A recent newspaper report recounts the reprimand and $3,500 fine imposed on a nurse who threw a cup of water in a patients face.
Queensland Nurse fined for throwing a cup of water at a patient
The Queensland Civil and Administrative Tribunal was told [the male nurse] threw water into a female patient’s face after she hurled her medication onto the floor during a “verbal exchange.”
…“The incident involved a female patient in her mid 20s with a history of disruptive and aggressive behaviour,” she said.
“In the past she had assaulted both other patients and staff.
The tribunal was told on the day of the incident, Mr Geary approached the patient with her medication and a cup of water.
“After some verbal exchange, the patient threw the medication to the floor … (and) [the nurse] momentarily lost control of his emotions,” Judge Kingham said.
“He threw the water into the patient’s face … (and) then picked up the medication and left the room.
“Later, the patient apologised to [the nurse] and he to her.”
Judge Kingham said [the nurse] “bore a responsibility” to behave professionally in the face of the difficult and challenging behaviour.
“His response (to the patient) was not in self defence, nor was it a proportionate response to a verbal exchange,” she said.
Let’s be perfectly clear, when it comes to professional behaviour towards our patients/clients, there is a clear, deep line in the sand here.
And if that line is ever washed feint by the unceasing tides of stress and workloads and difficult situations, it is up to us to re-draw it.
Intersection:
Having said that, I can completely empathise with this nurse.
I have found myself on more than one occasion (tho I am glad to say not too many more) tracking very close to crossing this line. I imagine I am not alone here (anyone else?).
These occasions are not made any easier when the patient steps over to your side and tries to pull you across with unrelenting, unwavering, button-pressing persistence.
Assertiveness, enforcing hospital policy, having zero tolerance for violence…these things are all on our side of the line and are to be encouraged and modeled.
But the other side of the line is where we are no longer in control.
Here there be dragons.
So.
It is important to acknowledge this line, and to recognise that whenever you are even in the emotional-ball-park vicinity of it, you must take appropriate action to change course. Immediately.
That may involve a momentary time out to re-check your emotions, simply taking couple of deep breaths….right through to completely removing yourself from this encounter and getting some help from your colleagues.
No matter how justified you feel in making any sort of point (or taking any sort of action) you are about to make: You are a nurse….so there is a line.
But do you agree with the response?
Interestingly, the Judge in this case noted that the nurse had “already faced other consequences of his action under the Public Service Act 2008”, but that this disciplinary action was initiated after a complaint from the Nursing and Midwifery Board of Australia.
Acknowledging that I do not know all the facts in this case, and based on the small amount of information provided in this report, I must say I think it could have been handled a little more skilfully.
I think my yearly registration fees would have been better utilised to give this nurse some performance management, and perhaps a little support rather than hauling him before a Judge.
The Tribunal declined to impose any further sanction and the nurse was ordered to pay the costs of the Board fixed at $3,500.
What are your own thoughts on this?
Well, being a nurse I can close my eyes and ‘see’ exactly what happened. I empathize.
However. We are professionals for a reason and that fine is deserved.
Leif
I work in a neuro ICU and recently took care of a young man with a whole lotta bleeding in his brainpan. He was not in his right mind. This is not uncommon with our patients. I am used to it. That being said, after 11 hours of repeatedly telling him to stop moving his arm, stop trying to take off his collar, stop pulling at wires, stop trying to climb out of bed, stop spitting at staff, stop kicking at his SCDs, stop pulling out his IVs I had to, for the third time, re-cannulate an IV and change his (again) blood-soaked linens, and I found myself yelling at him – that he’s being difficult, that we’re trying to help and he’s making that impossible, that he’s acting like my 2-year-old.
I have been wracked with guilt for days.
But sometimes we snap.
I could never imagine throwing water (or anything else) at a patient, but there’s a fine line between physical assault and verbal assault. I never imagined I’d yell at a patient like I did.
Suggesting taking time out and taking a deep breath is good advice as long as you have the time and space to do so. Nursing is sometimes long days, lots of stress, people waiting to have our time. Patients can be so rude and need to be put back into line if they are. Nursing does not mean victim and not being able to expect fair and respectful treatment. It is a job afterall. I think nurses are expected to put up with far more than most other professions. Not fair and should not be tolerated. At least it was only a glass of water. Sure she won’t do it again. Yes, it should not have happened but not sure anything else was working by the sound of it.
