Verbal abuse ... what are my rights?

[KHT]

So, I work in a facility where it's not uncommon to have patients who are confused and aggressive - out of psych issues or other diagnoses where aggression is an expected stage of their disease process. Sometimes, they're cranky or aggressive because they're seekers and you're not getting them their much needed "pain" med.

However, this latest patient is a whole new ballgame for many of us on the unit. Quadriplegic - so completely dependent for all activities of daily care. BUT, he is verbally abusive ... you F'n nurse, hurry your F'n ass in here when I call, F you! (racial slur here and there), and he goes on for 45 minutes that he eats up of your time "fixing" his position because he dictates every minute detail. I'm at a loss as to how to deal with this .. if it's coming from a confused patient, that's one thing but this is draining when it is coming from someone who is completely oriented and knows exactly what he is doing! 45 minutes each time repositioning is required is also a problem because it takes me away from my other patients who can go downhill very quickly but I wouldn't know it.

The charges, nurse manager, supervisors, head nursing office, all know about this patient because he calls them incessantly when things don't go his way. BUT he is allowed to continue this behavior. I'm dreading the next time I go in and find that I'm assigned to him!

[JKL33]

This patient doesn't have any TBI or right brain additional neurologic injury that could explain any of this? Perhaps contributing to the reason that 1) he does this and 2) it almost sounds like he can't help reverting back to it?

I'm trying to think...I just can't recall many (if any) situations where the patient was perfectly fine cognitively and did this kind of thing. At the very least he's fried some social and verbal filters ()

I promise I'm not so much of a bleeding heart that I make excuses for anything and everything any patient does. This just doesn't completely sound like he's in control...and somehow for me personally that usually makes things a little more tolerable.

I hope you have the support and backing of your NM and others; I know it can't be pleasant. I hope limit-setting is allowed.

I actually think something akin to an old-fashioned care plan is in order. Or perhaps your EMR has an appropriate one built-in somewhere that can be activated and customized. That will keep everyone on the same page, help maintain his safety, define reasonable effort to be applied toward making him as comfortable as possible, and help define/identify therapeutic interventions that may be appropriate related to his behavior.

Hopefully our peers from neuro and psych will weigh in!

(hugs)

[Beth1978]

The verbal abuse and racial slurs are unacceptable. The staffs' response can and should be care planned, along with a contract drawn up, perhaps by a social worker.

One of my instructors in school used several days of class time putting all class members into various situations that mimicked being dependent on others for care. Blindfolds for some, noise-cancelling headphones, arms and legs immobilized, etc. It was a very fruitful few days.

Every one of the quadriplegic patients I have cared for have been very time-consuming, probably due to the fact that there is so little in their control.

[Sour Lemon]

Document document document. Point blank tell him that his language/behavior is not appropriate and you will not tolerate it and that you will return when he has a more appropriate attitude and then walk out. Document word for word what was said. Go back in a little while later to check on him and be nice but firm. If he is still acting like that, repeat again and walk out. Continue doing this. Either he will figure it out and stop or you will only have to spend about 5 minutes with him each time instead of 45 before you walk out.

That's pretty close to what I do. I tell them their behavior/tone/language is not appropriate and that I will be leaving if it persists. The only "extra" I throw in is, "I'll be back to check on you in 10-15 minutes." I do NOT return before the minimum amount of time has passed, no matter how many times they call or what they say or threaten to do. I suppose I'd have to break my own rule if they called complaining of chest pain, but nothing like that has happened just yet.

Every time I return it's with a clean slate and a cooperative attitude. The ball is back in their court.

[Been there,done that, ASN, RN]

The patient has developed borderline personality disorder. It is a psych issue, however, it is a no win situation. It's now in the hands of the attending and administration. They know what's going on. He needs to be turfed and flagged as "do not admit".

In the meantime, have a witness in the room while you give care.

[TriciaJ, RN]

This guy has absolutely no control over anything in his life and he hates it. The only thing he can work independently is his mouth and it makes him feel powerful to see the reaction he can get out of people. Try to remember it's just verbiage and he can't exactly back it up with anything.

Try to give him control over as much as possible "Do you want to start with the soup or eat dessert first?" but do tell him he's not helping himself with the attitude. Good advice to leave the room every time the abuse gets cranked up. If he has any moments of acting human, try to use the opportunity to develop rapport. He wants to feel like a person even though he's going about it the absolute wrong way.

Good luck.

[mejsp]

I am sorry you are living this nightmare. I have no solutions, but love imagining the individual who could walk in as say, "Knock it off." Who would he listen to?

My psych experience is minimal, but I remember a physician telling me this. I was excusing a patient's behavior because of their bipolar diagnosis. The physician said, "That's not bipolar. He's being an a**hole." I hope your patient takes his business elsewhere. This is one where you exclaim, "Thank you Jesus!" when you hear he's been discharged.

[Wuzzie]

If he called me a "f'n nurse" I think I would have been inclined to say to him "I'm sorry, my name isn't F'n Nurse. I'll go find F'n Nurse for you." I'd leave for a short period of time and ignore his yelling/call light. Then I'd go back in all apologetic about not being able to find "F'n Nurse" and that he would have to settle for me. Rinse and repeat.

[Workitinurfava, BSN, RN]

Money is the bottom line. What a shame.

[OyWithThePoodles, RN]

That was what I loved about the hospital I worked at. The surgeons on our floor backed their nurses and would shut down verbal abuse of any kind quick. They would let the patient know that it was unacceptable and if it continued they would be discharged.

I feel for this guy, he has no control over anything. BUT you can be frustrated without being degrading. Racial slurs. Nope. I would refuse the patient. You shouldn't have to endure that.

Document.

[FolksBtrippin, BSN, RN]

This behavior is common in quads. Not to insult the many kind and good quads everywhere, but it is common maladaptive coping. Its about control.

He wants control because he feels he has none. He is not coping well with his dependence on you.

The best way to respond is to not react emotionally and show total control over yourself.There are certain things you have to do for him no matter how he acts. Just do them, in the order you decide, in the manner you decide, at the time you decide, unless he refuses care. Don't respond to the abuse. Pretend it's the sound of someone else's cell phone-- possibly annoying but not your problem.

Example:

Him: "You ****** dog! I told tou to get your fat *** in here 10 minutes ago!

You: I'm turning you to your left.

Him: don't you touch me you *****!

You: I'll be back in 2 hours to try again.

(Document refusal of care.)

2 hours later.

You: I'm here to turn you to your left.

Him: b*****! You ******! You should have done that before!

You: (Turn the patient. No need to speak. Don't explain yourself.)

Him: I'll report you to the Board! You ****!

You: (finish your duties and leave. Nothing deserves a response.)

Just keep doing it that way, with no expectation that he'll change his behavior. You don't actually need him tp change his behavior and that is where your power is.

[Ruby Vee, BSN]

Yes, acute care.

If he's in acute care, you might be able to get his physician to have a little chat with him. They aren't trained as social workers, but often patients (especially verbally abusive male patients) respect them more. If his physician is female, it might not work as well, but it's still worth a try.

[Here.I.Stand, BSN, RN]

Behavioral contract.