Need advice...life threatened by pt's family today

fmbaum · May 6, 2006

The risk management office looks at in-house risks to clients and staff and also has liason with legal who can request the equivalent of a restraining order. The response you describe sounds like a restraining order.

As to how to handle it, understanding is number one. Two is action, knowing the simplest easiest way to push that "they're here" button and keep a low profile while the machine works.

Health care employees meet the wide horizon of the public. It's not just the well educated, it's not the country club group, it's not just the winners of the good citizen awards. It's also the people who already felt pushed into corners by circumstance. Without the social skill tool set in that circumstance of pressure and fear the adjective "unreasonable" exists as real.

Accident or ill health can stress even the picture perfect client or family out of their comfortable coping mechanism set of reactions into unusual action patterns.

I mention understanding because a lot of really difficult responses by family are so difficult just because they feel helpless but love the client. Between helplessness and necessity perception is the seed of lack of reason. I have met several client parents who were in positions where they had to cope at that moment but the skills to do so had never been in their lesson plan. That's really where hope and trust are a half inch from anger and lashing out verbally or physically. Volatile barely describes it. A lot of communities and sadly families have a social structure that is involved with postures, pecking orders, attitudes, and even threats instead of explanations and social interactive skills

The sad fact is that a staff that is that well trained in these modern days usually also has so much responsibilitiy that the peripheral clients, the family, often cannot benefit as much as would be the ideal.

So understanding ... and understanding well enough to explain it in return demo to a wide variety of listeners is a good idea before trying to handle confrontation oneself. And action ... knowing what to do when so that the entire set of clients affected and yourself are able to continue with what you are there to do, which is health care. That kind of efficiency can cut confrontation to a minimum and not make the situation more murky for everyone involved.

fmbaum · May 6, 2006

There are laws that protect health care employees. Risk management has a real job in its description because employees can sue facilities who ignore known risks leading to harm of employees. A client family situation dealt with properly has risk management aware and informed, and shift supervisors. A discussed response pattern in client family situations brings emergency response duties of the supervisory into play. That is why protocols and procedures go beyond strictly health care medical topics. Employees are protected by those as much as clients. Vary from them and legal action can exist. Just remember, witnesses, witnesses, witnesses. Still, we'd al rather not have the negative experience suddenly jump out of nowhere. Reality states we ought to be prepared instead of pretend its a wonderful world where no one will ever be antisocial.

The Constitution and Bill of Rights describe a lot about what citizens in the United States are to expect, and also what they are expected to be. Not too many angry citizens who make a lot of noise about how society has crumbled stand up too well to the measure described as to what a citizen is expected to be and do and offer others freely.

HERLENE · May 6, 2006

Hi all,
I'm a charge RN at a chronic hemodialysis unit for a major dialysis group. We have a pt who's 16 with not only a slew of health problems but also some major psycho-social issues that extend to her mother and grandfather (who was found to actually be her father through dna testing at their prior clinic). To paint a clear picture of this family would take a while, so I'll cut to the chase. The grandfather today stated to 2 of our patients in the lobby that I would not be at that clinic past September and that he was going to bring in a gun and shoot me. This was after appx 1 hour of time spent by myself and my administrator talking with the mother and grandfather...talkng is actually too nice a word...this was more a pointless rambling by both about everything from our request that the mother remain in the waiting room during the pt's put on and take off to their mistrust of the black nurses in the facility. Both the grandfather and mother are those types of people we as nurses dread dealing with b/c they are completely irrational and skip from topic to topic...they are definitely not operating with a full deck, not to mention the whole incest issue. They've been disruptive to other patients and have bad mouthed the care received at our clinic to the transportation drivers, other pts, anyone who will probably listen, which has no basis at all...all of our other pts love our clinic and look forward to spending time with our staff. We've gone out of our way to accomodate the special needs of the pt and the family since their family dynamic is such a complicated one, all with the best interest of the 16 yo pt in mind.
Anyway, after I was told of this threat by the pts who he told, I immediately told my FA, the MD medical director, and the FA who's over ours and 4 other clinics. She contacted risk mgmt...we were told this afternoon that the police dept was contacted and a complaint filed, the mother and grandfather were contacted separately & told that the g'father was banned from our clinic/parking lot/grounds, etc and that 911 would be called immediately if he came onto our property, an armed security guard will be in our clinic on Friday and all next week. Of course the g'father denied the threats. However, he is so off his rocker, he is just the type of loose cannon that you'd see on the news. These people are just plain crazy.
My question is, how do I deal with this?!? The g'father stated to our senior FA that he thought I was a 'jellyfish' b/c I was letting a newly hired FA 'run all over me' (who is black)...she's not running all over me, she's the boss! This is the same reason he gave to the other 2 pts for killing me. I am scared and hurt b/c I just do not understand his screwed up rationale...I know you can't try to understand the thought process of a crazy person, but I just don't get it. I have never done anything to this family and have bent over backwards to accomodate them and their screwed up situation, have listened when I was ready to pull my hair out, and still been nothing but kind. So I'm hurt as well, I suppose.
Also, what are my rights as a nurse? Do I have the right to refuse to interact with them or does that go out the window when you're the charge nurse? Should I take advantage of the ECP counseling thing or whatever it's called lest this come back to rear it's head with me 5 years down the road?
Any input is appreciated here...sorry for the length...