I have a ton of sympathy to every healthcare worker who is abused by their patient, but I think this was well across the line and that the nurse stepped over it himself. You always have the one option, WALK OUT OF THE ROOM.
We are supposed to support each other in our units, I have had this happen to me on more than one occasion and my fellow co-workers have always stepped in to help out, whether it was just going in to talk to the patient while I stepped away to cool down or if they simply stood at my door. Simple shows of continuity and support from the nurses really do help in dealing with difficult and abusive patients. When they realize they have an entire group of people, not just one, to “fight” with they often back down, it’s typical bully behavior.
I understand how difficult it is to put up with this behavior, but also there have been studies done on hospital induced “delirium” that I have found quite compelling. These studies have noted that patients, especially ones who have had extended stays in critical care areas (like the ICU where I work) can often suffer from a delirium similar to sundowners that comes from a combination of medication, sensory deprivation (lack of “normal” sounds and sights) and lack of orientation (ICU’s tend to have no windows, lack of night and day, and round the clock treatments) which unfortunately can continue for a few days while the patient is transferred up to a progressive care unit until they “normalize” again. This may sometimes account for our “difficult” patients and their bewildered family who assures you they are “never like this at home”.
I also fully believe some people are just jerks, and there is nothing that you can do about them besides refuse to stoop down to their level.
I, in no way,condone his behaviour. I find that it is not possible the get the zero tolerance enforced in the QH hospital I work in. Abuse in The emergency department is a daily occurrence. On the wards if a patient is aggressive, insulting or verbally or physically violent, there is only empty threats to modify their behaviour. Very hard to deny a hospital stay and lifesaving treatment because a patient is rude, vile and aggressive. We tolerate racism, sexism and violence on a daily basis.
Having worked in the us for 6 years and oz trained and returned we have a much more supportive of staff in Australia ( sometimes not much more supportive). While I think the nurse was wrong and most likely crossed the line, I have experienced ABUSE from pts and we do have the right in Australia to callpolice/press charges, but we have a culture of accepting too much because they are ‘sick’ or in pain. Honestly if you screamed in the face of the checkout chick you would get thrown out/police called etc. Posthaste. I have been on the receiving end of atrocious behavior in the USA and have been asked what I did to cause it WTF? Working with jail pts i did tend to work with a high percentage of psychopathic individuals.There is no reason to treat anyone with disrespect let alone your caretakers. While I really try to model compassionate and professional care ( I always get in pt comments/evaluations of very caring) there is a difference between this and enabling abusive behavior and abusers. The USA hospitals have gone so far in protecting the pts that they forgot to support the staff. Honestly that response did sound like a river too far!
It’s very easy to become holier than though when condemning others behaviour.
Yes, we have lovely laminated cards explaining the consequences of physical and verbal abuse.
However the title of nurse does not anymore provide some esoteric level of tolerance to the demons of our patients. It just isn’t there anymore.
We also love to counsel and performance manage. Like he is some sort of problem that needs fixing.
What he needs is understanding. He has laready had a arse kicking by the looks of before hitting the AAT. Why destroy someone? Because authorities want to cover there arse instead of their staff.
I dont know all the case either or the behaviour of the nurse in question, but we do need ot look after our own. That’s because we ARE nurses.
(who mentioned this was a dementia unit??)
Whilst I by no mean condone this nurse’s behavior, I know I have come very very close to snapping on a few occasions, so I can’t judge too harshly. I think the most challenging pts are criminals, whose crimes you know, who continue to behave appallingly in the ED, sucking your attention away from other patients. There are a few of these pts who I almost don’t know how to look after, they push my buttons so well.
I have no empathy for the nurse. We all have a choice and he is no better than the patient if he lost his temper. In the USA, this would be considered abuse, nurse would have been terminated. What happens when he loses his cool again, if no one is there to witness. I work with people with dementia every day, yes it is frustrating and you have to learn to control your emotions, if you can’t then I suggest you find an alternative career.
Working in a dementia unit helps educates ones ability in dealing with conflicting behaviours. The patient at the end of the day has the right to choose or refuse. This is part of the cardinal rights of medication and is supported legally. Just document the outcome if the patient/client/resident refuses to take their meds. If it’s an ongoing concern perhaps a social worker or counsellor could assist in finding out the cause behind their decision. That’s my opinion.