Saw a nurse yelling at a patient in ICU

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So today was my first day volunteering at the hospital and I was walking in the ICU when I hear a nurse yelling at a patient. Just the tone and volume of her voice made the already decaying stench in the ICU palpable. This is more of an ethical topic rather than patient safety but I think it could play in the patient's stress levels.

I'm a pre-nursing student and I'm not aware of the whereabouts on ethics for nurses and hospitals yet. Do nurses have ANY rights to EVER yell at a patient, especially one in the ICU?

Specializes in Emergency Room, Trauma ICU.

When I was in the Trauma ICU we had combative head injury pts who we had to speak sternly to because they kept trying to get out of bed, pull their IVs, hit people, etc. You have no idea what was going on, the nurse could have been "yelling" at him not to pull out his breathing tube! Don't throw stones when you have no idea what is actually going on. And as for the decaying smell, that's people you're talking about. Maybe you think about that before condemning a nurse on something you think you heard.

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Yelling is subjective. And tone is as well. If you were just sort of walking by, hard to get a grasp on what was happening.

A stern "stop pulling at that" (meaning one's foley,IV, mask, NG tube....fill in the blank) is far better than having to restrain a patient with either mechanical or chemical restraint. And a nurse usually has to try other methods first.

And trying to have effective communication witih all kinds of machines humming and beeping and what not is difficult at best. Also, to assess response to pain, especially in a patient that has an altered level of conciousness, one needs to be sure that they are or are not responding to verbal stimulli--and a soft tone of voice doesn't cut it. I would want the nurse to YELL if they had to--we are talking about patient awareness or lack thereof here, Which is my understanding VERY important with ICU patients.

ICU is a critical care specialty. That takes more than a passing glance to master. Things may seem different there, because they ARE. We are talking life and death.....keep on machines or take off, does the patient feel pain? Is the patient aware of what is going on?

These are things you will begin to scratch the surface of when you are a nursing student. Until then, know that there are many, many assessment modalities that require an altered level of speech. That the ICU deals with people being kept alive by machinery. That the end result is going to be either a return to some level of function or death. And a death outright or organ donation which opens up a whole different set of circumstances. An ICU nurse has a tremendous assessment responsiblity.

And as a complete aside, you will find that the various smells that you encounter are not exclusive to the ICU.

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I never said this nurse was in the wrong for yelling, nor did I ever "condemn" her for it. I think many of you might have skipped the fact that I said I'm new to the hospital environment and I'm learning. This is what students do, they ask questions. I've learned a lot from everyone's response, and I really appreciate those who actually gave an insightful response without accusing me.

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Specializes in Critical Care.

It sounds like the ICU is not a good place for you. As a pre-nursing student I encourage you to not be so naive to the realities of nursing if that is what you aspire to become in the future. Very often nurses have to yell at confused or just plain combative patients so that the patient does not harm themselves. Some patients simply do not respond to asking nicely. Have you ever heard a patient yelling at a nurse? Or seen one kick and severely hurt a nurse? These situations are reality and the difference between you and that nurse is that she IS a nurse. You cannot judge the situation whatsoever because you are in no way a qualified professional.

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Specializes in ED.

There are times that I might yell for a hard of hearing patient who forgot to bring their hearing aids in that day, and on some rare occasions I do yell at a patient who needs immediate redirection (hurting themselves or about to hurt me). In general though I do not yell at my patients, and take special care with the psych patients especially being in the VA because of all the PTSD and having them just escalate to the point of needing police involvement. I also use plain English, no cursing, and normally its while giving them one or two options of the behavior I want seen except for the one who had grabbed me, was out of her skull, and I was just trying to startler her long enough for staff to come running.

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Specializes in ICU/CCU, PICU.
I never said this nurse was in the wrong for yelling, nor did I ever "condemn" her for it. I think many of you might have skipped the fact that I said I'm new to the hospital environment and I'm learning.

No but you said it's an ethical topic which is stating the nurse is being morally wrong.

Anyway, I am one of those person who if I speak loader my "tone" gets meaner. My husband tells me that but I can't seem to change it.

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Keep in mind that some (not all) patients are in the hospital because they aren't being compliant with their treatments, and nurses tend to see the same patients over and over, and sometimes they just won't listen, and have a bad attitude about everything. OR the patient is putting themselves by not listening to the nurses. I'm not really a yeller, but I think it could help some patients to realize how serious the situation is, and how important it is to heed the advice of their caregivers. Sometimes, you just gotta get on their level.

All that said, it's impossible to know whether this particular nurse's behavior was "right" or "wrong" without any sort of context, but I can tell you a story about a nurse yelling at a patient when it was both necessary and effective.

