Patient's being Violent to nurses

Occupational violence is not a new concern here in the nursing world but it is getting worse.  The dept. of labors 2011 report states that being a nurse in the ER or in the mental health unit or community is ranked top highest job for violence.  A nurse in the ER, nationally, is at a higher risk of being injured than a coal miner and a police officer.  The Emergency nurses association did a report on occupational violence in 2010 that polled over 13,000 ER nurses and the statistics of that study are astounding. 

A middle aged man is brought to the ER by the local PD after they were dispatched to the street that he lives on for “a man walking up and down street aggressively, yelling and screaming at things that aren’t there.”  The man is cuffed and wide eyed, sweating with spittle on his chin.  His cloths are filthy and he has multiple sores on his exposed arms.  He is looking at things and muttering.  He does not know his name or wear he is.  He is fighting the officers and they physically have to drag him to a room.  He has to be strapped to the bed for safety of the staff after he spits in the nurses face and tries to lunge at her while she is assessing him.   This is a man on bath salts. (This is a case I am familiar with.)

A newly 20 something young man is brought to the ED by the police in cuffs after he took a few swings at his mother while intoxicated and angry.  He made some suicidal statements so the holding tank becomes the ER.  The patient is uncooperative and spitting at the officers and the nurse.  He is sneering and making vulgar sexual comments to the nurse.  His raised voice echo’s down the hall as he swears and threatens the nurse.  Another all too often occurrence in the ER. (A case I am familiar with).

A male family member of a young woman gets very angry that they are waiting over an hour for the doctor. (Actual time 25 min) He begins slamming the door repeatedly and yelling threats down the hall. Security is called and the nurse asks him to please calm down, the doctor is with another patient and he will be down in just a few minutes.  He then tells the nurse to go **** herself and slams the door again.  Security asks him to wait in the waiting area to which he refuses.  Police are called for staff safety. (A case I am familiar with).

A 20 something male patient is in the ER requesting narcotics for back pain.  The patient does not receive any narcotics after the doc does his assessment, x-rays and lab work.  The patient throws the discharge paperwork in the nurse’s face after calling her a name that makes my skin crawl and then he proceeds to push the nurse into the wall before leaving.   (A case that I am familiar with).

As I write about these instances I can feel my heart is racing.  Every day in our ER we nurses and techs are met with at least one patient every few hours that is angry at something or is on something that causes them to be dangerous.  Our ER is just like every other ER across the country.  Patients are getting angrier and their behavior is escalating quicker to violence against us and our staff. This behavior is NOT what we signed up for and it is NOT a part of the job.  Why do you think that many nurses and many nursing administrators feel that “it’s just a part of the job?”  I am lucky to work at a place that puts nurse safety above all else and that does not penalize us for reporting the violence~ and our local PD are very protective of us as well.  That is not so for many nurses across the country.  How has the violence changed in your work area? How do you stay safe?

A few press releases recently on nurses being targets of violence.

http://www.ena.org/media/PressReleases/Pages/workplaceviolence.aspx

http://www.wpix.com/news/wpix-bronx-hospital-emergency-room-shooting,0,5266436.story

http://vitals.msnbc.msn.com/_news/2011/11/08/8705246-swearing-spitting-choking-er-nurses-endure-this-and-more

Being a preceptor to new grads is an honor

When I graduated nursing school wayyyyyy back in 1991, I was hired immediately by the hospital I currently work for.  I began my nursing career on a med-surg floor working the day shift alongside the nurse who was chosen to be my preceptor, Laverne Pellitier. I had never met Laverne prior to this and I was very nervous, not only to meet her but to “be a real nurse.”

Laverne was a seasoned nurse, very professional and very nice.  Her nursing skills were top notch and I learned sooooooooo much from her. She met me with a smile and a detailed packet of what I was to learn and how long I had to learn it.  I received a full 6 months of training alongside Laverne.  When the 6 months were up I truly felt ready to be on my own and to go to the night shift…Laverne had done her job and I was confident in my skills.  Now this isn’t to say there weren’t moments of fear, tears and pain BUT there were more moments of joy, laughter and learning.

I wish I could say that every nurse I worked with during those first few weeks was kind…but that isn’t the case.  There was quite a bit of “nurses eating their young and initiation type attitudes” going on towards myself and the 2 other new grads that had been hired.  We now know that these attitudes are called lateral violence and sadly it occurs far too often!   I hear horror stories about it all the time and in fact this type of unprofessional behavior causes many new grads to leave the nursing profession all together within their first year of nursing! (According to a literature review I performed on this topic recently).

All of this to say how proud I am of a young nurse that I had the honor of precepting as a new grad 3 years ago in the ER.  Her name is Sarah and today she received an award for excellence in patient care in the ER. She is a remarkable young woman and nurse who I have the privilege of working alongside now in the ER as a fellow nurse.  She came to me as a new grad full of intelligence and vigor!  Her passion for nursing was evident and my job was to orient her to ER nursing and to assist her in putting the pieces of all she had learned together in that world of ER NURSING.  I wish I could say she got a full 6 months to learn and stretch her wings but we do not have the luxury of having that much time to give…BUT she was ready to go off on her own despite the less amount of time….

When I decided to become a preceptor I wanted to treat the new grads as I had been treated by Laverne…I view the job of preceptor as an honor and a privilege. I want the new grads to feel safe and cared for and I pray they all have!  It is our job as professional nurses and human beings to treat our new grads with respect and kindness while assisting them in learning. Being in their new position is terrifying and how can they learn compassion for their patients if they are being treated with such hostile attitudes…and how can they feel safe to learn new skills and even make a mistake in that environment? I’m sure many of you have horror stories from your new grad days, but I hope more of you had a preceptor like I did!  Thank you Laverne, where ever you are!!~~

From the eyes of a patient

From the eyes of a patient.

