A Tool to Handle Verbally Abusive, Difficult Patients
A personal account of how a behavior agreement can help nurses gain control
I was 47 before I learned how to handle my difficult, mentally ill mother. It took a nurse to teach me.
Throughout her life, my mother had earned several diagnoses: anxiety and depression, bipolar disorder, histrionic personality disorder. These issues mostly manifested themselves in alternating stints of needy whining and frightening, angry outbursts. The most minor things set her off. The first chance I could, I ran to the opposite coast so that, if I saw her coming, I could at least jump into the ocean.
A few years ago, she was diagnosed with atrial fibrillation, and her doctors decided a heart monitor was in order. I flew out to shepherd her through this process and hopefully smooth the feathers of her doctor to whom she’d been referring to with a very derogatory name.
Hospital check-in included my mother swearing repeatedly, yanking forms from the fingertips of nursing assistants and throwing pens across the room. Of course, surrounding all of this behavior were my profuse apologies and notes to self of what gift to buy which beleaguered hospital employee. With my mother tucked in her bed before surgery, one of the staff came in with a tray of food.
“What the **** is this?” my mother asked, picking up the container of applesauce.
“A light meal to keep you strong,” the nursing assistant replied.
“How am I supposed to eat if I can’t open the ****ing applesauce?” She looked at me, holding out the small plastic tub covered with sealed foil. “Open the ****ing applesauce!” When I didn’t respond quickly enough, she threw it across the room. Silently, the assistant turned and left.
Shortly, a nurse wearing a stern look came in carrying a clipboard.
“Mrs. L.,” she said (using her full last name), “we’re here to help you.”
“You’re not here to help me; you’re here to kill me!” my mother replied.
“If you don’t want to be here, you can go home. Otherwise, you can sign this form that releases staff from the responsibility to treat you if you are abusive to them. Your abuse is not in their job description.”
My mother gave the nurse some push-back but the nurse held her ground, making clear that the choices were in my mother’s hands, that certain behavior was unacceptable and there would be consequences for aggressive outbursts. Every time my mother used expletives, the nurse responded with, “Mrs. L., that’s rude. Why would you talk like that to me?” She called her on her behavior and made it clear that she wouldn’t back down.
I was astonished at how quickly my mother’s behavior changed. Not only was she compliant, she became polite and even seemed to try to get the nurse to like her. This nurse was my hero.
Nurses have the right to polite treatment
Many hospitals and medical practices have an acceptable behavior agreement or contract like the one my mother had to sign. No one should have to bear the abuse that angry, intoxicated and mentally-ill patients heap upon them. These agreements normally outline:
• Inappropriate patient behaviors
• The impact these behaviors have on nurses, doctors and other staff
• How the behavior can impact healthcare delivery
• Consequences delivered if behavior continues
When explained that this behavior agreement is a tool to help both patient and staff, rather than a punitive measure, patients can respond surprisingly well. Many do not have a good grasp of the impact their behavior has on others. Caught up in their own emotions, they act out to dispel feelings in the only way they know how. Once reminded that their medical professionals are vulnerable, too, they may gain a new outlook.
The types of patient behaviors nurses should not tolerate include:
• Demanding, controlling or manipulative statements and requests
• A patient’s refusal to listen
• Lack of cooperation
• Verbal abuse
All of these fall short of violence, which requires more aggressive responses, including the “Code Gray” call for an out-of-control, combative patient. Still, the nurse may not be able to handle this patient alone and shouldn’t feel the need to do so.
Every hospital has harassment and anti-violence policies that travel nurses will probably review during orientation or before. Travel nurses should confer with other nurses, their supervisor or nurse manager for specific questions.
Reviewing these policies empowers nurses to know when patients cross the line and what steps to take. These policies also help nurse managers quickly determine how to respond to a nurse’s complaint, while being backed up by administration. The prepared nurse can then approach each patient with confidence.
Travel nurses working with American Mobile have the additional support of clinical liaisons who are available 24/7 during their assignments. Your RN liaison can be contacted if you have questions or concerns about your working environment or about other clinical aspects of your travel nursing job.
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