Verbal assault by a pt.

[imintrouble, BSN, RN]

I am still reeling over a verbal attack by a geriatric pt last week. Without getting into details, it was probably the worst I've been treated in years. None of it was warranted. His anger was not my fault, I was simply the object available when he blew his stack. I honestly tried to rationalize his behavior, he's scared, he's worried, the bills are piling up, case management talked to him, ........... The one excuse I couldn't give him was confusion. Completely alert person. I tried to defuse the situation, but opening my mouth to speak simply enraged him further. He was old and very sick. That didn't make his attack any less violent or any less painful. What is allowed where you work? How far can you go when a pt is completely out of control, and what they say is every bit as violent as a fist?

[Fribblet]

It's unacceptable, but as nurses we're expected to take it.

Stress, pain, and illness are explanations for behavior, not excuses. Bad behavior should not be tolerated.

[nursie_pants]

I had a patient go off on me once, completely unwarranted and not related to me or my care, but like you I was bearing the brunt of his rage.

I simply said, "You seem very upset, so I'm going to give you a few minutes to calm down. Please use your call light if you need anything in the meantime."

When I returned, the patient apologized and was back to "normal".

Some people apparently see nurses as fodder to take their anger out on. As long as your patient is safe and doesn't warrant your immediate care, I suggest giving them time to calm the eff down.

[RxOnly]

nursie_pants took the words right out of my mouth!

One thing I'd like to add is D-O-C-U-M-E-N-T!! Just in case this behavior becomes pattern, you'll want to make note of it so that if management does in fact decide to address it, there will be something in black-and-white for them to look at. You don't have to, and shouldn't, write down every swear word he spouted in his chart. I usually write that he was "verbally aggressive" and then state any interventions I took (re-education, prn medications, etc) and his response. I try and make it as objective as possible, but I always add "nurse manager notified of client's escalating behavior" if I feel it's something she should know- then I make sure to tell her, again, just in case it becomes pattern.

Chin up and good luck! I feel awful when any nurse has to endure this because we just shouldn't have to. It just plain sucks, but I'm sure there are plenty of clients that are happy with your care and are glad to have you as their nurse

[blamejoe]

I agree with nursie_pants. More and more over the past decade+ I've been in healthcare, it seems that nurses stop taking care of themselves and learning assertiveness, and then break down when issues arise that completely require self-care and assertiveness.

You're not expected to just bear the abuse, but you have to know it might come out. We see people at their worst. Nurses do a terrible job preparing ourselves IN ADVANCE on how to cope with this area of work. We all owe it to ourselves to practice before we break down. Respectfully remind the patient that they're being completely inappropriate, give them time to cool off, and when you return, if they don't apologize on their own, remind them that they owe you one. And keep in mind, document in the chart the patient's explosive behavior; it is necessary, identifies a possible mental health need, and is absolutely appropriate. It alerts others to the possibility of aggression as well. Do not threaten the patient that you're going to "write them up in the chart", but WHEN EVERYTHING IS CALM it is appropriate to inform them that you had to make a note to the doctor about their stress level and possible coping needs, and hopefully you'll be able to help them find the means to prevent feeling overwhelmed in the future.

[blamejoe]

haha, tag! :)

[Ayeloflo]

Options for him to consider:

Ask another nurse to witness the following

-Explain to him how you address violence at your facility. Tell him what you do at your facility.

-Tell him there is a form to complete and sign if he wants to check out AMA

-You call code gray (if under physical attack) for more help to subdue the the patients. I don't know what system you have at your place.

-You get a PRN order for restraint if you have to. Do not go looking for PRN order for anti-anxiety med cos when you can't have things your way, it's frustration, not anxiety (I know that many nurse misuse anti-anxiety meds for patients)

-You better set boundaries. You tell him to use the call button if he needs you otherwise you'll be checking on him q2hrs or whenever you are required to.

-Remind him that if you hit him, you could be arrested, and vice versa. Tell him that you could press charges against him if you chose to.

Keep in mind that families may telephone a patient with their issues that provoke a patient to anger. The patient might take it out on you. The patient many not discuss the issue with you, cos it's a private matter, and they don't want the nurse or other hospital workers to get involved in their personal issues. When he understand the options and he regains his calm and ability to reason, you might be more successful with therapeutic communication methods.

[caliotter3]

Document and take action as appropriate. It might not be a bad idea to bring another staff member with you when you care for this person.

[netglow, ASN, RN]

I think that the MOST important thing to do is to have witness as others have suggested. I think we hesitate because we DO NOT trust our management will support us and rightly so. Too many incidents that prove this. So, grab more than one person and get witness if possible prior to informing the NM.

[ReginaPhalange]

The worst verbal assault I have experienced was by a fellow nurse. She was completely inappropriate, spouting off demands like we were servants, and telling everyone how incompetent we were...because we didn't have a private bed WAITING on her after her surgery. She had no history of mental illness but it was apparent that something just wasn't right. We attempted to calm her down using all of our customer service tools our facility provides. We finally had to call in Patient Relations, the House Supervisor, and our Nurse Manager. It took us 4 hours to get her a bed on our surgical floor and she wanted all of our names to report us to the board for neglect. SERIOUSLY?!?! And, her husband was at her bedside the entire time and didn't try to calm her down or tell her she was being unreasonable one time. I documented my tail off because she was just crazy enough to really turn us into the board. So far nothing has come of it but we shall see. I think it's ridiculous how some people treat the people that are trying to HELP them!!

[GHGoonette, BSN, RN]

OP, it's never "nice" when we, as the closest targets available, are attacked in any way by our patients. Attempting to "talk them down" rarely works. Just let them vent-it's not personal.

Remember your psychology lectures. People admitted to hospital are no longer in charge of their own lives, and the uncertainties that they are experiencing find expression in numerous ways which would normally be unacceptable to them. Regression, aggression, dependence, you will come across all of these coping mechanisms.

My heart goes out to this old gentleman. Please convey my sincere wishes for his full recovery.

[Mulan]

Nasty people are nasty people, acting the same way regardless of the environment.