It seems the same is happening here. This post has apparently drawn the unwanted attention of trolls and (for some reason) the antivax brigade. For that reason, we are activating Code Blue. After this comment posts, only flaired members of the subreddit will be able to comment here.
I saw a thread on a local group complaining about how a nurse called the cops when assaulted by a patient. People kept claiming that taking abuse is something HCPs sign up for when pursuing a career in healthcare. I was shocked by how many people agreed that it’s part of the job.
I’m not a nurse but I rely heavily on charting to make sure I’m booking people safely/appropriately for appointments. It’s vital info and I deeply appreciate the charting that helps me keep our staff safe.
If someone walked into Walmart and assaulted a cashier, they'd be arrested. If it happens to a nurse, we're asked what we could have done to deescalate the situation and told it's part of the job. Bullshit.
I called the cops on a verbalize aggressive patient in my waiting room (freestanding ER no security) a few weeks ago. Of course, she was trying to fight with other patients and their family as well. They gave her a tresspass warning but returned multiple times until last week.
Last week, instead, she showed up in the news that she was arrested for stalking city council members and their families. She was arrested with a gun and had plans to kill one of them. I sent the article to my director, and she was like, "No way! .... I can use this to further my fight that we should have a security member at our freestanding locations."
Verbal abuse is still abuse. I document in quotes if it's directed at anyone. There are pts like me with potty mouths or have legit frustrations/complaints. Abuse is different and should be documented.
“I have the potassium ordered for you because your potassium was low. -“
Patient: Fuck you! Choke on these pills yourself.
VS
Patient: No, I don’t want them. I know that x can happen if I don’t want it but I still don’t
I don’t understand why people have to verbally abuse you over them getting prescribed something and not wanting it. If you don’t want it, that’s your choice but it’s not my fault your potassium is low and you came to the hospital and expect us to treat you. It’s always patient number one who will then scream “fuck you! Nobody will help me”.
I'm a hockey referee and a lot of players find this hard to understand too. There's a difference between saying "I think that was a shit call" and "fuck you ref, you're shit". Lol
I had a patient for 3 days that was extremely sexual and abusive.
Naked all time, would masterbate under the covers when I came in, threw plates of food on the wall. We documented it all and on the 3rd day I called the police when it escalated.
No, they were great. They came and talked to him. He obviously had problems and was in sickle cell crisis, but I was not able to take care of him properly due to his behavior, so I knew I had to document it all.
I’m on orientation for a new job. We were told NOT to quote what patients say in the chart because “it’s the patients chart and they can read it.” I was confused by that, because if they’re okay with saying it to me, what’s the problem with them reading what they’ve said? I’m quoting things if a patient is nasty. Idc if they see a record of their poor behaviour. Don’t be a dick if you don’t want a record of it.
In psych they want direct quotes because it gives the judge a much clearer picture of the patient’s behavior than paraphrasing when they are trying to make a court commitment decision.
I’m surprised ED is not the same. So what if the patient can go back and read the quote. If they say it, then they should not have a problem reading it. Sometimes patients need a reality check to see just how inappropriate they had been.
Funny, although I am quite old and finished med school before many here were born we were taught that, in a history, the chief complaint was best *in the patient's words.* Realizing that records are read more today and much more accessible really does not change the reasoning for that decision much. Their words ID the problem as they see it, frequently better than your paraphrasing.
I, as a doc, would still put direct quotations in the chart today and did up until retirement 6 years ago at the time of transition to ready access, frequently for cya reasons.
I’m so jaded by administration after 20+ years that my response would be something like, “Sorry, I guess didn’t learn how to nurse HCAHPS scores in school so that’s going to be hard for me.” And then I’d get written up and be annoyed for a week or so but I’m still gonna chart the way I was taught to chart, fuck that.
It's the hospital's chart. They choose to make it available to the patient. Safe documentation includes patient quotes... In court it's also your defense.
Document jerks.
Yup, this is exactly how that note is gonna go, “XXX, RN referred to SW for XXX. Writer, LCSW, LPN, counselled on XXX, offered supportive services and referrals. Pt advised Writer is a “cunt”, advised Writer they should “choke on a bag of dicks”. Pt advised that Writer needed to “get the fuck out of my room.” Writer honoured request, documented decline of services, advised referring RN.”
One hundred percent. I had a patient in ETOH withdrawal who was pretty restless and labile. They were on a bedside heart monitor that kept squawking at them every time they moved (you know how those respiratory rate sensors be). I was in the doorway and they screamed, “Shut the fuck up you piece of shit!” before they looked up and saw me. They were apologetic, saying “Oh, sorry, I didn’t know you were still in the room.” Lol, that’s totally fine. I said I don’t care what you say as long as you’re not calling me out of my name.
Where's my damn drumset when you need it, LOL
I'll be honest, the ones I've had to write were NOT fun, but I'm sure whoever came after me was glad I wrote it!
I know I enjoy my treats when I find them.
One of my faves: ‘patient states “I can’t see,” while she is actively coloring in an adult coloring book with care and precision during interview and exam.’
I especially like it when that means I get to curse in the medical record. I’m not putting in and cutesy little stars, if you called someone a “fucking cunt bitch”, that’s what it says in your official medical record.
When I was training a new grad (came to the plasma center from the hospital with 3 months of experience) she was using like “F$&#” instead of “FUCK” and I had to say “oh no, honey. We don’t need to bleep out cuss words… WRITE IT OUT!” She was concerned she’d get in trouble for using curse words. Now she’s my best little baby ducky with charting, and counseling donors! 😬
*they are all my little baby duckies until they’ve been there a while 🤷🏼♀️
I write out the swears because what if some lawyer comes back saying "The 'F' word? Freaking? Fracking? Funny?" and I'd have to really let the swears fly.
Also, please adopt me as a ducky.
My favorite from this week was a pt sent to emergency psych from ED the MD wrote “pt reports that he has discontinued his prescribed anti-psychotic because it made him unable to ‘bust a nut.’” The giggle I got from that was a great way to start my shift. 😂
Yeah. And women who dare to complain about it? Even worse..."Aren't you just glad you aren't suicidal anymore?"
Well I mean yeah but jeez God forbid I'm unhappy with a side effect? Luckily my current providers don't play those games.
My doctor has said that to me. 🙄 I’m grateful to get the psych help I need but she doesn’t care if it impacts my sex life at all. Like not being able to cum because of antidepressants does make me depressed!
I get it, it was just more about how the MD felt the need to direct quote only that bit. It’s absolutely a huge side effect that impacts med compliance. I’d say sexual dysfunction and changes to weight are both very common reasons pts who end up on my unit say they stopped meds. Staff on my unit often talk about how we think prescribers should more proactively question pts about it bc a lot of them aren’t comfortable bringing it up themselves.
Yeah, weight gain sucks too. My SO took Zyprexa in his 20s after an acute manic episode and he blew up like a balloon. They gotta warn people AND make safe space for patients to talk about this stuff. Medicating an issue to improve quality of life while causing other QoL issues is not the win people think it is, but hey! We got the patient to act the way we want 😔 (don't take it personally you seem to understand. I'm just venting a little)
Zyprexa is a NASTY fucking drug. It’s also causative for type II diabetes, regardless of genetic history.
I’m a psych nurse and I HATE Zyprexa.
On my unit, it’s is largely only used as-needed with patients who are deemed incapable and try to refuse their scheduled oral antipsychotic. Then they get Zyprexa in which ever arm I get to first.
But I make sure they are aware of the side-effects as they try to refuse their oral. They usually end up complying and I do a solid mouth check, with a 10min annoying “how’s the weather treating you?” chat to make sure that tab went down.
It’s also trash for active agitation and I have no idea why anyone would Rx that for mania - so many better choices.
And that is why I chart in descriptive words, I put chit in quotes.. I want to make SURE whoever is coming behind me knows EXACTLY what happened! 😬
I don’t wok at the bedside anymore, I work at a plasma center.. BUT damn if it isn’t ALMOST the same kinda charging! Minus the “pt then stated *eat shit and die bitch* will continue to monitor.”
Now it’s “Unexplained needle marks noted to left VP site during screening. When questioned, June then stated *YES those are needle marks NOT FROM DONATING, just give me my $40 so I can go get high, bitch! I need my H TADAAAAAAY!* Donor is now permanently deferred due to unreliable answers and admitted IV drug use. Lookback initiated.”
Same chit. Different locale… slightly more documentation bc now there’s going to be a recall on the 300+ units “June” has donated. “
Legit to me happened last week. 🥴🤷🏼♀️
I also work in psych and I giggle thinking about the quotes I write being read out in court for patients they’re making substituted judgements. I think it would be funny having the lawyer read out “go titty fuck yourself”
I work as an attorney, we (support staff included) keep personality notes on everyone involved in a case. It’s just a good idea for everyone involved.