I was precepting in an ICU, and we got a transfer from OB, who was being brought in due to acute respiratory failure...when they wheeled her in, she was yelling (as best she could for someone in respiratory failure) and carrying on about everything, and thrasing around. When she got into her room, she kept trying to push and kick everyone away, and she was ripping off her oxygen mask. Her sats were high 80s with the mask, and as soon as she'd take it off they would drop down to the 60s...she was scaring everyone. She was panting, saying she wasn't about to stay in that ICU, we needed to get away from her, and she was leaving the hospital. The nurse I was with got in her face and started yelling. The first thing she did was ask the patient if she wanted to die, and when the patient said no, she (still yelling) told that woman that if she didn't want to die, she needed to get herself together, keep her oxygen on, and listen to the people around her, because they knew how to help her. She also told her that she had a newborn daughter upstairs that was depending on her. After that, this patient listened to everything we said, and ended up being pretty pleasant. We had this patient several more times and she was very grateful for her care, and didn't hold the way the nurse spoke to her initially against anyone.

It is definitely not always okay to yell, but in certain situations, you have to get your point across, and fast. Had this nurse not spoken to this patient in a way she understood, things could have gotten really bad for her.

Also, I want to say that this nurse I was with was a WONDERFUL, compassionate, caring person, and was normally very gentle and patient. But I was pretty impressed with how she handled that situation.

I guess it's my opinion that it's not okay to yell out of frustration. But, sometimes, you gotta get real and make a patient REALLY hear what you're saying.

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Specializes in ICU, Geriatrics, Float Pool.

Have you ever tried to convince a confused patient to please stop trying to smack you across the face as you try to get her onto a level surface so she won't fall over and injure herself? That happens regularly in the hospital and sometimes you have to raise your voice because confused, agitated patients aren't going to listen to your polite request as they try to punch you in the face.

Not saying this was the situation but in ICU I've had patients try to yank out their lines, ET tubes, etc. and I have raised my voice to get their attention or distract them as I try to make sure they don't injure themselves.

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When I talk louder, I drop my tone becuse that's easier for them to hear. If I spoke high pitch, they still would t hear me.

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Specializes in Med/Surg, Academics.

Like others have said, you have to define yelling in context. However...

...there are very, very few situations in which true yelling would be acceptable. Very few, and I have yet to see a situation in which it *was* acceptable.

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Specializes in ICU.
Keep in mind that some (not all) patients are in the hospital because they aren't being compliant with their treatments, and nurses tend to see the same patients over and over, and sometimes they just won't listen, and have a bad attitude about everything. OR the patient is putting themselves by not listening to the nurses. I'm not really a yeller, but I think it could help some patients to realize how serious the situation is, and how important it is to heed the advice of their caregivers. Sometimes, you just gotta get on their level.

All that said, it's impossible to know whether this particular nurse's behavior was "right" or "wrong" without any sort of context, but I can tell you a story about a nurse yelling at a patient when it was both necessary and effective.

I was precepting in an ICU, and we got a transfer from OB, who was being brought in due to acute respiratory failure...when they wheeled her in, she was yelling (as best she could for someone in respiratory failure) and carrying on about everything, and thrasing around. When she got into her room, she kept trying to push and kick everyone away, and she was ripping off her oxygen mask. Her sats were high 80s with the mask, and as soon as she'd take it off they would drop down to the 60s...she was scaring everyone. She was panting, saying she wasn't about to stay in that ICU, we needed to get away from her, and she was leaving the hospital. The nurse I was with got in her face and started yelling. The first thing she did was ask the patient if she wanted to die, and when the patient said no, she (still yelling) told that woman that if she didn't want to die, she needed to get herself together, keep her oxygen on, and listen to the people around her, because they knew how to help her. She also told her that she had a newborn daughter upstairs that was depending on her. After that, this patient listened to everything we said, and ended up being pretty pleasant. We had this patient several more times and she was very grateful for her care, and didn't hold the way the nurse spoke to her initially against anyone.

It is definitely not always okay to yell, but in certain situations, you have to get your point across, and fast. Had this nurse not spoken to this patient in a way she understood, things could have gotten really bad for her.

Also, I want to say that this nurse I was with was a WONDERFUL, compassionate, caring person, and was normally very gentle and patient. But I was pretty impressed with how she handled that situation.

I guess it's my opinion that it's not okay to yell out of frustration. But, sometimes, you gotta get real and make a patient REALLY hear what you're saying.

I had an almost identical situation happen. Only that was the first night. The second night I had her we realized that her central line was irritating her heart, and explained she could not lay all the way over on one particular side. And she would do it anyways because she was mad, I'd hear her monitor go off because she was in v-tach. The second time it happened I told her to roll onto her back and she smiled at me and rolled even further onto her side. I assisted her onto her back and yelled at her. She easily could have caused herself to code. I had no more problems with her after that. I don't think she realized how serious it was until I yelled at her.

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Specializes in Acute Care - Adult, Med Surg, Neuro.

The only time I have yelled is when a confused patient grabbed me by the neck of my scrub shirt. I loudly said "NO!" and many of my co-workers came rushing in to help me. I also raise my voice to hard of hearing patients. I have also yelled "STOP!" a few times while rushing into a room with a confused patient trying to climb out of bed, or in one instance a patient unpacking a surgical dressing with their fingers.

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