Unruly Patients

[tmitch]

I am a pre-nursing student and I have browsing this website. (It's fantastic!) However, I came upon a thread regarding your most "icky" situations. I was mortified when I read about the old man who relieved his sexual byproduct on the face of a poor, unsuspecting young girl. Then I though to myself, 'what could you do to show an unacceptingly rude patient that you don't bite, or do anything else for that matter, the hand that "feeds" you?' Within ethical realms of course. My first instinct would be to grab the biggest Foley I could find.

If you have any stories reguarding sweet, subtle justice...please share.

[Tweety, BSN, RN]

During our Physch. rotation, we had a lot of lectures on "therapeutic communication" and it's a bit much to get into here. We even had role playing in class and had to film ourselves to critique how we were communicating.

Sometimes I wish that we could truly tell jackass patients what we really think of them. With very unruly patients I take a time out and leave the room. Rarely do I loose my composure, but it's the noncompliant ones I have trouble with. "If you don't want the treatment, I don't care, just let me know so I can move on to the next patient" has I'm afraid come out of my mouth. :)

[Stitchie]

I usually tell them the behavior is unacceptable or ask them why they are so angry (if they are being rude to me). But I work in an ER -- the rules can be a little different.

[Surgical Hrt RN]

3rdshiftguy said:

During our physch. Rotation, we had a lot of lectures on "Therapeutic communication" and it's a bit much to get into here. We even had role playing in class and had to film ourselves to critique how we were communicating.

Sometimes I wish that we could truly tell jackass patients what we really think of them. With very unruly patients I take a time out and leave the room. Rarely do I loose my composure, but it's the non-compliant ones I have trouble with. "If you don't want the treatment, I don't care, just let me know so I can move on to the next patient" has I'm afraid come out of my mouth. ?

Tweety,

Don't feel bad, I have uttered those same words!! It's enough to make you crazy if you let it! I had a young twenty something guy that had severe cardiomyopathy related to drug use. He needed a transplant but couldn't get one because of the history. So, of course, we evaluate him for an LVAD. (left ventricular assist device). He was being abusive to all the nurses. Swearing, throwing things, making degrading comments. He needed a foley, it was the doc's order since he was getting lasix round the clock! His BNP was > 3000!!

Anyway, he refused the foley, was being belligerent, and called the nurse before me a b**ch! So, I went in the room and told him...."Look, the doctor wants this foley put in, you consented to treatment, so we are doing this. No one is forcing you to stay, if you want I will get the AMA papers for you. The choice is yours, but I will not be treated this way. Either get with the program or go home. " I walked out of the room, gathered my supplies, came back, and he didn't speak to me for 4 hours, however, I did put the foley in! ?

[mattsmom81]

Gotta admit I've uttered the same words as Tweety and Hrt RN...personally I think nurses take too much abuse from everyone and this is why it propogates. We can't say it often or we'll become a 'problem employee'.

Also gotta admit I might feel tempted to bypass a few comfort measures for procedures for those really ugly abusive patients. They will always get basic care from me but to be honest, the extras will not be offered if they are rude and nasty to me. It's only human nature, IMO, we tire of the 'customer service at any cost' attitude and we should.

[kc ccurn]

Many times you have to set limits to their behavior. Sometimes my 2 year old behaves better than the patients. how many times have you removed their fingernails from your arm and tell them that it's not okay to pinch, swear, don't bite me....etc. If they don't change their behavior, tell them that you will be back when they choose to cooperate. If they don't want to cooperate, sometimes I will have the doc talk with them, or the family if possible. If not, well then, sedate/paralyze and intubate.....just kidding although we've all wanted to keep some pt's intubated until they are ready to go home :chuckle

[orrnlori, RN]

I took care of a drug dealer who had been kidnapped and tortured by another drug dealer over a period of several days. He'd been shot, stabbed, burned with battery acid and had lost one ear. He was real scum. He was horribly abusive to the nurses, particularly when it came time to do dressing changes. One night he was really really being abusive, called me a b**tch, cursing etc right before I was to do his dressing changes. I asked him had I ever disrespected him. He just looked at me. I then asked him if he understood that I had control over his pain medications and told him he needed to think about that. I left the room and collected my temper, realized I shouldn't have said it but still didn't feel bad I had, when I went back about 1/2 hour later and asked him if he was ready for his dressing changes, he said yes. I took care of him over the next few weeks and while he wasn't a pleasent person to deal with, he never did call me any further names or give me a hard time. We just tolerated each other.

