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?

[Popwhizbangz, LPN]

For me, that kind of thing is my bread and butter, my moment to shine, use my skills.

I get a LOT of that, actually steer it from others to myself.

There are alot of useful tools. Here's a few:

1) Thick thick skin. I judge my own work, have learned to ignore nonsense complaints.

2) I try to think of the way to respond that will have the most beneficial effect, NOT what comes naturally.

3) If a patient plays fair, I'll do anything I can for them, more than anyOne else on the floor

4) Not Playing fair? Tough as nails, you get nothing beyond the absolute minimum.

5) Playing fair again? All is forgiven, see 3). Folks learn, and I have very satisfied thankful loyal patients, because I'm good to them, even if at the moment it involves some tough love....

Hope that helps, comments welcome....

[Kooky Korky, BSN, RN]

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!!

She was post-op and probably adversely mentally affected by the anesthetic and other meds, not mentally ill. Presumably she was in pain. You or someone on your floor likely knew she'd be coming to you post-op and likely had a fair idea of when. You kept her waiting FOUR HOURS. You said the hsuband was "bedside", then you said you had to find her a bed. I take it the issue was lack of a PRIVATE room, a preference she had probably made known in advance.

And you think she was not justified to be upset?

I don't really understand that you don't understand. You have probably never been in a situation like hers or you would know how it feels to be post-op, both bodily and emotionally. Surgery is terrifying, an assault of the most basic kind, the physical, on a person's state of wholeness.

You also don't seem to see how aggravating, frustrating, and completely unhelpful it is to have someone try to pacify you with customer service tools instead of just getting you the private room.

She didn't have to be rude, but she probably did need to be forceful. If not, she'd have had to wait probably four DAYS for that private room - just guessing. I submit, though, that she was not in full control of her behavior, given that she was post-op.

I don't blame the husband for not intervening. He was likely just glad she was alive. he was probably out of his element, not knowing what to do, really.

Suggestion: What I'd have done is just state how long it would likely take to get the private bed, give a brief explanation that a discharge and room cleaning had to take place first, apologize once, then offer to get the manager if she wished, as I have done all that I have it in my power to do to rectify the matter. I'd have told her that someone in Admissions had messed up or that the bed we thought we would have for her was unavailable because the discharge we'd anticipated had not come about due to the patient who was in it taking a turn for the worse or that person's doctor was late coming in to discharge her or whatever. But i'd have put the blame where it truly lay.

For both you and OP - I'd have let her know that yelling at me wouldn't change anything and that it would be upsetting to me, since I am, after all, human and furthermore, not to blame. I would let her know that I felt attacked and felt unjustly condemened for something that was not my fault. I'd let her know that I was happy to help and would take good care of her but I needed her to not scream at me or blame me unjustly. I'd have privately made a note to do only the minimum for her, not to go into her room any more than absolutely necessary.

I'd have let her know that it certainly would also do her no good, that is, "you musn't stress your body. You've had surgery. You need all of your energy to recuperate and heal." Maybe get her deep breathing, visualizing a restful nature scene. Then I'd have left and not gone back until I absolutely had to.

Sorry to be critical of you. perhaps I have misunderstood you. I hope you won't be angry at me.

[Kooky Korky, 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.

The interesting part is that they take it out on who they perceive to be weak and unable to retaliate or on who they don't respect - the female nurse. Rarely, by comparison, do they dump on male nurses or on a doctor of either gender.

[pedicurn, LPN, RN]

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.

exactly ... it's humiliating.

it's true that dr's /pt's /ot's don't have this abuse unleashed upon them (unless the p't is mentally ill or has dementia)

the only people who get it are nurses and aides, cleaners, food service people.

p'ts and families view us as low status workers.

it wears on one; can take a toll on emotional health. ever wonder why some nurses just look so beaten down .... years of swallowing their self-respect has contributed to their illhealth

[Fribblet]

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.

Why are we expected to take it? Talk to your fellow nurses. It's a culture we've created with the stupid image of an "angel of mercy" and the martyr mentality you see all over these forums.

We can blame management, the hospitals, the patients, or whatever, but we don't demand better for ourselves. It's our own fault.

