When does staff rights start

Julius Seizure · Feb 27, 2016

One time. One time is too many.

Sniper06 · Feb 27, 2016

I am so frustrated that patients seem to have so many rights and staff have so few. What can you do with a psych patient that is clearly acting out but there is no way to punish them. At my hospital I can't even insist that they go to a room by themselves.

emtpbill, ASN, RN, EMT-P · Feb 27, 2016

Very intriguing discussion. I am just pondering now, as a nursing student, how I would act if presented with a situation where s colleague is being harassed based on ethnicity.

Working as a medic in a 911 system I have been witnessed to several incidents where my partner was racially harrassed. In those situations we have the luxury of what happens in the ambulance stays in the ambulance: many times I have had to put patients in line based on their actions.

Now I would never, ever physically harm a patient but the few times I have had to straighten a patient out based on their very inappropriate comments I have taken great pleasure afterwards thinking about how I handled a patients untoward attitude.

OldDude · Feb 28, 2016

All area of nursing have evolved into staff having no rights or back up from administration; the patient or patient's family can say anything they want, to anyone they want, anytime they want and that's ok - as long as staff doesn't upset them. The biggest concern of admin is reimbursement and good patient satisfaction surveys.

TerpGal02, ASN · Feb 28, 2016

I often wonder on this too, especially after the week I just had. We had a batch of particularly verbally abusive patients.

TheLittlestNurse · Feb 29, 2016

Once. Zero tolerance. The hospital I used to work in recently implemented a non-discrimination policy. In a nutshell, pts can no longer refuse staff members on the basis of any protected class (e.g., race, gender). So, they took a small step forward for staff rights, but we still had problems with racial slurs and such. Verbally abusive pts are hard to handle, because unless they're totally out of control, you can't just sedate them or chemically restrain them. I usually respond to verbal assault with something direct, firm, and emotionally neutral. I have straight up told pts that "it is not acceptable to say xyz"...or that i will continue speaking with them when they stop xyz. If the abusive speech continues, they get nothing from me except standard care. I continue assessing, passing meds, etc., but I will keep it short, sweet, and to the point. I am not rude, but I do not engage them any more than necessary while they are actively being verbally abusive. I document quotes from the pt and check "abusive" under their behavioral assessment. I also make it clear to the pt and family that I do not have to accept abuse and will not listen to it. If it becomes an ongoing issue, rather than just a temper tantrum, the manager needs to step in and set boundaries with the pt too. One pt on my floor was so nasty that risk management, ethics, SW, the hospital supervisor, and the unit manager had to have a conference with the pt and family to create a behavior contract. Cognitively intact pts don't get a free pass to practice hate speech just because they're in a hospital...ever.

ETA: It's important to speak up on behalf of other staff too. I think a lot of people forget that they do have a right to be free from abuse and discrimination at work, even in nursing!

pigginsrn · Mar 4, 2016

Is this a psychiatric unit? If so, What do you expect to be done? I don't let things like that bother me. In fact we usually find humor it things like that on my unit. If it's there is not signs of physical threatening behavior. Ignore it and let it roll off your back. I usually just smile and walk away. My very first day working as a psychiatric nurse a patient yelled, "Hey white ***** lady get me a maxi bad Now!!! Becoming offended by is a choice. I would rather not, so I don't.

elkpark · Mar 4, 2016

Well, my take on this is a little different. I've worked in psych for decades. I've been called, and watched my coworkers get called, everything you can think of and then some. It's fine to say "zero tolerance" and "no hate speech," but the reality is that, in healthcare settings, you can't punish a client for saying something you don't like, even something that nobody likes, and, once you start talking to them about "zero tolerance" and "unacceptable" when they know you have no way to enforce anything in this matter, you're just throwing away your credibility. I agree with pigginsrn that the best option is just to consider the source and ignore it. Take the high road. If you let them see that they're getting under your skin, you're rewarding the behavior and they're getting what they want. "Sticks and stones may break my bones, but names will never hurt me" (unless I let them hurt me ...) As charge nurse on an inpatient psych unit, I have been known to approach clients who were calling other staff offensive names and explain, pleasantly and professionally, in the same tone I would use to explain that they're expected to make their bed in the morning, "We don't use racial or ethnic slurs here; you are being treated with courtesy and respect, and you are expected to treat others here with the same courtesy and respect that you are being shown," and leave it at that. Beyond that, you're just getting into a power struggle you're going to lose.

pigginsrn · Mar 4, 2016

That's about all you can do in healthcare. The best time to talk to them about respectful behaviors that we expect is not in the heat of the moment. I usually say, I can see you are frustrated right now we can talk about what is bothering you a little later and then I say I'll come back in 30 minutes or whatever and then I always keep my word. If something happens on the unit I make sure to go to the patent and let them know why I can't. Now there are some patients it's better just to not react at all and calmly go about your business.

We need to remember that many people if not most, are hospitalized because they haven't learned how to using healthy coping skills and need help learning behavioral control. Otherwise the would just be some jerk on the street. Psych requires a good sense of self, a whole lot of patience, an absurd sense of humor and some thick skin. It's not for everyone.

Sniper06 · Mar 6, 2016

It is a psych unit. I understand that we have to have thick skin because of what we do. I am not so much concerned about one or two off the cuff remarks from a patient. I am more concerned about a patient targeting a staff member every day non stop. More specifically, and from a legal position as a manager am I allowing quid pro quo racial harassment if the client is allowed to verbally attack a staff member on a daily basis. The client I have in mind is more Cluster B than Axis I. I guess I probably should have published this post under legal nursing. I have been working in Psych for 15 years and I understand how we historically treated situations as these. I just wonder if it is time to push the envelope on staff rights.

Sniper06 · Mar 6, 2016

It is a psych unit. I understand that we have to have thick skin because of what we do. I am not so much concerned about one or two off the cuff remarks from a patient. I am more concerned about a patient targeting a staff member every day non stop. More specifically, and from a legal position as a manager am I allowing quid pro quo racial harassment if the client is allowed to verbally attack a staff member on a daily basis. The client I have in mind is more Cluster B than Axis I. I guess I probably should have published this post under legal nursing. I have been working in Psych for 15 years and I understand how we historically treated situations as these. I just wonder if it is time to push the envelope on staff rights.