This is my number one story why I never want to do bedside nursing again. While I'm not proud of what I said to him, it did solve the problem. I'm not real certain it was really a wrong solution in the long run. It worked for me. No one pays me enough to be verbally abused by a patient or a doctor.

[Brickman]

If I even think that a patient might give me a hard time I will laughingly make a statement to the effect that I get to choose what size needle will be used. So far has worked like a charm. And let me add that calling police on a patient that has been physicaly abusive is an option.

[gwenith, BSN, RN]

Why do we feel guilty for refusing to tke abuse???

I have lent over a patient and quietly said - "Life lesson - You get more bees with honey"

Some who are demanding "You! You can get me some ice for my jug!"

I have said "Please?"

"Huh"

"The word is please - and a thank-you would be appreciated too"

Most of the time this emabarrasses the person so there is no escalation of bad behaviour.

I think it comes down to limit setting. Right from get go refuse to take bad behaviour set the limits and make it clear they will get more being nice than nasty.

I have also used the blank stare for those unco-operative patients "refusal is your right - there is the door" but then I work in a "public" hospital in a universal health care system and we don't have to pander to the patient - they rapidly find out that if they complain about us after refusing treatment that the health tribunal is terribly unsympathetic and bringing a lawsuit is difficult. We still make sure we document well though.

[Ortho_RN]

3rdShiftGuy said:

During our Physch. rotation, we had a lot of lectures on "therapeutic communication" and it's a bit much to get into here. We even had role playing in class and had to film ourselves to critique how we were communicating.

Sometimes I wish that we could truly tell jackass patients what we really think of them. With very unruly patients I take a time out and leave the room. Rarely do I loose my composure, but it's the noncompliant ones I have trouble with. "If you don't want the treatment, I don't care, just let me know so I can move on to the next patient" has I'm afraid come out of my mouth. ?

UGH! We have one of those on our floor now.. In with a foot ulcer due to diabetes.. They are doing everything they can to try and save the foot, but this guy is soooooooooo uncompliant its not funny... He eats whatever he wants, regardless of the diet ordered.. Sugar jumps to 400+ wants his insulin then he eats like a pig again. The drs even wrote an order "do not allow any outside foods other than his prescribed diet".. Like we can stop it.. He ordered a pizza the other night and had it delivered to his room.. WOW!!! he goes outside to smoke, comes back in complaining that he needs pain meds.. I think the doctors should just go ahead and cut the foot off and stop wasting our (nurses) time... :angryfire

[USA987, MSN, RN, NP]

IV drug abuser in the ICU...kept holding his breath while watching his monitor...said he liked to see us b*&ches run into the room as his monitor alarmed....I gently reminded him of a little story called "The Boy Who Cried Wolf" and I shut off the monitor in his room and walked out (which really scared the crap out of him, not realizing we had a monitor at the nurses station!).

And now I am in Maternity. I try to turn everything back to the patient, reminding them patient safety is #1...and our goal is to have two healthy people leave the hospital TOGETHER. That usually shuts them up!

[Speculating]

3rdShiftGuy said:

Sometimes I wish that we could truly tell jackass patients what we really think of them. With very unruly patients I take a time out and leave the room. Rarely do I loose my composure, but it's the noncompliant ones I have trouble with. "If you don't want the treatment, I don't care, just let me know so I can move on to the next patient" has I'm afraid come out of my mouth. ?

Tweety, you haven't learned by now you can whisper anything you want into their ear as long as there's nobody around to hear you. Humor always works well too. I one of my pts. who keep disconnecting his chest tube by himself if I caught him again I was going to Taser him ? On my way home that night I was having a discussion with his MD in the elevator. There wa just the two of us so I don't want to hear any HIPAA stuff. This particular MD tells his pts. that are rude to their nurses that they need to be nicer to their nurses than anyone else. Because, these nurse are capable of withholding the pills they need to keep them alive or in fact not keep them alive. So, they need to be nicer to teir nurses than anyone else they know.