Fine line of abuse

2 Today I was speaking to a nursing recruiter for a facility that I won't name. In one moment it sounded as if he was trying to convince me to join the facility and in the next breath it sounded like he didn't want anyone to join who wasn't able and willing to suffer assaults from their patients on a daily basis. During the discussion I didn't think about it too much but after I came home and continued to think about the conversation it made me wonder about the fine line of abuse that nurses should take.

On one hand I can understand that a patient may have a hard time dealing with whatever is happening to them and they try to find an outlet for their frustration. Sometimes that outlet is the nurse because they are there.

However, where does it end? Where do you say "Ok this amount of verbal/ physical abuse is ok but one more and it is over the line"?

And as for the abuse- if it sounds like the facility is allowing the nurses to go through abuse by the patients, are they off the hook if they tell the nurses up front that they condone/ allow patients to abuse the nurses?

I wanted to hear others take on this especially since there have been discussions about poor work conditions and how much should nurses condone and whether or not they should speak up.
Speak up.. Become a target. Dont work there.

If the recruiter specifically made a point of bringing this up it can only mean that they are having a lot of nurses who refuses to put up with it. Hey, that is good news.

Verbal assaults are one thing. It's not fun to be insulted and called names, but this is the unfortunate byproduct of a culture that glorifies crudity and has elevated profanity to an art form over the past 30 years or so. I've learned that this is almost never about the person who's being screamed and/or cursed at, but a combination of factors that is far more complex than can be addressed here.Physical violence is a horse of a different color, and IMO should never, ever be tolerated. I work in an LTC where there is one resident who requires 2-3 staff members to restrain him from punching the medication aide whenever he gets a suppository; though he is demented (and the rest of the time, a great guy), we refuse to let him hurt people. So there is NO WAY anyone who is A&O should be allowed to get away with punching, hitting, kicking, throwing objects, or otherwise deliberately harming a healthcare worker.I had a patient a few years ago who was detoxing from meth and ETOH; one night he shoved his tray table at me and knocked me to the floor, then came after me. Luckily I had the presence of mind to yank the call light out of the wall before I went down, and within seconds there were 10 people in there hauling him back onto the bed and putting on the four-points. He bit one aide on the arm (he was HIV and Hep. C positive!) and kicked another nurse (who was about four months pregnant) in the belly before finally being restrained. The hospital had assault charges filed on our behalf, and the patient wound up going straight to jail after being discharged.But if they hadn't, I'd have pressed charges myself and urged my co-workers to do so as well. Too many times facilities fail to protect their staff, and if we don't fight for ourselves, who will?

I do not tolerate abuse, not physical not verbal. I do not care what state of mind a patient is in, it is just not called for. People are not allowed to go to a fast food place and verbally and physically assult the workers, so why should we allow ourselves to be victims. it upsets me when people justify patients bad behaviors with excuse like: they are upset because they are sick,sad, demented, whatever. vilolence against nurses should be unacceptable no matter what excuse is given. until we as nurses no longer tolerate such behavior, it will keep occuring. if we make excuses and tolerate such crap, we are to blame.

I am from a military background. Nurses are respected officers that don't take abuse. "Frustration" and "acting out" were not valid excuses for abusive behavior nor should they ever be. In the military I had the authority to "neutralize" the threat with whatever force I felt was appropiate to protect myself, my staff and property. In your case you have an even more powerful tool at your disposal. That is the power of refusal! Stay as far away from that facility as you can!

Had an 81 YO pt. tonight with dementia. At times we had her in four point restraints, giving her IM zyprexa twice. She was hitting, yelling and trying to bite. (Tried all the re-orienting, ambulating, etc. to avoid restraints) She was verbally abusing us most of the time - bad language, threats. Without restraints she was trying to physically abuse us and the other patients. She was strong - took three of us to get the restraints on. She actually broke the bed at one point. The on-call dr. had us give the extra IM zyprexa but was reluctant to give more meds d/t her age. He said she was at the max he could give her, even though it wasn't working. The psyche consult note said not to give Ativan as it might make her delerium worse.The only solution for her is to thoroughly sedate her, which I hope her regular dr. will do. When I am old, I would much rather be sedated than be like that. Personally, I think Ativan would have helped.We did what we could to avoid physical abuse. We ignored the verbal abuse.I can't imagine calling the police and pressing charges.

I think for a lot of us, we have a set line in our heads that probably far exceeds what the normal social and legal standards in any other situation would allow. On one hand, I can accept that a person is ill so they may be a little verbally abusive. No big deal to me, that stuff for the most part just rolls right off of me. The octogenarian with dementia or the Alzheimer's patient... sure, i'm liable to get a bit of physical abuse from one of them, but I am not going to allow them to injure me or one of my co-workers. For the average patient (or family member for that matter) I tend to gauge their actions as to if they behaved the same way in another setting altogether; what would likely happen? Imagine a person kicking a shoe store employee in the face. Imagine a person throwing their glass of water on the waiter because they are hungry and have not received their meal.

Yes, it is a fine line.I'll give more leeway to a person with dementia.

I accept that I will have to protect myself from patients in DT's or with severe dementia. Someone has to take care of them, and I accept that they are not always in control.I do not accept abuse from people angry at their situation in life. I do my best to support them, however if they try to take advantage of that, or use me as a punching bag I will quickly refer them to a higher authority. I did this just this week with a patient who wouldn't say anything nasty to me, but repeatedly cussed out my staff when I was off the floor.Tait

Quote from firefightingRNI think for a lot of us, we have a set line in our heads that probably far exceeds what the normal social and legal standards in any other situation would allow. On one hand, I can accept that a person is ill so they may be a little verbally abusive. No big deal to me, that stuff for the most part just rolls right off of me. The octogenarian with dementia or the Alzheimer's patient... sure, i'm liable to get a bit of physical abuse from one of them, but I am not going to allow them to injure me or one of my co-workers. For the average patient (or family member for that matter) I tend to gauge their actions as to if they behaved the same way in another setting altogether; what would likely happen? Imagine a person kicking a shoe store employee in the face. Imagine a person throwing their glass of water on the waiter because they are hungry and have not received their meal.

I was a floor nurse before going into education- boy was that a mistake. Students were allowed to do whatever they pleased. I am disabled now after teaching 3 yrs. I am lucky to work tele triage but you still get yelled at some and the benefit there is if they will not calm down you can say you will be glad to call back at a more opportune time. My ears can take it but my body got tired of being mistreated in education.

I believe that anyone will do what they believe they can get away with. Patients, sales clerks, the cable guy, bank teller, they will all resort to some type of abuse if it is allowed. I believe in drawing a line, which neither the patient, the physician, or myself is allowed to cross. The first attempt is shut down immediately. The only one who gets a bit of a lee way is the patient suffering from dementia. I don't approach them alone. The one time I came close to being assaulted by a patient, an aide had put the patient up to it and allowed her into our locked nurse's station. I got myself into our locked med room. Needless to say it didn't go over well with the rest of the staff.GrannyRN65