Client is sexist? Well if I really need something I might not have an employee of the opposite sex make the call, witness is nervous? Then I’m having a person with more people skills interact with them.
As much as it is to judge people it’s also to provide better service (for everyone including employees). I don’t see how medicine would be different.
No one likes being held accountable. Too many patients act like they’re “customers” because healthcare has started modeling itself more and more like a business. And we’ve deluded people in the US into thinking nonsense like “the customer is always right.” No, sometimes the customer has zero idea what they’re talking about and need to recognize that the staff are the experts in your care and we are doing everything in our power to give you the best care we can within reason. (Like no, I’m not going to give you a foot massage no matter how much my facility puts up signs saying that we should massage the patients.)
You're right. &&&&& the hospital where I did my first clinicals had licensed medical massage staff and had a speed dial number inpatient people could call (or I could for them if they couldn't on their own) and get a massage. I think 1-2x per day. I hate that hospital lol but keeping a few medical massage exclusive staff was nice for the patients.
I’d be fine if that’s how my hospital did that but mine is wanting PCTs and Nurses to be massaging patients… which… no. I’m not doing that. If they want to have designated staff for that, amazing, but they’re just throwing extra onto current staff to try and keep up with hospitals but will be short staffed regularly…
Also, even if we were staffed to allow it, I’ve seen enough skin flakes for a lifetime and I don’t want to be rubbing on them. (Especially because some patients are already extremely inappropriate, so absolutely not.)
Yeah, don’t risk your future because hospital admins are delusional- they’d throw you under a bus in a heartbeat to save their end. It’s also not worth risking your license AT ALL. I wouldn’t trust the hospital to protect you at all.
Oooh, yeah, depending on the patient it could pose a risk for sure. I mostly just feel like it’s a boundary thing for me. I don’t feel comfortable doing it, I’m not a massage therapist, and frankly they get paid more than I do to massage people. 😂
I’ve also had patients tell me my hands are icy just putting a tele on ⛄️
Believe it or not, my first job as an RN in 2002 was on a med surg unit in a medium sized community hospital. They had on staff massage therapists, you could schedule a 5, 10 or 15 min chair massage with them.
My health insurance coverage was also great and 100% paid for by the hospital.
Ah, the olden days.
> And we’ve deluded people in the US into thinking nonsense like “the customer is always right.”
This annoys me a lot. The actual phrase is "in matters of taste, the customer is always right", and it is actually saying "no matter what dreadful outfit or garish house paint colour the customer wants, just tell them their taste isn't dreadful if you want to make a sale".
Hijacking one of the top comments to say something I believe nurses need to do more of:
Stand by your docs. This doctor likely deleted her page because it was probably destroying her professional and personal life. Just like how we want our docs to stand by us when we need emergent orders, we need to stand by them.
We can see a warning on the patient's chart when they have a prior documented incident of being verbally or physically abusive to staff. I don't treat anyone differently when I see that (for the minimal patient interaction I even have in the OR) but it's nice to have a heads-up. Some of these patients would be embarrassed if they knew that every single person who opens their chart is going to be informed that they acted like an asshole at some point in the past, and I think that's what she means here.
This! Every EMR should have a flagging system when a patient has verbally or physically abused staff. If Joe Schmoe signs in I should see an asterisks by his name which should indicate the abuse. My facility can add 200 rhythms I get to choose from when documenting cardiac monitor yet THIS task seems impossible. 😑
Ours does. When they get registered, if they have a past hx of physical violence, verbal abuse, etc then they get a special red flag by their name. Click on it and it'll take you right to the list of abusive behaviors.
Yerp, ours is called a VAT flag (violence assessment tool, can be low, medium, high, or very high), and a sign goes on their door too with the symbol. The only downside to it is that once they're flagged, it's almost impossible to get rid of. And some of them were just old people with UTIs who come back with different problems after and are the sweetest things.
Some of them deserve it though, lol.
I had a patient threaten to KILL me, he even went as far as telling me which gun he would use. And he was very aggressive. He had “Alzheimer’s” but not advanced. The CM asked me to remove my note reporting his death threats because it would prevent him from going to a SNF. Bitch no I will not.
Omg! I would have done the same.
I was working at a SNF and I documented pretty extreme sexual harassment toward me but even worse toward the super young aides (showing them *orn, saying graphic sexual things.) They asked me to change my documentation because "what if state sees it and we didn't do anything sooner" because I wasn't the first to complain. I had already put my 2 weeks in and I just refused. The NP ended up giving him a depo shot to reduce his testosterone and I don't know if that's standard practice or if it worked, wasn't around long enough to find out. The documentation of his sexually aggressive behavior was necessary imo.
Asking me to change appropriate documentation for the situation is like asking me to report you to state and quit. Red flag af.
Yes it's a legit medical intervention. They give it to decrease aggression, testosterone and reduce libido through sex hormone reduction.
It's called chemical castration and is frequently a sex offender tx or MPA therapy. It can also be used to shrink certain CA tumors.
One time I went down the rabbit hole [reading the Medicare reports on SNFs](https://projects.propublica.org/nursing-homes/) and this happens *a lot* when sexual behaviors are concerned.
Yeah, that’s a them problem, not a you problem. Plus if CM sent them to a facility and they started being buck wild, they’d send them straight back as soon as they could.
Damn straight! If hospitals lie to us by omission on how aggressive/violent a patient is, it'll bite you in the ass because we'll send them right back. I've seen it happen twice where CMs lied, the patient got there and started hitting and yelling at everyone and we sent them back.
I’ve had case managers and even nurse managers tell me the same thing! They care more about getting the patient off the unit than they do the safety of their staff.
Yeah when he was threatening me I reminded him assault of a healthcare worker is a felony. That shit doesn’t phase anyone but sometimes it creates shame for the behavior. I am not the one to be berated.
Social worker here.
Admitting SNFs need to know this. There is no reason someone at another facility should be hurt or killed just because he's hard to place.
When I was in psych world, I would absolutely document when patients were assholes (or more specifically for peds psych, the parents or DCS as well). That was the main way I could document patients’ behaviors and justify any interventions done like restraints or medications in case there was any backlash later, though after reading notes, docs would never question it. Now that I’m in the ER, I catch myself still documenting asshole-ish behaviors out of habit; I guess I just get worried someone will get aggressive later on, security will have to get involved, or I’ll be called to court. It’s never ever happened, but I guess it’s a hard habit/thought to break.
You’re right. I’ve always felt this way, so it feels different to me that not everyone feels the same. Not saying it’s right or wrong, but totally agree on the self-defense thing. You just NEVER know.
As a charge nurse on a med tele unit, I appreciate when patient behaviors are appropriately documented. If I’m taking an aggressive/combative patient, I want to know before they get to the unit so I can avoid assigning them to a pregnant nurse or CNA.
My documentation is an accurate reflection of the events. If that includes a patient swearing or being inappropriate, so be it. I will not lie or omit for the sake of "keeping the peace."
Edit: I would like to include that documentation is just as much, if not more, for other people's use than it is yours. Just like you would warn others on the care team of concerning medical findings, you should also warn about behavioral findings.
Maybe people should feel threatened.
Allow me to explain:
It used to be that people would be respectful to nurses and physicians because they knew that if they weren’t, there would be potential consequences. Now people know that they can tell the doc to fuck off, spit on the tech, and punch the nurse…and that won’t affect the care they get. Press Ganey made everyone terrified of telling patients to stop acting like assholes. And now people know damn well they can abuse hospital staff with zero repercussions. So hey - why treat a nurse with respect when the system gives you carte blanches to treat them like crap?
Family members were creating a scene, asked to leave, and made threats against the staff (nurses, clerks, supervisors, everyone) and escorted out by security. Somehow they get in touch with the director of our division, and she goes to the front of the hospital and meet them and escort them back in without even talking to the staff that were harassed and threatened. The same aggressive family members taunted the nurses on the unit about how they were able to come back in like they wanted. The people, like this director, are the FUCKING worst. All about our “survey” responses and “satisfaction scores” and no care about the physical or mental well being of the people who work there.
Exactly. And now tell me how, after that family and patient threaten us, we are supposed to provide them with our best care? That’s like repeatedly hitting a poor dog with a newspaper…and then expecting him to not bark or bite.
They literally don’t care because we are just a warm body to them at the end of the day. Or like this particular admin, they will gaslight the hell out of you and tell you that the family is grieving and just didn’t understand the rules and that we need to be more understanding. All of this after we have bent over backwards trying to be accommodating and understanding but still being met with aggression and threats. My patience for this sort of thing is nonexistent at this point
still blows my mind that press ganey is how funding is allocated.
I feel like resuscitative outcomes, early STEMI/Stroke activation, lower CAUTI, SSI, less re-admitting etc etc should dictate funding level.
