Commentary on "Hospital staff sick of violent drunks"

...they are more likely than in the past to report acts of violence, emergency department staff were “very kind-hearted and forgiving” and that meant countless louts got away with unacceptable behaviour.

(via Hospital staff sick of violent drunks | Rockhampton News | Local News in Rockhampton | Rockhampton Morning Bulletin)

This article got me fired up. I've written about violence against nurses before, and I wrote that post when I was a CNA, when I was new to the idea that getting punched was just part of the job. I was stunned that people thought that this was OK. Now I'm an ER nurse, so I am exposed to violence every time I work. I have the unfortunately rare luck to work in an ER where my facility takes staff safety seriously. I'm incredibly impressed that they created a 4-hour-long hands-on class to teach us how to protect ourselves. Had to cost a bundle. Our security staff are awesome and on the spot, and our local PD usually takes only minutes to arrive. I truly feel that people have my back.

Trouble is that patients still seem to think that nurses are not real people. I would be angry if nobody cared about my safety from an institutional standpoint, as was the case in my previous post, but that does not apply in my current position. The issue that steams me lately is the apparently novel idea that nurses are not waitresses, punching bags, ignorant children, maids, or housekeepers. I'm tired not only of being punched and kicked, but also of being ordered around ("go get me some water") and even of, eg, being belched on. Would you burp on someone anywhere else and blow it in her face? No! So why is it OK when it's a nurse? Where is it written that normal rules of adult engagement are off when one party is a nurse?

I have talked to patients about this when they are cognitively with it and their behavior has become over the top, and they really haven't thought about it. Most are ashamed once they do. I used to think this patient education was possibly inappropriate, but not anymore. I no longer balk at educating patients regarding appropriate means of addressing trained medical professionals (hint: "honey" and "sugar" are not among them) and about things my job does and does not entail. I probably (if your condition allows it) will get you some juice and crackers if you ask me, but if you imperiously order me to get them for you, we're going to talk first. Usually all I have to do is ask where they work or what they do and then ask them, "If someone came into your job and talked to you like that, would you put up with it?" Usually, no. I do not understand why a person who would not even order an ACTUAL waitress to bring them something to drink will order me to do it when I'm clearly involved in a life-and-death situation elsewhere.

There is an absolute threshold of bad behavior that I'm willing to put up with without commentary. It flexes on the basis of the patient's condition, obviously. But people who are there for a medication refill and start yelling at me when I cross the threshold about their wait...no. In the last few months I've started simply saying, "The yelling will stop now, and then we'll talk." To my surprise, it almost always does. Efficiency increases. Patients seem able to collect themselves, our interactions go better, and I'd estimate that 90% of the time by the point I leave the room they've apologized for yelling and I've been able to sympathize with their wait. Everyone seems happier.

Do people really need such clearly stated guidelines? We as a profession must be putting off the wrong vibes somehow. And don't even get me started on how parents let their kids talk to healthcare professionals. If I'd talked to any adult the way they do, I'd have been outside and then back, sniffling and saying, "yes ma'am."