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?

[pedicurn, LPN, RN]

Pedicurn,

What exactly is a 30 something "loss of control" professional female? Perhaps you can clarify that one.

A "particularly snobby" couple isn't going to give a civil response to anyone, because they are, as you put it "particularly snobby." Particularly snobby people are not nice. If they were, we would call them "particularly polite".

You are correct, men are not usually referred to as "the girl". No, I have not had a patient ask "Can the girl get me something to drink?" in reference to me. I have been called "young man" on several occasions.

Both men and women can be verbally abused by doctors. Residents learn very quickly that female nurses are NOT weaker. Anyone who believes that female nurses are "easier to unload on" is in for a rude awakening and abrupt attitude adjustment. I've seen arrogant doctors cower after getting on the wrong side of certain female nurses. I love it. I've also seen female and male nurses verbally abuse doctors, especially residents, so it goes both ways. There have been times when I've been ashamed of my fellow nurses for the way they talk to doctors and patients.

Suggesting that we don't need evidence or studies to validate behavior is dubious. There is a whole movement towards evidence based practice. Your personal observation was that you worked ONE ENTIRE twelve hour shift with a male nurse and that he didn't receive bad treatment while you did. So based on that ONE shift, you have concluded that it was because he was male and you were female? Is it possible there are some other reasons why he gets along with the doctors and patients better than you? Your personal observation and opinion is not a substitute evidence.

As I said, I stand behind my female co-workers 100 percent. I proudly support the female surgeons, anesthesiologists, nurse practitioners, physician's assistants, charge nurses, nurse managers and staff RN's, and CNAs I work with every day. There are many women who I am glad to say are my role models in the workplace.

Of course sexism still exists. My own mother wanted to be an attorney, but was told by her high school guidance counselor that women didn't do that. She was marching for civil rights before I was born. And now you are labeling me as sexist and offensive to females, and you say that I'm doing a disservice to women? I say workplace abuse and violence is an issue that BOTH male and female nurses frequently face and that we must remain united.

I don't believe that studies are unimportant ....we need studies in this evidenced based field.

I simply recounted observation ... which is a basic (informal) research technique

And.... just because I observed those incidents over one shift does not mean I am basing my entire view on what happened on one shift. Obviously I bring a lot more to the table than that ... including a diploma - a bachelors - variety of experience and 26 yrs of experience as an RN. I haven't been in this field for 5 minutes.

My views are relevant ... they are very relevant.

You said that I reached my conclusion after my experience during one shift .... that is insultingly patronising.

Many of my coworkers share my views.

We won't be debased by anyone telling us our views don't count..... or that they are of minor significance. Or shock-of-shocks ... we are unable to interpret correctly and need to have someone else do it for us.

Sexism is still here and it is an explanation for some of the poor behaviour we are reading about on this thread

[aquaphone]

I don't believe that studies are unimportant ....we need studies in this evidenced based field.

I simply recounted observation ... which is a basic (informal) research technique

And.... just because I observed those incidents over one shift does not mean I am basing my entire view on what happened on one shift. Obviously I bring a lot more to the table than that ... including a diploma - a bachelors - variety of experience and 26 yrs of experience as an RN. I haven't been in this field for 5 minutes.

My views are relevant ...they are very relevant.

And so are the similar views held by many of my female coworkers who have been in this field for many, many years.

We won't be debased by anyone telling us our views don't count..... or that they are of minor significance.

Sexism is still here and it is an explanation for some of the poor behaviour we are reading about on this thread

Pedicurn,

Of course your views and experiences are important, and sexism does still exist. But I ask you to consider that male nurses do face a great deal of verbal and physical abuse from patients, as well as disrespect from physicians. I have personally faced it many times, and don't you think my experience is important, just like yours?

I had one family member come into his wife's room and start screaming and cursing so much that I had to lock myself in a supply room and call security. I had never even met this person. I just heard him screaming from outside the room. His tantrum was triggered by the physician's refusal to speak with him in a timely manner regarding his wife. My boss later criticized my decision to call security, although the man was out of control and disrupting the entire ICU.

