Pt/Family RAGE

[sawbuck]

Any of you experience verbal, mental, and or physical abuse from the patients or family you take care of? The frequency of this has noticibly arisen in the past 5 or so years.

We see immeadiate acting crisis teams to provide support and care to the family and patient when their issues begin. Our nurses and aides seem to have none of this support. We go through episodes of inner anger and strife without assistance of how to channel it out of our systems. We go home with these problems and asorb it all, possibly improperly, or maybe not even asorbing it. Thus, not wanting to return to work or to take on the same patient/family, which drops out the consistancy factor of care.

Any ideas or report of teams supporting US for a change?

Randy

[FroggysMom]

It's sort of "the squeaky wheel gets the grease."

EVERY hospital should implement a Visitors' Code of Conduct that includes patients' families and is part of the Admission Packet.

They should have to sign it to even get admitted.

Then administration should STAND BEHIND NURSES when they are harassed by hostile, ignorant families.

Just my opinion....but I predict it won't be happening soon b/c of the "Customer Service" attitude so prevalent these days.

-gag-

Yes, I see that too. Everyone is afraid to "offend" the abusing family members, even though the family is offensive because of the almighty bottom line.

[CseMgr1, ASN, RN]

It's sort of "the squeaky wheel gets the grease."

EVERY hospital should implement a Visitors' Code of Conduct that includes patients' families and is part of the Admission Packet.

They should have to sign it to even get admitted.

Then administration should STAND BEHIND NURSES when they are harassed by hostile, ignorant families.

Just my opinion....but I predict it won't be happening soon b/c of the "Customer Service" attitude so prevalent these days.

-gag-

Make that gag a maggot. "Customer Service" is nothing but fodder for the poor, spoiled and entitled society we live in. As for me, I'm getting mean in my old age: If these hostile and ignorant families don't want to play nice, I'll be MORE than happy to show them the door: "And don't let the back door hit ya where the good Lord split ya, honey!"

[RN34TX]

And let's not forget the ever-expanding wealth of excuses and labels given to our abusive visitors:

1. They are going through a rough time right now.

2. You need to put yourself in the patient/family member's shoes and understand where this anger is coming from.

3. They are experiencing grief or a loss of control right now.

4. They have a bad or no support system.

5. They have poor coping skills/mechanisms.

6. If you nurses would just keep patients/families informed and involved in their care, they wouldn't act out this way.

And the list goes on.

So, abusive visitors everywhere, feel free to scream, curse, throw things, bang fists, and even physically threaten the staff because it's really not your fault that you are acting up and you aren't responsible for your own behavior.

It's usually because the nursing staff is doing something wrong or failing to do something for you that's causing all of your grief.

At least that's how administration looks at it.

[sawbuck]

Oh, YES...Many, MANY times. I once had a rather nasty encounter with the son of of a home care patient who had been inappropriately admitted (and under political pressure, I might add), to our HHA under Medicare. Discharge planning had been carefully documented by our Social Worker and every nurse who had an encounter with this man and his son thoughout the four months we were involved with his care. Well, lo and behold, the day of discharge finally comes (and not a day too soon, I might add), I get an irate phone call from the son. I cannot get a word in edgewise, as I patiently attempt to remind him that Medicare does NOT pay for custodial care, for he is screaming at me that he "has to have chux and diapers for his Dad". After he has been politely asked to lower his voice and declines to do so, I inform him very coldly: "Sir, I am NOT sending a nurse back out there in order to provide diapers and chux for your father". This immedately provoked a tirade of expletives from the other end of the phone, and I hung up on him. Not fifteen minutes later, I get pulled aside by my boss, who has received a call from our Corporate Office, as Foul-Mouthed Son has now called them and lodged a complaint against me. She starts into me, and I get right back into her face and angrily inform her that I was not ONLY not going to take any more verbal abuse from this family member, who together with his father had manipulated their scheming little ways through EVERY HHA in our area in order to get free diapers and chux, but I was also NOT going to tolerate it from anybody...EVER again. Her eyes got wide as saucers, as I went on, pointing my finger at her for emphasis: "You were WELL aware that these two had been through the system even before the admission happened, and I am NOT going to take the blame for that, either". I had never talked to a supervisor like that before, but I didn't care. These people know EXACTLY what they are doing, and all I have to say is that I am pleased as punch that I don't have to deal with them anymore...and don't have to risk being fired because I STOPPED kissing their rear-ends! :angryfire

Hi, thanks for the wonderful experience input. I am working with my administrators, house psychologist, and others to pursue a new and needed team for support, council, and react to us in the immeadiate situation (not 2-3 days later). Any ideas ot thoughts that might be in focus?

[sawbuck]

Hi, thanks for the wonderful experience input. I am working with my administrators, house psychologist, and others to pursue a new and needed team for support, council, and react to us in the immeadiate situation (not 2-3 days later). Any ideas ot thoughts that might be in focus?

[DusktilDawn]

Well finally came across the Visitors Code of Conduct at my facility. Interesting thing is now they are calling it "Visitors Commitment." It its included in a brochure that is supposed to be given to all visitors. I will only post that section of the brochure:

Visitor Commitment

To ensure your safety and provide the best quality of care for our patients, we ask all of our visitors to review the following:

1. Visit your loved one during visitation time.

2. Keep down noise and movement in the patient care areas.

3. Weapons of any kind are not allowed in any area of the hospital.

4. ----------- hospital has zero tolerance for any perceived or real, threat or violence towards our patients, and their loved ones or our staff.

5. After visiting hours visitors MUST wear an ID badge at all tiimes.

6. Be mindful of and respect the rest and recovery of other patients in the hospital.

7. Any visitor who is impaired, intoxicated or who interferes with patient care will be immediately removed from the facility. They may not be allowed a visit for the remainder of that day and/or the duration of the patient's stay.

