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Is this really the norm?

Posted

Specializes in rehab. Has 10 years experience.

Alright I'm gonna keep this as anonymous as I can. I just am wondering if this is really the norm or should I be as upset as I feel...

But lately we've had residents on our unit that have become worse. Verbal abuse is common on our unit, however it is starting to get to all of us. But with it being 5 days a week, 8 hours a day it would get to anyone. And I mean we get the f*** you, motherf***ing b*****, a**h*** and so many other curses. And it's not just one, it's several people. I chart everytime someone on my unit is cussed out and report it. However nothing is ever done.

Some of our residents are physical (not super often though, thank god), or if not they are threatening and all I hear is "What did you do to cause the situation?" When it's explained that we haven't done anything it's like they just go- oh ok and that's it.

But I know where I work it's more of a 'last resort' place. But what can we...heck I do to keep the morale up? Because we all are feeling the strain now...

Woodenpug, BSN

Specializes in MPCU.

I'll make the arrogant/naive/ignorant presumption that you sincerely wish to address this issue.

I don't deal with "residents" that's an issue for landlords.

When I encounter an abusive patient I find it helpful to say "I know you are better than that. You will respect me as much as I respect you." Then I explain the options and empathize with whatever excuse the patient had for being abusive. Sometimes it's valid. They feel that they have no control, that they are being forced to accept treatment. Most of the time it's just manipulative bx fostered by the workplace culture. Still, empowering the patient and giving them some other option instead of abuse seems to help. Then again, I have options, including refusing an assignment or an employer. So your situation could be different and what I think irrelevant.

OP, I am pretty new (to nursing and this forum) so I may not have much to offer. I am sure others will that might benefit you. In my very short experience with this type of behavior from residents (yes, they are residents in environments other than hospital / clinical / landlord settings), you must provide a safe environment for your other residents first and foremost. If this type of behavior is directed toward other residents it becomes an abuse situation that must be addressed immediately. Immediate interventions to calm the abusive residents and provide safety for the others. No, this abusive behavior should not be the norm directed towards staff either. I would think that a psych consult would be in order if there are no physical / medical issues causing the outbursts that need to be addressed. If your DON or facility administrators allow this type of behavior to continue without intervening, I would seriously look for another position. Good luck to you.

nurse2it

Specializes in med/surg, cardiology, advanced care. Has 20 years experience.

I worked in LTC for almost 4 yrs where this type of behavior is common. I was called every name in the book, slapped, kicked, spit on and more by pts with dementia. If this is coming from pts who are "normal" and management does not intervene, then it will continue. It is so difficult to work in this type of environment, I chose to leave and took a large pay cut.

KalipsoRed

Specializes in Telemetry. Has 3 years experience.

If these patients are mentally challenged in someway or demented then the best thing you can do is get a psych consult. If they aren't and are just being rude then I would just say, "Please don't talk to me that way, I'm doing what I can to help you." (Really what should be legal for us to do is turn around and leave them to their own device....I do not feel, as some older nurses seem to, that I should have to continually put up with being abused because of my profession. Yes, we are a caring profession, and for the most part I'm willing to give people a few out bursts, but you are talking about long term patients that continually do not change. No nurse should have to put up with continual abuse just because we chose to care about people.) However, back in reality the best you can do is stick up for yourself and your co-workers by asking the patient not to talk to you in that manner. More importantly, for the sanity of your co-workers and yourself, you all need to be more verbally kind to each other. It really helps if your aid just got told she was a f***ing c**t by a resident that later you compliment her for doing something well. You help each other stay out of the grips of depression by being supportive of each other. Frankly though I'd be looking for a better job because you don't deserve to be treated like that at work and your stupid employer should be doing something to support you, but like so many stupid employer's they won't. You owe your employer no loyalty or support, get the heck out of there.

NurseLoveJoy88, ASN, RN

Specializes in LTC. Has 6 years experience.

OP, I am pretty new (to nursing and this forum) so I may not have much to offer. I am sure others will that might benefit you. In my very short experience with this type of behavior from residents (yes, they are residents in environments other than hospital / clinical / landlord settings), you must provide a safe environment for your other residents first and foremost. If this type of behavior is directed toward other residents it becomes an abuse situation that must be addressed immediately. Immediate interventions to calm the abusive residents and provide safety for the others. No, this abusive behavior should not be the norm directed towards staff either. I would think that a psych consult would be in order if there are no physical / medical issues causing the outbursts that need to be addressed. If your DON or facility administrators allow this type of behavior to continue without intervening, I would seriously look for another position. Good luck to you.

You have the perfect text book answer, but even with psych consults and providing a safe environment some residents still are verbally abusive. I have the patience of an Angel but it can wear on you to be verbally abused daily by residents. What I did to get through my day was to take frequent 3-5 minutes breaks in a corner somewhere and just breath and remind myself that I can go home and they can't.

imintrouble, BSN, RN

Specializes in LTC Rehab Med/Surg. Has 16 years experience.

I would move on. Sometimes you come across a single pt/res who will abuse you. Most of us can handle single attacks. It sounds to me like there is an entire culture of "abuse the nurse" where you work.

If will eventually affect the way you feel about yourself. Or, God forbid, you yourself could become abusive.

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

If this is new behavior it could be related to CVA, TIA, medication ----. Ruling that out, set boundaries. Ruling that out - go work elsewhere. If you threaten someone you could be in trouble. I agree. This type behavior is abusive and you did not sign on for that.

kalevra, BSN, RN

Specializes in ED, Telemetry,Hospice, ICU, Supervisor. Has 5 years experience.

Were not talking about resident physicians right? These are patients your talking about?

