Verbal abuse ... what are my rights?

Nurses General Nursing

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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!

Specializes in Geriatrics, Dialysis.

That's such a frustrating situation to be stuck in. At least since you are in an acute care setting you know that at some point this jackass will leave. We had one like that in LTC. Our administrator finally got so sick of the antics this person was evicted. It's not an easy thing to evict somebody from a SNF, took a month for the eviction process and even then we had to find a place that would take this resident. It took another month after we had the eviction notice to find alternate placement. Believe me there were plenty of times we would have loved to just roll the jerk out the front door and say goodbye. I always wondered how many lies we told the facility that ended up accepting this person. Must have been some whoppers seeing as to how they called us pretty regularly for a while asking for advice on how to handle this person's behaviors. Eventually the calls stopped, which then made me wonder if the person was transferred to yet another facility or if they died. I guarantee the calls didn't stop because the behavior stopped.

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Specializes in Flight, ER, Transport, ICU/Critical Care.
I'm not a nurse, but maybe a sock and duct tape would do the trick.

10/10 - would totally approve and do again!!

Buy the really good tape and use clean socks, after all we aren't monsters - right?

Kidding!

Anything that involves duct tape is prolly not going to be therapeutic. Tho I did see 3 rolls duct tape, a blue tarp and a shovel in my neighbors trunk earlier today - that can't be good.

:angel:

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Specializes in Neuroscience.
Wow, I think you should heed your own words.

The text speak as your last words for profanity is a really classy touch to support your point.,

Yes, he has a lot to be pissed about and is entitled to be angry , I get that but that doesn't give him carte blanche.

Does he have the right to spit, bite along with his verbal outbursts?

He needs help and you have offered some advice but belittling the original poster accomplishes what?

It's for anyone who feels that way. They really don't have the ability to do anything for themselves, and I think it's only fair that we remember that. No one likes to take care of a quadriplegic because they have so many wants and needs, but I think it's best to think how you would feel if you were them.

I care for so many of these patients, and How we treat this patient at this stage will set up how quickly he accepts reality. The OP has to consider how to treat this patient and not consider it an affront or abuse. She's not being abused, she is dealing with a patient who has nothing but his mouth in which to act out.

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Specializes in SICU, trauma, neuro.
This person has lost his ability to do anything for himself. If that were me, I'd be pissed. This isn't an issue of him lashing out at you, this is an issue of him coming to terms with his grief at his loss and inability to care for himself, and attempting to have some control.

he tells you to hurry up, that's what he would've done when he could use his legs

He tells you he needs it now, he'd get it if he could

He has an itch he literally can't scratch, it might be gone by the time you get in the room, but it was there, he can feel, and this is hell for him.

Every single quad I've had has asked me to kill them, and I work in neurosurgery so I see more than I'd like. Think about being so helpless that you can't even wipe yourself, pee on your own, bathe or scratch an itch. Imagine the hell of being poked, not able to move, but able to feel it.

Get over yourself. You have it so good, your patient does not. This is a stage of grief he has to work through. In my opinion, be glad he's not a clicker, and try to talk to him. Tell him how much time you have, and draw that line, but understand this is going to take some patience.

TLDR: Don't whine about having to use your legs and arms to help someone without that ability. ffs.

A couple of thoughts...1) he is entitled to *feel* however he wants, but not entitled to be abusive.

Would his behavior be excusable if he was spitting or biting or hitting? Of course not. 2) Plenty of people experience catastrophic injuries and manage not to verbally abuse people -- esp ones who are trying to HELP them. 3) The OP didn't cause his injury, so why is it ok to take his anger out on her? 4) The OP isn't his PDN -- she has other pts. This one does NOT have the right to infringe upon the others' nursing care. 45 minutes for every REPOSITIONING is monopolizing her time.

5) Not being abused?? Substitute the word "spouse" for "patient." If her "spouse" were saying "get your F'ing ass in here" and using RACIAL SLURS, would you be defending the behaviors? No? So why are you defending him and excusing his behaviors?

What if as a nurse you observe the pt treating his spouse like this... would you tell the spouse "He is angry about his loss of control -- don't complain because you can still use your arms and legs and HELP HIM... for F's sake."?? I hope not!! If I heard that advise coming from a professional, I would immediately report their sorry self. Using their alleged authority and alleged knowledge to encourage someone to put up with abuse of ANY kind is beyond unacceptable nursing practice.

But anyway, continuing #5) his BEHAVIOR is pretty clearly verbally abusive. Behavior -- not circumstance. Who the recipient of the behavior is, does not change WHAT the behavior is. It's verbal abuse and needs to be dealt with as such.

