In a prior blog (which I cannot find) I mentioned how psychiatric patients’ inappropriate and
aggressive behaviors may be overlooked due to our desire to help them. However,
NEVER, did I say those patients were given a pass if they, even as a little,
gestured to harm healthcare workers.
I say that as another
psychiatric patient, this one I was caring
for, was being held in the emergency department while waiting availability of a psychiatric inpatient bed. A
process I also described in that previous blog as taking days and even weeks before the patient is
transferred. On the other hand, the former mentioned patient was not a patient
I was caring for but a patient I knew about as the patient had been in the
emergency department for over a week. A patient that had been threatening the
staff from day one when the patient punched a healthcare worker the first day
the patient was in the
Knowing I go
from 0 to 1,000 in a nanosecond I avoided that patient at all cost, as I knew
any confrontation with the patient would not go well. However, despite the self
imposed restraint I maintained a heighten awareness that I would, without
hesitation, most definitely, get involved at any moment if needed to since the
patient had already hurt someone in the department and I had convinced myself
it would not happen to anyone I shared the shift with.
the highest it got to was DEFCON 4 (DEFCON 5 being the highest). That time
being when the patient demanded the attending physician talk to the patient at the patient’s room, the
attending only agreeing to speak to the patient from outside the room and with
security present, good idea.
shenanigans and manipulative behavior from the patient went on during the
entire time the patient spent in the emergency department. Because of the
patient’s behavior the nurses were intimidated and would only give the patient
care with security present.
while the nurse was passing out medications to the patient, the patient
assaulted the security guard who was in the room to protect the nurse while the
nurse was providing care to the patient. Within moments of the commotion we all
ran into the patient’s room where we found the patient face down on the floor
and the security guard on top after the security guard had subdued the patient.
Shortly after our arrival, the security guard passed me a pair of handcuffs and
I placed them on the patient’s wrist, securing both wrists in the back, then we
lifted and placed the patient, face down, on the stretcher.
nurse, after exiting the patient’s room, asked for police to be called via 911.
Surprisingly, it took the police over 2.5 hours to arrive citing the patient
was no longer a threat after being handcuffed. Again, that was not a patient I
was caring for.
week later to the psychiatric patient I was caring for and the focus of this
story. Like the previous mentioned psychiatric patient this patient too was waiting transfer to an inpatient
behavior health facility. The patient I was caring for I had taken care of
before and a number of times before as well as these patients are frequent
flyers and well know to emergency department staff. However, because of the previous
experience I have since
shared with psychiatric patients and any other patient who seem to be volatile
the following script, “I understand what you are going through and I want you
to know we are here to help. If you become overwhelmed at any moment for any
reason let us know. If you become inappropriate it will not be in your best
interest. Is that understood?”
Thus far those
patients have all replied, “Yes.” To include this patient who has said to me
before when I have cared for him and he got testy in the past and I shared with
him the same, “I know you can hurt me.”
Anyhow, for whatever reason, this one night in particular I
had to visit the patient after he threaten to kick the charge nurse telling
her, “Do I have to kick you in the stomach in order to get some attention
by me the patient denied he said that to “her” but when I asked the patient,
“How did you know it was a female I was talking about?” The patient confessed
he had threatened the charge nurse, who was a female, thus I said to the
patient, “Okay,” and I walked out of the room. Once at the nurse’s station I
asked the clerk to call the police, not security but the police.
occasion the police arrived shortly and after they interviewed the patient the
police shared with me that the patient had apologized, would remain appropriate
and wished to be seen by a behavior counselor. My answer was, “Nope. That no
longer was an option as the patient had violated the agreement we had.” In my
opinion as the provider of the patient’s care the patient was being
manipulative to test how far he can push, figuratively speaking, the staff. As
far as I am concerned being manipulative is inappropriate as well as healthcare
workers are there to help others and not for the pleasure of some to play games
Because of my
zero-tolerance after the police said they could not arrest the patient on a
threat I told the charge nurse I would discharge the patient, as I did not want
the patient in the emergency department. After hearing me tell the charge nurse
my intentions of discharging the patient the police officer offered to take the
patient to the county hospital where there was inpatient behavior health
services, if that was what the patient wanted and I said fine as I was
discharging the patient regardless.
How uncaring and uncompassionate
to discharge someone needing help critics say.
To those critics, by dismissing those who annoy us we are
freed to focus on those who value, trust, and appreciate us for the care we
give. By no means am I suggesting we become healthcare Nazis and dismiss
everyone we disagree with. But these doomed distractions set a tone of
volatility for the remaining shift that leaves healthcare workers on edge and worse
of all vulnerable. Tolerating these distractions only sets a precedence as to
what is acceptable and as long as healthcare continues to be a doormat not only
will others wall all over us they will wipe their feet on us as well. Adding to
those stresses, these distractions affect, both directly and indirectly, the
care we give to those who appreciate us. Thus it is both, those who appreciate
us, patients, and those they appreciate, healthcare workers, who have the most
to lose from us catering to those who appreciate us the least.
Doubling down on that point I will add that on this we MUST
stand in solidarity and NOT waiver. Otherwise those who annoy us will not
change their behavior as long as they can find tolerance elsewhere. Pandering
is not advocacy. Neither are accommodating, placating, or appeasing. And
contrary to healthcare administrators’ demands none of those submissive
gestures make anyone more caring or compassionate either. Not to mention, those
distractions are behavior healthcare administrators would not accept from their
loved ones at home yet healthcare administrators want us, healthcare workers,
to tolerate that venomous behavior from patients who tread on us. NO! Because the
only thing indulging those who make unreasonable demands against us does is leave
That is why, at the accusation of committing heresy in an
industry genuinely dedicated to helping others, that I call for siding in loyalty
with our employees and coworkers over petulant, unreasonable, angry, and
demanding patients or outsiders who will harm us if we do not submit to their
EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. This is not about us versus
them but about convincing them we are looking out for their best interests and
if they desire our help, they must stand with us. If they decline, they must
leave. Because asking to be catered to until they get what they want is
manipulative and NOT what we are here for as it only divides healthcare workers
trying to help others.
administrators lack the testicular fortitude to push back against those who
tread on us does it mean I will bow as well. NO! I say dismiss those who
annoy us. Thank you for coming and come again. Next!