Need Help with hostile enviroment?

Published

I love my patient, I love my job, and until recently I loved the family. I started working for the family when my patient was just seven months old, and learned quickly that the sibling has problems with "melt downs" he yells, screams, throw things, threaten to hit parents, and is only eight years old. The parent has all kind of excuses.....he hasn't had his meds yet, his teacher is off sick, his dad upset him before he left town, it goes on....! He's said to me numerous time "my god just shut up, stupid" "you have to listen to me" at first the parents made him apologize to me, and hug me, but now they don't even say anything anymore, well the last straw came a couple of weeks ago, I was singing to my patient to calm him down and I heard "omg will you just shut up" when I asked who he was talking to he said "you stupid" I am desparate for any kind of suggestions, summer vacation is coming up and he will be there during my shift. It is easy to say "get a new job" or "just leave", but I do care for my patient.

Thank you

Up Vote Up Vote ×
Specializes in Medical.

Can you talk to the parents in a more direct way? Something like - I really enjoy working with X but if we don't start setting limits on his behaviour and instituting consequences then I'm sad to ssay I'll have to look for alternatives.

Up Vote Up Vote ×
Specializes in Psych, Skilled Nursing.

i think you posted in the wrong topic? :)

@TS

Yeah I agree that setting limits would probably work with the kid/client,

showing consistency and finding what triggers his behaviors can also help you prevent

some outburst of attitude. Looks like the parents are still in denial.

Up Vote Up Vote ×

Thank you so much for the suggestions, I have tried to speak with the parent, this has been going on for 20 months, long time, and I do know it isn't my performance, I have gotten high marks on my evals, but just writing it down getting it off my chest has helped alot and I thank you for letting me vent. I will see how next week goes and if it cont. it may be a sign for me to move on, I love my patient, but I also need my sanity!

Up Vote Up Vote ×
Specializes in Psych, Skilled Nursing.

Are you doing home care?

Up Vote Up Vote ×
Specializes in home health, dialysis, others.

The parents need some serious help to control the older child. Tell them that his behaviour makes it difficult for you to care for the little one, and be very empathetic with their plight.

Get the social worker from your agency involved. Maybe they can be directed to appropriate agencies.

This could constitute a hostile work environment but you probably don't want to go there at this time.

Best wishes.

Up Vote Up Vote ×
Specializes in PICU, NICU, L&D, Public Health, Hospice.

Yes, I agree that you definitely need an active MSW relationship in this home. It is not appropriate for parents to allow a child to verbally abuse a professional nurse in their house...period. This behavior is most likely directly related to the presence of a medically challenged sibling in this child's home. He is quite possibly acting out in order to gain some attention from the adults in his environment. His parents need some help in regaining control and the MSW can be a valuable resource.

Meanwhile, it is imperative that you address a few things directly with the parents and the child, with or without MSW present. First, you will not be called names...period. Second, he may not...EVER...tell you to shut up...it is impolite and you will not tolerate it. As others have said...you must have clear and unbending boundaries, because clearly the parents do not.

Make sure that you have documented the behavior of this older sibling. Make sure that you notify the team of your plan for discussion and the response and outcome to the meeting. Good luck.

Up Vote Up Vote ×
Specializes in Health Information Management.

I completely agree with the boundary-setting suggestions made by the other posters. However, I have one caveat to add. The parents may well become hostile when you start to set boundaries with the child, and there's only so much you can do without their support. So you will have to make it clear that you won't continue to work in that environment if they permit the behavior to continue. And then you will HAVE to stand by that decision, even if it means you leave the job and your patient. If you back down from a stand like that without any significant improvements or changes on the part of the parents, you'll never get any respect from any member of the family. If you stay with this patient over the course of several years (a time frame that seems reasonable to consider, given your statements about your patient), that name-calling, fit-throwing eight-year-old could well turn into a physically dangerous 14-year-old, with the same lack of respect for you imprinted on a mind housed in a bigger body. By then, the parents will have even less chance of improving or controlling his behavior. You seem attached to your patient but you have to think about this situation in the long-term as well as the short, for your own mental and physical safety.

I wish you the best - it sounds like a really tough situation.

Up Vote Up Vote ×
Specializes in Medical.

TDCHIM articulated far better than I why you need to involve the parents, rather than creating and trying to enforce behavioural change alone - that's what I meant!

Up Vote Up Vote ×

You mention the older child takes meds - does he have a mental health condition that is underlying his behavior? It is possible his parents do not have the skills or knowledge to know how to deal with his needs. You have to know the root cause of the behavior if you want consequences to be effective. They may also be completely burnt out from caring for their ill child or feel guilty becasue the ill child gets a lot of their attention and not want to discipline him. Even that you are there and the younger child has you and one on one attention may make the older child feel very unimportant and ignored.

You obviously can't parent him. You can set boundaries but how are you going to enforce them? Your only option would be to leave as you can't discipline him. My guess is that if you interacted with him and tried to befriend him and made him feel special too that his behavior towards might improve. He probably senses your dislike of him and be reacting to that.

Others have given you good ideas about other avenues to explore.

Up Vote Up Vote ×

When I was in the third grade our teacher would not allow us to use the phrase, "shut up". For some reason, that has stuck with me all my life and your mention of this in your post made me remember.

Up Vote Up Vote ×

Does he talk to his parents like that? If so, how do they respond?

Up Vote Up Vote ×
+ Join the Discussion