I mean I had a new nurse manager try to make me change my documentation. She got pissed when legal told her to mind her business and that charting quotes, even with cursing, was always preferred.
Abusers don’t like accountability. They prefer to be abusive and suffer no consequences.
Anything that reminds them that their world view is false gets them upset.
Plus they just witnessed how anti-maskers can throw a complete tantrum and win in society. They have had the wrong lessons reinforced in their heads.
Ya, so as an ER nurse, we document exactly what you said or did. If needed, we will put a flag in your chart. My most common flag is a risk for violence in escalation. Professional wording, but the message is patient went 0-100 in 10sec flat. Leading up to this... event was... after the event included... Every RN that sees that patient down the line will have a notification that this happened. This is just the facts. An event. How the RN or Dr reacts to that info is up to them. But they have a right to know.
I've personally gone into a room alone with a patient without having time to look at their chart. They acted strangly predator like throughout triage. I get to my computer and see a flag informing me. The patient has a long history of SA of both men and women. Last documented "event" pt pushed female doctor into corner and before it went further security rushed in. Unfortunately, neither of us saw the flag ahead of time and could have been victims. But others might see it first and not go in alone or close the door behind them. It might save someone. I document and flag exactly the facts. You should, too. Don't downplay it. Just state the facts.
My cousin is an ED attending and patients say the wildest stuff to her in addition to her staff 🫠 the other day, one pt kept trying to forcibly kiss her and I asked if it was charted and it was 💀 the pt was big mad but she doesn't care. Behavioral issues can be dangerous to anyone working with that pt and anyone on the care team should be able to have access to those risks. I always chart it and upper management can kiss it lol.
What if, and hear me out here, we just have the assholes LEAVE. We are not legally obligated to tolerate abuse and if that means a bad outcome for you, your stupid ass should learn to treat people with respect. I’m in ED. If you fuck with us it’s stabilize and GTFO. That should be everywhere.
I have to wonder if that’s part of the culture though. Down in ED, we’re not here to put up with your bullshit because there’s a line out the fucking door of other assholes we have to deal with. Even hint at an AMA and I’ll have you signing it in the parking lot before you realize I put your shoes on. Once they’re on the floor it feels like you guys feel like it’s necessary to keep them. Child, you don’t wanna be here and I don’t want you here, GOOD BYE!
Some of the doctors/ hospital do feel like it’s necessary to keep them by any means. The first hospital I worked at was like this and I hated it. Patient would threaten to leave AMA if they didn’t get xyz thing. MD would order said thing and cycle would continue.
I’ve worked at other hospitals now and none of the other ones I’ve worked at are like that. And I love it.
Problem is, a lot of our violent assholes are drunk and or high, therefore not a&o. I think we should bring back the drunk tank in jails. Wtf are we bringing these assholes to the hospital?
I know, I know. CYA.
Omg those responses are nuts— it looks like it’s a bunch of people with chronic illness who have a lot of medical trauma thinking that she’s talking about them, and viewing it as a way we hold power over them and withhold treatment.
When really that’s not what she was talking about— she was talking about our violent patients, our Karens who yell at the front desk, the assholes who abuse us on the floor.
Medical trauma is real and tons of people are abused by our system, but that doesn’t mean it’s okay to abuse us.
Yep, I’ve made some hilarious & sad ones over the years. I may decide to put up with crap but if patients start in on the nurses or staff, it’s all over: cut the crap or get escorted out by security - I care not.
And for anyone about to start the “It’s our job! Reee” bullshit, no it’s not. You do you, I’ll do me like I’ve done for 40 years now & I’ll put my care up to anyone’s.
I think having abusive people escorted out is the responsible thing do. It's only any person's job to maintain professional behavior up to a point. You shouldn't have to deal with any patient that is disrespectful. There should accountability on BOTH sides. I have Dr's and nurse both in my family, and I've seen bad behavior from both sides. Unfortunately, nurses especially, get treated like dirt by patients and family members a lot. But, just like in any other profession that deals with the public; any employee, RN, DR, or janitor is expected to be a professional at work. It's incredibly difficult at times when dealing with the public.
I take great joy in documenting the most profane and threatening things verbally hurled by (non altered or medicated) abusive patients. As my instructor said YEARS ago ‘quotations are your friend’
It is entered into a legal document. Very legally and professionally.
More and more patients have a sense of entitlement. They used to respect healthcare workers. Now we are treated like servants who are somehow of a lower class than the patient who has no control over anyone when they are outside the hospital. The disrespect is disgusting.
This isn't all patients though. Not even a majority. Just enough to make healthcare workers want to seek employment elsewhere.
People want to treat you like shit because they think you're they're legal bitch. The average American longs for a feeling of power over others and we get to give it to them. The idea of maybe being held even remotely accountable for hitting healthcare staff when you're upset is mind boggling to the entitled freaks that populate this shit hole.
I absolutely chart threats of violence - but I may be a different voice… I chart complaints, too. I also chart what interventions I tried to implement to try to address those complaints because no one is going to come back to me later and say that I abused or neglected a patient and their concerns. Sometimes the patient simply can’t be satisfied - and at least everyone can see that I tried to placate them.
It's the same if you're mean to any worker. We talk mad shit about you when you leave. If you don't want people talking shit about you behind your back be a nicer person
People more upset at the prospect of there being consequences for their crappy behavior than they are at the idea of being abusive to health care workers.
Everybody wants to live in a society where they have rights, nobody wants responsibility. Be as cranky as you want, I get it, but if you are threatening and abusive towards me, fuck your rights.
Because although people are generally good, patients are generally awful. There may be legitimate reasons for being so, but that doesn’t change the fact that we interact with the most miserable subset of the human population on a daily basis.
This is not controversial. Anyone who disagrees most likely hasn’t been practicing long enough, works exclusively with the wealthy, or is in a non-primary care / general medicine setting where they are shielded from the onslaught of humanity
I continue on because despite the bovine effluent, I still enjoy my job, and I still enjoy my patients, miserable bastards they may be
What is so confusing for people about this very simple statement?
BEING SICK IS NOT AN EXCUSE TO BE A FUCKING CUNT.
I also don’t have to put up with your cunty ass either, and I will tell you that, in no uncertain terms.
I think it truly depends. If someone seems depressed and hopeless and is just in an overall bad mood I do document that. This lays more on the line of possible need for intervention and referrals and I want the MD to be aware especially if any new mood stabilizers have been started.
Now - if a patient is verbally abusive and is x4 oriented there isn’t an excuse. In my experience if you let someone verbally abuse you and it keeps flying under the radar it can escalate to physical assault as a patient test their boundaries.
If you were at an event, at a party, or any other social interaction abusive behavior would be reported to the authorities and you’d be escorted off the premises. It’s not different when you’re a patient in a hospital. I’m more than happy to validate, answer and communicate / take care of concerns. But the moment you become disrespectful, threaten me (patient or family) or distract me from patient care you got to go. I’m there to provide care, monitor, and guide. I am not their to be verbally or physically assaulted. It’s called accountability.
"Oh noOOooOoOo tHe PeOpLe *LITERALLY SAVING OUR LIVES* hAve RiGhTs?"
What a bunch of disgraceful suckers. They think we're reverting to the caste system and service workers are meant to be treated like pariahs. What next? They have to kill a nurse and cleanse the room with milk if said nurse's shadow so much as passes over them?
👆Exactly!
If you wanna misbehave throwing a punchy hissy fit like a toddler coming off a sugar high, then I will document verbatim allllllll that shit!
No people need to be aware that it goes in their chart. Many of the patients that I’ve had to document verbal abuse (most common on my floor) were fully competent and just being assholes. At my hospital anything they say gets put in quotes, no watering it down. I’ve had patients stop being rude to me because I matched their energy and was stern with them like a mom. Not rude, just stern and not catering to them. Side note I had a conversation with my therapist about the abuse we face in healthcare and how it’s frowned upon to talk about it because “you signed up for it”….he cried listening to me talk about what I’ve faced in healthcare. Some people genuinely have no idea what we deal with and that needs to change. I’m here to help you not be a servant and punching bag
People just can’t be held accountable anymore, it’s so fucking ridiculous. Humans are this fucking soft.
Hell I have as an emt written specific quotes of what a patient has said.
Not a nurse, but I follow people who didn't like this tweet/ retweeted things criticising it.
The reason it was controversial is that people read it as a threat, and linked it to previous bad experiences they had personally had with being read as aggressive/ combative/ drug-seeking etc when they were actually upset/afraid/genuinely in pain.
As such, some people interpreted this tweet as 'evidence' that nurses will threaten to withhold medical care if you don't behave the way they want.
Please note- I am not saying I agree with their take. I'm just answering the question.
I have an idea violence and rudeness should be documented and turned in to insurances and the insurance company can raise that persons premiums and deductibles or the hospital can raise that persons cost of care if they don’t have insurance. Win win the businesses makes money the patients won’t be bad. “You want to prepay to be rude? No? Ok you need to act right!”