:saint: I don't always think nurses have rights. It's unspoken anyway. Your government constitution protects your right as a person and therefore, you are doing the right thing to report threats such as those. You have the right to be protected from psychopaths such as those who would kill and blame it on psychosocial behaviour!

Hellllllo Nurse, BSN, RN · May 6, 2006

Sota, Wow.

I am also a hemodialysis charge nurse and have also been recently threatened with violence at my clinic. The only thing they did was UM and SS spoke to the pt and changed my schedule so that I will not work with this pt anymore.

I am very pleased to hear that your company is taking proper steps to protect you.

I know you are stressed out, but with the security guard there, I think it will help alot.

brown eyed girl · May 6, 2006

The same advice applies to nurses and non-nurses alike: Get a firearm, a CCW permit, and training in how to use it.
Irrational people do irrational things, the police cannot be everywhere, and average response time is 4-6 minutes from a 911 call.
You DO NOT have to live in fear, and just because you're a nurse doesn't mean you should be defenseless in case this nutcase hides out down the street and follows you home one evening after work! The armed guard for a week will do you no good next month or at the gas station on the way home.
Stay safe and remember: it is better to be tried by 12 than carried by 6.

I know that's right!

MissMonica · May 6, 2006

Excuse me. Yes, you absolutely can REFUSE to care for a pt. and with a reason as valid as this, it should be a non-issue. I am shocked your facility has not referred this pt and family to another service facility since the threat he made against you. You should not have to work under these conditions and fear for your safety.

I work in a large hospital/acute care on a med/surg floor. I have refused a couple of pts in my career. If I couldnt take another day of the outrageous demands of the family, etc....

As long as youre not constantly refusing this pt and that one for silly little things or personal discrimination, we all have the right to refuse, just like patients can refuse a certain nurse they dont like.

aquaphoneRN · May 6, 2006

Buy a can of Bear Repellent immediately, try this link:

http://www.safetygearhq.com/bearspray.htm

The repellent has a range of 20-30 feet, and sprays an area so HUGE you cannot possibly miss your target. It's extremely effective, TRUST ME, I know from experience.

Carry it with you at all times in your purse, a fanny pack or even better in a paper bag in your hands.

If that inbred red-neck mother xxxx comes anywhere near you spray him without a moments hesitation and then tell the police he said he was going to shoot you in the face.

Of course, you should file a complaint with the police now, before any of this happens.

He's probably just shooting his mouth off, but if he's serious, no one, including the police, will be able to protect you. Only YOU can protect yourself, and for that, you MUST have a weapon with you at all times. This, unfortunately, I know from experience.

PANurseRN1 · May 6, 2006

I'd serve him with a restraining order. It doesn't matter that he's backed off temporarily; he threatened to kill you by September.

Gabie Baby · May 6, 2006

What is an FA?

I think you absolutely should never again take care of this person's relative. Ever. It makes no sense at all to put yourself in jeopardy.

You probably should transfer, at least temporarily, to another facility. Or the pt should be forced to get dialyzed at another facility and the whole family should be banned from your present facility. This is a very serious matter and don't think for one single, solitary second that it is not. These days, with the whole world gone nuts, you have to take these threats extremely seriously. Make sure your family and friends know about this, in case something does happen to you.

