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

[hipab4hands]

Sorry Granny nurse, but I have to respectfully disagree. I'm willing to bet when these folks are "stressed" in other situations, i.e. work, bosses, their own customers - that they are not allowed to act in this manner.

For some reason, it becomes acceptable and we excuse it when it occurs in the hospital, but wouldn't be tolerated anywhere else.

[fergus51]

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.

I would think we were in the same unit:chuckle It's one of the things I warn Canadian nurses about when they ask me about working down here. Behavior codes seem very different.

OT, but can you imagine if people could use the stressed excuse for assaulting or acting crazy with other professions? "Well, yeah I hit the cop, but I was stressed"... Right:rolleyes:

[fergus51]

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:

Frankly, if anyone doesn't feel that they could abide by the rules we had set out I wouldn't be too upset to not have them as a patient in my hospital. There was nothing in our rules that was unreasonable. Don't become violent, respect visiting hours, respect other patients privacy... I don't think those are unreasonable expectations for a patient or their visitors. I don't expect people to be perfect or for them to obey these rules 100% of the time, I only expect them to be spoken to about the incident if they don't and come up with some way to see that it doesn't happen again. They go along nicely with the patients' rights we had posted all over the hospital (things like, you have the right to a second opinion, you have the right to ask questions until you receive the information you need to make a decision, you have the right to refuse any procedure or care from anyone you choose, you have the right to timely pain control, you have the right to respect from the healthcare team... the list goes on but those are the ones I remember off the top of my head).

I've been in the hospital as a patient and with family members and friends as a visitor. I'm not saying every nurse is an angel or every family member or patient is evil any more than you would suggest that every nurse is evil and every family member or patient is an angel. I'm saying when we have problems with a nurse, we can deal with it in a better way than hitting them. You have every right to be angry about that nurse's behavior, but you were also obviously able to not hit her. You could go to the charge nurse, the manager, the doctors, hospital administration, your lawyer... heck the newspaper if need be. I don't expect patients to give up any of their rights when they become patients. I just also didn't expect to give up any of my rights when I became a nurse. I hold myself to a very high standard of behavior in my interactions with my patients, thank you very much. I simply expect my patients and their family members to behave with a minimum amount of civility. I never signed a waiver giving away the right to not be assaulted or threatenned. I've been fortunate to have never had that happen to me in the workplace. Some of my coworkers have not been so lucky and I can tell you that I don't think any amount of stress excuses illegal acts on the part of the nurse or the patient.

[perfectbluebuildings, BSN, RN]

I think there are a couple of types of situations being written about...

When Grannynurse had the IV being started and requested a couple of times for it to be stopped and was refused, that is a whole different ballgame than a visitor who starts screaming at the nurse because they don't have a blanket for themselves. Do you see what I mean? In the first case, the patient's rights were being compromised; in the second type of instance, it is the visitors who are frustrated and upset over something, but the patient's care is NOT compromised. Patients do have the right to complain or say something if they feel like their care is being compromised, definitely and we all realize that I think. But threats or violence don't accomplish anything. I realize and understand that families are stressed and upset about their family member being in the hospital, but I just don't think it's right for the nurse, or for anyone, to be expected to be the dumping ground for all that stress in the form of yelling, threats, or extreme disrespect.

I guess my point is that, of course if the nurse is giving bad care the patient definitely has the right to complain. But it seems that a lot of the situations being written about by other nurses here that may have escalated into threats or violence, were not about good or bad patient care.