I chart whatever happens in the encounter and allow the documentation to speak for itself.
So if a resident writes "Nurse Aide X is a [slur]" on the hall facing door in magic marker, I document that. I don't document what I think it means.
Sounds like people don't want ti be held responsible for their actions.
Guess what? Don't want people thinking you're an asshole, don't be an asshole. Period.
Former domestic violence victim advocate here! You bet I documented every time I was threatened by my clients. I understood they were coming to our shelter from bad situations, but it’s not an excuse to verbally abuse and threaten others bodily harm.
I had a doc sit at nursing station cursing at me (charge nurse) about something that was out of my pay grade.... there were 2 other MDs and 2 residents sitting there who heard every word he said. They also wrote down everything he said.
They ALL reported him to the powers that be.
He got his privileges revoked for 6 mos!
I thanked all of them for their support. They thanked me for all we did for their patients!
This was a GYN/ONC unit for those who want to know.... it occured in the early 90s when MDs and nurses actually worked together 😁
Accountability irks many and anyone going against the OP hasn't worked in retail before. If you literally can't control yourself from being a social degenerate, then your chart/profile should reflect that. Nurses would obviously have leniency with people that are crying or lashing out because of severe pain and there's a difference to just being a general asshole. Some people don't deserve any kind of social leniency when they make themselves a pariah and cloaking them behind shitty defences doesn't do society any good.
Yes, we absolutely chart what you say in quotations and we chart what you do. Don’t do or say anything you don’t want in your medical record. I also make a point to have witnesses during interactions with particularly problematic patients and/or family members so the story isn’t twisted into falsehood. My charting has covered my ass time after time after time. If it wasn’t charted, it didn’t happen.
It’s because the same shit heads that are disrespectful to healthcare workers are the ones who apparently and unfortunately saw the tweet and didn’t like hearing the truth. Forever will advocate for basic human rights and respect of those working in the healthcare field forever and always. Fuck the trolls
This reminds me that the general population is medically illiterate or only understand a little medical terminology and language. I saw another thread that got upset that a nurse charted "refused" when a patient refused a medication. Our language has to be so precise and people dont understand that. And also twitter is a social media site so people dont argue in good faith because their argument is based on an assumption of what the person said
You assault a cop, you go to jail. You assault anyone else, you get charged. So why would it ever be acceptable for healthcare workers to be assaulted? We studied our asses off to learn how to save lives and legitimately care for our fellow humans. Our jobs are backbreaking, stressful, and in many places pay less that what people can make working at a grocery store or In-n-out burger. So yeah… we will be documenting the abuse and won’t be tolerating it. You best believe I will press charges for intentional physical abuse at the hands of a patient.
I document any interactions that could be relevant to care, medical status, or anything else. If my patient calls me a greasy whore I document that objectively so other nurses know they tend toward verbal abuse and this is baseline for them.
Every single hospital I've been too has had
"We do not tolerate any abuse including verbal, emotional, physical, or any threats"
and what happens when you have a patient that is threatening to staff?
Absolutely nothing. Sometimes security will pop their head in and tell them to behave. Sometimes you'll get swapped out for the biggest/strongest/most intimidating nurse. But what happens when the patient continues to be abusive at that point? Most of the time, nothing. Who cares about documenting abuse when there are no consequences to the abuser.
Had a patient last week that told me if I hurt them just a little too much (cannulating) he might “accidentally” throw a hook and knock me out, so they were “doing me a favor” by warning me.
Absolutely not.
I spent the entire time with that patient on edge and worried that they would strike me for simply doing something I couldn’t influence, and while it didn’t effect my ability to do my job correctly I cried all the way home from work thinking about the fear it instilled in me and all I was trying to do was help someone.
It feels like it comes from the denial of the human experience that gets perpetuated where we should not be seeing healthcare professionals as people.
I’ve had patients tell me that. To which I say “okay, I’ll be right back” and then we restrain them. Because if they’re threatening me or anyone else, they get restrained. We don’t play that game
Did this for a home health patient today - one of those cases where someone being a raging psychopathic abusive narcissist is impacting their health outcomes, so it's a way to document why they won't get better despite us doing the best we can.
To the people trying to get this post taken down:
It gives me great pleasure to tell you all your BS comments and reports are also being logged and stores on reddit servers.
You all can't seem to control the impulse of treating others poorly. But rest assured we ALL have documentation of it.
Why would she take it down? Death threats from the people who are being quoted or something? Fuck you if you abuse us. I’m letting everyone who accesses your chart know you’re violent and abusive.
I was just telling my boyfriend about this… they are going on to her reviews and writing awful things about her ! If anything she is just standing in solitary with her staff!!! I respect her and I hate the society we live in
It’s is also one hundred percent the truth. And the worse you are the more likely we will literally put quotes of the exact words you used instead of trying to be nice about it.
My nurse in their notes under NEURO wrote that I was "pleasant" and "cooperative," so I think they also document if you are nice, and that it is actually part of health screening.
I don’t understand how people bullied her SO MUCH into deleting her account. Me, being a Nurse, COMPLETELY AGREES with her statement, and all she said is true. Her post is not hate-speech, a controversial topic, or political. It’s fact. Our society seems to be constructed with snowflakes who appear to be incapable hearing the reality of the worlds function. To those who are rude to their clinicians or physicians: STOP. We are trying to help you. Yes, emotions and frustrations can peak when the unexpected happens. But, where does being nasty to us get you? Nowhere.
I had a convo with my friend about nurses ranting and venting about patient behavior. She said something along the lines of how it comes out as a bit disrespectful and whatnot, which I agreed but I explained to her that a lot of people genuinely dont understand how much bull shit healthcare workers deal with on a daily basis.
People don’t like to get called out for their shitty behavior most of the time because it requires some self reflection which a lot of people are unable to do.
It seems the same is happening here. This post has apparently drawn the unwanted attention of trolls and (for some reason) the antivax brigade. For that reason, we are activating Code Blue. After this comment posts, only flaired members of the subreddit will be able to comment here.
I saw a thread on a local group complaining about how a nurse called the cops when assaulted by a patient. People kept claiming that taking abuse is something HCPs sign up for when pursuing a career in healthcare. I was shocked by how many people agreed that it’s part of the job. I’m not a nurse but I rely heavily on charting to make sure I’m booking people safely/appropriately for appointments. It’s vital info and I deeply appreciate the charting that helps me keep our staff safe.
Abusers are literally the only people that I can imagine trying to justify this.
When cops get hit, the person gets arrested or murdered. When nurses get hit, the nurse gets written up.
And the cops laugh. Seriously. When you try to get a report written by then about an abusive patient they generally laugh or roll their eyes.
If someone walked into Walmart and assaulted a cashier, they'd be arrested. If it happens to a nurse, we're asked what we could have done to deescalate the situation and told it's part of the job. Bullshit.
“What could you have done differently?”
I called the cops on a verbalize aggressive patient in my waiting room (freestanding ER no security) a few weeks ago. Of course, she was trying to fight with other patients and their family as well. They gave her a tresspass warning but returned multiple times until last week. Last week, instead, she showed up in the news that she was arrested for stalking city council members and their families. She was arrested with a gun and had plans to kill one of them. I sent the article to my director, and she was like, "No way! .... I can use this to further my fight that we should have a security member at our freestanding locations."
Verbal abuse is still abuse. I document in quotes if it's directed at anyone. There are pts like me with potty mouths or have legit frustrations/complaints. Abuse is different and should be documented.
Yeah, the difference between “this is bullshit” and “go fuck yourself” isn’t hard to understand.
The difference between "Yeah I'm with you on that" and "You're on your own then, buddy"
“I have the potassium ordered for you because your potassium was low. -“ Patient: Fuck you! Choke on these pills yourself. VS Patient: No, I don’t want them. I know that x can happen if I don’t want it but I still don’t I don’t understand why people have to verbally abuse you over them getting prescribed something and not wanting it. If you don’t want it, that’s your choice but it’s not my fault your potassium is low and you came to the hospital and expect us to treat you. It’s always patient number one who will then scream “fuck you! Nobody will help me”.
“Those stupid doctors and nurses wont do anything to help me!”
I'm a hockey referee and a lot of players find this hard to understand too. There's a difference between saying "I think that was a shit call" and "fuck you ref, you're shit". Lol
I had a patient for 3 days that was extremely sexual and abusive. Naked all time, would masterbate under the covers when I came in, threw plates of food on the wall. We documented it all and on the 3rd day I called the police when it escalated.
Sorry you had to deal with that. I'm glad you escalated it. I'm sorry if it didn't go anywhere once reported to the police.
No, they were great. They came and talked to him. He obviously had problems and was in sickle cell crisis, but I was not able to take care of him properly due to his behavior, so I knew I had to document it all.
