Saw a nurse yelling at a patient in ICU

[inspiredbynavy]

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?

[ComeTogether, LPN]

You really would have had to hear the words spoken. Often times I'll get to know a patient really well and can be heard joking, laughing even playfully yelling depending on the situation.... I've been know to crab or "yell" when a patient gets out of bed without help, too. Not in a bad way but like "Mr. Jones!! You're going to fall!" Anyways, you really have no way of knowing what was going on and especially you not being part of the nursing team I would just leave it alone.

[xoemmylouox, ASN, RN]

Shoot I yelled at my dad while he was in the ICU- he kept trying to take his ET tube out when he first woke up all confused.

[runsalot]

I work on a Nero ICU=. Confused sometimes combative patients. We use our outside voice inside.

[CT Pixie, BSN, RN]

I wasn't a nurse at the time but something similiar happened to me as a CNA but I wasn't the observer, I was the observed and could have lost my job and my CNA cert from the State as well as possibly being brought up on charges all because of what someone deemed as 'inapproporiate and abusive behavior'

We had student CNA's in house. One in partiuclar went to her instructor who then went to my supervisor demanding something be done about my 'behavior' and 'abuse' of a patient. The student had told her instructor she had heard me yelling/screaming serveral times from down the hall at a resident 'I said sit down...DOWN..... DOWN, you CLOWN!!"

Yes, those words came out of my mouth and yes in a much louder than normal volume. Now the back story. My resident was VERY HOH but a sweet, sweet man. I was in the processed of transferring him from bed to his w/c. When he was close enough and it was safe to, I said, ok, you can sit down. He asked me to repeat it and again I said, you can sit down. He laughed and said, I can't frown? I'm not frowning. I laughed and said, no, I said sit down. This went on several times. He then thought I said to him, you're a clown. Until I brought my voice level up a few notches..I said sit , DOWN, DOWN, not your a CLOWN. Both the resident and I got a laugh out of this.

The student heard 90% of what was said, and had no idea of the context or why i was yelling. Thankfully, my super knew this patient well, knew me well and knew that the student was probably mistaken or didn't hear the whole thing. The student said "I know what I heard" and marched down to the residents room.

You could hear her ask, "did Pixie call you a clown?", Joe: what?, Student: Did Pixie call you a clown?, Joe: Did Pixie say what? Student: YOU'RE a CLOWN!

Ahh, see you're yelling and calling him a clown too! :)

[Ruby Vee, BSN]

I realize some patients may be hard of hearing, but you could just tell by the TONE of her voice that it wasn't just her trying to talk to a patient that was hard of hearing. I did not hear the exact words she had said. I felt like it wasn't my business at the time. Like I said, I'm fairly new to being in a hospital. This is a completely new environment to me. And what I meant by my metaphor of a "decaying stench in the ICU" was that it kind of smelled different than other parts of the hospital (definitely not in a good way either), and then I realized that there were patients dying there as well. Probably not the prettiest choice of words, but that was what depicted my mood at the time.

You made a conscious effort NOT to hear the words because you felt that "it wasn't your business at the time." Yet in the interim, you've decided that not only IS it your business, but what was going on was wrong.

If you didn't hear what was said, you don't know what was going on. Enough said.

[Ruby Vee, BSN]

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.

Like the non-accusatory way you brought up the whole topic? No one skipped the fact that you said you're new to the hospital environment or that you're learning. What I think most of us focused on was the negative way you presented the entire situation, complete with a negative (and colorful) description of the smells in the ICU. If you want nonaccusatory, insightful responses, you're going to have to ask your questions in a non-accusatory and non-inflammatory way.

[Altra, BSN, RN]

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.

Then apparently you've never been in a situation in which there was physical danger present now: a patient who was going to yank out his ETT now; a patient or visitor who was physically harming another individual now; nor a patient found to be in immediate life-threatening distress now.

[Esme12, ASN, BSN, RN]

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.

This nurse was probably NOT yelling out of frustration. This is a perfect example of the "Mommy voice" necessary when someone is in full panic mode, out of control, confused....frightened....hysterical. It is that no nonsense tone that snaps them back to reality....in psych it's that show of force...authority.

[Been there,done that, ASN, RN]

Ditto to above.. I have had to "yell" several times to get my HOH pt to hear me. Mix HOH with dementia and you have a hell of a shift...OP, try to say "lay down", or "lets get back in bed", or "don't pull on that" in a loud voice and tell me how that sounds to you..

Apparently it should be "please don't pull on that".

[Hygiene Queen]

Apparently it should be "please don't pull on that".

And don't forget to say "thank you" when the pt instantly stops trying to kill himself, and then (with a twinkle in your eye and big happy grin) say, "Gee, Mr. Jerk! That suuuuuuure was a close call! Can I bring you some coffee? Fluff your pillow? I got da time!"

[Sun0408, ASN, RN]

And don't forget to say "thank you" when the pt instantly stops trying to kill himself, and then (with a twinkle in your eye and big happy grin) say, "Gee, Mr. Jerk! That suuuuuuure was a close call! I can I bring you some coffee? Fluff your pillow? I got da time!"

Ain't no body got time for that :)

famous words of Sweet Brown !!!

[sallyrnrrt, ADN, RN]

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.[/quote

we made an assessment via the SUBJECTIVE, communication you gave us, it was you that questioned the ethical communication, and enhancing stress levels, paralleled with your melodramatic decaying stench......comments from a "pre nursing student", doing volunteer work. basicly you were in a foreign country, and didnt speak the language well.....by this i mean, because you have not yet been exposed to the migration of a client, on their continum of wellness in a critical care environment, the technologies, assessment, and literal life saving critical thinking process it takes to keep said client on this side if the ground, if possible.........because you did not know what was going on, and right now do not posess the educational experiences to understand it, your preceptions could have been guided by speculation.......and you come to a nursing blog, of which you presented your observation ....... those of us possessing the education, work experiences, and literally have worked in critical care decades, were trying to give you reality orrientation, explanations............just my personal humble, albeit limitted 41years of professional nursing experience....got a bit taken back by it..you are asking real nurses, and so far have been given REAL ANSWERS