[perfectbluebuildings, BSN, RN]

I've been in the hospital as a patient and with family members and friends as a visitor. I'm not saying every nurse is an angel or every family member or patient is evil any more than you would suggest that every nurse is evil and every family member or patient is an angel. I'm saying when we have problems with a nurse, we can deal with it in a better way than hitting them. You have every right to be angry about that nurse's behavior, but you were also obviously able to not hit her. You could go to the charge nurse, the manager, the doctors, hospital administration, your lawyer... heck the newspaper if need be. I don't expect patients to give up any of their rights when they become patients. I just also didn't expect to give up any of my rights when I became a nurse. I hold myself to a very high standard of behavior in my interactions with my patients, thank you very much. I simply expect my patients and their family members to behave with a minimum amount of civility. I never signed a waiver giving away the right to not be assaulted or threatenned. I've been fortunate to have never had that happen to me in the workplace. Some of my coworkers have not been so lucky and I can tell you that I don't think any amount of stress excuses illegal acts on the part of the nurse or the patient.

Thank you Fergus; I was posting at the same time and in this paragraph, you explained things so much better than I did.

"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...

Grannynurse"

I agree with this very much so too... respect on both sides and of course the nurse has to be the professional... I think these two points of view do not have to be mutually exclusive.

[Fuzzy]

I've been treated very well by the nurses when I have been in the hospital. They have always been good about answering my questions and seeing to my needs.

However, as a veterinary technician, I must say some of the clients (people) that I deal with are very difficult. Granted sometimes they are in a very difficult situation with a sick or terminal pet, cost of tx, etc. However some people have inadvertly been rewarded for their obnoxious behavior by getting their way. So anymore if I have someone who is being a 'turd', I leave the room as long as the patient (animal) isn't compromised. For this I have my employer's blessings. I don't say a word--I just leave. If they continue to be obnoxious, then my emplyer will go in and have a chat with them. Thankfully my employer will 'fire' clients for being chronically difficult to deal with. We have only fired 4 clients the 12 years that I have been here and life was wonderful afterwards. Life is just too short to have to deal with people who don't want to listen to you. I'm glad that they can go down the road. I do feel for the patients though as they didn't necessarily choose their owners.

Fuzzy

[DusktilDawn]

I would think we were in the same unit:chuckle It's one of the things I warn Canadian nurses about when they ask me about working down here. Behavior codes seem very different.

OT, but can you imagine if people could use the stressed excuse for assaulting or acting crazy with other professions? "Well, yeah I hit the cop, but I was stressed"... Right:rolleyes:

Exactly, if you hit a cop, the cashier at Wal-Mart, or an absolute stranger it would not be tolerated. The point is that the sort of behavior that would not be tolerated elsewhere is tolerated in nursing. If I spoke to a waitress in a restaurant they way I have been spoken to on occassion, I would no doubt be refused service and asked to leave. In healthcare, refusing to treat a patient because they or their family are abusive is not an option for us.

I think the attitude that it is part of our job is to tolerate abuse needs to change. I don't see doctors putting up with the abuse that nurses do. The reason is, in general, people believe it is part of our job to tolerate this behavior. Sorry, what factors changed in regards to stress when the doctor is present....they are still in the same situation and still dealing with the same stress, the only difference is with WHOM they are dealing with.

It seems nurses have a tendancy to downplay abuse unless physical injury occurs. Most experts will agree that violence starts as nonverbal threatening behavior, than escalates to verbal harassment, than physical violence. Tolerating one form of abuse makes it easier for abuse to escalate.

I'll be the first to agree that a patient has the right to refuse treatment/care that I may have to implement. "You're not coming near me with that foley," I can accept, "Come near me with that foley and I'll belt you one," is not something I should have to tolerate.

Our facilities and we as nurses need to become aware and educated on this issue. There needs to at least be a minimal guideline in regards to what behavior is acceptable. Education for staff in regards to anger-diffusion. Zero tolerance policies. Our patients have the right to receive the best care we can give them. We as nurses have the right to work within a safe environment.

[grannynurse FNP student]

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

Please do not try to divert this disagreement or the issues being addressed. It is funny, that only here in the U.S. do nurses voice their fear of physical assualts by patients or their families. And it is only here, that nurses feel justified in meeting force with force. Some should look at Great Britain or New Zealands response to disruptive patients and/or their families. They have done research, published their findings and do not suggest meeting force with force.

