Verbal assault by a pt.

[imintrouble]

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?

[nursie_pants]

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.

With all due respect, I wonder how often RNs working in a PACU or OR have to deal with conscious, non-sedated patients tearing into them. (?!)

My heart, on the other hand, goes out to all the health care providers out there who have to deal with/care for the rude/mean/nasty/awful patients who demean and abuse them. Bless the hearts of 99% of our other patients who make our work meaningful.

[lindarn]

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.

I am not responsible for them, "not being in control of their lives". They are responsible for not being in control of their lives, by seeking medical treatment in a hospital. I realize that many health conditions are not over our control, and that the only treatment available for them is in a hospital . And, yes, this can be scary.

HOWEVER, why is it that the only brunt of their anger and feelings of helplessness, is directed only towards the nursing staff. I have never seen a patient lash out at the RTs, Doctors, PTs, OTs, Dieticians, etc. Why is that?

Because nurses are powerless, have no control over their work, or working conditions, and are seen as, "showing up on the wrong side of the Budget balance sheet", and are seen as a drain on hospital finances. We are not seen as important, not the moneymakers, and therefore, by virtue of our "learned helplessness", we are supposed to take the abuse.

Sort of like, "you are worthless and cost us money, so I would rather that you take the abuse so I don't have to". I am more important than you are (It matters not, that administration is responsible for the **** poor working conditions, that make it impossibe to do our jobs). So says administration.

Just some food for thought!

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

[GHGoonette, BSN, RN]

Heh heh, I knew I'd get some heated responses...

First question: why are you guys so offended? My comments were directed to the OP, to help her come to terms with the unwarranted attack which she suffered. So you don't agree. Tough.

Second question: do you seriously imagine that because the bulk of my experience has been in PACU, that it has been my only experience? I have dealt with abusive, oriented patients-back in my student days, and it was no easier for me then than it is for the OP now. But I dealt with it, and it did not unduly upset me, because I was able to understand what my patients were going through.

Third question: just because a patient is "sedated" do you think it's a walk in the park to deal with them when they're coming round from anaesthetic, and everything that's been seething in their subconscious comes surging to the surface? When a 3 year old swears your genitals out from under your clothes, or the grown man throws punches at you because he thinks you've been messing with his wife, or you take a kick in the stomach from the little girl with a history of sexual abuse?

Finally: So this elderly person didn't make provision for his old age. Hmmm; when last did you speak to your parents about cost of living increases over the past 40 years? There's basic necessities out there that cost anything up to 1000% more than they did in the 1970s. To stay abreast of increases, and to stay ahead of the game in your retirement planning, you needed to put away about 15% more per annum-each year-just to maintain your standard of living. How many currently retired people do you know who managed to do that?

The question as to why it's always the nurses who have to listen to such rants...is because they are invariably first on the scene.

Understand me, please; I'm not advocating that nurses should just "take it". I'm saying that nurses should take it from where it comes, and if it warrants counter-action, then by all means go for it.

[tiroka03, LPN]

I agree about the documentation. I agree about the stress. But, it still hits hard, and can throw you for a loop. I know it usually happens when your the most busy, and now you feel like you want to cry, or yell back or scream at someone else. It hurts. You need to take a few mins to yourself after being the object of such an abuse. You are a person too. Yes, we are supposed to be professional, but we need to bandage our wounds as well. I for one think that if the caretaker is hurt, everyone hurts. SO, go in the bathroom and cry, hug yourself, read a scripture, look at some calming pictures on your ipod. Heck with the load, it will be there when you get back in a couple of mins.

[mcleanl]

When a pt is out of control (or a family member for that matter) I always make a point of telling them, "just so you know, I am going to be documenting everything you say to me and it goes directly in your chart." It usually works....people don't seem to like the idea of their craziness being documented.

[TheChair1]

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.

So why are we "expected" to take it? I was at the DMV last week and a man completely lost it with one of the women working behind the desk and began to be extremely verbally abusive. They ended up calling the police. The man was handcuffed and taken away and they were asking the lady working if she wanted to press charges. Why are we as nurses expected to tolerate verbal and in many cases even physical abuse? This is one of those aspects of nursing that I will never understand and one of the reasons I hope more men enter the profession so that this crap will stop.

[Bella'sMyBaby]

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.

Agree that this Behavior should be documented.

Disagree that every swear word should NOT be documented.

State Surveyors/Auditors get a realistic picture when the exact, specific statement is documented.

State/Auditors don't care if the note states, "Nurse verbally assaulted by patient."

You want the Surveyors to see this Resident for the Jerk he is.

Also, by not documenting exactly what the patient says can affect Reimbursement as well.

[shoegalRN, RN]

I work ER and verbal abuse is like the norm. Our policy now is if a pt gets verbally abusive (including yelling, shouting curse words, pointing their finger, threating, etc) we are to use the panic button and security will come running and do a "show of force" and a possible take down.

I don't tolerate verbal abuse. The minute someone starts yelling, I hit the panic button and leave it at that. It's amazing how the pts are now "calm" once they see the big boys. Some even start crying, and some will apologize and be cooperative for the rest of their stay in the ER. Some will theaten to sue and then leave AMA.

The bottom line is nobody should have to tolerate abuse, don't matter if they are sick or not.

I went to Urgent Care last week for a head cold. I had to wait 30 minutes past my appointment time, I was feeling miserable, and not one time did I ever raise my voice at the nurse or started cursing and acting beligerent. So being sick is not an excuse.

[Ayeloflo]

Heh heh, I knew I'd get some heated responses...

That's because many nurses work so hard, barely take lunch breaks, get subjected to abuse and nothing is done about it. On top of that many pray just to be able to keep their jobs for another day. It really does hurt when you are doing your very best for the patients. So, my good friend, many responders to your post have been victims of these events and it's a sensitive matter. I hope you can understand. Take care.

[imintrouble, BSN, RN]

Thanks everybody. It always helps to know you've all been through the same thing. I did document, not verbatim, because I simply didn't have time. I think I'll make time from now on.

I have since found out this pt was baseline an ugly old man. Because I had to absorb all that anger he threw at me, without defending myself, I felt diminished. I really hate that feeling.

Thanks again.

[aquaphone]

As long as the patient isn't in immediate physical danger, take a walk. I've left the room plenty of times when a patient was abusive. Sometimes you just have to do it.

[yetanotheramanda]

thanks everybody. it always helps to know you've all been through the same thing. i did document, not verbatim, because i simply didn't have time. i think i'll make time from now on.

i have since found out this pt was baseline an ugly old man. because i had to absorb all that anger he threw at me, without defending myself, i felt diminished. i really hate that feeling.

thanks again.

wow, i think you really hit it on the head with that statement. i would never, not for one second, but up with such abuse on the street or in my personal life. at work we are expected to take it, and it really hurts.