how do YOU deal with unruly patients?

Trauma Columnist · Jan 6, 2004

I'm an ER RN (probably translated as I'm a b*&^h - tee hee hee). I give people several chances before I come down on them. However, I will never tolerate being hit - people need to understand they go to jail!!! No ifs, ands or buts! This is of course if they aren't demented or otherwise incompacitated. However, I don't consider drunk and stupid or drunk and high as incompacitated! And...don't touch any of my co-workers either - the silver bracelets fit pretty snugly too! I don't tolerate being sworn at either - I tell people (as another poster suggested) - "I'm being polite to you, I expect the same in return". However, if they continue to swear at me the next thing out of my mouth is: "I'll be glad to come back when you can behave" then I leave and return in 10 minutes! Get real - we deserve respect!

Nurse Ratched, RN · Jan 6, 2004

When I worked a regular med floor, I would offer the obnoxious pt the opportunity to sign out AMA if they felt they were no longer in need of care, otherwise, to remember that they had no more right to be verbally abusive to me at my job than if we met out on the street. Certainly it's important to be understanding that the hospital is no one's idea of a good time. Irritable patients are one thing - it's to be expected; aggressive/abusive ones are entirely another and we are not required to tolerate that.

When working psych, unruly takes on a little different spin. Behavioral contracts and expectations are commonly used. Usually the worst patients are the ones who are there on involuntary holds, so I can't offer them a request for discharge form to sign, but the ones that are there "voluntarily" are always given the choice to ask the doc to sign them out. They are reminded that if they cannot control their behaviors, it is our responsibility as the staff to prevent them from harming themselves, others, or disrupting the unit.

Marie_LPN, RN, LPN, RN · Jan 6, 2004

Originally posted by dar15
Well you said not to take it personally. I interpreted that to mean that it was ok for ppl to have a go at us...we just have to be understanding about it.

And a lot of people take it personally, thinking that the pt. is yelling at them when that pt. is venting their frustrations of various reasoning. That was my point.

I draw the line at the namecalling and insults. It all depends on the situation as to what i'll say.

mags-rn · Jan 6, 2004

I have heard many people take the matter of fact attitude including myself telling the patient that language like that will not be accepted here we have other patients that do not need to be subjected to it as well as ourselves.

Also, you have to remember, pts strike out for many reasons, probably none due to the nurse. May have received bad diagnosis, may have family who do not care, may be scared. The nurse must keep herself in check. It has nothing to due with you, most of the time. I know when I was a pt, the nurses I am sure wanted to strangle me. But, I was tired of tests, tired of saying I can not help you, tired of being sick and tired of surgery after surgery. Not once did I have a nurse yell back at me. Not once did I have a nurse teach me either about what to expect .I just swore I would be a better nurse. Teaching and holding a hand are not beneath me. I also do not need a doctor nor the pt to validate my worth. If someone does not respect you, its their problem.

Marie_LPN, RN, LPN, RN · Jan 6, 2004

Originally posted by mags-rn
I Also, you have to remember, pts strike out for many reasons, probably none due to the nurse. May have received bad diagnosis, may have family who do not care, may be scared. The nurse must keep herself in check. It has nothing to due with you, most of the time.

Exactly!

gwenith, BSN, RN · Jan 7, 2004

This is from my union website

Zero Tolerance to Violence

At the annual conference in 2000, delegates endorsed a resolution calling for a Zero Tolerance to Violence by 2002 Campaign, and the setting up of a working party to put together the required resources to assist members in the formuilation of appropriate policy development to occur in workplaces. The working party which was subsequently formed consisted of Jocelyn Rogers, Kay Foran, Chris Hahne and Kate Jenner. The campaign has a multifaceted approach aimed at:

1) The community - raising awareness of what is happening and telling them that this behaviour is not acceptable to nurses.

2) Nurses themselves - telling them they do not have to accept that violence is "part of the job", and that something can be put in place to prevent or minimise it.

3) Employers - to identify that this is an issue for their nursing staff and to work with them to develop and implement policies and procedures to prevent or minimise violence. Also to have procedures clearly identified for when an incident does occur inclusive of debriefing procedures. Furthermore we need to identify where there may be gaps in legislation, protocols etc that may inhibit actions being taken to prevent violence or lay charges against individuals.

4) Government - To work with government to ensure there is legislative basis to protect nurses in the workforce and allow them or their employer to take appropriate actions and against individual perpetrators of violence.

http://www.qnu.org.au/about_qnu/occupational_health_and_safety/zero_tolerance_to_violence

nurseygrrl, LPN · Jan 7, 2004

how do YOU deal with unruly patients?

Serve them up a delicious knuckle sandwich and a nice tall glass of shut the hell up! :roll

Seriously though, on my unit I have to let my patients know who's boss right off the bat or they'll run right over you. I've seen what they do to floats!! :eek:

I just tell them I'm here to take care of them...not to be abused. I will walk out of the room and tell them I'll come back when they're ready to treat me like a human being. Usually works like a charm and we're good after that!

Rapheal · Jan 7, 2004

I set limits in a firm monotone voice. Last week I really surprised myself when a patient started to yell at me and I said "Stop yelling at me- I will not tolerate that." He apologized and was nice the rest of the day.

But I have noticed that in the 11th hour of my shift I really have to work at being monotone when people are rude.

jnette, ASN, EMT-I · Jan 7, 2004

THAT'S how !!!

(jus' kiddin', jus' kiddin'... )

PMHNP10 · Jan 7, 2004

Ahhh...the unruly pt. That is the wonderful thing about working in an inpatient closed psych unit. When pts start escalating, disturbing the milieu, and staff is unable to redirect, we assist them in enhancing their calm with a little geodon 10-20mg IM (or haldol 5-10mg IM) and ativan 1-2mg IM to the rear. More often than not people tend not to act out again if they are capable of rational thought. If they are incapable of rational thought, the cocktail goes a bit towards clearing them up so they become capable.

live4today, RN · Jan 8, 2004

Originally posted by jnette

THAT'S how !!!

(jus' kiddin', jus' kiddin'... )

:chuckle :roll :chuckle :roll You never cease to crack me up, jnette!

mattsmom81 · Jan 8, 2004

There's some truth to the inference made earlier that assertiveness training is necessary in nursing. I was raised to be a 'nice girl', and when I first encountered nasty people I really didn't know how to deal with it. My mother's take on nasty people was 'get away from them'. Well that isn't always possible...

I had to learn assertiveness quickly in nursing. To be honest, nurses need MORE...as a profession we have not been nearly as assertive as we should have been through the generations.

Practicing in school how to deal with ugly patients, doctors, manipulating bosses should be a prereq!