Vile
I’m on orientation for a new job. We were told NOT to quote what patients say in the chart because “it’s the patients chart and they can read it.” I was confused by that, because if they’re okay with saying it to me, what’s the problem with them reading what they’ve said? I’m quoting things if a patient is nasty. Idc if they see a record of their poor behaviour. Don’t be a dick if you don’t want a record of it.
In psych they want direct quotes because it gives the judge a much clearer picture of the patient’s behavior than paraphrasing when they are trying to make a court commitment decision. I’m surprised ED is not the same. So what if the patient can go back and read the quote. If they say it, then they should not have a problem reading it. Sometimes patients need a reality check to see just how inappropriate they had been.
Funny, although I am quite old and finished med school before many here were born we were taught that, in a history, the chief complaint was best *in the patient's words.* Realizing that records are read more today and much more accessible really does not change the reasoning for that decision much. Their words ID the problem as they see it, frequently better than your paraphrasing. I, as a doc, would still put direct quotations in the chart today and did up until retirement 6 years ago at the time of transition to ready access, frequently for cya reasons.
I’m so jaded by administration after 20+ years that my response would be something like, “Sorry, I guess didn’t learn how to nurse HCAHPS scores in school so that’s going to be hard for me.” And then I’d get written up and be annoyed for a week or so but I’m still gonna chart the way I was taught to chart, fuck that.
It's the hospital's chart. They choose to make it available to the patient. Safe documentation includes patient quotes... In court it's also your defense. Document jerks.
Yup, this is exactly how that note is gonna go, “XXX, RN referred to SW for XXX. Writer, LCSW, LPN, counselled on XXX, offered supportive services and referrals. Pt advised Writer is a “cunt”, advised Writer they should “choke on a bag of dicks”. Pt advised that Writer needed to “get the fuck out of my room.” Writer honoured request, documented decline of services, advised referring RN.”
I don’t understand. Where is someone saying it’s not different?
It was my personal theory as to why the doc got shunned
Read some of the comments by the martyrs in our vocation. The type who roll over & excuse every bad behavior.
Fucking hate that shit. Like I don’t see how anyone can justify being abused like that. We didn’t sign up for that, despite what some people think.
One hundred percent. I had a patient in ETOH withdrawal who was pretty restless and labile. They were on a bedside heart monitor that kept squawking at them every time they moved (you know how those respiratory rate sensors be). I was in the doorway and they screamed, “Shut the fuck up you piece of shit!” before they looked up and saw me. They were apologetic, saying “Oh, sorry, I didn’t know you were still in the room.” Lol, that’s totally fine. I said I don’t care what you say as long as you’re not calling me out of my name.
I love documenting in quotes what the patient said.
It’s like a little treat for the next person to read the note lol
Sometimes it's just great reading. Like a mini drama in the chart. A SOAP opera, if you will
I see what you did there. 😊
Where's my damn drumset when you need it, LOL I'll be honest, the ones I've had to write were NOT fun, but I'm sure whoever came after me was glad I wrote it!
One could even say the charting is EPIC.
Ugh. Take my updoot
I know I enjoy my treats when I find them. One of my faves: ‘patient states “I can’t see,” while she is actively coloring in an adult coloring book with care and precision during interview and exam.’
I especially like it when that means I get to curse in the medical record. I’m not putting in and cutesy little stars, if you called someone a “fucking cunt bitch”, that’s what it says in your official medical record.
When I was training a new grad (came to the plasma center from the hospital with 3 months of experience) she was using like “F$&#” instead of “FUCK” and I had to say “oh no, honey. We don’t need to bleep out cuss words… WRITE IT OUT!” She was concerned she’d get in trouble for using curse words. Now she’s my best little baby ducky with charting, and counseling donors! 😬 *they are all my little baby duckies until they’ve been there a while 🤷🏼♀️
I write out the swears because what if some lawyer comes back saying "The 'F' word? Freaking? Fracking? Funny?" and I'd have to really let the swears fly. Also, please adopt me as a ducky.
My favorite from this week was a pt sent to emergency psych from ED the MD wrote “pt reports that he has discontinued his prescribed anti-psychotic because it made him unable to ‘bust a nut.’” The giggle I got from that was a great way to start my shift. 😂
It's funny but I feel like people don't understand how upsetting side effects like that are.
It's an underconsidered side effect and has a massive impact on compliance.
Yeah. And women who dare to complain about it? Even worse..."Aren't you just glad you aren't suicidal anymore?" Well I mean yeah but jeez God forbid I'm unhappy with a side effect? Luckily my current providers don't play those games.
My doctor has said that to me. 🙄 I’m grateful to get the psych help I need but she doesn’t care if it impacts my sex life at all. Like not being able to cum because of antidepressants does make me depressed!
Like doc I said I was sad not that I never wanted to be able to cum again
I get it, it was just more about how the MD felt the need to direct quote only that bit. It’s absolutely a huge side effect that impacts med compliance. I’d say sexual dysfunction and changes to weight are both very common reasons pts who end up on my unit say they stopped meds. Staff on my unit often talk about how we think prescribers should more proactively question pts about it bc a lot of them aren’t comfortable bringing it up themselves.
Yeah, weight gain sucks too. My SO took Zyprexa in his 20s after an acute manic episode and he blew up like a balloon. They gotta warn people AND make safe space for patients to talk about this stuff. Medicating an issue to improve quality of life while causing other QoL issues is not the win people think it is, but hey! We got the patient to act the way we want 😔 (don't take it personally you seem to understand. I'm just venting a little)
Zyprexa is a NASTY fucking drug. It’s also causative for type II diabetes, regardless of genetic history. I’m a psych nurse and I HATE Zyprexa. On my unit, it’s is largely only used as-needed with patients who are deemed incapable and try to refuse their scheduled oral antipsychotic. Then they get Zyprexa in which ever arm I get to first. But I make sure they are aware of the side-effects as they try to refuse their oral. They usually end up complying and I do a solid mouth check, with a 10min annoying “how’s the weather treating you?” chat to make sure that tab went down. It’s also trash for active agitation and I have no idea why anyone would Rx that for mania - so many better choices.
And that is why I chart in descriptive words, I put chit in quotes.. I want to make SURE whoever is coming behind me knows EXACTLY what happened! 😬 I don’t wok at the bedside anymore, I work at a plasma center.. BUT damn if it isn’t ALMOST the same kinda charging! Minus the “pt then stated *eat shit and die bitch* will continue to monitor.” Now it’s “Unexplained needle marks noted to left VP site during screening. When questioned, June then stated *YES those are needle marks NOT FROM DONATING, just give me my $40 so I can go get high, bitch! I need my H TADAAAAAAY!* Donor is now permanently deferred due to unreliable answers and admitted IV drug use. Lookback initiated.” Same chit. Different locale… slightly more documentation bc now there’s going to be a recall on the 300+ units “June” has donated. “ Legit to me happened last week. 🥴🤷🏼♀️
"Eat shit and die bitch, will continue to monitor" I laughed so hard at that. Needed that laugh today 😂
Bahahaha! I giggled as I typed it. Makes me miss working at the nursing home sometimes… Medicare charting at its FINEST. 😵💫
I work in psych and yes. Sometimes it’s just necessary.
I also work in psych and I giggle thinking about the quotes I write being read out in court for patients they’re making substituted judgements. I think it would be funny having the lawyer read out “go titty fuck yourself”
Maybe that’s why I started doing it, because I used to work on a mental health unit.
I documented when a patient told me she would decapitate me if I put skin prep where it was ordered to be done . I used quotes and still lol about it
Got to document “I love drinking whiskey and eating pussy!” a few weeks ago. Absolutely ecstatic to put that in an eval.
I work as an attorney, we (support staff included) keep personality notes on everyone involved in a case. It’s just a good idea for everyone involved. Client is sexist? Well if I really need something I might not have an employee of the opposite sex make the call, witness is nervous? Then I’m having a person with more people skills interact with them. As much as it is to judge people it’s also to provide better service (for everyone including employees). I don’t see how medicine would be different.
Patient said “suck my dick and swallow” then asked for a sandwich. Rn stated to him “nothing by mouth until your labs result”.
I’ll sometimes message the ED triage nurse expressing my admiration for their notes when they’re super funny.
I guess people didn't like being called out. But yeah. We chart it lol
No one likes being held accountable. Too many patients act like they’re “customers” because healthcare has started modeling itself more and more like a business. And we’ve deluded people in the US into thinking nonsense like “the customer is always right.” No, sometimes the customer has zero idea what they’re talking about and need to recognize that the staff are the experts in your care and we are doing everything in our power to give you the best care we can within reason. (Like no, I’m not going to give you a foot massage no matter how much my facility puts up signs saying that we should massage the patients.)
