how to deal with abusive patients?

  1. Hi All,

    I am a second-degree BSN/RN who graduated in Feb 2013. While I have only been practicing as an RN for a little over a month, I have had several years of experience in the healthcare industry. Up until a few days ago, I was confident that I could handle any amount of B.S. that a patient could throw at me. However, I had a patient push me to my limit a few days ago and am on the verge of losing my job.

    Here is my question: At what point is a nurse obligated to continue treating an extremely verbally abusive patient on a non-psychiatric med-surg floor? Without going into specifics, one patient continuously attacked me throughout my 12-hour shift regarding my race, ethnicity, and physical appearance. I finally snapped and told the charge nurse that I would not treat this particular patient due to the nature of her attacks.

    This A&O*3 patient told me that I was fat, continuously inquired about my ethnicity, told me I had "N-lips" (I am quite proud of my exotic, ethnic features), etc etc. She also accused me of deliberately drugging her even after she specifically requested a PRN medication. She told me she was afraid I was going to "rob her" and requested that another nurse supervise me at all times.

    I was told that such treatment is "part of nursing" and that I should "learn to accept it". Screw that. Patients like this could make accusations that could cost me my license, right? Does anyone have similar stories to share?
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    About melbot

    Joined: Jun '11; Posts: 10; Likes: 2
    student and mom; from US
    Specialty: Med Surg - OR, nursing homes, hospice,


  3. by   twinmommy+2
    Thats one of the reasons I love working at the VA, the uniformed Police Officers who have arresting privilages if needed (not that this person would be arrested, so don't flame please).

    Document, document, document. And for someone like this it can't hurt to have someone there with you as back up for a witness.
  4. by   jadelpn
    Psych consult. Obviously this patient has something going on. Dementia, UTI......
    Also, make sure you document ie: patient agitated and states "------" , charge RN aware. Make sure that this patient has a signed inventory of all items in the room with them, as then that protects all of you.
    The charge RN in this instance needs to assess the patient and come up with an alternate plan of care. Social work consult, family meeting, administration if need be.
    This patient MAY just be a jerk, however, the constant commentary points to an alternate issue that needs to be ruled out.
    The only thing you can do is an impartial assessment of findings to the Charge RN and have her take it from there.
    Remember, people are jerks, however, anything this constant needs intervention at a higher level than yourself.
  5. by   Tait
    Wow. All I can say is I am sorry you had to go through that. I show no humor with patients who are intolerant. While you don't have to be completely lenient with their behavior, since nursing has an odd combination of customer service but still there is a level of respect that is different in that from other professions, but I would try to get to the bottom of it. First off I would have talked to the charge early and said "Listen, this patient is not comfortable with me and it is making doing my job unsafe as she isn't compliant with my care, we need to change the assignment." It sounds like you already had another nurse involved in the situation, so might as well make the swap.

    Second I would have tried to see if there were any family members I could talk to. As others mentioned, there may be a mental status change, through a big part of me just thinks she was mean. Assumptions on my part aside, perhaps talking to family could clarify if her behaviors are common for her, or if she is showing signs of something more serious.

    As my husband often reminds me someone else's perceptions of you are merely their own and should not impact the way you feel about yourself. Bravo for managing the full 12 hour shift, not that tolerating abuse is what I recommend, but I think I would have read her the riot act by hour three if I was being treatged that way.


  6. by   CodeteamB
    Good points. This patient may have a reason for her behavior (like the above mentioned UTI) or she may be a despicable human being, I have seen plenty of both.

    The things Jadelpn suggested are great for covering your butt, an I agree DOCUMENT!! I do not think you should be expected to put up with this. I am sorry you did not get support from your charge.

    If this occurred in my hospital the patient would be told she must stop, first by the primary nurse, then by the charge. If the abusive behavior continued she would be having a come to Jesus discussion with security. In the case of one particularly foul racist I remember our unit manager getting involved. At the very least they should change your assignment.

    If none of this occurs, then I am sorry. Hold your head up, the problem is not with you!
  7. by   SuzieVN
    You're gonna get nasty patients- some will even look like Betty White- and will stick attack you and degrade you. Just cross your fingers that something, anything, happens to get them transferred out. Death, even. It's a 'no win' situation', every time.
  8. by   rockymnthoney
    I have to disagree respectfully with those who are trying to blame that patient's behavior on a medical reason, some patients are just nasty inside and out! I would first ask the patient to stop harassing me and then call security! Working in the ER I have been hit, kicked, had vomit and urine thrown at me and cussed at. I agree though document, document, document every word a patient says. Until states and hospitals make it a priority to take care of their nurses these types of incidents will only get worse!
  9. by   Mommy&RN
    We have an administrative discharge protocol. Once the primary nurse, charge, supervisor, the MD. Sometimes the MD will follow through with it , we go up the chain. If the MD shuffles his feet
    About about discharge, I'll tell him/her to come observe the outbursts.