I should have said something...

Nurses General Nursing

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Recently I admitted a patient in 5 point restraints going through ETOH withdrawal who needed Ativan IVP. A coworker and friend was helping to secure one of his wrists and when the patient wiggled, she slapped him on the hand and said "NO." Right then, at that moment, I wanted to say something, but I bit my tongue. This isn't the first time I've felt guilty about not saying something. A couple months ago, a coworker was verbally demeaning an elderly and demented patient of mine by mocking her to her face, which really ticked me off and I really almost said something to her as well.

I guess I just dont have the guts at the moment to say something. I guess I feel like since I'm one of the newest RNs there, that I will get crap for speaking out or criticizing something a more experienced nurse does. Also, the nurse I first mentioned is very very defensive and if I would have said something at that moment, I am quite positive she would have reacted in a 'dramatic way.' However, I am still feeling guilty. I guess I just needed to get it off my chest and hear what advice I could get from you guys.

Thanks in advance to all who reply...

A little volume for a drunk and uncooperative patient- absolutely.

Ok, I don't feel comfortable with this comment. To me this seems a little insensitive. A lot of people suffer from chemical dependencies and I dont feel comfortable calling someone who I am taking care of a "drunk." I try to use empathy, and to me that doesn't seem empathetic. He was going through a lot. I can't imagine how hard it must be for someone experiencing ETOH withdrawal, but I would assume it's not easy. I think too many people are quick to get angry at patients when they see ETOH on ther list rather than going that extra step to try to treat the patient fairly. It isn't our job to judge their habits, just take care of them. Right?

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Specializes in Telemetry, Nursery, Post-Partum.
A little volume for a drunk and uncooperative patient- absolutely.

Ok, I don't feel comfortable with this comment. To me this seems a little insensitive. A lot of people suffer from chemical dependencies and I dont feel comfortable calling someone who I am taking care of a "drunk." I try to use empathy, and to me that doesn't seem empathetic. He was going through a lot. I can't imagine how hard it must be for someone experiencing ETOH withdrawal, but I would assume it's not easy. I think too many people are quick to get angry at patients when they see ETOH on ther list rather than going that extra step to try to treat the patient fairly. It isn't our job to judge their habits, just take care of them. Right?

Empathy for a patient willingly seeking treatment for chemical dependencies, absolutely. Being firm with a "drunk" who needs 4 point restraints and IVP ativan is also 100% necessary. I feel bad for these patients, but you need to be firm (and loud at times) because these patients are unpredictable, and can be dangerous. I have seen patients hit staff, destroy beds (while in 4 points), pull knives on staff members, etc. At this point in their treatment, they need our firm, forceful sides, and definetly their IVP ativan!

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Specializes in Day Surgery/Infusion/ED.
I totally understand... I should have been more tough. :o I guess I was just wrapped up in the whole situation, there were at least 2 other nurses in the room, as well as security, a sitter, and I know the Nursing Supervisor, and Clinical Nurse Consultant was either right outside the room or just in the hallway. I dont know who did and who didn't see what I saw though. I think I was trying to prioritize in my head what I needed to do (since everyone had hyped me up for this patient) and since I'm fairly new, it's hard for me to balance everything at once. I will definitely work on that in the future though. Do you think it's too late to say something? This happened at least 2 weeks ago.

I think you are going to have a difficult (at best) time trying to explain why you waited two weeks to speak up. You have to follow your conscience, but be prepared for some hard questions if you say something now.

Also, no excuses. It doesn't matter who else was in the room or within earshot. That's just another way of trying to reassign blame. You are responsible for acting as a professional, period.

FWIW, I had to report a nurse for abusing a peds. pt when I was a freshman nursing student, so yes, it can be done, no matter how new you are to nursing.

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A little volume for a drunk and uncooperative patient- absolutely.

Empathy for a patient willingly seeking treatment for chemical dependencies, absolutely. Being firm with a "drunk" who needs 4 point restraints and IVP ativan is also 100% necessary. I feel bad for these patients, but you need to be firm (and loud at times) because these patients are unpredictable, and can be dangerous. I have seen patients hit staff, destroy beds (while in 4 points), pull knives on staff members, etc. At this point in their treatment, they need our firm, forceful sides, and definetly their IVP ativan!

Maybe I didn't make my point very clear. I hhave no problem with the being firm part. I absolutely think it is important to be firm so as to protect safety of everyone. However,

I did have a problem with referring to the patient as a "drunk."