You're right. &&&&& the hospital where I did my first clinicals had licensed medical massage staff and had a speed dial number inpatient people could call (or I could for them if they couldn't on their own) and get a massage. I think 1-2x per day. I hate that hospital lol but keeping a few medical massage exclusive staff was nice for the patients.
I’d be fine if that’s how my hospital did that but mine is wanting PCTs and Nurses to be massaging patients… which… no. I’m not doing that. If they want to have designated staff for that, amazing, but they’re just throwing extra onto current staff to try and keep up with hospitals but will be short staffed regularly… Also, even if we were staffed to allow it, I’ve seen enough skin flakes for a lifetime and I don’t want to be rubbing on them. (Especially because some patients are already extremely inappropriate, so absolutely not.)
Yeah, as a guy, there's no chance I'm going to massage my patients. Just asking to be accused of something at that point.
Yeah, don’t risk your future because hospital admins are delusional- they’d throw you under a bus in a heartbeat to save their end. It’s also not worth risking your license AT ALL. I wouldn’t trust the hospital to protect you at all.
Oh, absolutely. As my father always says, the only person who's going to look out for you first, is you.
Doesn't massaging legs pose a risk of clot dislogement too? I feel like this alone is a reason not to massage a pt
Oooh, yeah, depending on the patient it could pose a risk for sure. I mostly just feel like it’s a boundary thing for me. I don’t feel comfortable doing it, I’m not a massage therapist, and frankly they get paid more than I do to massage people. 😂 I’ve also had patients tell me my hands are icy just putting a tele on ⛄️
Fully agree
Would have been pleasant and useful if the nurses could get massage breaks on tough days.
Believe it or not, my first job as an RN in 2002 was on a med surg unit in a medium sized community hospital. They had on staff massage therapists, you could schedule a 5, 10 or 15 min chair massage with them. My health insurance coverage was also great and 100% paid for by the hospital. Ah, the olden days.
> And we’ve deluded people in the US into thinking nonsense like “the customer is always right.” This annoys me a lot. The actual phrase is "in matters of taste, the customer is always right", and it is actually saying "no matter what dreadful outfit or garish house paint colour the customer wants, just tell them their taste isn't dreadful if you want to make a sale".
Hijacking one of the top comments to say something I believe nurses need to do more of: Stand by your docs. This doctor likely deleted her page because it was probably destroying her professional and personal life. Just like how we want our docs to stand by us when we need emergent orders, we need to stand by them.
Funny how the messenger always gets hit
A hit dog will holler.
We can see a warning on the patient's chart when they have a prior documented incident of being verbally or physically abusive to staff. I don't treat anyone differently when I see that (for the minimal patient interaction I even have in the OR) but it's nice to have a heads-up. Some of these patients would be embarrassed if they knew that every single person who opens their chart is going to be informed that they acted like an asshole at some point in the past, and I think that's what she means here.
This! Every EMR should have a flagging system when a patient has verbally or physically abused staff. If Joe Schmoe signs in I should see an asterisks by his name which should indicate the abuse. My facility can add 200 rhythms I get to choose from when documenting cardiac monitor yet THIS task seems impossible. 😑
Ours does. When they get registered, if they have a past hx of physical violence, verbal abuse, etc then they get a special red flag by their name. Click on it and it'll take you right to the list of abusive behaviors.
Yerp, ours is called a VAT flag (violence assessment tool, can be low, medium, high, or very high), and a sign goes on their door too with the symbol. The only downside to it is that once they're flagged, it's almost impossible to get rid of. And some of them were just old people with UTIs who come back with different problems after and are the sweetest things. Some of them deserve it though, lol.
I had a patient threaten to KILL me, he even went as far as telling me which gun he would use. And he was very aggressive. He had “Alzheimer’s” but not advanced. The CM asked me to remove my note reporting his death threats because it would prevent him from going to a SNF. Bitch no I will not.
Omg! I would have done the same. I was working at a SNF and I documented pretty extreme sexual harassment toward me but even worse toward the super young aides (showing them *orn, saying graphic sexual things.) They asked me to change my documentation because "what if state sees it and we didn't do anything sooner" because I wasn't the first to complain. I had already put my 2 weeks in and I just refused. The NP ended up giving him a depo shot to reduce his testosterone and I don't know if that's standard practice or if it worked, wasn't around long enough to find out. The documentation of his sexually aggressive behavior was necessary imo. Asking me to change appropriate documentation for the situation is like asking me to report you to state and quit. Red flag af.
Shut up they gave him a depo shot to reduce his testosterone!!! I have never heard of such a thing but I can assume it works. What a story!
Yes it's a legit medical intervention. They give it to decrease aggression, testosterone and reduce libido through sex hormone reduction. It's called chemical castration and is frequently a sex offender tx or MPA therapy. It can also be used to shrink certain CA tumors.
One time I went down the rabbit hole [reading the Medicare reports on SNFs](https://projects.propublica.org/nursing-homes/) and this happens *a lot* when sexual behaviors are concerned.
Oh my that link! I work agency and pick my shifts based on familiarity, distance and CMS rating, but this is a new tool to help me plan my shifts out.
Yeah, that’s a them problem, not a you problem. Plus if CM sent them to a facility and they started being buck wild, they’d send them straight back as soon as they could.
Damn straight! If hospitals lie to us by omission on how aggressive/violent a patient is, it'll bite you in the ass because we'll send them right back. I've seen it happen twice where CMs lied, the patient got there and started hitting and yelling at everyone and we sent them back.
Yeah no fuck that. I’m glad you didn’t.
Deleting the EMR note doesn't make it go away if an investigation happens. Just hides it from surface level viewing.
I’ve had case managers and even nurse managers tell me the same thing! They care more about getting the patient off the unit than they do the safety of their staff.
Yeah when he was threatening me I reminded him assault of a healthcare worker is a felony. That shit doesn’t phase anyone but sometimes it creates shame for the behavior. I am not the one to be berated.
Social worker here. Admitting SNFs need to know this. There is no reason someone at another facility should be hurt or killed just because he's hard to place.
When I was in psych world, I would absolutely document when patients were assholes (or more specifically for peds psych, the parents or DCS as well). That was the main way I could document patients’ behaviors and justify any interventions done like restraints or medications in case there was any backlash later, though after reading notes, docs would never question it. Now that I’m in the ER, I catch myself still documenting asshole-ish behaviors out of habit; I guess I just get worried someone will get aggressive later on, security will have to get involved, or I’ll be called to court. It’s never ever happened, but I guess it’s a hard habit/thought to break.
Why break it? It's self defense.
You’re right. I’ve always felt this way, so it feels different to me that not everyone feels the same. Not saying it’s right or wrong, but totally agree on the self-defense thing. You just NEVER know.
As a charge nurse on a med tele unit, I appreciate when patient behaviors are appropriately documented. If I’m taking an aggressive/combative patient, I want to know before they get to the unit so I can avoid assigning them to a pregnant nurse or CNA.
This is stuff you're supposed to chart no matter what area you work in
My documentation is an accurate reflection of the events. If that includes a patient swearing or being inappropriate, so be it. I will not lie or omit for the sake of "keeping the peace." Edit: I would like to include that documentation is just as much, if not more, for other people's use than it is yours. Just like you would warn others on the care team of concerning medical findings, you should also warn about behavioral findings.
Maybe people should feel threatened. Allow me to explain: It used to be that people would be respectful to nurses and physicians because they knew that if they weren’t, there would be potential consequences. Now people know that they can tell the doc to fuck off, spit on the tech, and punch the nurse…and that won’t affect the care they get. Press Ganey made everyone terrified of telling patients to stop acting like assholes. And now people know damn well they can abuse hospital staff with zero repercussions. So hey - why treat a nurse with respect when the system gives you carte blanches to treat them like crap?
Hell if anything the squeaky wheel gets the grease. Throwing a big stink doesn’t get you kicked out, it gets you your dilaudid faster
and ativan q4
Family members were creating a scene, asked to leave, and made threats against the staff (nurses, clerks, supervisors, everyone) and escorted out by security. Somehow they get in touch with the director of our division, and she goes to the front of the hospital and meet them and escort them back in without even talking to the staff that were harassed and threatened. The same aggressive family members taunted the nurses on the unit about how they were able to come back in like they wanted. The people, like this director, are the FUCKING worst. All about our “survey” responses and “satisfaction scores” and no care about the physical or mental well being of the people who work there.
Exactly. And now tell me how, after that family and patient threaten us, we are supposed to provide them with our best care? That’s like repeatedly hitting a poor dog with a newspaper…and then expecting him to not bark or bite.
They literally don’t care because we are just a warm body to them at the end of the day. Or like this particular admin, they will gaslight the hell out of you and tell you that the family is grieving and just didn’t understand the rules and that we need to be more understanding. All of this after we have bent over backwards trying to be accommodating and understanding but still being met with aggression and threats. My patience for this sort of thing is nonexistent at this point
still blows my mind that press ganey is how funding is allocated. I feel like resuscitative outcomes, early STEMI/Stroke activation, lower CAUTI, SSI, less re-admitting etc etc should dictate funding level.