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Specializes in Case manager, float pool, and more.
A couple of thoughts...1) he is entitled to *feel* however he wants, but not entitled to be abusive.

his BEHAVIOR is pretty clearly verbally abusive. Behavior -- not circumstance. Who the recipient of the behavior is, does not change WHAT the behavior is. It's verbal abuse and needs to be dealt with as such.

Love this. I have dealt with similar before. This is just not acceptable behavior, period.That your management enables this behavior by not dealing with it is really sad.

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The OP has to consider how to treat this patient and not consider it an affront or abuse. She's not being abused, she is dealing with a patient who has nothing but his mouth in which to act out.

I think that's why she posted in the first place. She's trying to figure out how to handle it. I hope you noticed she spoke only of the behavior, not the person. That shows me she doesn't need to "get over herself". I don't much enjoy being called names but I've been at this gig for a long time and I'm not afraid to tell a patient to knock it off. They usually know I mean business. It takes awhile to get to that place. I'm not sure why you think he gets a pass with his behavior over other patients. He's an adult not a toddler and he knows better. Yes he's angry, but name calling and racial slurs are not acceptable under any circumstances. What he's doing absolutely fits the definition of verbal abuse. His provider has dropped the ball on this.

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Specializes in SICU, trauma, neuro.
I think that's why she posted in the first place. She's trying to figure out how to handle it. I hope you noticed she spoke only of the behavior, not the person. That shows me she doesn't need to "get over herself". I don't much enjoy being called names but I've been at this gig for a long time and I'm not afraid to tell a patient to knock it off. They usually know I mean business. It takes awhile to get to that place. I'm not sure why you think he gets a pass with his behavior over other patients. He's an adult not a toddler and he knows better. Yes he's angry, but name calling and racial slurs are not acceptable under any circumstances. What he's doing absolutely fits the definition of verbal abuse. His provider has dropped the ball on this.

Excellent point. Excellent.

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Why do nurses feel they have to put up with verbal and physical abuse from patients, pts' families, and co-workers? Has anyone noticed our acceptance of these behaviors has only lead to increased and escalated violence towards nurses? I understand Pts and their families are stressed, scared, in pain, etc but stop making excuses some Pts are just a-holes. I agree with the other post that you need to be firm with the pt and tell him that he needs to be respectful and speak appropriately to the nurses. You treat pts respectfully and deserve the same treatment in return. I've used similar techniques when dealing with abusive Pts and had positive results. It has actually helped to foster a better nurse - pt relationship. I've even had Pts open up to me about why they are so angry. Showing respect for myself made the pt view me as more human with emotions they could relate to which, allowed the pt to communicate openly with me.

As nurses we aren't doing ourselves or others any good when we allow verbal and physical abuse. Not one of us would allow our children to behave this way. Yet sometime in the last 15 years this behavior has become more and more acceptable. Verbal abuse is not in my job description and I do not tolerate it from others. As nurses we are compassionate and caring for others but letting Pts behave inappropriately is not caring. I find it neglectful to let my pt continue behaving in this manner. Individuals lashing out at others are repressing their feelings. I'd rather educate my pt how to express their emotions in a positive way.

I hope your pt is being more courteous and you are able to begin a healthier nurse/pt relationship.

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Agreed!! She is completely being verbally abused. The patient is not a child just "acting out". And if my kids dared to "act out" in such a manner I would consider myself a neglectful mother who didn't teach them how to treat others or express themselves in a healthy way.

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I don't think the pt's behavior should be rewarded with the nurse's personal iPad. Then when he throws the next temper tantrum he can knock the iPad on the ground and break it.

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Specializes in SICU, trauma, neuro.
I don't think the pt's behavior should be rewarded with the nurse's personal iPad. Then when he throws the next temper tantrum he can knock the iPad on the ground and break it.

oh my goodness...I missed that suggestion!! Uh no...pts can watch the cable/satellite TV that the hospital provides. Providing my own devices to use sounds like a huge boundary violation....you can't provide extra amenities to select pts. Not to mention it could be a huge liability! For all you know, a depraved individual (such as one who uses racial slurs :whistling: ) could open up the device's camera, take a member pic and make a livelihood-ending allegation. And that nurse's phone would indeed have a member pic on it! Obviously a quad wouldn't be doing this, but a PO'ed-at-the-world para or amputee could.

Now YouTube on an in-room computer could be a option. I have done this myself -- pulled up playlists of a pt's favorite musical genre. Our spiritual care dept also provides CD players and CDs to pts.

Of course it should go without saying that these ideas can help fix boredom, or can fix the overstimulation from hospital noise. It won't fix abuse.

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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.

He went off on the doctors ... demanded this and that for his medications and at what time, etc. and they accommodated every single one of his requests.

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