I had a male patient punch me in the face. I've been verbally abused by plenty of patients, both male and female. The verbally abusive females didn't seem intimated by me, male or not. I've had physicians shout and behave inappropriately towards me many times, and I've had to write them up or put them in their place plenty of times. Believe me, these are things male nurses ALSO have to put up with. This is not a MALE or FEMALE issue, it is a NURSING issue.

Please, we should be working together on this. A hospital administration with a culture of blaming nurses is the problem, not gender. We nurses need to support each other and stick together. Let's not be divided on this.

[pedicurn, LPN, RN]

Pedicurn,

Of course your views and experiences are important, and sexism does still exist. But I ask you to consider that male nurses do face a great deal of verbal and physical abuse from patients, as well as disrespect from physicians. I have personally faced it many times, and don't you think my experience is important, just like yours?

I had one family member come into his wife's room and start screaming and cursing so much that I had to lock myself in a supply room and call security. I had never even met this person. I just heard him screaming from outside the room. His tantrum was triggered by the physician's refusal to speak with him in a timely manner regarding his wife. My boss later criticized my decision to call security, although the man was out of control and disrupting the entire ICU.

I had a male patient punch me in the face. I've been verbally abused by plenty of patients, both male and female. The verbally abusive females didn't seem intimated by me, male or not. I've had physicians shout and behave inappropriately towards me many times, and I've had to write them up or put them in their place plenty of times. Believe me, these are things male nurses ALSO have to put up with. This is not a MALE or FEMALE issue, it is a NURSING issue.

Please, we should be working together on this. A hospital administration with a culture of blaming nurses is the problem, not gender. We nurses need to support each other and stick together. Let's not be divided on this.

Ofcourse abuse and violence is a nursing issue and we must stand united.

I have seen many a male coworker being abused.

We must have zero tolerance for this behaviour.

However the case of female abuse is often a little different. I stand by my case that sexism (both overt and covert) often remains a contributing factor

[CapeCodMermaid, RN]

Unless the old man was physically aggressive or abusive why let it bother you? Sticks and stones may break my bones....being hollered at only hurts if you let it. I work with old people, psychotic people, and old psychotic people. If they start hollering/cursing/yelling at me or another member of the staff, I quietly tell them that kind of behavior is not allowed in my building and I will not subject myself to it. I walk out of the room and return later.

I act like the professional I am. I will not be called 'the girl', I will not be treated like a servant, and I will not let anyone who is an idiot to ruin my day.

[imintrouble, BSN, RN]

Unless the old man was physically aggressive or abusive why let it bother you? Sticks and stones may break my bones....being hollered at only hurts if you let it. I work with old people, psychotic people, and old psychotic people. If they start hollering/cursing/yelling at me or another member of the staff, I quietly tell them that kind of behavior is not allowed in my building and I will not subject myself to it. I walk out of the room and return later.

I act like the professional I am. I will not be called 'the girl', I will not be treated like a servant, and I will not let anyone who is an idiot to ruin my day.

With all due respect, "sticks and stone may break my bones, but names will never hurt me" is the height of idiocy. Watch the face of a child when a parent is screaming at them or calling them names. I only say a child's face because they have not yet developed the talent of hiding what they feel. It hurts, being yelled at, it just does. Generally I handle those situations better, but as one poster suggested I was completely blindsided.

[Caffeine_IV]

Words do hurt. OP I'm sorry about your ordeal.

I hope you don't have to provide care for this person again.

[GHGoonette, BSN, RN]

OP, I saw this pic, and thought it might cheer you up....

[CapeCodMermaid, RN]

With all due respect, "sticks and stone may break my bones, but names will never hurt me" is the height of idiocy. Watch the face of a child when a parent is screaming at them or calling them names. I only say a child's face because they have not yet developed the talent of hiding what they feel. It hurts, being yelled at, it just does. Generally I handle those situations better, but as one poster suggested I was completely blindsided.

I'm assuming if you've made it through school and have a license, you are an adult. You are just as guilty for calling ME a name. It didn't bother me because I am an adult and have learned not to let comments from people I don't know bother me. I don't let what patients say bother me either.