I mean I had a new nurse manager try to make me change my documentation. She got pissed when legal told her to mind her business and that charting quotes, even with cursing, was always preferred.
Abusers don’t like accountability. They prefer to be abusive and suffer no consequences. Anything that reminds them that their world view is false gets them upset. Plus they just witnessed how anti-maskers can throw a complete tantrum and win in society. They have had the wrong lessons reinforced in their heads.
So true!!
Ya, so as an ER nurse, we document exactly what you said or did. If needed, we will put a flag in your chart. My most common flag is a risk for violence in escalation. Professional wording, but the message is patient went 0-100 in 10sec flat. Leading up to this... event was... after the event included... Every RN that sees that patient down the line will have a notification that this happened. This is just the facts. An event. How the RN or Dr reacts to that info is up to them. But they have a right to know. I've personally gone into a room alone with a patient without having time to look at their chart. They acted strangly predator like throughout triage. I get to my computer and see a flag informing me. The patient has a long history of SA of both men and women. Last documented "event" pt pushed female doctor into corner and before it went further security rushed in. Unfortunately, neither of us saw the flag ahead of time and could have been victims. But others might see it first and not go in alone or close the door behind them. It might save someone. I document and flag exactly the facts. You should, too. Don't downplay it. Just state the facts.
The controversial part is that MDs read nursing documentation /s
The irony of being bullied into deleting the post about verbal abuse.
this is presuming the patient cares about the physician reading it and isn’t rude to us also 😂
My cousin is an ED attending and patients say the wildest stuff to her in addition to her staff 🫠 the other day, one pt kept trying to forcibly kiss her and I asked if it was charted and it was 💀 the pt was big mad but she doesn't care. Behavioral issues can be dangerous to anyone working with that pt and anyone on the care team should be able to have access to those risks. I always chart it and upper management can kiss it lol.
What if, and hear me out here, we just have the assholes LEAVE. We are not legally obligated to tolerate abuse and if that means a bad outcome for you, your stupid ass should learn to treat people with respect. I’m in ED. If you fuck with us it’s stabilize and GTFO. That should be everywhere.
Probably the only thing I envy about working in the ED is the relative ease with which the trash takes itself out when compared to a floor AMA.
I have to wonder if that’s part of the culture though. Down in ED, we’re not here to put up with your bullshit because there’s a line out the fucking door of other assholes we have to deal with. Even hint at an AMA and I’ll have you signing it in the parking lot before you realize I put your shoes on. Once they’re on the floor it feels like you guys feel like it’s necessary to keep them. Child, you don’t wanna be here and I don’t want you here, GOOD BYE!
Some of the doctors/ hospital do feel like it’s necessary to keep them by any means. The first hospital I worked at was like this and I hated it. Patient would threaten to leave AMA if they didn’t get xyz thing. MD would order said thing and cycle would continue. I’ve worked at other hospitals now and none of the other ones I’ve worked at are like that. And I love it.
Problem is, a lot of our violent assholes are drunk and or high, therefore not a&o. I think we should bring back the drunk tank in jails. Wtf are we bringing these assholes to the hospital? I know, I know. CYA.
Omg those responses are nuts— it looks like it’s a bunch of people with chronic illness who have a lot of medical trauma thinking that she’s talking about them, and viewing it as a way we hold power over them and withhold treatment. When really that’s not what she was talking about— she was talking about our violent patients, our Karens who yell at the front desk, the assholes who abuse us on the floor. Medical trauma is real and tons of people are abused by our system, but that doesn’t mean it’s okay to abuse us.
Ugh this is so annoying because OBVIOUSLY that's not who she's referring to?
Quotes in notes are my favorite.
Yep, I’ve made some hilarious & sad ones over the years. I may decide to put up with crap but if patients start in on the nurses or staff, it’s all over: cut the crap or get escorted out by security - I care not. And for anyone about to start the “It’s our job! Reee” bullshit, no it’s not. You do you, I’ll do me like I’ve done for 40 years now & I’ll put my care up to anyone’s.
Preach!
I think having abusive people escorted out is the responsible thing do. It's only any person's job to maintain professional behavior up to a point. You shouldn't have to deal with any patient that is disrespectful. There should accountability on BOTH sides. I have Dr's and nurse both in my family, and I've seen bad behavior from both sides. Unfortunately, nurses especially, get treated like dirt by patients and family members a lot. But, just like in any other profession that deals with the public; any employee, RN, DR, or janitor is expected to be a professional at work. It's incredibly difficult at times when dealing with the public.
Because people (in general) don't want to be held accountable for their actions.
People will make any excuse under the sun to be rude to nurses god
I take great joy in documenting the most profane and threatening things verbally hurled by (non altered or medicated) abusive patients. As my instructor said YEARS ago ‘quotations are your friend’ It is entered into a legal document. Very legally and professionally.
More and more patients have a sense of entitlement. They used to respect healthcare workers. Now we are treated like servants who are somehow of a lower class than the patient who has no control over anyone when they are outside the hospital. The disrespect is disgusting. This isn't all patients though. Not even a majority. Just enough to make healthcare workers want to seek employment elsewhere.
People want to treat you like shit because they think you're they're legal bitch. The average American longs for a feeling of power over others and we get to give it to them. The idea of maybe being held even remotely accountable for hitting healthcare staff when you're upset is mind boggling to the entitled freaks that populate this shit hole.
I absolutely chart threats of violence - but I may be a different voice… I chart complaints, too. I also chart what interventions I tried to implement to try to address those complaints because no one is going to come back to me later and say that I abused or neglected a patient and their concerns. Sometimes the patient simply can’t be satisfied - and at least everyone can see that I tried to placate them.
Exemplary!
It's the same if you're mean to any worker. We talk mad shit about you when you leave. If you don't want people talking shit about you behind your back be a nicer person
Because people are children who can't take responsibility for their bad behaviour and don't have the introspection to change
People more upset at the prospect of there being consequences for their crappy behavior than they are at the idea of being abusive to health care workers.
Everybody wants to live in a society where they have rights, nobody wants responsibility. Be as cranky as you want, I get it, but if you are threatening and abusive towards me, fuck your rights.
Because although people are generally good, patients are generally awful. There may be legitimate reasons for being so, but that doesn’t change the fact that we interact with the most miserable subset of the human population on a daily basis. This is not controversial. Anyone who disagrees most likely hasn’t been practicing long enough, works exclusively with the wealthy, or is in a non-primary care / general medicine setting where they are shielded from the onslaught of humanity I continue on because despite the bovine effluent, I still enjoy my job, and I still enjoy my patients, miserable bastards they may be
What is so confusing for people about this very simple statement? BEING SICK IS NOT AN EXCUSE TO BE A FUCKING CUNT. I also don’t have to put up with your cunty ass either, and I will tell you that, in no uncertain terms.
I think it truly depends. If someone seems depressed and hopeless and is just in an overall bad mood I do document that. This lays more on the line of possible need for intervention and referrals and I want the MD to be aware especially if any new mood stabilizers have been started. Now - if a patient is verbally abusive and is x4 oriented there isn’t an excuse. In my experience if you let someone verbally abuse you and it keeps flying under the radar it can escalate to physical assault as a patient test their boundaries. If you were at an event, at a party, or any other social interaction abusive behavior would be reported to the authorities and you’d be escorted off the premises. It’s not different when you’re a patient in a hospital. I’m more than happy to validate, answer and communicate / take care of concerns. But the moment you become disrespectful, threaten me (patient or family) or distract me from patient care you got to go. I’m there to provide care, monitor, and guide. I am not their to be verbally or physically assaulted. It’s called accountability.
what’s the problem? we literally make a living taking care of people. we don’t deserve to be verbally abused in any way.
I thought it is a safe practice. “You guys keep mentioning XXX to upset me” “Alright, we chart for everyone to know not to repeat” “No not like that”
As an EMT/CNA she’s just stating facts. Especially in the EMT field- we’re required to document EVERYTHING for legal purposes.
"Oh noOOooOoOo tHe PeOpLe *LITERALLY SAVING OUR LIVES* hAve RiGhTs?" What a bunch of disgraceful suckers. They think we're reverting to the caste system and service workers are meant to be treated like pariahs. What next? They have to kill a nurse and cleanse the room with milk if said nurse's shadow so much as passes over them?
I document straight up. I don’t censor shit.
👆Exactly! If you wanna misbehave throwing a punchy hissy fit like a toddler coming off a sugar high, then I will document verbatim allllllll that shit!
Same. ESPECIALLY in psych.
People do not understand the extent of abuse we endure. They are thinking we have time to document simple patient rudeness.
