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!

[Kooky Korky, BSN, RN]

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.

OP is not whining. She understands all the severe losses this pt has endured and is enduring and will continue to endure. She doesn't need to get over herself. She just needs the pt to know that it is not acceptable to maltreat others just because he has a horrible situation. Not only is it not ok to be ugly to other people, but being ugly makes his situation many times worse because it drives people away from him.

It's hard to see that you apparently do not grasp this fact.

[missmollie, ADN, BSN, RN]

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.

He's a quad. He can't knock anything around.

[Wuzzie]

He's a quad. He can't knock anything around.

missmollie I really admire you for taking care of these difficult patients and you have certainly given us food for thought. I have a question though, would bringing in personal electronics for a patient's use cross some sort of boundary? In acute care I think it would but how about long term care?

[CapeCodMermaid, RN]

We have boundaries in LTC as well. No one should bring in or use personal belongings for a resident. We'd have to get the activities department involved.

[Wuzzie]

We have boundaries in LTC as well. No one should bring in or use personal belongings for a resident. We'd have to get the activities department involved.

I thought so. These kind of things seem to foster staff splitting as well.

[Kooky Korky, BSN, RN]

He's a quad. He can't knock anything around.

He might have some ability to do so.

[maxthecat]

I wonder if it would help if you got a Psych Clinical Nurse Specialist to come work with this gentleman on a daily basis for a while. They are experts at letting clients vent and progress to working with the emotional issues and trauma, yet insisting on firm behavioral boundaries with clients toward them and toward other staff who work with clients. This might work or it might not, but it's another avenue to explore.

[missmollie, ADN, BSN, RN]

missmollie I really admire you for taking care of these difficult patients and you have certainly given us food for thought. I have a question though, would bringing in personal electronics for a patient's use cross some sort of boundary? In acute care I think it would but how about long term care?

I don't think so. I often use my cell phone to play music for patients during baths, I've watched depressed patient's perk up when being able to watch movies of their choosing using my ipad. I work in progressive care which means the majority of our brain and spinal patients are there for a while. You're either doing great and in acute care, or poorly and in ICU. If the patient is on progressive care, they have a long road ahead of them. Little things like this add value to their stay, even if the hospital doesn't provide it. I also accept full responsibility that the electronic may get broken or stolen, and I am okay with that.

I believe it's a personal decision, but this is also how I was raised. I never considered if it was crossing boundaries, and I will have to think about this before deciding if I will change what I do. Often family will not be present, and these patients are so alone.

I would love to see the hospital provide the ability to check out electronics that can be voice controlled, but with budget restraints I don't see that happening. You've given me something to consider.

[Here.I.Stand, BSN, RN]

He might have some ability to do so.

Yup. It's called a SCI at C5-C8.

[Here.I.Stand, BSN, RN]

I would love to see the hospital provide the ability to check out electronics that can be voice controlled, but with budget restraints I don't see that happening. You've given me something to consider.

This is something I can absolutely get behind!

[kp2016]

You should start with a formal complaint to your manager cc HR re the racial slurs. This is a form of discrimination which is a federal offense. Your employee is legally required to protect you.

This patient is out of control and it is the place of management to have a meeting with him to set reasonable boundaries. Once your formal written compliant for racial discrimination is on the table I have a feel management will be very interested in dealing with his behavior.

[oldenurselady]

What about a psych consult? Maybe push for psych NP or CNS to see him. Is his paralysis new onset or long standing? Does he have a family? They should be involved too if possible.

Before the days of "customer service," our manager went in to rooms of offensive patients and laid down the law about appropriate behavior. Most who received a visit, straightened out. We had one nurse file a police report about a vulgar speaking groper in his 40's. These days the manager and administration would probably discipline the nurse. Our manager's response was basically, "He wouldn't go to the mall and talk to people like that. Too bad for him." It is sad this man has lost much of his function, but it is not the fault of your staff.