How many of us nurses have been patients a time or two?  What do you recall from your experience in the hospital? 

I have been a patient only a handful of times in my life~ thank you Jesus!  I have had 2 children that were delivered in the hospital…one experience, from my patient perspective, was good and one was very bad.  I had a day surgery experience which was wonderful and I have a childhood memory that was horrific.  What is interesting to me about the memories of these experiences is that my barometer of rating the experience is how I was treated by my nurses.  I cannot for a second recall the doctor in most of these experiences…hmmmmmm.

When I had my first child I was 19 years old, married and scared out of my mind!  The labor was long and painful.  The nurses that tended to me during labor and delivery are somewhat of a blur…  After my daughter was a born, that night I was in terrible pain and alone in my room, (babies were taken to the nurse’s station area back then)  I rang my bell to tell the nurse I was in terrible pain with cramping…a very long time seemed to pass…an older nurse came in, didn’t identify herself and said, “what do you want?”  I told her my problem and she said, “What did you expect when you have a baby at 19…it will pass” and she left the room.  I cried myself to sleep.   I didn’t dare to ring that bell or ask a single question after that.

When I was 7 or 8 I was in the hospital for a few days with an acid problem in my stomach.  My mother came and went but at night I was alone.  I only remember one nurse and she had red hair, was overweight and mean.  She practically growled at me from what I recall…the one thing that really sticks out in my mind and I remember it vividly is night she came into my room and told me to roll over.  I was in bed playing don’t break the ice…I asked her why…she said, “I have to check your back for a rash.”  My mother wasn’t there and the other woman patient was gone too…I remember feeling scared but I wasn’t sure why.  I asked the nurse if she was going to give me a shot.  She said no.  I rolled over and she pulled my bottoms down and quickly shoved a needle into my butt cheek and then left the room……I remember just crying and feeling so scared. 

I wonder what was going on with the 2 nurses that I just spoke of?  From what the first nurse said to me I can presume she was hostile towards me because I was 19 and she felt  I was perhaps “loose…” and from the second nurse I can presume she didn’t like children…  either way their attitude toward their patient was disturbing and extremely unprofessional. Maybe they were burnt out? 

I had not thought of these experiences in many years until yesterday when a scared pregnant teenager entered triage and asked where labor and delivery was.  My experience came rushing back like a flood. As I reflected on both of the mentioned experiences I cringed.  I have always made it a practice to enter the patient’s room with a smile, tell them my name and title and then address their issue.  I hope that I have NEVER treated anyone in such a manner as I was treated.  I am thankful for the experiences now and I’m thankful for the recall of them so that I can keep in mind the patient perspective.  Treating people/patients as we want ourselves and our families to be treated should be our motto as a nurse.  I’m thankful for the reminder today. 

Then and Now...

I grew up in a small town in Maine.  My mother was a stay at home mom…my father worked full time and many times, over time, in the local paper mill.  We were not poor but we were not rich.  My brother and I had all the material things that were necessary and a few fun things for birthdays or Christmas.  We did not eat out in restaurants, my mother cooked all of our meals, and if we were sick we stayed home from school and my mother took care of us.  There wasn’t anything that bag balm, duct tape and Vicks couldn’t fix!! 

Thinking back on several childhood illnesses, what I remember, is laying on the couch in my pj’s, comforter and pillow situated so I could see the TV and the famous orange bowl (puke bowl) on the floor by the couch.  I would sleep, puke, run to the bathroom, sip flat cola and nibble on toast until feeling better.  If we had a fever my mother would give us Tylenol and Vicks hot packs.  Sometimes our illness lasted several days and we would remain on that couch until the symptoms passed. I say all of that because it is very troubling for me to see a culture today that is unable to think through how to care for the typical illnesses that run through our communities.

Our healthcare system is out of control with its spending, as is our government with its spending.  I hear from nurses all over the country (ENA) who are concerned for this very thing as well. The abuse of the healthcare system is a hot button topic (one that every ER nurse in the country to go on for hours about!) The ER’s are overcrowded and in that mix is the person who has had a sore throat for 1 day, a child who has been nauseous for 2 hours, a child with a fever for 4 hours and has not had any Tylenol…People do not either know how to care for these basic illnesses or are unwilling to or don’t have the ability to be the stay at home mom with the time to do so.  Quick fixes are what people want. 

As a nurse I am saddened that my role as educator has been removed!  The patient is the consumer now and they do not want to be taught anything…they want us to fix it…give them a magic pill and send them home.  I am sad that we in healthcare have stopped being the patient advocate and the patient has stopped wanting that …teaching them how to help themselves…teaching them how to use natural cures for simple health issues…teaching them that by losing weight and eating healthy foods to help with inflammation that is causing so many of their health crisis…encouraging them to stop smoking, and on and on it goes. 

The patient of this day gets down right angry if the healthcare team tries to encourage healthy behaviors for better health.  Our healthcare employers are concerned about customer satisfaction and thus discourage making the patient uncomfortable in any way…so NO patient education for healthy living, it tends to offend. 

We are not helping our patients by giving into their every demand (like they know more than the doctor what will help their problems), or by handing out prescription pain medication by the handfuls for every possible ailment.  Sadly, as I listen to nurses in every possible nursing field, we are not helping our communities by dumbing down our health care system…by NOT educating our patients with practical and alternative therapies to promote better health.    

Times they have changed, and not for the better in healthcare.  I wonder…if our economy continues to do a nosedive, will healthcare be forced to go back to times of old?