Patient's "right" to abuse nurses...I need your opinion

[MsNewbee]

Hi, everyone. I'm a year out from graduation and have been working my job so I haven't posted or been on in a while, but a topic came up on the job and it just rubbed me the wrong way. I didn't want to ruffle feathers at the hospital so I decided to turn to my peers on allnurses for guidance.

I recently had a patient that really tried my nerves. I'm a super patient person and she made me question why I chose nursing (which I thought would never happen!). She would ask me for pain medication and as soon as I would leave her room she would be on her light again asking for the same thing. She literally rang her light 15 times in 10 minutes. I counted because I would answer her. She did this everyday for at least 3 hours every morning for the 5 straight days that I had her. She was cognitively intact. She wanted to go smoke outside, but needed staff with her and no sooner that she went outside by herself (while I was with another patient) she broke her wheelchair then demanded that I go with her. I only had 8 other patients to take care of, no big deal right? She complained about everything from the food, to the other staff, to the other patients. Her room was next to the nursing station and she would scream my name down the hall while I was charting because I was in her line of sight. I started hating my name just because of the shrill way she would scream it and she did this constantly. If I left to tend to another patient she would scream my name louder. I could hear her screaming for me while I took lunch breaks. She yelled at other patient's family members as they would passed by her room. I got so frustrated I told her we were human beings that should be treated the way she herself would want to be treated and her behavior was not acceptable. I didn't know what else to do or say to her. Eventually, she hit my tech and started smoking in the room and that's when administration said she had to go on the 5th day with me.

I made a sarcastic comment and said, "Can someone take the light and just put it somewhere, she knows I'm coming." The nurse supervisor who was getting off of work said, "it is her right to abuse you." I just looked at her back as she sauntered off to the elevator with my mouth open because I couldn't believe what she just said. I thought a better response would have been, "she needs to have her call light in case she has a need that hasn't been addressed." or something along those lines, but she was serious. I determined at that moment I would not pick up any more shifts because I was begged to come in that day and that was what I got. I felt like the "higher ups" really didn't care about me or my mental well being.

My question is do patient's have the right to abuse us? Am I just being a baby and should suck it up because this is my life/job now? I am really dreading going in tomorrow. I loved my job until I had this one crummy patient. I woke up crying in the middle of the night on my third day with her because I knew she was going to do this every time I showed up. I was fighting back tears for those 5 days at work and I cried once in my car on my lunch break. How do ya'll keep the fire that inspired you to go into nursing from going out?

Please help, I'm feeling sooooo helpless and drained .

[AceOfHearts<3]

Patients have absolutely NO right to abuse us. Her behavior was so far from acceptable and should have been addressed as soon as it started. It is not ok to abuse the call bell or to scream and disrupt the entire unit.

I can't believe the hospital allows patients to go outside and smoke. Both facilities I've worked at have been smoke free and the answer was always no to smoking- the patients were offered a nicotine patch. Staff also does not have time to babysit patients on smoke breaks- there are sick patients that take priority.

The culture on my unit is to not put up with this. We call alert and oriented patients out on their behavior all the time. I've told a patient before I'm there to help, but I am NOT their servant and the way they are talking to me is not appropriate.

I'm sorry you had to put up with this. Your charge nurses, manager, and supervisors should have had your back and should have addressed this disruptive behavior if the patient did not listen to you.

[meanmaryjean, DNP, RN]

Is it at ALL possible that the supervisor was being sarcastic? Because that was my first thought about her response.

[MsNewbee]

Thank you for that. I just didn't know I could do anything other than pull my own hair out. I offered her the patch and she declined. She had on a fentanyl patch that she said didn't work and demanded oxycontin from me that she wasn't prescribed and her doctor had already told her no to.

Thank you for letting me know that I wasn't a whiner because I sure did feel that way (in my mind).

[nursej22, MSN, RN]

At my former facility each patient was presented with a patient's bill of rights and responsibilities, which included that patients would be cooperative with care and follow facilities rules that included no weapons and no smoking. They were also informed that infractions may result in discharge. And they followed through with it.

Use of any tobacco products, except for gum, patches or prescribed inhalers were not permitted on the grounds, for patients, visitors or staff.

[JBMmom, MSN, NP]

I'm surprised that such a demanding patient wasn't traded to different assignments for so long. If someone is known to be that draining, our charge nurses do their best to A)give the nurse the lightest possible assignment with the demanding patient and B) not assign the same nurse repeatedly- to avoid such a situation. As for their right, just no. I have told many patients things like- I am happy to provide the best care I can for you in the next eight hours, but I will not tolerate abusive language behavior towards myself or my staff. I will call security if it continues to be an issue. Most people calm down after that. Especially an alert and oriented person? Unacceptable. I also find it highly unusual that your patient can do out and smoke, I haven't seen that yet in my hospital. I would question why management did not get involved earlier with this patient's behavior. It was clearly disruptive to everyone and should have been addressed.

