Patient/Family Rage

[sawbuck]

Hi, anyone out there experiencing, witnessing, or hearing about the mental, verbal, and even physical rage directed at nurses and nursing staff by patients and familes.

We see more and more of it nowdays.

Any thoughts, ideas, or plan to rectify it? Does your institution have a plan for "us?" as well as "them?"

Randy

[fergus51]

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:

It isn't just US nurses, I'm Canadian working in the US. The reason I feel this has more to do with administration is that I did not see this type of behavior in Canada. Patients still got frustrated, some nurses and doctors still had "attitude", but yelling, name-calling and violence were not tolerated period. I agree with you that some health care workers have attitude and could learn better conflict resolution skills, but families can deal with that by asking to speak to the charge nurse or nurse manager. They do not need to yell, rant, hit, bite, spit, throw themselves on the floor, etc. and won't if they are not allowed to. People will often rise to your expectations of them IMO and I think it's insulting to patients and their loved ones to expect that they can't behave civilly even when they are stressed.

I also think it's sad that the first and only person to get any negative consequences when families or patients get out of control is the nurse.

[Marie_LPN, RN, LPN, RN]

I also think it's sad that the first and only person to get any negative consequences when families or patients get out of control is the nurse.

:yeahthat:

[Marie_LPN, RN, LPN, RN]

The reason I feel this has more to do with administration is that I did not see this type of behavior in Canada.

And i also feel the same way, because i seriously doubt it was "the nurse" that came up with this customer service, customer is always right" craze.

[tencat]

I'm sorry, but if I am being physically threatened you can bet your sweet patootie that I'm not going to try to 'descalate' the situation. I'm going to get out and keep myself safe. Whatever happened to putting responsibility for one's behavior with one's self? I don't make someone scream and yell. They scream and yell because they don't think that they have to behave in a civil manner, and they have people that tell them 'it's ok to be this way.....you are stressed out and need understanding'. People need limits set for them because for some reason many people cannot be expected to act like civil human beings on their own. I believe that the vast majority of people can and will be civil, but it's that small minority that takes most of our time and energy to deal with. Those few should not sap all our time and energy, and if there were strict rules about expected conduct that were strictly enforced, they wouldn't be able to.

[Marie_LPN, RN, LPN, RN]

I think a "patient code of conduct" is a great idea.

[grannynurse FNP student]

It isn't just US nurses, I'm Canadian working in the US. The reason I feel this has more to do with administration is that I did not see this type of behavior in Canada. Patients still got frustrated, some nurses and doctors still had "attitude", but yelling, name-calling and violence were not tolerated period. I agree with you that some health care workers have attitude and could learn better conflict resolution skills, but families can deal with that by asking to speak to the charge nurse or nurse manager. They do not need to yell, rant, hit, bite, spit, throw themselves on the floor, etc. and won't if they are not allowed to. People will often rise to your expectations of them IMO and I think it's insulting to patients and their loved ones to expect that they can't behave civilly even when they are stressed.

I also think it's sad that the first and only person to get any negative consequences when families or patients get out of control is the nurse.

I have been taken to task, by my peers, for threating to slap a nurse who refused to stop digging in my arm, attempting to start an IV, after twice requesting her to stop. Both she and some fail to realise that I and any other patient have a right to refuse to be touched by any healthcare person. And to continue to do so, is A & B. Sorry but I was assaulted once, in my entire career. And it was by a son, while I was wheeling his father out of ICU, after he had signed out AMA. And he was arrested. I have seen peers esculate situations with families or a patient and had never seen a staff member attacked. I've, unfortunately, witnessed angry confrontations between staff and families. We are the professionals or so we claim. If you respond in kind to anger, you will receive it back. There are times when we need to step back, tell the patient or family we cannot deal with them and get a supervisor.

Expecting a family member or patient to react in a normal way is unrealistic. For most, being in a hospital is a time of great stress. And people react to stress in many different ways, including making unrealistic demands on the staff. The best response is an "I'm sorry, I can't get that, do that, etc, for a visitor. It is against hospital policy".

Grannynurse:balloons:

[fergus51]

Expecting a family member or patient to react in a normal way is unrealistic. For most, being in a hospital is a time of great stress. And people react to stress in many different ways, including making unrealistic demands on the staff. The best response is an "I'm sorry, I can't get that, do that, etc, for a visitor. It is against hospital policy".

Grannynurse:balloons:

I just completely disagree. Most of our families do react in a "normal" way. Most of our families do not yell, scream, throw things, assault staff, etc and I see no reason why that type of behavior should be excused with "well, they're stressed". To me, that's insulting to them.

