How to set limits on inappropriate pt behaviors

liebling5, MSN, RN · Jul 1, 2008

:yeahthat: That's a great response!

ONCRN84 · Jul 1, 2008

It usually works. I was so ticked off at someone's behavior the other day that i said "Ya know, I don't have to stand here and take abuse. If this was McDonalds, you'd have the cops called to remove you from the premises. Unfortunately, I can't do that. So I'll just leave until you decide to act like an adult. And stop cussing at the staff."

I don't rationalize bad behavior. You swing at me? You just bought some wrist restraints. I'm not going to try to explain why you lashed out by saying "oh, he was scared" or "I must've startled them". No. I'm not risking ANYONE's safety, especially my staff! You want to yell at me and use foul language? Fine. I'll come back when you get a grip. I don't get paid enough to deal with that crap.

miko014 · Jul 1, 2008

Ugh, GoldenLuvr THANK YOU for this: "I'm not going to try to explain why you lashed out by saying "oh, he was scared" or "I must've startled them"."

I am SO sick of other people making excuses for why pts/family members act like the back half of a horse!!! They act like it's okay, because "they are scared/frustrated/stressed" etc. Like I'm not stressed? Give me a break! But I am pretty strict. I will go for awhile without reacting. Then I give them that sort of friendly, "do you know that you are acting like a jerk right now" hint. Then I lay down the law: Yelling/cussing at me is NOT okay. Following me to other pts rooms is NOT okay, and if you do it again I will shut the door in your face. Other pts have the right to privacy as well. You need to sit down and cool off for a few minutes, and if you can't control yourself, I will call security to do it for you.

I have only ever had one pt where I actually had to call security, and one family member who advanced on me like he was going to hit me, so I refused to go back into the room (after telling them I wouldn't be back and getting another nurse to take over - I would never just abandon a pt - especially if it was because their family was a bunch of jerks!). Other than that, it has always worked. True, some people act differently from their norm due to stress/illness, whatever. But some people are just JERKS.

I'm still waiting for the official diagnosis of "a**hole" to pop up! But nom that wouldn't work, because soon enough they would be getting disability for it!!!!

MassED, BSN, RN · Jul 1, 2008

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? that's tough when you have such rude, disrespectful patients. i explain over and over until i ask them if security would be a better option to help them calm down. or they can leave ama.
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?!?!

either they can wait (you're only one person after all with a series of tasks on different patients to complete, or go ama. if they are rude, obnoxious or loud, explain to them that security can be called to ensure order is resumed, or however you'd want to state it. some people can't and will never understand when a nurse is busy and they are moving as fast as they can, that you are not addressing them quickly enough. so be it. i say let it roll off your back (but watch your back) and document the trouble in their record, and not only let the charge nurse know you're dealing with a bunch of rogue patients, and you need some backup.

MassED, BSN, RN · Jul 1, 2008

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.

I think that response is nice and straight forward. That gets the point across without coddling someone when you are busy and trying to attend to very sick people. I don't have time for rudeness when there are true emergencies occurring.

MassED, BSN, RN · Jul 1, 2008

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.

I've learned not to give them any tangible time for them to clock watch for when you'll be back in there. Sometimes you can't get back in there as promised. Better to be honest and say it's busy and you're not sure when you'll get back in, but you'll do your best to TRY and get back quickly. I would NEVER talk that way to a nurse that is trying their hardest, and often you SEE the nurse is moving fast and busy busy busy. The patients need a basic understanding of exactly what kind of environment they are in, to fully grasp (if that's possible) where they are in the scheme of things (are they respiratory, abd pain, bleeding issues, etc.). Once they know we prioritize based on A,B,C's, I find they have a little more understanding of the position we're in. Sometimes, anyway, but I've had my fair share of someone trying to chew me out - their ignorance, not mine.