And you are correct, I have not actively practiced nursing since November 28, 1988. That does not make my observations or opinions any less valuable then yours or anyone elses, atleast not in my humble opinion. I could say that I think all nurses who respond with force or threats to a patient or a family member are the least professional individuals I have ever come across but I will not. I will not force myself to be that unprofessional.

Grannynurse:balloons:

[grannynurse FNP student]

I think there are a couple of types of situations being written about...

When Grannynurse had the IV being started and requested a couple of times for it to be stopped and was refused, that is a whole different ballgame than a visitor who starts screaming at the nurse because they don't have a blanket for themselves. Do you see what I mean? In the first case, the patient's rights were being compromised; in the second type of instance, it is the visitors who are frustrated and upset over something, but the patient's care is NOT compromised. Patients do have the right to complain or say something if they feel like their care is being compromised, definitely and we all realize that I think. But threats or violence don't accomplish anything. I realize and understand that families are stressed and upset about their family member being in the hospital, but I just don't think it's right for the nurse, or for anyone, to be expected to be the dumping ground for all that stress in the form of yelling, threats, or extreme disrespect.

I guess my point is that, of course if the nurse is giving bad care the patient definitely has the right to complain. But it seems that a lot of the situations being written about by other nurses here that may have escalated into threats or violence, were not about good or bad patient care.

What you are referring to is quite true and you are being honest. However, I have seen, listen to and read about staff complaining about patients and/or families and reacting in anger to their unreasonable demands. Don't you and other think that we have all had unreasonable demands made of us? It is how one reacts to even the most unreasonable demand that, in the end, can defuse a volatile situation, without injury to anyone.

The NOPD reacted to on-going stress by assualting a 61 year old man. Two of them were fired today and the other is suspended. There are those that will say the officers were reacting under stressful conditions. And their behavior should be excused. After watching what happen and seeing the bloody aftermath, on the victim, I don't. I feel the same way about my peers. We are the professionals, just like the police officers are. When we lose control, everyone suffers.

Grannynurse:balloons:

[DidiRN]

I'm not trying to divert anything...but alot of your posts on here you really seem to have lost empathy towards bedside nurses after being away all these years, and at times you are extremely critical of us. Sorry, but that's my observation. I was a nurse back in 1988, and things have changed dramatically. Especially in regards to trust, respect and treatment of health care providers.

I don't know what you are talking about in regards to "force by force"...you are the one who threatened to hit or actually did hit a nurse who wouldn't let go of your arm. When all you had to do is yank it away, if that was the really the case. There is no excuse for YOUR threats and use of force against a health care provider. I really have not seen anyone else here advocate what you are talking about.

Please do not try to divert this disagreement or the issues being addressed. It is funny, that only here in the U.S. do nurses voice their fear of physical assualts by patients or their families. And it is only here, that nurses feel justified in meeting force with force. Some should look at Great Britain or New Zealands response to disruptive patients and/or their families. They have done research, published their findings and do not suggest meeting force with force.

And you are correct, I have not actively practiced nursing since November 28, 1988. That does not make my observations or opinions any less valuable then yours or anyone elses, atleast not in my humble opinion. I could say that I think all nurses who respond with force or threats to a patient or a family member are the least professional individuals I have ever come across but I will not. I will not force myself to be that unprofessional.

Grannynurse:balloons:

[Marie_LPN, RN, LPN, RN]

It is funny, that only here in the U.S. do nurses voice their fear of physical assualts by patients or their families. And it is only here, that nurses feel justified in meeting force with force.

I haven't seen where anyone's said they will meet force witrh force. What i have seen is plenty of people saying that they will not let someone carry out their threats.

Perhaps the U.S. nurses voice a valid concern, that used to be something that wasn't a problem in the past.

[Marie_LPN, RN, LPN, RN]

There is no excuse for ANY threats or force from ANYONE.