WittySarcasm, BSN

Specializes in rehab. Has 10 years experience.

@ kalevra- Yeah these are patients that are on our unit.

To everyone else thank you. I was just half wondering if this was some crazy norm that I had missed in nursing homes. Especially since everyone above me seems so unworried about any of it.

And no none of these are new behaviours, they either have been going on for months now or the patient has a history of it.

CT Pixie, BSN, RN

Has 10 years experience.

I've worked in SNF/LTC since the early 80's. I can only speak for my own experiences but I have noticed (as have several other friends who are also nurses) that the residents/patients behavior has really gone downhill. I have had more screaming, cursing, yelling, threatening and physical abuse occur with A&O pts than my dementia/alzheimers etc pts. Its sad really that this behavior is allowed.

Oh and families?! They REALLY have gotten worse right along with the residents/patients!

WittySarcasm, BSN

Specializes in rehab. Has 10 years experience.

What's sad is that our dementia patients are angels compared to the ones that have no actual reason to act this way.

And families...erg not even gonna comment on them...*shudders*

RN-ing, BSN

Specializes in Critical Care, corporate wellness/DM. Has 10 years experience.

Some patients and/or families have no coping skills, so when they are faced with a stressful situation, they cuss and scream and spit. Its not because of a diagnose-able mental disorder (until someone invents one), its because they were never taught appropriate ways to handle their emotions in stressful situations.

Psych consult? No. Finding your happy place? Yes!

DizzyLizzyNurse

Specializes in Peds Medical Floor. Has 12 years experience.

Do we work at the same place? If it's an A & O resident I tell them, "I'll give you a few minutes to calm down and I'll be back." Chart, chart, chart. (I had a facility ask me not to put swear words in my charting, you know if the resident called me the B word or whatever. I was like, "If you are ok with them calling me that and won't do anything about it, it shouldn't be a big deal to put it in th chart!" If it's a resident with dementia and I can't take another minute I'll either ask someone to stay with them so I can take a few minutes to calm down or I make sure they are safe and not in danger and walk away for a few minutes and re approach later.

honeykrown, MSN, NP

Specializes in family practice.

I have just had one abusive patient and i told her that she had no oright to insult me becuase i have respected her in every way and if she wouldnt apologize, I would do my job without the extra perps she got. After a while she got the message and just complained.

There is no reason for an A&O patient to be abusive and if I encounter another one, I would gladly tell them that just as they would take action if i were to abuse them, i would not hesitate to take action for their behavior towards me (that is after warnings of course). I have very little tolerance for BS

WittySarcasm, BSN

Specializes in rehab. Has 10 years experience.

Chart, chart, chart. (I had a facility ask me not to put swear words in my charting, you know if the resident called me the B word or whatever. I was like, "If you are ok with them calling me that and won't do anything about it, it shouldn't be a big deal to put it in th chart!"

Oh I so do this. Me and an aide both chart exactly what is said because the way I see it if I'm quoting them exactly to what they said then I'm going to write it all down. If I make a couple of them blush because of the crude language then maybe they will do something. Otherwise they can sit and read every word they say!

CoffeeRTC, BSN, RN

Has 25 years experience.

If they are sane, no dementia and able to control themselves...I just walk away and tell them that I refuse to listen to them. If they want care from me, I will be back when they are calm and respectfull.

I've noticed a rise in this type of behavior with the younger, short term patients that feel entitled as a "customer".

I am new to nursing and am working in a SNF/LTC facility on a dementia unit. I work midnights, and just this morning there was an incident between a resident who is known to be combative and one of my aides. This makes 2-3 incidents for involving this resident in the past 4-5 days ALONE. After the incident, the resident would not follow any directions, completely ignored everything that I and my aides said or requested, and just did as they pleased. I was so frazzled by the time the next shift came on that I wasn't sure what way was up. I was trying to keep other residents away from this resident for their own safety and still get my job done, and my aides were doing the same - it was nuts and ridiculous. We had almost everyone else on what seemed like lock down until the next shift arrived for fear that this resident would harm another. This through off the schedules of every other resident and as many know, that's not a good thing with dementia patients. I have to work tonight too and while I should have been with a preceptor last night (preceptor called off... I was left to my own on the floor after one night of orientation on midnights, 2.5 weeks total in the building) I damn well hope there's a preceptor tonight... I was comfortable for the most part, but when the incidents began occuring, 4 of us on the floor was not enough to help keep ourselves and 48 other residents protected from one unruly resident who is bigger than all of us... The aide involved was a stocky, good sized man, the rest of us didn't stand a prayer if this resident decided we were the target next. I consider myself a strong person and fairly confident in my skills, but I wanted to cry by the time the next shift came on, especially since in the middle of all this, there was a safety practice drill - I was extremely overwhelmed, did my best to remain calm and get the job at hand done, but dang, I was exhausted and frustrated and upset because I should NOT have been on my own yet... Tonight hopefully goes better...

I don't get it, we do what we can for residents and patients alike, and yet we still get treated terribly by many of them. I understand they are frustrated and would rather be anywhere else but there, but still, there should be some sort of level where we can say enough is enough and not have to take the abuse - we worked hard to get where we all are and didnt choose this profession to be verbally abused every shift, if we wanted that, there are many other professions we could have gone into without going into debt to go to nursing school and be all we can be... I refused a home care assignment just today because the patient had gotten nasty and called me every name in the book because he was frustrated - I understand its a B to live like he has to, but I don't deserve to be belittled or verbally abused for a 12 hour shift, or even half that shift - I don't need the $250 that bad to put up with it on a night off from the SNF/LTC facility... I will enjoy my night instead with my husband lol