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You are going to jail…thank you for coming and come again!

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 emergency department.
 
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.
 
That said 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.
 
Those 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.
 
One night, 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.
 
The charge 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.
 
Fast-forward a 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 around here?”
 
When confronted 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.
 
On this 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 with.
 
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 us vulnerable.
 
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.

Just because 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!

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