Gabie Baby · May 6, 2006

I do NOT carry in any school or health care facility. However, you can be assured that there is one in my car if it is not on my person. However, legally speaking, a license to carry concealed is valid everywhere except for schools and governmental buildings (and in some jurisdictions where ETOH is served). Your employer could fire you for carrying to work, but it wouldn't necessarily be illegal to do so. Also, any business owner can ask you to leave the property of you are carrying, but that's why they call it a "concealed weapon". Nobody will ever know I have it but me; unless I am forced to defend myself or another.
If I felt at risk from the car to the door (or the reverse) at a hospital, I'd call security to walk me there.

It is not illegal to carry revealed. Anywhere.

SotaRN · May 7, 2006

Thanks for the great feedback everyone...

First of all, I am so sorry to those who've rcvd threats worse than mine...and Fire Wolf, I can't even begin to imagine what you went through.

To update the drama, we had a police officer on site Fri for their treatment...the crazy grandfather didn't show. The mom was relatively calm so our group administrator, social worker, me and my immediate boss took her into the conference room for a meeting w/the officer outside in case she flipped. Our group admin did most of the talking...as an example of how irrational this woman's thought process is, she said that she wasn't going to have us abusing her dau (which of course has never happened)...big boss said that none of this staff come in for work at 5am and work for 12+ hours to abuse anyone, we do it b/c we care to which she replied 'that's you're problem not mine'...????? She was told that if she became disruptive again we'd call the police and CPS services would be called to get her child. She had no response to that but rambled on about something totally unrelated. She said she's told her dau to not ask for any help and if she feels sick or bad just suck it up and wait til her tx is finished. I couldn't keep my mouth shut to that one & told her that both of them had a responsibility to tell staff if somethng was wrong...she said we must think we have hands of gold. :banghead: Get the jist of how crazy this family is???

My biggest issue since all of this has happened is dealing w/the why...I know they're crazy though which helps make sense of something that can't be made sense of. I've been a nurse now for just a little over a year & this is the 1st time I've dealt w/a pt like this one. I suppose I'm seeing nursing for what it really is as opposed of through the eyes of someone on the outside, if that makes sense. It p's me off too as said in previous posts that we are expected to remain tolerant of this type of behavior, even taught to be forgiving of people under stress. Why is that? Would an MD put up with it? No, we cannot refuse care, but why should we be threatened, verbally abused in the process? Is this a hold over from the Florence Nightengale days or is it just a reflection of our society's over emphasis on political correctness and not calling a spade a spade? They don't teach you this crap in nsg school, that's for sure, and I see now why so many nurses would say 'don't go into nsg' while I was wide-eyed and over-eager going through school. Sound cynical? You betcha. Thinking of quitting nsg? No thx; these people won't have that power over me. I just need some time to get my feet back under me I guess.

SotaRN · May 7, 2006

An FA is a facility administrator, generally an RN, who basically runs the clinic.

B/c of the national kidney council, my understanding is that we can't just tell them to go elsewhere, especially considering that it was a family member that made the threat and the threat was not made directly to me. No, that doesn't diminish the fact that a threat was still made. We've contacted them and no doubt will be justified in getting them out immediately if the mom becomes disruptive again...at the very least she'll be carted off to jail. I looked into getting a restraing order against this man but found out that he would be summoned to court along with me and any witnesses before one would be issued (per the superior court office). I feel this would just antagonize the family and make the situation worse considering she's still a pt...bottom line in my opinion is that we need to get them out of the clinic period as peacefully as possible. Of course it p's me of that we can't just say 'get out and don't let the door hit you on your way out' but thx to the kidney council for that. As far as a trf to another clinic, I could probably very easily, but this is a new clinic that I've helped to grow and I'll be diddly dmd if this trash is going to scare me away from a place that aside from this pt/pt family, I love dearly. I feel backed 100% by my company, bosses and the MD's and even the other staff. We started a while back having 2 present during take on and off just for a witness since the mother had started to lie about things that were instructed. I've also been documenting on her every single day, even things that seem to not matter. I started doing this at the advice of one of the MD's about a month ago when we started to see a pattern in things the mom was saying or twisting. Generally we only doc on flowsheets/nsg notes are saved for things out of the ordinary which is different from the hosp setting.