I thought my answer was actually pretty close to yours. The problem comes when that answer isn't good enough. The nurse can say sorry all she wants and be as polite as pie, but some families just get out of control regardless of how nice the nurse is (I've seen that many times in my current unit). That's why a code of conduct or just plain simple rules are important. They don't have the right to threaten or hit a nurse. It's illegal. Just like they don't have the right to threaten or assault a patient. I'm not asking for families to be perfect, just civilized. If they can't do that, they need to leave.

[DusktilDawn]

I just completely disagree. Most of our families do react in a "normal" way. Most of our families do not yell, scream, throw things, assault staff, etc and I see no reason why that type of behavior should be excused with "well, they're stressed". To me, that's insulting to them.

Agreed. I also noticed it is not the patients or families in the most stressful of circumstances who will behave this way. I've been amazed at how some people will maintain their dignity, courtesy, and respect throughout the most adverse of circumstances.

I do think staff should be trained how to de-escalate situations, however, I also think there needs to be set guidelines in regards to behavior for visitors and patients. Defining limitations and boundaries actually will help prevent problems.

I also worked in Canada, and did not see alot of the deplorable behavior I see now working in the US. Staff often are not backed up when dealing with abusive visitors or patients. Usually bad behavior tends to get rewarded.

[pedseducator]

At my hospital, the administration has made it mandatory to go to a class on "Work Place Violence" and encourages staff to report all and any problems. We also have signs by all doors stating from the sheriff that it is an arrestable offense to commit an assault or battery on a healthcare provider. Our CEO has increased the number of security officers as well. We are told we have the right to come to work and feel safe. Our CEO is pro-staff and this results in retention of employees. I think we are blessed to have such support from our administration!

[grannynurse FNP student]

I just completely disagree. Most of our families do react in a "normal" way. Most of our families do not yell, scream, throw things, assault staff, etc and I see no reason why that type of behavior should be excused with "well, they're stressed". To me, that's insulting to them.

I thought my answer was actually pretty close to yours. The problem comes when that answer isn't good enough. The nurse can say sorry all she wants and be as polite as pie, but some families just get out of control regardless of how nice the nurse is (I've seen that many times in my current unit). That's why a code of conduct or just plain simple rules are important. They don't have the right to threaten or hit a nurse. It's illegal. Just like they don't have the right to threaten or assault a patient. I'm not asking for families to be perfect, just civilized. If they can't do that, they need to leave.

Sorry but I will refuse to sign a Code of Conduct. And any hospital that makes it a condition of my stay, well I will not return to that hospital. Your response that most families respond in a normal way, is in opposition to what your peers have posted on this thread. One would think that every patient and every family makes unrealistic and unwarrented demands. Most families and most patients do not. But try lying on the other side of the blanket for a while. Try being on bedrest and waiting for a bed pan. Or asking for pain medication and waiting 30, 45 or 60 minutes because the nurse feels you really aren't in that much pain because you have visitors. Don't think it doesn't happen? Think again. Go back and review some of the threads on demanding patients, visitor and request for pain management.

As for threatening a staff member. I threatened one because SHE REFUSED TO STOP DIGGING IN MY ARM. THAT IS MY RIGHT AS A PATIENT, just as it is yours. All she had to do was stop the first time I asked her to, which she chose to ignore, as well as the second request. Try to understand that for a while. I have been hospitalized four times in the past year. With one exception, I was treated by professionals in a professional manner. And I refuse to bow down or back up from my rights as a patient. I have never forced any treatment on a patient, even when I thought the patient was wrong, and I will not have any forced on me. I think I understand the pressures on nursing, having been an RN for more then thirty years. I have also strove to understand the stresses that impact on my patients, especially when it impacts on their behavior. I am the professional, they are not. I am held to a higher standard then the patient and family member. And if one does not believe this, I feel sorry for them and their patients.

Grannynurse:balloons:

[URO-RN]

I just completely disagree. Most of our families do react in a "normal" way. Most of our families do not yell, scream, throw things, assault staff, etc and I see no reason why that type of behavior should be excused with "well, they're stressed". To me, that's insulting to them.

I thought my answer was actually pretty close to yours. The problem comes when that answer isn't good enough. The nurse can say sorry all she wants and be as polite as pie, but some families just get out of control regardless of how nice the nurse is (I've seen that many times in my current unit).

That's why a code of conduct or just plain simple rules are important. They don't have the right to threaten or hit a nurse. It's illegal. Just like they don't have the right to threaten or assault a patient. I'm not asking for families to be perfect, just civilized. If they can't do that, they need to leave.

Right on.

[DidiRN]

I think I understand the pressures on nursing, having been an RN for more then thirty years. I have also strove to understand the stresses that impact on my patients, especially when it impacts on their behavior. I am the professional, they are not. I am held to a higher standard then the patient and family member. And if one does not believe this, I feel sorry for them and their patients.

Grannynurse:balloons:

You haven't actually practiced as a nurse though since the 1980's, correct?