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Discussion

Patients and boundaries

I have been dabbling in home health for a while now and have been having trouble setting boundaries.

Recently I had a patient who was verbally aggressive towards a me. I have dealt with my fair share of angry patients but this one is still bothering me. The aggression was not a result of his disease process, he was a younger man, around 55 and was cognitively intact.

He is a new patient of mine and I had several initial questions for him and he kept screaming at me telling me how much of an idiot I am for asking such stupid questions. He also made a comment that I better watch my back in his neighborhood because people in scrubs get "robbed and stuck" because they are likely caring meds or valuables (cell phone ect.)

I told my manager that I was not willing to return to this case and explained the situation. They said to suck it up.

I have been a nurse for many years and have fairly thick skin, but being verbally harassed for an hour just took a toll on my mentally and physically. I was shaking walking to my car and was really scared (silly I know)

How would you handle this situation. I'm having anxiety already dreading the follow up and I'm thinking about outright refusing the case, but I fear they will terminate me. Times like this I yearn for the hospital environment where I could quickly call security. Home health sure isn't the semi-retirement laid back atmosphere I thought it would be :(

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    • Experts

    Ewwww! Nothing like being slimed in the line of duty. How nice to have such supportive management! Are you the first one who asked not to be sent there anymore? Why can't someone else go? Because they all refused and you're the only one left? Your manager needs to call Mr. ******* and tell him if he can't stop abusing nurses he can just go without. But they want the revenue so it becomes your problem.

    What would be the worst thing about being terminated? Would you have to dumpster-dive? Would it be really hard to find another job? I'd have to really need the paycheque to take that kind of abuse. And threats. I really hope you have enough options available that you can tell this agency to take a hike. Or you refuse the assignment and they don't actually terminate you. Or you go back to Prince Charming and tell him to knock off the crap or you're walking out the door.

    Good luck. I'll be thinking good thoughts for you.:up:

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    • Author

    No I'm actually the first nurse to see this patient. The problem is that most of the other nurses are newer so they "don't like to send them to difficult cases". Which is a bunch of bologna.

    I need a paycheck to pay the rent, long story short my options for acute care are limited due to an injury.

    I have loved the laid back pace of home health and have had nothing but positive experiences aside from this. I just wish management would be more involved and listen when their more experienced nurses encounter a problem.

    I am going to refuse, I guess if I am terminated for this then it is meant to be. Something about this man just seemed off and he genuinely frightened me.

    They will probably make a fuss but I am hoping they don't terminate me. Setting boundaries is just a weakness of mine, guess I better buck up.

    Thanks for your reply :)

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    No I'm actually the first nurse to see this patient. The problem is that most of the other nurses are newer so they "don't like to send them to difficult cases". Which is a bunch of bologna.

    I need a paycheck to pay the rent, long story short my options for acute care are limited due to an injury.

    I have loved the laid back pace of home health and have had nothing but positive experiences aside from this. I just wish management would be more involved and listen when their more experienced nurses encounter a problem.

    I am going to refuse, I guess if I am terminated for this then it is meant to be. Something about this man just seemed off and he genuinely frightened me.

    They will probably make a fuss but I am hoping they don't terminate me. Setting boundaries is just a weakness of mine, guess I better buck up.

    Thanks for your reply :)

    All that keeps going through my head is that you are a better person than I, because the second he raised his voice with me, much less started threatening, I would've walked right out. I would have probably thrown in a threat of my own, that of calling the police because he was threatening my safety. Now, I don't know and don't care if it would stick with LE, but at the end of the day, oftentimes just mentioning police is an effective way to stop bad behavior.

    One thing for sure, I'd probably quit before they fired me. Employers who 'have my back' like that, well, I think I'd rather dumpster-dive...

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    Don't refuse quite yet, just change your tactics. Are you positive this guy is intact? I think social work and the case manager need to be consulted to deal with the apparent anger and agression that this patient has over...well, everything.

    First off, why are you seeing this guy? If it is something that he can be taught to do, all the better, and a quicker exit. However, this is the important part. DO NOT go back there alone.

    If he is also getting other disciplines, then by all means, ya'll go at the same time. At the very least, bring the social worker back with you to assess his mental status.

    If the powers that be decline to have you all go at once, then I would decline for my own safety. Call your malpractice insurance first for guidance.

    Be 500 percent sure that all of your i's are dotted and t's crossed documentation wise prior to your refusal. That you did not make a future appointment with this patient (and again, malpractice insurance can help you with this information).

    It does sound to me like your patient is blowing steam out of his ears that in fact he has found himself in a place where he is homebound (unless he is not, then that constitutes a D/C, no?) relying on people to care for him at 55 years old. Another concept is that if he has a family member who helps (or would be willing to "learn" parts of care that he may need) that person needs to be there when you go. It is amazing to me how quickly attitudes and bad behavior change when Auntie/Mother/Sister is in the house.....

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    • Experts

    You said you are a seasoned nurse and something about him genuinely frightened you. Go with your gut. Do not override your gut. But the other posters have come up with excellent advice about how to keep your ducks in a row and hopefully keep a job you otherwise like. Good luck and be safe.

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    I completely agree with the recommendation that you visit this patient with another team member.

    At this time, there is no therapeutic relationship and the guy has essentially warned you which means that you should be very cautious.

    Keep your management VERY up to date on his behavior and language. Document in detail his EXACT comments when you can. Notify the provider of his animosity and hostility addressing how it is impacting his care.

    Good luck and be safe.

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    • Guides

    I don't find hostility related to nurses "asking stupid questions" to be all that unusual in home care patients who have lived with their limitations for many years because they really do get burnt out by what they see as the annoying and repetitive questions that serve to remind them that although they live at home the "hospital" is never far away.

    I might even interpret the scrubs comment as a warning that could protect me. I've known lots of home health nurses who wear street clothes ("business casual"). From what you've said so far I might not give up right away but in all cases I think nurses should trust their instincts as far as their personal safety is concerned. It's unfortunate that people who could use us the most deny themselves the benefits by their disruptive behavior.

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    • Author

    Very sound advice my friends, I will update tomorrow how things go.

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    What has me concerned is that his threats are so specific and not just blowing off hot steam. OP has the right to feel safe and this is not the case. Management doesn't sound too supportive, at least not until something serious happens.

    OP is stuck between a rock and a hard place. But for my $0.03 I opt for safety. Let the agency deal with him.

    To OP - good luck and be safe. Let us know how you make out.

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    I worked home are as an LNA for years. I'm not sure why your supervisor didn't take this report seriously. Before you go back to that PT you need to sit down and talk to whoever it is that's the first in the chain of command.

    Granted sick people say weird stuff but there is no way I would go back there alone. Your office should have spoken with him! That day!

    I hope things settle down. I would also see about wearing slacks in teas of scrub pants when or if you go back.

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    This guy should be discharged for aggressive behavior and implied threats.

    As a last resort, if I could not afford to lose the job and had no other options, I would insist that the agency provide an armed guard.

    Providing an armed guard is not uncommon in major metropolitan areas.

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