[MomRN0913]

I've endured it before. There are some downright nasty people and the sick people who have no outlet. If they are AAO I just walk away. You don't have to take the abuse. Walk away, that's it.

Try not to take it personally. because this will probably happen multiple times in your bedside career. Sorry your so upset.

[handyrn]

When I encounter people like this, I usually try to find the cause of the aggression. As nurses, we run our tails off trying to please and comfort our patients, and think we are doing a good job and that the patient has all their needs met. Sometimes, there are things that we forget about that could be causing the trouble.

1. Is the patient a smoker who has gone several hours without a cigarette? I have seen some people get pretty grumpy due to this.

2. With all the lights, beepers and buzzers, it is impossible to get good quality sleep in a hospital. Don't we all get a little (or a lot) grumpy with no sleep?

3. Pain. I have run into elderly people who get grumpy due to pain but won't ask for pain meds because they have always been told to tough it out. I even had one patient that wouldn't take pain meds after a nasty fall because she felt it was her "penance." Very sad.

Sometimes just listening to your patient vent is all you need to do. When we are no longer in control of our lives, as when in a hospital, sometimes we just need to vent to feel like we are being heard.

[TheCommuter, BSN, RN]

A belligerent person will be escorted out of the bank by security if he starts verbally abusing the tellers. A person who does not behave himself on a major airline will be restrained by the air marshall. A customer who starts throwing plates at the waiter inside the restaurant will likely leave the place in handcuffs. A student who threatens and curses at the college professor might be expelled from school.

However, people feel that they can lash out at the nurse with absolutely no fear of being kept in line. It's a sad phenomenon.

[TheCommuter, BSN, RN]

when we are no longer in control of our lives, as when in a hospital, sometimes we just need to vent to feel like we are being heard.

i'm able to vent my frustrations without cursing at others or threatening to harm people. our patients and family members need to take a few lessons on civil behavior, basic social skills, and all of the good stuff that every kindergartner should learn.

[nicegirlnurse]

In this case, I would have shut my mouth and turned around and walked out. Give him some time to cool off, notify the charge nurse or supervisor, and try your best to not let it get to you. It's an awful feeling when this happens, but unfortunately it *does* happen.

[TheChair1]

The interesting part is that they take it out on who they perceive to be weak and unable to retaliate or on who they don't respect - the female nurse. Rarely, by comparison, do they dump on male nurses or on a doctor of either gender.

This is why it ticks me off when female nurses are on here saying things such as, "well the patient has been through a lot. Surgery is physically and emotionally taxing, they have been waiting for hours for a private room so of course they are going to be upset .... yada yada yada." Well duh! Unfortunately that is not the point. As long as nurses continue to allow themselves to be viewed as weak then these people are going to continue to treat us like crap when we are trying to HELP them recover usually due to some type of chronic condition that they may have been able to avoid if they had practiced a healthy lifestyle.

If a patient gets out of line with me and I feel remotely threatened and they are not suffering from pyschosis, dementia, and some sort of bizarre confusion then I'm not putting up with it. I'd document and call security and the manager because my ability to do my job effectively could be reduced if I am scared for my safety. If I wanted to go to work and knowingly risk getting hurt I would have joined the military ... at least there is hazard pay! Ladies grow a backbone, be firm, and expose these abusers for who and what they are before one of them sends you to your maker.

[Who?Me?]

While I understand patients getting upset and in my 18 years of nursing, I have seen a few (understatement of the day BTW!), yelling at you is not acceptable. I agree with the suggestions to document the incident, getting your manager involved, let their doctor(s) now how Patient X is acting, and let the patient know that you understand being upset, but this behavior is not acceptable and is not a productive way of getting what they want.

Does your facility have some counseling, support groups, or chaplain services available for Patient X to talk to? These individuals are usually trained to deal with what the patient is going through and usually have more time then you do during your shift to help the patient sort through the issues going on in their life.

Sounds like you were completely blindsided by this verbal attack and those are the times it affects us the most. Realize that Patient X wasn't truly angry with you, but was furious with all the uncontrollable cr@p that is going on in his life.

All the best.