What Constitutes Patient Abuse of Staff (and Other Patients) & What Should We Do?

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120px-Alarm

Recently  a nurse I know talked about a stressful shift where a patient with dementia and long history of agitated behaviors in a variety of facilities was repeatedly verbally abusive, using the call bell inappropriately (to ask for a cookie and then refuse it when staff brought it, to complain about how messy his room was and order the staff to clean it up,  and a variety of other creative manipulations), and intentionally setting off the exit alarm by sitting on the floor and leaning on the door and once was observed walking out of his room, pushing the door setting the alarm off and returning to his room.  She believed it was deliberate.  In addition he frequently told staff members that the their father was a pimp or mother a whore along with other explicit sexual remarks.

Imagine a relentless siren going off!  Or listen to this nursing minute over and over again for 8-12 hours!  Can you 120px-Alarmimagine trying to think in the middle of such chaos?

She contacted physician on call.  The physician was supportive of sending the patient to the emergency room, but the nursing Alarmsupervisor said that that had been done earlier in the week several times and the patient repeatedly came back with no substantive changes in medication.  She warned that this would add a slew of paperwork and that it would be ineffective.  The patient held his thumb on the call bell for three hours straight and then fell asleep.

120px-AlarmWhat’s even worse, she explained, was that she had expressed her concerns to the Director of Nurses and Assistant Director of Nurses 2 weeks earlier following a similar shift and from what she could see, nothing had been done to protect the staff or residents.  She also mentioned that this patient’s roommate was a quite and mild mannered man who was not able to use the call light or likely to complain.

This nurse was extremely stressed and frustrated.  Does the administration understand how this kind of behavior impacts staff and patients?  Do they take it into account when deciding staffing ratios?  Do physicians consider this when ordering prn, (as needed medications) such as a topical sedative?  

I think these kinds of behaviors are abusive! And that the safety of staff and patients should be a factor when determining staffing and chemical restraints.Alarm Is there a lack of awareness/concern about how this impacts staff and patients? Would more staffing would minimize need for medication?  Probably!  I also think it is irresponsible for a facility to admit a patient without considering these and putting them in place, especially when there is a trail of documented abusive behaviors.

What do you think?

If you are a healthcare leader looking for ways to support staff, check out Elizabeth Scala’s Rejuvenation Collaboration virtual self-care program.  It is a great resource to offer staff and the fourth in the series starting the week of Oct 21st 2013.  Show them you care and support the hard work they are trying to do!

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5 Responses to What Constitutes Patient Abuse of Staff (and Other Patients) & What Should We Do?

  1. Pingback: Major Shifts in Healthcare to Come | Elizabeth Scala, Reiki Nurse | Nurse Consultant | Speaker & Facilitator

  2. Sally O'Hara says:

    We can do it. I would like to have a group of us, who want to, (only 18 and over) to show love and come together to plan to speak up about us deserving civil rights too. Suggestions where to meet to plan?

    • Sally, tell me more about what you have in mind. I’d love to help. Feel free to say more here or beth@bethboynton.com. One idea I have that we could work on virtually is creating a list of healthcare professional rights. Like we have the right to be treated respectfully, have the resources to do our work according to standards of care, work at a reasonable pace at least most of the time. Would you be interested in spearheading something like that?

      Also, google + hangouts allow for up to 10 for video conferencing. In the next few months I’ll be announcing plans for a series of interviews that will be recorded. The technology can be challenging, but my business associate is tackling that. Anyways I can envision interviewing a group of nurses (and others) that are interested in talking about this. It ends up as a youtube on my channel.

      Anyways, happy to talk more. Beth

  3. Lu Ann Wahl says:

    I tend to think that as long as filling beds is the focus of care, milieu grievances reported to managers might be swept under the rug in trade for the distraction of medical minutia workload driven systems… If it’s not common sense than it may be about dollars and cents. Can’t really fault them for that. They’re doing what they can with what is trickling down eh? So let’s just move on shall we? Ha! This is where nurse creativity comes into play. We can view each case of behavior as a call for nursing creativity. Dementia is a condition that requires patience, tolerance, kindness, med management, and tongue- in-cheek a bit of toddler know-how. It’s easy not to take things personal if you’ve been away from the constant verbal drivel, often times droned on day after day or screaming and yelling. But if your depleted, it’s a red flag for inner frustration overload to combust into something you might regret later. Behavior (or illness of all origins for that matter- my opinion) is an “effect”. Think how to alter the “cause”… is it fear, loneliness, impulsivity due to boredom or just plain organic decline? The challenge is to question if we can shift the patients’ and our own thoughts to joy, comfort, belongingness, and appreciation? Form follows thought. Thought is energy. we can shift energy. (Just hold a warm cuddly puppy…that will shift your energy…). Energy transmutes. You can create the ripple effect on your unit. I’ve worked on units where we gave hand massages, dispersed soft squeeze things, allowed elders artistic expression to apply stickers, paint, fold and tear paper and magazines for collages… made sundaes and showed nostalgic slide shows to get them to engage memories of times gone past. (nurse initiated, we didn’t look to the higher ups to budget these things necessarily). Now I’m no angel. Bedtime sleepers have come after PM snack a bit earlier in some cases just to help patients simmer down. I have great admiration for those in the trenches. Do no harm but keep the peace! (mind you, while short staffed, with limited resources and limited breaks and full bladders…it can be done!) Nothing like a good back, neck and scalp massage to de-stress a peer or a patient. Share the luv you ‘all:) I don’t have the answers but I believe it’s a mix of balanced stim/destim. And that’s for everything and everyone on the unit- patients and staff… I was on a unit once and announced prayer and reflection time. It was amazing how the connection to a “practice” got the attention of the patience and they naturally adapted into a church behavioral presence. We nurses have to have our back-up arsenal of tactics. Balloons, warm wash clothes, finger nail polish, animal visits…. build your resources of creative tools. And don’t forget to “Take your Break” There will be times when a screamer, biter, pincher will rule the roost. These patients give us contrast for the sweetest man or women that makes the whole shift worth it. Nurture yourself and it becomes a lighter task to nurture others. I see you supported, rewarded and empowered to reset the thermostat on your unit despite any perceived lameness of others. Teehee that’s why we are the nurses taking care of patients and they are not! You have the DNA, now “Go for it”! And that’s a nursing order!!!! All the Best my kindred flamers (I’ve Combusted and reformed after a mere 5 anger management sessions with EAP).

    • Hi Lu Ann,

      Thanks for sharing your thoughts here. You are obviously devoted and creative in your work. I do wonder if you might also see some leadership and ultimately consumer responsibility for preventing nurse burnout? I think you are letting them off the hook too easily with respect to ideas that making money and filling beds are acceptable priorities.

      When nurses get burned out we know care is compromised. Burnout is predictable when we don’t give nurses the resources they need to provide care according to at least decent standards most of the time.

      When management ignores staff concerns, I believe this is akin to looking the other way when someone on the street is getting beat up. A strong sentiment for sure. Taking care of yourself and all of your recommendations are wonderful ideas and well worth trying. And I also recommend that Elizabeth Scala’s work in providing self care tools and knowledge to be great resources for leaders and staff. It is a great resource to offer staff and the fourth in the series starting the week of Oct 21st 2013. http://rejuvenationcollaboration.com/

      At some point individuals must make there own decisions on how to best take care of themselves. Like an abusive relationship, sometimes the best thing to do is leave it. This too, will have a rippling effect on the unit and healthcare in general.

      My goal would be for managers to work with staff to create healthy workplaces for patients and staff.

      Beth

What are your thoughts?