[Fribblet]

I'm assuming if you've made it through school and have a license, you are an adult. You are just as guilty for calling ME a name. It didn't bother me because I am an adult and have learned not to let comments from people I don't know bother me. I don't let what patients say bother me either.

Actually, no one called YOU a name, as any educated adult who read the post you quoted can clearly see.

[Popwhizbangz, LPN]

Its not an easy situation, common as it is, but there are things you can do to lessen it.

Part of the skill is figuring out the underlying cause(s) of a rant and tailor your response to the cause. If one way doesn't work, try another and so on until something helps.

Here are some of the categories I have come up with -

Demented and/or delirious people - I have an easy time not taking these folks rants personally, as they are so impaired and misinformed. Distraction often helps, esp when memory is impaired. Can't tell you how many times a violent demented person has agree to walk with me and forgot the whole things very quickly, thanked me for the nice (1 or 2 min) walk. Never addressed their original concern directly at all.

People who are afraid - soothe, reassure.

Bullies. Sometimes people seem fully in control of their rants, seem to be trying to force folks to submit to their unreasonable demands. People often learn this technique well because it often, sadly, works for them - e.g. make a scene in a restaurant and they comp your bill, just to convince you to go away. Many prescriptions seem to be written for the same reason. If I can convince such people that they get NOTHING that way, except things they don't want, AND that I'm good to them with they play nice, we often learn quickly to get along. There are things you must do for people, of course, but you can make clear that they get nothing more than that, that even sick people are expected to meet the minimum expectations of any Kindergarden student. When this works, it works very well, and I usually build a lasting (even into future admissions) understanding and a surprisingly positive relationship. Holding people to adult standards is a form of respect, and I explain that to them.

You can also make yourself, your time with them, into a negative reinforcer of sorts. E.g. give true, frank, appropriate education that they clearly don't want to hear, every time they call on you inappropriately. Tell folks they are fully responsable for their own behavior, they are adults, that the average 5 year-old gets this stuff, you can't tantrum every time things don't go your way, that you need to share (including your nurse with other patients), etc. If you stay deadpan, don't get into an big argument, stay in control yourself, they will quite often decide to stop, often much sooner than you think. Remember, these are people deciding to act badly, so they can promptly decide to change, if you give them a reason. It then helps to promptly change your approach to whatever they find pleasing - avoids resentment that you pay for later (often very soon). Avoid any sense of winners and losers.

These things take practice and self-control over words, affect, etc., as well as trial and error in individual cases, but I have great luck with them, working consistently (by choice) with the least pleasant, the most abusive and aggressive, the least cooperative patients on floors loaded with many of the least workable patients in the region, people often admitted primarily because they are so difficult, agressive, provocative, etc.

[Popwhizbangz, LPN]

It also helps, a skill that takes time and persistent effort over years perhaps, but anyone can build, I think, to sort out negative feedback and ignore the unreasonable stuff ( I only register feedback I respect, as much as possible - still a work in progress - the rest is just and annoying puff of hot air with an annoying buzzing sound, so to speak), and learn from the reasonable stuff. You can, given time, teach yourself to develop thicker skin. The better armored you are, in a sense, then the more safe and confident you can feel, and then you can stay in better control of yourself and the situation.

Of course I always still make every effort, trying to find the most effective/powerfully persuasive response, to convince them to stop, whether I'm being attacked or anyone else. That often involves enlisting back-up, as much as it takes to make a strong enough impression. I would never counsel anyone to 'just take it with a smile' - that would be unfair, and the last thing you want to do is teach an abusive person that they have found an easy mark. It often fuels their behavior.

[Popwhizbangz, LPN]

One last thing - I wholeheartedly endorse, and practice, zero tolerance for threatened or actual violence - such a basic threat to safety warrants and ethically & legally justifies use of force, threatened or actual, to maintain safety. I strive for the least restrictive/aggressive approach possible, but safety comes first in the end. Abusive speech at time signals you are on the path towards such a scenario, and when it seems useful I let patients know it. We are expected to tolerate some risk of various kinds, but we are NOT expected to be victims, and it seems to me, should actually be expected to ensure to the best of our ability that we are the opposite of victims - strong, in charge. Its best for everyone involved.