8. Hospital staff will try to accommodate special visitation needs when and where possible.

Now I will say that where I work, there is zero tolerance for physical violence towards staff. They gray area is when it comes to verbal/emotional abuse.

Personally I think they should have stuck with the name "Visitors Code of Conduct" instead of changing it to "Visitors Commitment." I think abuse language/actions should have been included, such as you are not allowed to call the nurse witch. Limitations need to be set in regards to behavior and nursing staff need to be backed up when people cross the line on these limitations.

Nurses are putting up with nonsense that would not be tolerated elsewhere in businesses that deal with "customer service." Frankly were are not in the "customer service" industry, we are in the health care profession, our job is not to appease or please.

[sawbuck]

Hi, thanks for the wonderful experience input. I am working with my administrators, house psychologist, and others to pursue a new and needed team for support, council, and react to us in the immeadiate situation (not 2-3 days later). Any ideas ot thoughts that might be in focus?

[NRSKarenRN, BSN, RN]

from healthleadersmedia.com

dec. 2, 2005 -- news features -- healthleaders extra!

jcaho releases draft 2007 national patient safety goals

rapid response teams, patient suicide prevention, worker fatigue, and disruptive behavior are among the topics covered by eight proposed 2007 national patient safety goalsfor hospitals and critical-access programs released november 29.

the jcaho posted the draft on its web site along with goals for its other accreditation programs. organizations have until january 8, 2006, to comment on the proposals.

go to www.jcaho.org. to view and comment on the proposed goals.

the jcaho will review comments from the field review after the january 8 deadline. the commission will most likely release the final goals early next year, setting an implementation deadline of january 1, 2007....

hospitals: [color=#363a90][color=#363a90]candidate 2007 national patient safety goals field review -

see page 7:

goal 16:

discourage disruptive behavior

rationale for goal 16:

disruptive behavior not only decreases staff morale, but also has a negative effect on patient safety. in a study conducted by ismp, 88% of respondents encountered some form of disruptive behavior. types of disruptive behavior included condescending language or voice intonation, impatience with questions, reluctance or refusal to answer questions or telephone calls, strong verbal abuse or threatening body language and physical abuse. this behavior was not limited to physicians, but frequently involved other members of the healthcare staff.

requirement 16a:

organizations have guidelines for acceptable behaviors to identify, report and manage behaviors that cause disruption to patient safety.

implementation expectations for 16a:

1. the organization develops a code of behavior which is embraced by the organization’s governance, management, and medical and clinical leadership.

2. unacceptable behaviors are defined with input from all levels of the organization.

3. the organization encourages staff to report instances of disruptive behavior without fear of retribution.

4. the organization ensures that staff will not face retribution for reporting instances of disruptive behavior.

5. processes are implemented, as appropriate, to manage unacceptable behavior.

6. education is conducted at all levels within the organization with regard to acceptable behavior.

7. the organization periodically (as determined by the organization) surveys staff with regard to behavior climate.

8. the organization has a process to assist staff in managing stresses associated with the healthcare work environment.

http://www.jcaho.org/accredited+organizations/hospitals/standards/field+reviews/07_npsg_hap_cah.pdf

timeframe

posted for comment through january 8, 2006

comment here: website link to field review

click here to complete the online field review.

[sawbuck]

Hi, thanks for the wonderful experience input. I am working with my administrators, house psychologist, and others to pursue a new and needed team for support, council, and react to us in the immeadiate situation (not 2-3 days later). Any ideas ot thoughts that might be in focus?

Warn: (0%)

[Stitchie]

I've read this book -- just finished it, and find some of the conclusions very insightful. It's a worldwide problem, and part of the problem is that nurses are invested with heavy responsibility with little authority.

Yes, it is important to realize that family members are put in difficult positions and we have to be sensitive to that, but there are family members/patients who just cross the line.

"Customer service" is a ploy to increase numbers of bodies in beds while overworking nurses. When we have 4 or 5 or 6 or 8 sick patients, do we really have time to do more than the basics? How many of us have been told to "keep your patients alive through the night" and let the rest fend for themselves?

Nurses have a strong voice in the healthcare community -- and letting management know that abuse will not be tolerated -- zero tolerance -- may be a drastic step to take. It's time to use that voice! We owe it to our patients and our ancillary staff to take a stand against 'management' who only want to increase the bottom dollar and their fat bonuses at the end of the year. Maybe a few inquiries from the local PD and the thought of nurses getting tough on being placed in dangerous situations without protection just may get their attention -- after all, if you can hit them in the wallet (bonus) that's where it hurts the most for those administrators in their ivory towers.

[nosnow1]

Why does a patient's family believe that we are to be in the room 24/7? If I could I certainly would, but we all know in the hospital setting that kind of care just can't happen and probably won't. I had a situation occur, and I was assured by the more experienced nurses that I handled the situation correctly, and did what was required, but I still am very upset...so upset I questioned whether I chose the right career (yes I am a new nurse..just shy of 3 months). I am sick and still crying over the way the family spoke and made me feel incompetent. I know there is no right answer and thank you for letting me vent, maybe by doing so I can and will have a better day today.

[Katie82, RN]

Hey CseMgr1, you must have inherited some of my old patients when I moved...... I will not tolerate that kind of behavior from those kind of folks, and I have experienced a lot of it. I have always been lucky in that I have had employers who backed me up on this. I work very hard for my patients, and their sense of entitlement astounds me sometimes. Case management is a valuable service and I have enough people who need it so that I will not waste my time on someone who seeks to abuse me. Let patient's son try to navigate the system alone and he'll realize how valuable you are.