Solutions for Belligerent Patients

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Specializes in ED.

This is not an uncommon topic in the world of ED nursing, but I think it's an important one. I was curious as to how other nurses and facilities deal with the issue. I had another extreme reminder of this issue the other day. I was putting an IV in an unresponsive infant when EMS brought a mother in with her kid. According to EMS, the kid had a hand abrasion. Since I was busy and there were no open beds, I asked them to bring to kid to triage. There weren't even any kids in the WR ahead of her so she literally would have been the next one called. However, the mother pitched a fit and said, and I'm paraphrasing of course, "I'm not going to no f$#**!@ waiting room! I came in the ambulance! I get to be seen right away!" She literally refused to leave, continued to yell and curse in the middle of our children's ED and demanded to be seen immediately. Of course this is not a new scenerio, in fact, it's a typical one. However, I still think this is completely unaccepable. Legally we can't throw anyone out and now, with customer service gone mad, most hospitals expect nurses to cater to abusive patients and family members. I don't think it's fair or safe to have a non-urgent patient seen before other patients simply because they make the biggest fuss. Is there any real solution?

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Specializes in ER, pedsER, SICU, Trauma.

Do you have patient advocates? I think I am spoiled at my really massive ED but we have 24 hour pt. reps that are amazing at calming situations like this. Obviously, we don't just dump our problems on them but if I was working with a another sick kid they could try to redirect and calm the angry mother. Sometimes you just have to put your business face on and tell her she is going to have to wait. It is really hard to quickly explain our theories and evidence based priorities to someone who 1. has no idea about the nursing/medical field and 2. also has a sick kid. She is not thinking about anything else. That's a tough call but since I'm not sure how many resources you have at your ER its hard to say. We also have an annual class about decreasing workplace violence/belligerence. It helps a bit.

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Specializes in school nursing, ortho, trauma.

I find that lowering my tone and telling it like it is (pollitely of course) is usually helpful. bfp1987 does make a good point - mom's worried about her child and really doesn't care if there is a mass casualty coming in the door - she wants results and wants them now.

"Ma'am, I understand that your child is injured. We have no open rooms - one should be opening shortly. Cursing at me (threatening me, getting loud etc) will not change that situation."

If they continue to act beligerent call security.

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Specializes in Emergency, CCU, SNF.

Duct tape and restraints?

It really is difficult to explain triage to someone who is worried, anxious or screaming at you. Explaining that an EMS ride doesn't mean you get seen right away falls on deaf ears....and everyone has just wasted valuable time dealing with the irate "customer".

I found the best way for me to explain things was being calm, matter of fact and learning to just step away. Didn't always work though...lol! Sometimes another nurse or ED colleague may have better luck with that individual. Then of course there is always security as a last resort.

Really no good answer, sometimes you just gotta wing it and hope for the best.

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Specializes in Critical Care.

Mom needs Haldol, benadryl and Ativan IM with the biggest needle I can find....just make sure to catch the kid when mom passed out of course!

- Just kidding.....

From my EMS background people have a severe misunderstanding and they believe that just because they arrive via an ambulance that they get to be seen first...WRONG! Many time i have had BS patients who can go to triage and I tell the nurse when I get there (depending on the census) that they can go to triage because they are busy. Most of the PTs ask why am I going to triage and I simply tell them that their injury (altho it may hurt) is not life threatening and that the there are more seriously sick patient back their who need to be treated first. This abuse of the 911 system has been going on for only god knows how long and it's ridiculous. Quite frankly if they don't like it then they can call my chief and complain but ya know what a hard dose of reality is sometimes hard to swallow, so next time don't call my ambulance for BS and just drive yourself. It's funny cuz the people who need an ambulance (CP/SOB etc) are the ones who drive to the ER and the ones who don't need it are the ones that call 911. Maybe Im the stupid one but doesn't this logic seem a bit flawed?

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Specializes in Oncology/Haemetology/HIV.

Aerosolized ativan and a valium salt lick???

It is one thing for a parent to get upset when their child is seriously hurt, but it sounds like this was a simple hand abrasion.

Explain the triage procedure to her calmly, by nurse, and reiterate it w/ a supervisor present. Have a pt rep try to calm her. But if that does not work.

If this was a simple abrasion with minimal bleeding, there is no acceptable excuse for this behavior. Explain that if she cannot control herself, as it is not an emergency, care will have to wait until she is able to control herself. And you will be happy to have security remove her if she is unable to control herself at all. And have your largest security officer standing at your side. DFACs can come and help with her child, as she as so obviously unable to handle the stress.

If it was a simple hand abrasion, it can wait until the "real" emergencies are handled.

(It would be nice to know how this child's abrasion occurred, why it merited a an EMS run, who's "real" emergency care was delayed by EMS having to bring in a simple abrasion case, and whether Mom is paying for EMS out of her pocket /what her insurance will cover)

Of course that is easy for me to say, as I currently work for an employer that would not kowtow to that behavior, and most nurses do not have that security. But the bad part is that when facilities/staff cater to that behavior, it merely encourages worse behavior. And it is also teaching the child/other patients that the way to rapid care is to behave badly.

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Specializes in ER.

The CHILD has to have a medical evaluation, but Mom certainly can be turned away, or sent to the WR, until she composes herself. If she chooses to bring the child with her, it's not on you.

Also important is that the medical evaluation doesn't have to take place within a particular time frame.

In this situation though, I would explain that everyone has to be triaged, and right now the only seat to be had is in the actual triage booth, if she would come along. Otherwise, was she refusing care? If so she has to leave the premises, and we could call a taxi, security or police in that order to help her on her way.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Security.

No matter what, there is still an acceptable modicum of behavior. When they are not in control of themselves, the belligerent (unnecessarily belligerent of course) need their own version of time out.

Give them a warning, and then simply call security.

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Specializes in Hospital Education Coordinator.

Instead of calling it triage, call it "Priority care" and explain that one of the most experienced nurses is to assess which MD to call first, or some BS like that.

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Specializes in LTC Family Practice.

LOL @ the Valium Salt Lick and Duct Tape solutions...gave me a great chuckle.

That aside, saftey first - your saftey, call security and let them 'splain, if that doesn't work I'd go with both the Valium Salt Lick and the Duct Tape:lol2:

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Specializes in home health, dialysis, others.

A few months ago, my step-father took very ill on vacation in a foreign county. We called for an ambulance, but they sent out a DOCTOR to our hotel to determine if the ambulance was warranted. Wow! Imagine that! No ambulance if it is not needed! (It was, and he went)

Why was a child with an abrasion brought to the ER? Don't the EMTs do any triage? Or was the mom screaming so much they just gave up?

ALWAYS err on the side of YOUR safety first - call your manager and security.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Why was a child with an abrasion brought to the ER? Don't the EMTs do any triage? Or was the mom screaming so much they just gave up?

EMS can no more refuse to transport a patient than the ED can refuse to see/treat one. If someone insists on transport to the ED, it is provided. Some areas have started to charge a transport fee that can help decrease abuse of the 911 system, but that's not done everywhere.

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