Don't let this one experience drag you down too much. Focus on the positive experiences you've had, and will continue to have, after this miserable one. Good luck!

[MsNewbee]

I hope that she was! She works the opposite shift of me so I've never worked with her directly before. The patient's behavior was so consistent. The nurses on the night shift would comment how awful this patient was until I started working with her and then suddenly she could sleep at night. I thought it was because she expended so much energy hollering at me all day.

That's why I didn't say anything to any supervisors or bring it up because it could have been a joke, but I was curious to see how the patient's underlying behavior for the comment should have been addressed and how I can keep going on if I'm smiling through tears stinging my eyes.

During a meeting we were informed that reimbursements were based on patient satisfaction and now we wouldn't get paid if patient's weren't happy and then this lady showed up and they assigned her to me. She was there 8 days and I had her for 5. I thought the whole situation was a cruel joke.

[heron, ASN, RN]

Ringing the call bell 15 times in 10 minutes is not even normal drug-seeking (in the pejorative sense of the term). That level of short term memory loss is more consistent with dementia. Did anyone ask for a psych consult to help get a handle on mental health issues that might be affecting her behavior?

Without having a fuller clinical picture, it's hard to be helpful other than to say that the first step would be setting firm limits that are consistently enforced by all staff. If admin isn't backing you up, that's pretty tricky.

[anitalaff, BSN, RN]

Patients have absolutely NO right to abuse us. Her behavior was so far from acceptable and should have been addressed as soon as it started. It is not ok to abuse the call bell or to scream and disrupt the entire unit.

I can't believe the hospital allows patients to go outside and smoke. Both facilities I've worked at have been smoke free and the answer was always no to smoking- the patients were offered a nicotine patch. Staff also does not have time to babysit patients on smoke breaks- there are sick patients that take priority.

The culture on my unit is to not put up with this. We call alert and oriented patients out on their behavior all the time. I've told a patient before I'm there to help, but I am NOT their servant and the way they are talking to me is not appropriate.

I'm sorry you had to put up with this. Your charge nurses, manager, and supervisors should have had your back and should have addressed this disruptive behavior if the patient did not listen to you.

I couldn't agree more!!

[RNperdiem, RN]

Is this person even sick enough to be in the hospital? Her level of behavior is extreme, and I have been a nurse for a long time.

This is where you have a talk with your charge nurse and say that tomorrow, you want a different assignment. Do not ask; tell.

If the charge keeps assigning you this patient, you are being dumped on.

As a new nurse, it is difficult to say no. But learning to say "no, I cannot take you out to smoke right now", "No I will not work overtime", "No, I need a different assignment tomorrow" is a life skill you need to survive in nursing.

[PeakRN]

It sounds like this patient needed to have some limits set and enforced well before this happened. Patients who cannot behave appropriately and do not want to participate in their care can be discharged home.

We do not allow smoking in the hospital or on property, and we do not allow patients to leave the unit to smoke. Patients who leave hospital grounds without an order (these are pretty much restricted to our oncology patients who are going to family events for a very short period of time) are considered to have eloped the facility. They are no longer patients and if they are a risk (including things like having an IV in place) we call PD for a check the welfare.

If the patient hit your tech he or she needs to file a police report. That is never acceptable behavior, battery is not and never should be considered okay. I have sent patients to jail before for battery on a health care worker and would do so again. In my state it is a felony and I think it should be everywhere. Patients are in a position of trust with staff and if they abuse that position they need the same punishment that anyone else in a position of trust gets.

[MsNewbee]

Ringing the call bell 15 times in 10 minutes is not even normal drug-seeking (in the pejorative sense of the term). That level of short term memory loss is more consistent with dementia. Did anyone ask for a psych consult to help get a handle on mental health issues that might be affecting her behavior?

Without having a fuller clinical picture, it's hard to be helpful other than to say that the first step would be setting firm limits that are consistently enforced by all staff. If admin isn't backing you up, that's pretty tricky.

Yes psych saw her and the only thing they said was she has anxiety and was taking clonipin scheduled twice a day. She didn't have memory loss. She would hit the call light while other staff was in the room just to ask for the same thing because they weren't moving fast enough. I spoke with the only person who would ever come and visit her and found out her only surviving relative didn't even want to acknowledge her, but he couldn't tell me why because he was just another resident at the assisted living facility that they both lived. All I could conclude was she was lonely. I tried to spend time with her when I had down time at first, but I got worn down with all the constant complaining. It really didn't help she could see me from her bed.