I have a question for ER nurses: What is your departments policy on verbally abusive patients? Do you have signs posted about respect? Do you have specific steps you take when someone is verbally abusive?
The reason I ask? I have come to the end of my tolerance of being verbally abused by people. I'm about to do something about it. Or lets say I am about to demand that management do something about it.
It is particularly bad in triage. People come in with their own frustrations or a chip on their shoulder and they take it out on us. And I am done being the subject of their wrath. And fuck the whole using communication techniques and de escalation techniques. I am tired of trying to be understanding. In what other workplace or profession would taking abuse be an expectation of a job? It is ridiculous. It is about time nurses stood up.
A survey was done by the emergency nurses association that was published this summer about 50% of ER nurses have been either physically or verbally assaulted at work. I don't even believe this. I know that ALL ER nurses have been subject to verbal abuse. Its happens daily.
Why do nurse let themselves be treated like this? People attracted to nurses want to take care of people, help them. We are groomed to believe that we are supposed to be understanding, to put ourselves in the patients shoes. With the corporate environment in today's hospital, the customer is always right. We don't want to make anybody unhappy because they will go elsewhere. Someone might complain. It will make satisfaction statistics go down.
Nurses have the right, like any other worker, to be treated with respect. We have the right to work in an environment where violence in any form is not tolerated. Nurses have the right to expect management to develop a specific policy in which abusive patients are dealt with. Nurses have the right to expect the hospital to make clear from the moment patients, visitors step in the door, that any kind of violence will not be tolerated. Who is going to make these changes? Nurses.
21 comments:
Many hospitals have lots of polices in the place that amount to little more then lip service on the issue.
If you want to test the theory try kicking someone out and watch the response.
In one case I got a lecture from both the charge nurse and the doctor as to how inapproriate it was for me to do so as the patient must have had something wrong with him otherwise her wouldn't have been there.
In justifying their stances a few comments about how my bearing served to escluate the situation...
I'll spare you my response to them.
Just about everyone in education has been verbally assaulted, and in some cases, physically assaulted (our principal and two teachers were physically assaulted in our middle school last year). The only difference is, when you are verbally assaulted by a patient, you may see that person again, but when in education, when you are teaching, you are expected to continue to teach that student who verbally assaulted you, and you will still have to deal with that student's parent. And of course, the district policies are useless and meaningless.
In addition to nurses and teachers I believe that police officers receive a lot of verbal and physical abuse -- but they get to carry weapons. You need to talk to your administrators about arming nurses and teachers!
Here are a few of the facts from that ENA study - I got these from the ENA Web site.
More than half of emergency nurses surveyed report experiencing physical violence on the job, and one in four has been physically assaulted more than 20 times in the past three years.
One in five emergency nurses reports having been verbally abused more than 200 times in the last three years.
More than two in three emergency nurses (67 percent) in the study rated their perception of safety in the emergency department at five or lower on a ten point scale.
The system I work in opened a ER in the burbs outside the metro area. Local city and county police officers staff our ER. They were shocked to see and hear the abuse that the staff had put up with. They stated they where treated better and also was amazed on the amount of crime that occurs in the hospital by patients and visitors. The ENA just did a another survey this week and I will be interested in the results. I also believe that rules of respect should be posted with the patient rights. I have worked in a trauma center where staff has been shoot by visitors, and that ER had city county and state law officer twenty-four seven. This issue should and cannot be ignored anymore. the growing concern with patient satisfaction has armed the public with the belief that can do has they wish. To the public (patients) management does little to protect staff from such behavior and it is even encouraged to report staff for sticking up for them selves. What can we do to meet safety and still meet the best intere3st to our patients.
Believe me, this isn't just an ER thing.
Do you think that how the hospital deals with abusive patients is directly correlated to what kind of hospital it is? For example: smaller, more community-based hospitals are more customer-satisfaction oriented, and therefore, adopts the customer is always right philosophy. Whereas, larger, metropolitan and/or academic hospitals, while still concerned about attracting new "customers", doesn't seem to coddle abusive patients.
I only ask this because I've worked for both. At the smaller hospital, we had patients abuse staff, and administration turn around and take the patient's side (even sending them fruit baskets). Their opinion was always of "the nurse/doctor must have done something to make the patient mad because the patient is always right". No matter what the situation, even if the patient was clearly the asshole at fault.
Working in the larger hospital, I have to say that we are still mindful of patient satisfaction, the hospital has adopted a zero tolerance towards abusive behavior. Patient abusive towards me? That's a call to police, and we do have our own police department inside the hospital (and the run the names of any patient they are called about...usually discovering outstanding warrants in the process). Can't talk to me like a rational adult? Fine, I'll just leave and when you cool your jets and can speak to me without hurling insults, then we will have a conversation.
The seasoned nurses are up on their game and will not tolerate being abused. The newer nurses we have to learn them along as most nursing schools still teach them to bend over and take it like a good little submissive. It is made very clear, you treat us with respect, and we will return in kind.
