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!

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

I worked on an inpatient unit where more than half of the patients were like this, and management was apathetic to the bedside nurse's struggle to provide effective care with this added pressure. Every day was a nightmare, dreading the countdown leading upto our shifts and after our shifts dreading having to return.

Negative reinforcement helped these types of difficult types of patients to become compliant or at least marginally less combative.

I left that job, I'd suggest the same for you. In time, an environment like that will cause you to burnout... and you can't care for patients when you yourself become unwell. Look for employment elsewhere with better practice supports and nurse to patient ratios. It's your managements faukt for not trying to effectively address this.

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

@kookykorky Questionable, but... an aggressive quad patient can certainly bite and spit.

[Guest219794]

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 to change his behavior and that is where your power is.

In general, I agree with your approach. Not validating, not arguing. The OP has a job which is independent of the PTs behavior. Being offended is pointless, and a poor use of energy.

But, as far as this being a coping issue: Maybe. Also possible the guy is an a**hole. Plenty of people with four functioning extremities are, and having quadriplegia is no protection from this phenomenon.

Either way, it's not the nurse's problem.

I would continue to do my job, and document. Absolutely nothing wrong with giving him a bit of a time out, and document your reasons.

Basically, his current behavior get's him what he wants. As long as this is the case, the behavior won't change.

[Sunshine.nurse]

Sounds like he is pissed at the world for his paralysis and taking it out on everyone. I feel rather sorry for the staff that has to care for this person. However, shouting racial slurs and cussing at staff is unaccecptable. Management needs find another facility that will accept him (if he has not blown through all of them and they won't refuse to take him back), then call a family meeting and tell the family if he doesn't stop his abusive behavior, they will be forced to cut this guy a 30 day notice. The family should be able to get through to him. Where is the UM? It is part of their jobs to deal with these kinds of issues.

[mslove717]

I have had patients like this. Common mal-adaptive coping mechanism. They can't move - life sucks. They have lost control. By barking at you, they have some control back. It's totally a psych thing.

That said, abuse of nursing staff by patients is NEVER okay. They have the right to their anger, but they do not have the right to abuse others because of it. Lay it out to him, straight up tell him I am here to care for you, but you do not have the right to speak to me like this. I am leaving now (after making sure he is stable). And leave.

If he immediately yells, don't go back right away. Sometimes sending in someone else can help because they have to start a new cycle of control and it can be too much for them right then. It's a tag team effort all shift. One of the first times I dealt with this on a LTC unit, I sat at the nurses station charting as a pt yelled "NURSE" (with a CNA in there, they were fine, they just wanted to control me/making me hop/take up my time because I was new and she was testing waters). After she learned I was not going to be controlled by her, she got better with her verbal abuse and need to control.

When you're in the room, describe what you are doing, lay out a plan. When the verbal abuse starts you can say - no, you are not speaking to me like that. If it continues you say I am leaving now, you are stable and I will not be treated like this. You HAVE to be firm and let them know you are not the punching bag for their anger.

[MsQueensRN, LPN, LVN]

Happens all the time, at least your patient is immobile and cannot additionally throw things or attempt any physical harm. I have had many a patient like yours, and once it goes racial I absolutely refuse to provide care. Is there any possibility of arranging a behavioral contract with this individual? If they have a psych disorder then this is not an option, however if there is no psych issue then this may be a route to consider. It would usually involve the patient's doctor, social work, and the nurse manager creating a specific set of terms or expectations of the patient's behavior. If the patient goes against these terms, there are specified repercussions that can include discharge (as long as their condition permits).