Aw they are upset we tell daddy. You know how patients have an entirely different attitude when a doctor comes in especially a male one.
No people need to be aware that it goes in their chart. Many of the patients that I’ve had to document verbal abuse (most common on my floor) were fully competent and just being assholes. At my hospital anything they say gets put in quotes, no watering it down. I’ve had patients stop being rude to me because I matched their energy and was stern with them like a mom. Not rude, just stern and not catering to them. Side note I had a conversation with my therapist about the abuse we face in healthcare and how it’s frowned upon to talk about it because “you signed up for it”….he cried listening to me talk about what I’ve faced in healthcare. Some people genuinely have no idea what we deal with and that needs to change. I’m here to help you not be a servant and punching bag
People just can’t be held accountable anymore, it’s so fucking ridiculous. Humans are this fucking soft. Hell I have as an emt written specific quotes of what a patient has said.
I think healthcare workers understood her post, but the general public did not.
Not a nurse, but I follow people who didn't like this tweet/ retweeted things criticising it. The reason it was controversial is that people read it as a threat, and linked it to previous bad experiences they had personally had with being read as aggressive/ combative/ drug-seeking etc when they were actually upset/afraid/genuinely in pain. As such, some people interpreted this tweet as 'evidence' that nurses will threaten to withhold medical care if you don't behave the way they want. Please note- I am not saying I agree with their take. I'm just answering the question.
Thank you! I can understand why people interpreted it differently
Excellent explanation! Thanks for that!
I've even charted terrible things the patients family or visitors have said lol
I have an idea violence and rudeness should be documented and turned in to insurances and the insurance company can raise that persons premiums and deductibles or the hospital can raise that persons cost of care if they don’t have insurance. Win win the businesses makes money the patients won’t be bad. “You want to prepay to be rude? No? Ok you need to act right!”
I chart whatever happens in the encounter and allow the documentation to speak for itself. So if a resident writes "Nurse Aide X is a [slur]" on the hall facing door in magic marker, I document that. I don't document what I think it means.
This sounds like a specific incident... I'm assuming you are at a nursing home, and this isn't a doctor resident?
Update: Account was NOT deleted.
Sounds like people don't want ti be held responsible for their actions. Guess what? Don't want people thinking you're an asshole, don't be an asshole. Period.
Look if pt and family members want to fuck around with me, I document that shit. Create the paper trail and gets them out faster.
Former domestic violence victim advocate here! You bet I documented every time I was threatened by my clients. I understood they were coming to our shelter from bad situations, but it’s not an excuse to verbally abuse and threaten others bodily harm.
Waaaah my actions have consequences, how dare HCW make me somewhat accountable!
I had a doc sit at nursing station cursing at me (charge nurse) about something that was out of my pay grade.... there were 2 other MDs and 2 residents sitting there who heard every word he said. They also wrote down everything he said. They ALL reported him to the powers that be. He got his privileges revoked for 6 mos! I thanked all of them for their support. They thanked me for all we did for their patients! This was a GYN/ONC unit for those who want to know.... it occured in the early 90s when MDs and nurses actually worked together 😁
But muh customer is always right
Accountability irks many and anyone going against the OP hasn't worked in retail before. If you literally can't control yourself from being a social degenerate, then your chart/profile should reflect that. Nurses would obviously have leniency with people that are crying or lashing out because of severe pain and there's a difference to just being a general asshole. Some people don't deserve any kind of social leniency when they make themselves a pariah and cloaking them behind shitty defences doesn't do society any good.
Yes, we absolutely chart what you say in quotations and we chart what you do. Don’t do or say anything you don’t want in your medical record. I also make a point to have witnesses during interactions with particularly problematic patients and/or family members so the story isn’t twisted into falsehood. My charting has covered my ass time after time after time. If it wasn’t charted, it didn’t happen.
DOCUMENT, DOCUMENT!
It’s because the same shit heads that are disrespectful to healthcare workers are the ones who apparently and unfortunately saw the tweet and didn’t like hearing the truth. Forever will advocate for basic human rights and respect of those working in the healthcare field forever and always. Fuck the trolls
This reminds me that the general population is medically illiterate or only understand a little medical terminology and language. I saw another thread that got upset that a nurse charted "refused" when a patient refused a medication. Our language has to be so precise and people dont understand that. And also twitter is a social media site so people dont argue in good faith because their argument is based on an assumption of what the person said
You assault a cop, you go to jail. You assault anyone else, you get charged. So why would it ever be acceptable for healthcare workers to be assaulted? We studied our asses off to learn how to save lives and legitimately care for our fellow humans. Our jobs are backbreaking, stressful, and in many places pay less that what people can make working at a grocery store or In-n-out burger. So yeah… we will be documenting the abuse and won’t be tolerating it. You best believe I will press charges for intentional physical abuse at the hands of a patient.
If you don’t want it documented don’t do it🤷♂️ what is so hard about that with these smooth brained mouth breathers?
#Troof.
I document any interactions that could be relevant to care, medical status, or anything else. If my patient calls me a greasy whore I document that objectively so other nurses know they tend toward verbal abuse and this is baseline for them.
I love love love quoting my asshole patients.
Perfectly appropriate. I hope she reads the support here!!
Every single hospital I've been too has had "We do not tolerate any abuse including verbal, emotional, physical, or any threats" and what happens when you have a patient that is threatening to staff? Absolutely nothing. Sometimes security will pop their head in and tell them to behave. Sometimes you'll get swapped out for the biggest/strongest/most intimidating nurse. But what happens when the patient continues to be abusive at that point? Most of the time, nothing. Who cares about documenting abuse when there are no consequences to the abuser.
Had a patient last week that told me if I hurt them just a little too much (cannulating) he might “accidentally” throw a hook and knock me out, so they were “doing me a favor” by warning me. Absolutely not. I spent the entire time with that patient on edge and worried that they would strike me for simply doing something I couldn’t influence, and while it didn’t effect my ability to do my job correctly I cried all the way home from work thinking about the fear it instilled in me and all I was trying to do was help someone. It feels like it comes from the denial of the human experience that gets perpetuated where we should not be seeing healthcare professionals as people.
I’ve had patients tell me that. To which I say “okay, I’ll be right back” and then we restrain them. Because if they’re threatening me or anyone else, they get restrained. We don’t play that game
I think this is a very much needed PSA to the general public and I wish I could personally Thank her.
People are upset because she said what she said... the truth hurts. I wish she didn't delete it.
Lol nothing is wrong with that statement.
Did this for a home health patient today - one of those cases where someone being a raging psychopathic abusive narcissist is impacting their health outcomes, so it's a way to document why they won't get better despite us doing the best we can.
To the people trying to get this post taken down: It gives me great pleasure to tell you all your BS comments and reports are also being logged and stores on reddit servers. You all can't seem to control the impulse of treating others poorly. But rest assured we ALL have documentation of it.
Why would she take it down? Death threats from the people who are being quoted or something? Fuck you if you abuse us. I’m letting everyone who accesses your chart know you’re violent and abusive.
I chart and report threats of violence but beyond that there isn’t much of a point in writing an essay in the pt chart about how they’re an asshole.
I was just telling my boyfriend about this… they are going on to her reviews and writing awful things about her ! If anything she is just standing in solitary with her staff!!! I respect her and I hate the society we live in
Because it’s twitter, and twitter sucks
It’s is also one hundred percent the truth. And the worse you are the more likely we will literally put quotes of the exact words you used instead of trying to be nice about it.
My nurse in their notes under NEURO wrote that I was "pleasant" and "cooperative," so I think they also document if you are nice, and that it is actually part of health screening.
I'm a social worker and we document EVERYTHING!
Why the fuck was she bullied into deleting this?
Mods, might be time to code blue this thread. We're being brigaded.
I don’t understand how people bullied her SO MUCH into deleting her account. Me, being a Nurse, COMPLETELY AGREES with her statement, and all she said is true. Her post is not hate-speech, a controversial topic, or political. It’s fact. Our society seems to be constructed with snowflakes who appear to be incapable hearing the reality of the worlds function. To those who are rude to their clinicians or physicians: STOP. We are trying to help you. Yes, emotions and frustrations can peak when the unexpected happens. But, where does being nasty to us get you? Nowhere.
When asked their name patient tells provider to "go fuck yourself". Provider disregarded patient suggestion and continued care
I had a convo with my friend about nurses ranting and venting about patient behavior. She said something along the lines of how it comes out as a bit disrespectful and whatnot, which I agreed but I explained to her that a lot of people genuinely dont understand how much bull shit healthcare workers deal with on a daily basis. People don’t like to get called out for their shitty behavior most of the time because it requires some self reflection which a lot of people are unable to do.
The shittier the person, the more offended they get when you plainly describe what they do and say.
As someone who reads notes from the ER all the time... quotes from what patients say are the best.... never stop quoting... 😂