into doorway and began to yell "How do you get here from ______? I NEED DIRECTIONS!" (VERY loudly, while she was on the phone with family member... this pt was next in line to be d/c'd).

I politely responded "I'll be with you as soon as I am finished here." I made eye contact with her from pt A's room as I helped pt A to said chair.

Yelling continues.

"You said that FIFTEEN MINUTES AGO!! get ANOTHER NURSE NOW, for GOD'S SAKE, GET ME OUT OF HERE!"

I am immediately uncomfortable, but stand my ground. State I will be with her shortly.

As I return from discharging Pt A, Pt B comes into the hallway (STILL hooked up to monitor, pulling all cords) "YOU ARE KEEPING ME IN THIS ROOM ON PURPOSE!!" "(saying my name), I am NEVER COMING HERE AGAIN!! You are IGNORING ME ON PURPOSE!!"

(very loud now, attracting attention of all persons in earshot.)

"I HAVE TO GET HOME TO MY DOG!! THIS IS RIDICULOUS!!!"

uhh.

How do you even respond to that?

My third patient was laughing/making fun of her, which added to the mess.

I pondered getting security, but they were busy watching drunk people.

??

How do I cultivate my limit-setting skills with people who have gone off the deep end?!?!

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Specializes in ICU/Critical Care.

I would have lost my mind with that patient...

This would be my response:

"Please stop yelling now. There are sick patients here trying to rest.As you can see I am busy. You are next on my list and I will be there as soon as I can"...

Probably not the nicest but its straight forward. I work in the inner city and get a lot of 20 year old GSW victims who are whiney and this type of attitude/response always works when they get out of line.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

Oh wow. Some people can be so unbelievably inappropriate. I don't think there was any right way of responding to that situation. It sounds like you made the best of it. I probably would have given her an apologetic look and said, "I'm so sorry about the wait. I will be with you in 15 minutes." If she continued the tirade I would have probably warned her that I would need to call security if she did not lower her voice. Sometimes nothing you say is right.

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Specializes in Ortho, Case Management, blabla.

You need to have kids. Then you can get that inflection into your voice when you say, "I'll be with you in one moment." It takes practice.

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Specializes in ICU/Critical Care.
You need to have kids. Then you can get that inflection into your voice when you say, "I'll be with you in one moment." It takes practice.

Thats how I talk to the younger patients I have. I turn into "mama" nurse

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You need to have kids. Then you can get that inflection into your voice when you say, "I'll be with you in one moment." It takes practice.

when you get REALLY good, you dont need to say anything....just the LOOK....will work......seriously.....dont go into apology mode.....too much of that , and they will think there is some reason you should be apologing.

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I've tried the please stop yelling you are disturbing the other sick patients reasoning. I find it dosen't work well. If the patient is out of control yelling at you their most likly they cannot be reasoned with or they would not be yelling. Last time I tried this with an out of control post surgical patient the reply was it's your fault I'm yelling It's your fault I'm disturbing the other patients.

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Specializes in ICU/Critical Care.
I've tried the please stop yelling you are disturbing the other sick patients reasoning. I find it dosen't work well. If the patient is out of control yelling at you their most likly they cannot be reasoned with or they would not be yelling. Last time I tried this with an out of control post surgical patient the reply was it's your fault I'm yelling It's your fault I'm disturbing the other patients.

If I got that "It's your fault, I'm yelling.." response, I would have said "I'm not forcing you to yell at me" and walk out of the room. How is it your fault that they are raising their voice? I'm not forcing anybody to do anything. Kind of reminds of this patient I had who was a non-compliant diabetic that had a femur fracture. Well he was in the hospital for two months, refused his antibiotics, his insulin, ate up anything he could get his hands on and would go outside to smoke and he was mad at the hospital because his leg wouldn't heal. Whatever.:banghead::rolleyes:

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While I am only a student and don't have experience with patients yet, I do have experience in the restaurant industry. Several times, I have needed to use the restroom (#2!!) and when I get back behind the bar, people are giving me nasty looks because they had to wait. When they say something, I usually ask what they do for a living. My usual response? "Do people get mad when you have to use the bathroom?"

Or if they are angry about something else and being rude to me I ask them what they do for a living. If they work with the public I ask them if they appreciate getting treated the way they are treating me at the moment. If they don't work with the public, I usually tell them they are lucky enough to work with no one being rude to them.

Some of the looks I have gotten are classic. People usually get the point and are better customers afterward. :lol_hitti

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Specializes in ICU.

i had an irate patient's son screaming at the top of his lungs, threatening to "clean my clock"...i stood up to him, spoke very quietly that i was happy to have a conversation with him, but i was not going to stand there and let him yell at me........he ranted and raved a bit more, each time i responded more quietly that the conversation would start when he gained control of himself and stopped yelling......people were in the halls looking, watching......i never broke eye contact with him, never got caught into his rage...eventually he got the message and went back into his mom's room......i kept my professionalism and he looked like the gluteus maximus he was! :lol2:

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Specializes in School Nursing.

sorry you had such a crappy shift. you did not deserve that kind of treatment. i think you handled it very well.

:heartbeat

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I've told more than one patient that I will gladly listen to them and help them as soon as they decide to treat me with the same respect I'm giving them. Until then, I'm going to care for my other patients. I leave, let them stew for a minute, then come back asking if they want to change their tone.

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