Dangerous Terrain: When Patient's Put Nurses At Risk
Sometimes I try to pinpoint when it became unsafe for nurses to nurse. I can never really find the shore in that ocean. However, in some instances, that is truly the case. The change of thought from patient to client and then to customer has altered the nurse-patient relationship. This in itself isn’t a bad thing, but the clamor for 5 Stars from Medicare has simultaneously improved patient outcomes and experiences while, at times, worsening these interactions. Newer more powerful pain medications, substance abuse and drug misuse, and the lack of consequences for patient’s bad behavior has led to an epidemic of nurses being mistreated and afraid at work. In this article we’ll discuss possible causes for the current atmosphere and how we can move towards a safer environment for patient’s AND nurses.
There was a time when doctors and nurses had a rather sterile, well choreographed, and confined relationship with patients. But those days are gone and that’s a good thing. I think it’s amazing that we can openly discuss the patient’s care in front of the patient and that they can add input and ask questions. It improves the care we provide and the care they receive. I think monitoring outcomes is also beneficial. However, as we all have seen, the drive to get those 5 stars from Medicare has led to the “patient is always right” mentality. And this mentality supersedes the safety of nurses. What this means in the real world is that when patient’s are verbally abusive, issue threats, and strike fear in nurses, it is swept under the rug and nurses are told simply to “Suck it Up” or the patient’s illness is held up as an impermeable shield from any sort of consequences. The goal to have good survey’s returned has not just knocked nurse safety to the bottom of list, it’s eliminated it. We have to find a way to balance nurse safety, 5 star surveys, and patient frustration without leaving nurses out in the cold. And this is just the tip of the iceberg. The complicated arena of substance abuse had made nurses unknowing targets.
An increasing number of patient’s are entering the healthcare system for the sole purpose of receiving powerful narcotics such as Morphine and Dilauded. This is not to negate the millions of people who truly need these medications. But we must shed light on the ever increasing instances of drug-seeking behaviors and their detrimental impact on the healthcare system and the risk to nurses. Some of this can be linked to the Fentanyl and Methamphetamine epidemic sweeping the nation. Nurses receive little training and protection from detoxing patient’s. Their emotions are labile, they are unstable, they are sick, and when they don’t receive the pain medication they want, they are dangerous. Period. They become erratic, destroy rooms, threaten the staff, throw things, and the nurse is tasked with administering medications to help calm them down without the assistance of security, physicians or NP’s! We need better programs, training, and processes that will allow these patient’s to be funneled into the correct facilities with appropriately trained staff, thereby keeping patient’s and nurses safe. But nothing is this simple.
So what do we do when we have a truly sick patient that must stay in the hospital because they need care but that are also abusive and threatening to staff? I have no idea. Yet, I know the answer isn’t to continue putting nurses at risk. We must start a dialogue and collectively create real life solutions.
Going forward there must be ZERO tolerance for nurse abuse of any kind. Physicians, NP’s, Nurse Managers, and Administrators must stand behind and support nurses. There must be consequences for violent language, postures, and behaviors from patient’s to nurses. Most of all, NURSES MUST SUPPORT OTHER NURSES. If a coworker comes to you and says she is afraid, then she is afraid. You must support and guard her because one day, you may be afraid, just like her.