Patient/Family Rage

fergus51 · Dec 19, 2005

This all comes down to management IMO. I have worked in several hospitals and have noticed it is FAR worse at my current workplace than anywhere else I've ever worked and it's because it is tolerated by management. They have that "the customer is always right" mentality, so families can get pretty crazy without fear of consequences.

The best way to rectify it imo is to set clear boundaries from the beginning and enforce them strictly. At one place I worked families were given a code of conduct type sheet explaining their responsibilities as visitors (it also explained what the staff would do for them such as answering any questions they have, treating them respectfully, etc). If they got out of line, they received a warning. If it continued they were taken away from the bedside by the manager and got one more warning in private. Next incident security would come and escort them out just like they had been warned. It was made very clear that they have no "right" to visit, it is a priviledge. After that some were allowed to come back if they agreed to behave themselves. Those that were really out of hand were only allowed to come back if security could escort them and stay with them on the unit to make sure they behaved, though I've only seen that happen once. Management never questionned the nurse or blamed her. Families there seldom got out of hand and nurse morale was so much higher in this regard.

Judee Smudee, ADN, RN · Dec 19, 2005

In my long career I have never seen such high expectations and such a sense of entitlement in people when it comes to health care. This is occuring at a time when the actual level of avaliable services is decreasing in many places accross the USA. This results in a sense of rage and indignation that ends up being aimed at the person who is most assessable and who just happens to be least responsible for the sorry state of health care, the nurse.

psalm, RN · Dec 20, 2005

...yes, entitlement and thinking a hospital is a hotel with room service. I am irritated when a SO of the patient are no help emotionally or physically to the pt but expect food and warm blankets from the staff, a working TV and phone!! Unfortuanately, the lack of respect for the hospital staff, the yelling and vulgarities that we are subjected to, are more commonplace than just a few years ago.

...these people suck all the energy out of us, the squeaky wheel getting the grease, unless we set limits and STICK to them. I document on the nurses notes and even write an incident report if it gets sticky or abusive...so that there is a record of what is happening.

...but you knew all of this.

Kalico · Dec 20, 2005

This is not exactly rage but how much of this, by this I mean sexual harrassment from patients, do you actually experience in the workplace?

http://www.cnn.com/2005/HEALTH/12/16/nurses.harassment.ap/index.html

hipab4hands · Dec 20, 2005

It only happens and is tolerated because management and top administrators allow it!

They want the hospital to be a spa like experience, but don't want to provide the personnel to do it. So, naturaly, it's the nurses fault when things go wrong.

Personally, I refuse to allow it. If a patient gets verbally abusive or starts making threats, I stop the conversation, and will offer them the opportunity to talk with a supervisor. I'm not getting paid enough to put up with the abuse.

bluemerle · Dec 20, 2005

So what do you do when the family starts making demands on you such as the "Warm Blankets, working TV and Phone" and all the other percs that they think that it is there for them?

Do you have to remind them that they are not the patient? Just curious. I am not a nurse yet but I can't belive the nerve that some people have.

Melody

fergus51 · Dec 20, 2005

So what do you do when the family starts making demands on you such as the "Warm Blankets, working TV and Phone" and all the other percs that they think that it is there for them?
Do you have to remind them that they are not the patient? Just curious. I am not a nurse yet but I can't belive the nerve that some people have.
Melody

"I'm sorry, but we can only provide blankets for the patients, we don't have enough for visitors. If you would like to pay for the phone to be hooked up, the man that does that will be by tomorrow".

grannynurse FNP student · Dec 20, 2005

I find it interesting, the attitude of U.S. nurses and what they presume to be the causes of patient and/or family member attacks against them. They tend to blame the administrators of their facilities, for a customer is always right attitude, that they the nurses, are presuming is the root cause. A review of the research literature, here in the U.S., address means of control, including the use of tazers, armed security guards, etc. A review of overseas research literature reveals the aim to be at the root causes of the frustration and anger, on the part of nurses, patients, and families. And the measures that can or have been taken to reduce both. And they do not include the use of tazers or armed security guards.

I have been on both sides of the blanket, as have family members. And I have observed that when family members or a patient's anger begins to escalate, it is generally in direct response to either a preceived attitude from staff or in direct response to staff esclation of anger or in response to a patient's request beging directly ignored. No longer are nurses willing to take the time and energy to de-esclate a situation. Many claim having too many patients and too little time. I wonder how many have ever stopped to think how much more of their time is used in an angry confrontation?

Grannynurse:chair:

Homesick Gypsy · Dec 20, 2005

As a recent patient in the hospital, I'd like to add my two cents. I received and signed a "patient code of conduct" and behaved myself accordingly, as did my visitors.

However, shortly after being placed in my room, a nurse insisted that I must have a hormone patch after my hysterectomy. My doctor and I agreed that we would wait and see what happens. She insisted - I kept saying no, and when I went to sleep, she placed it anyway. For the next two days, I was in a rage - wanting to kill myself, hurt the staff, throw my food tray. I restrained myself as much as possible, but I was a wreck and I knew something was wrong. I even called the chaplain one night, I was in such a state. It got better on day four, then when I got home and my daughter changed the patch to a fresh one, same reaction. I removed it and have been fine ever since. No one ever caught that I was having a drug reaction.

This same nurse also gave me Darvoset, insisting that it wasn't related to codeine in any way, and then promptly left the room. It took her 30 minutes of my screaming for help to come back with Benadryl, and then it took two separate doses to get the reaction under control. She also dropped the tray table on my abdomen (with 36 staples in my incision) and didn't put it in the nurse's notes.

In talking with friends and family after this episode, the common complaint was that the medical staff doesn't listen to what the patient is trying to tell them. I can't tell you how many times I've been dosed with meds I'm allergic to, even though it's in large red letters on my file, I'm wearing an allergy bracelet, and they asked me 10 times. Many nurses have been thrown up on because I tell them I'm nauseated and they say I'm not. This has happened to several friends as well.

I'm not excusing boorish behavior, just offering an explanation for SOME of the frustration which is vented at the medical staff.

All the staff I had at my latest hospital visit - except for the one nurse - were excellent, but dealing with her was extremely frustrating.

Judee Smudee, ADN, RN · Dec 20, 2005

I usually always listen to patient except at those times when I have 10 or 12 patients. At that point I become so bogged down that I don't hear anything including the fire alarm going off. If you asked me I would say that homesick gypsy was a victim of assult on her person and violation of her personal space..

SFCardiacRN · Dec 20, 2005

Hospital stays are a time of great stress for patients and family. We must remain professional and patient at all times. Dealing with rage can be tricky and setting realistic boundaries can be difficult especially for less experienced nurses. Sometimes trading patients can help diffuse situations. We are only human and may have personality conflicts with certain people. Unacceptable requests or behavior should be forwarded upstairs and documented CAREFULLY!