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Specializes in ER.

The reaction to throw the baby out with the bathwater in the case of a generally good nurse who screwed up is as shortsighted and judgemental as refering to "fat cows" and "crazies". This is a knee jerk reaction. With regard to the situation, what will be gained at what cost?

I suppose you would have to look at the whole picture.

Is this a nurse who regularly is rude to patients and oversteps physical boundries.

Is this a nurse who is usually exellent and caring. Had they just been pushed too hard at one moment during a particularly stressfull shift.

Was this action actually damaging to the patient, causing physical damage and/or emotional turmoil. The nurse responded poorly, but this could be utilized as a learning experience.

If the nurse is receptive to an honest and open realization that they were stressed and made a mistake, it might be more therapeutic and effective to let the nurse reflect on what he/she was feeling that led them to act in that way.

I feel that positive remediation could be more effectively accomplished through peer support as opposed to a punitive response from administration.

Oh well, maybe I'm seeing this too optimistically.

Probably would be better to hang the nurse out to dry. Most likely everyone would be better with this individual out of nursing.

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Specializes in pure and simple psych.

Thanks, GardenDove, I needed a chuckle.:chuckle

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Specializes in tele, stepdown/PCU, med/surg.

I personally believe you are not AS guilty as the person who slapped the ETOH patient but that you still have duty to report it, there is a distinction between those too.

Also, to minimize further anxiety for the patient, I would only reprimand (say "NO!") to the other nurse IF it seems to you that the slapping will imminently happen again in the room. Otherwise, I would wait until you both leave the room, and then address the issue with that staff member.

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To elaborate on some questions from previous posters:

This is a nurse who tends to get very dramatic very easily. If she asks for your help and you say yes but take a few more seconds to finish up what you're doing, she walks away in a huff saying forget it. This nurse has also had warnings for other things in the past (not for this specific type of action).

Please... I really can't take more 'grow balls' comments. It's offensive. I feel like I'm getting yelled at by some posters... my goodness! :o Like I said before, it was almost like I didn't even have the chance to think of how to react with everything that was going on. Again, I am working on this and I know this skill will improve in time. Thank you all again.

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Yes, your instinct is correct, and your insecurity as a newbie got in the way. Well, it never gets easier. I've been called on the carpet, called names by my peers, and "reduced in rank" for criticising the wrongs I've seen around me. But I promised myself a loooong time ago that I would rather be fired for doing a job right than to keep a job and lose self respect. Repeated that a couple of times when I was being 'counseled' about my attitude. and it shut them up. That being said, look for another position and keep on speaking up. Our patients need you, and your heart.

Oh, and thank you Sanctuary for your kind words. You made me feel better. I feel this way as well, but sometimes feeling something is much easier than proving it through your actions. (especially around much more experienced nurses)!

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Specializes in Psych, Ortho, Stroke, and TBI.
A little volume for a drunk and uncooperative patient- absolutely.

Ok, I don't feel comfortable with this comment. To me this seems a little insensitive. A lot of people suffer from chemical dependencies and I dont feel comfortable calling someone who I am taking care of a "drunk." I try to use empathy, and to me that doesn't seem empathetic. He was going through a lot. I can't imagine how hard it must be for someone experiencing ETOH withdrawal, but I would assume it's not easy. I think too many people are quick to get angry at patients when they see ETOH on ther list rather than going that extra step to try to treat the patient fairly. It isn't our job to judge their habits, just take care of them. Right?

To be fair, I think you misunderstood canoehead's statement. He/she wasn't calling anyone a "drunk." Rather saying that they were drunk, as in the state of being drunk. Nothing inappropriate about that. If someone's intoxicated, they are infact drunk.

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Specializes in NA, Stepdown, L&D, Trauma ICU, ER.

Maybe I didn't make my point very clear. I hhave no problem with the being firm part. I absolutely think it is important to be firm so as to protect safety of everyone. However,

I did have a problem with referring to the patient as a "drunk."

She wasn't referring to the pt as a drunk aka skid row bum, wino, pick your alcohol related adjective. She said 'a drunk and uncooperative pt' which from the OP, was true. If I go out tomorrow night, get hammered on margaritas, pick a fight and wind up in the ER in 4-points, darn tooting I'm being drunk and uncooperative. That's completely different from the disrespectful reference to the homeless guy at the bus stop "oh him, he's just a drunk". There's definately a difference

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