With this attitude, you would think that my hospital is a shithole, when on the contrary, we have been nationally ranked in excellence, and Magnet designation.
It's a shame not all hospitals don't back up their nurses and treat them like easily replaceable cogs.
IN our hospital the signs are posted and the nurses receiving abuse just pick up the phone and call the police themselves.
I live in Canada and we don't aim to please or care about "customer" satisfaction.
We can't really throw people out for being verbally abusive from triage. In triage, it's the worst because you're the only one there and you will likely be slapped with an EMTALA violation if you say or do anything to imply that you don't want to treat them.
For the people carrying on in triage about the wait or "you're a racist bitch" or whatever, I just say, "That's inappropriate language and threats will not help you to get back faster. Please have a seat. If you make another threat, use foul language, or raise your voice to me or anyone else here again, I will have you sit next to security for the duration of your stay here in the lobby."
I've had to run behind the "security" door (yes, our triage has a "safe door" that you can run behind that automatically locks) a couple times when people came storming at me in my little cubicle while making threatening gestures/yelling/carrying on. Don't rely on security to get off their ass and help you in a timely manner either.
So, yeah, basically, there are signs up that say that this is a "respectful work environment", but the law doesn't really care if you're being yelled at or treated disrespectfully by a patient...you still have to treat them until the "appropriate medical screening exam" is complete.
Visitors you can be more liberal. I usually give a verbal warning to simmer down, and if that doesn't work, sorry, you are outta here!
Personally I have no problem with telling off an abusive patient who I already know is not having a serious medical issue (ie abuse drug seekers, etc) and I have thrown people out on occasion. I also liberally use 4 point restraints and Haldol on particularlly difficult people.
I don't know if our hospital has a policy against this or not....doesn't matter, because it isn't utilized. Either myself or a fellow nurse is verbally abused or threatened almost on a daily basis and NOTHING is done about it. In fact, the most that is ever done is for someone from management to come over and talk sweetly to the patient to see if they can smooth things over....with the patient.
Call me a bitch or threaten to punch me and you get a free meal ticket....How's that for a policy??
Not really anonymous..just can't remember my google password.
What other profession? I hate to break this to you, but any/all of the customer service 'professions' are all expected to bend over and take it from the customer. I was routinely expected to take abusive language from customers, whether it was as a cashier or phone rep.
Frankly, I'm pissed that hospitals have gone over to the customer service model. Medical personnel are there to make people better, not wipe their asses for them.
Just think how pissed off the patient is after they've spent all that time with you & just get an rx for ibuprofen?
They take all that anger out on me - a pharmacist. Oh yeah & they think their 4 hour wait means there is no wait for that ibuprofen when they get to me - NOT!
There is absolutely no expectation in society of manners and the concept of civil behavior. People have become crass, angry, impatient uncivilized folks of entitlement - from every level of the socio-economic spectrum.
I thought I'd seen it all until this year's flu season when some of the most well off people became rampant crayzees when trying to obtain flu shots. I, too, had to get threaten to withold all shots until the anger and greed stopped.
Horrifying!
I was recently assaulted by a patient. This is the 3rd time in the past 2 months a patient was allowed to get out of control and push me around. This came right after administration took away our full time security coverage in the ER because it wasn't cost affective. I wonder if my law suit will be cost affective.
well...I think this goes along with the fact people come to the ER for a "cure".....especially this H1N1 season....Ive been yelled at by so many Moms because I didnt do anything for there sick kids.....I just wish they were more educated. I actually had a lady tell me , after I asked if she gave her kid TYlenol for her 104 fever that she was so worried about....she said "NO,I wanted you to see how high her fever was".....OH. MY. GOD.
The whole hospital system can go to he!! as far as I am concerned.
I am in grad school now and will never see the inside of a hospital again. Oh HAPPY DAY!!!!!!!
For the record, I got into a few FISTFIGHTS with psychiatric patients. Good for me. I didn't beat the crap out of anyone. Just made sure they understood their was some major hurt coming down the tracks if they didn't cool it. Amazing what a headlock and taking someone to the floor will do for their combative nature.
Of course administration had their "concerns". I guess they figured it was wrong of me to respond appropriately and defend myself. Those idiot administrators are gaping a$$holes IMO.
Good luck with your career. I am out of this crap. Over a decade is long enough for me.
I knew healthcare was doomed when the hospital I was working at paid a bunch of money to have "Disney Consultants" come give us lectures on customer service in the late 1990s.
I once applied for a job at a disney store at christmas just for fun. They told me during the interview that I was an actor and the sales floor was a stage.....that was the end of that interview.
What other worker? Retail, hon. As a 10 year vet, retail. You re every temper tantru throwing custmers' bad-day target. Even in the pharmacy, they just don't quit. We are with you, and if you find something that works, lemme know!
Want to stop abusive patients? Catheters should take the fight out of anybody. "Is that so? I'm doing a terrible job? Sounds to me like you need a good old fashioned catheter, that should do the trick."
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