RN1982 · Jul 1, 2008

I would also like to point out that I never tell a patient how long it will take me to get there like 10 minutes, 20 mins, etc. Because if your not there in that amount of time, it ticks the patient off even more.

pagandeva2000, LPN · Jul 1, 2008

I experienced this at work today, but from a collague who is an administrator. She brought a family member in (I just got to work), and rather than go to the charge nurse, she sees me and asks how long does it take for a patient to get sent home after seeing the doctor. Her relative is a new patient, and all new patients have to be interviewed by a nurse to gather demographical data, maybe do teaching and such. Also, the patient will be slotted to see a nurse if they are newly diagnosed with a disease, need vaccines, taught to self administer insulin, etc...

In other words, basically, I am saying that each case is individual, based on the patient's needs...maybe they need a translator, the nurse discovers other problems that need to be addressed and so on, so, I explained this to my collague/administrator. Also, I was about to see a patient and she was really interrupting me from doing what I needed to do for mine. I went to find out who had the chart, tell that particular nurse to see this relative next, who it was, and why.

One hour later, this administrator is shouting my name up and down the hallway and saying that this person was not seen yet (I admit, that shocked me, also) as if I could do something about it. She's shouting that her relative is diabetic, has been there since 9am (it is now after 1pm), etc... Now, this woman works here, she knows that we see a high volume of poor patients, and most wait. I also know that we owe each other a courtesy, but, give me a freaking break! The other patients did not have to know that this one was 'priviledged' and it makes it harder for the rest of us after she goes. I went to the charge nurse and we did expedite the visit. Then, I told that administrator that she really placed us in a bad light. She really should have gone to the charge nurse, not an LPN to address this issue, for one, and then, to shout up and down the hallway to attract attention to the fact that her relative was to receive special treatment was not that nice. ...you'd think that this woman, who works with us would know better...

pagandeva2000, LPN · Jul 1, 2008

I would also like to point out that I never tell a patient how long it will take me to get there like 10 minutes, 20 mins, etc. Because if your not there in that amount of time, it ticks the patient off even more.

I was told the same at school...NEVER tell them how long it will take, because my professor said we will be made to look like liars everytime. :chuckle

MassED, BSN, RN · Jul 1, 2008

I experienced this at work today, but from a collague who is an administrator. She brought a family member in (I just got to work), and rather than go to the charge nurse, she sees me and asks how long does it take for a patient to get sent home after seeing the doctor. Her relative is a new patient, and all new patients have to be interviewed by a nurse to gather demographical data, maybe do teaching and such. Also, the patient will be slotted to see a nurse if they are newly diagnosed with a disease, need vaccines, taught to self administer insulin, etc...
In other words, basically, I am saying that each case is individual, based on the patient's needs...maybe they need a translator, the nurse discovers other problems that need to be addressed and so on, so, I explained this to my collague/administrator. Also, I was about to see a patient and she was really interrupting me from doing what I needed to do for mine. I went to find out who had the chart, tell that particular nurse to see this relative next, who it was, and why.
One hour later, this administrator is shouting my name up and down the hallway and saying that this person was not seen yet (I admit, that shocked me, also) as if I could do something about it. She's shouting that her relative is diabetic, has been there since 9am (it is now after 1pm), etc... Now, this woman works here, she knows that we see a high volume of poor patients, and most wait. I also know that we owe each other a courtesy, but, give me a freaking break! The other patients did not have to know that this one was 'priviledged' and it makes it harder for the rest of us after she goes. I went to the charge nurse and we did expedite the visit. Then, I told that administrator that she really placed us in a bad light. She really should have gone to the charge nurse, not an LPN to address this issue, for one, and then, to shout up and down the hallway to attract attention to the fact that her relative was to receive special treatment was not that nice. ...you'd think that this woman, who works with us would know better...

well, she DOES have to come back to work, now, doesn't she..... bad thing for her to have such stupid, poor behavior. That'll bite her in the *ss.

RN1982 · Jul 1, 2008

She'll regret doing that I hope. I would never bring my loved one into my workplace and demand special treatment.

northshore08 · Jul 1, 2008

well, she DOES have to come back to work, now, doesn't she..... bad thing for her to have such stupid, poor behavior. That'll bite her in the *ss.

She'll regret doing that I hope. I would never bring my loved one into my workplace and demand special treatment.

Auwe. Wouldn't want to be that administrator. I bet your dept won't be the only one discussing that behavior. :eek: