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...
Specializes in Adult Critical Care, Cardiothoracic Surgery.
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.
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.
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
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!
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
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*
All patients/residents have "a reason to act this way". I do not say this to justify their actions but in the hopes that you, and others, will develop a little more empathy towards all of our Residents. They are going through a difficult period in their lives and many of them, even those without a psychiatrical diagnoses, have never had a need to develop adequate coping skills. They are now coping in the best way they can.
That being said you absolutely deserve a work enviornment free from abuse but often, as nurses, we fail to recognize that we participate in the creation of the culture within our communities. In reading your posts it seems to me that the true problem here is an adversarial relationship between the direct care staff and management. I sense this only because you mention that the problem has persisted and "they" do not take action. I remind everyone that as the patient advocate it is up to us to take action. In a sense "we" are "they".
I saw some good recommendations for psyche evals and such. I think this should be your course of action rather than just looking for a new job as others mentioned. Just remember that psyche also includes psycholgy, not just psychiatry and medication. It is entirely possible that a counselor can help the Resident develop better coping skills and move past this difficult time in their life with a bit more ease.
In your defense I agree that you should accurately document the behaviors/symptoms as you describe but remember that you are doing it to help communicate to the team an accurate description so the Resident can receive proper treatment. You are not doing it to show management what they need to correct. It is, afterall, completely about the Resident and how we can help them.
You are a good caring nurse. That shows because you took the time to ask for help and to document accurately so please do not take this response as ill towards you in any way. I would not have responded to your post alone but after reading the many others responses, coupled wth your posts, I thought I would share my perspective in the hopes of directing us back to the Resident's needs. Thanks for understanding.
Thanks for your replies, and I don't take any as attacks.
We've tried psych evals, asked behavioural health and doctors for them- stating the reasons (one of the reasons we chart all problems we have so well- so they can read exactly what happens)- but they keep putting it on the back burner. Like the either say "I never heard about it," when told face to face 3 times. Or "Well what are you doing wrong to the resident?" I'm sorry but when I try to tell a resident that is leaving meat and milk for a puppy that doesn't exist and she turns and raises a fist at me, I really can't tell you what I did wrong besides tell her the puppy isn't there.
I've tried every tip they use on the redirecting, and everyone ends up with a fist being raised at me. Times like that, or when we hear "You're dead! You will die soon when I get a hold of you." Or "Wait until you are in the parking lot alone, that's when I'll be laughing at you!"
But we've gotten used to it and just see it as being a normal part of where we work.
If you are charting all of this and they are doing nothing or blowing you off and putting it back on the staff...maybe you can call the ombudsman and ask for help?
As far as the leaving food on the floor for a puppy.....don't argue with this person. Play along. Maybe you can tell them you will feed the dog later or put the food away. Can you let them put the food down and sneak back in later to take it away?
We had a person who would go around and open ever door at night and "lock" it..People would argue with him until we just let him go and followed him....no behaviors after that.
Specializes in Mental health, substance abuse, geriatrics, PCU.
I've tried every tip they use on the redirecting, and everyone ends up with a fist being raised at me. Times like that, or when we hear "You're dead! You will die soon when I get a hold of you." Or "Wait until you are in the parking lot alone, that's when I'll be laughing at you!"
But we've gotten used to it and just see it as being a normal part of where we work.
Umm.... No. If a perfectly A/O patient threatens you like that, you call the police and you charge them. As nurses we cannot tolerate this type of behavior because tolerating it can be just as bad as doing it. If your incompetent managers won't stick up for you then maybe a few police investigations will open their eyes to the fact that they aren't protecting their employees. Yes, you maybe fired for calling the police, but I would rather do that than have some patient who thinks he's a thug to wind up going through with one of his threats.
Umm.... No. If a perfectly A/O patient threatens you like that, you call the police and you charge them. As nurses we cannot tolerate this type of behavior because tolerating it can be just as bad as doing it. If your incompetent managers won't stick up for you then maybe a few police investigations will open their eyes to the fact that they aren't protecting their employees. Yes, you maybe fired for calling the police, but I would rather do that than have some patient who thinks he's a thug to wind up going through with one of his threats.
That's what we all have decided to do from now on, because as we decided- if no one wants to care for us, and protect us from threats then we can easily protect ourselves by letting the police handle it.
OK, I'm going to ask a really stupid question here, I'm asking it because I have been in your shoes way too often...Have you the nursing staff spoken directly to the docs about this? The reason I'm asking is that I've worked with many patients like that and have complained and complained to supervisors, and documented and documented (incidentally I doubt that anyone reads your documentation, they never do) to no avail, until finally the other nurses and I decided to bombard the docs with calls about the behavior issues. Every day, every shift, every incident.
Turns out that they were aware that the patients had "behavior" issues, and were "combative" but no one had really explained to them that the patient was beating the ever-loving crap out of the staff on a regular basis. Because administration never will say anything; a facility that is accepting those types of patients probably has such a poor reputation that those are the only kind they can get. And they aren't going to rock the boat.
Usually if you persist in impressing upon the docs that these patients are a danger to staff, to themselves, and to other patients, they will do something.
And yeah, the families are the worst too. I've had family members threaten to come in and shoot everyone. Drunks, drugged, they come in and abuse the staff, AND the patients, management does nothing. Although we had a doc who regularly wrote T.O.s forbidding family members to come in. They leave it to the nurses to sort out. No security either, we nurses end up calling the cops, and then get in trouble for overreacting.
RN-ing, BSN, MSN, NP
79 Posts
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!