No Free Pass for Disruptive Patients (or Their Families)...

Recently I had the honor of visiting with a healthcare team... nurses, doctors, security, case managers, and social workers and I listened to their experiences in managing disruptive patient/family behaviors. It was painful to hear about how alone they felt in dealing with patient disruptive behavior. Shocking - not only are nurses and physicians disruptive, there is a third layer that we struggle with in healthcare and it is patient disruption. And "patient" includes the family members who yell and scream and threaten our teams.

What did I hear? This team felt like failures. This team felt unsupported. This team felt abandoned by their leaders, left alone to manage hostile, uncivil behavior for an extended period. What was really unfortunate...This is not a one-time event. This is a pattern that exists on an almost daily basis in almost every hospital in America. Patients threaten our staff, they threaten to get them fired, they demand treatments/medications and then scream when they don't get them, etc. Of course, not every patient, just like not every nurse is disruptive but failing to acknowledge these situations exist and failing to address them as leaders is a fail on our part.

Healthcare is a stressful place to be. Patients are sicker than they have ever been. The complexity of their medical conditions are continually increasing. Add to that, patients in need of psychiatric care end up on medicine units or staying extended periods in our ED waiting on an open bed at a treatment facility. Add to that, not everyone we encounter who is struggling with addiction or mental health issues is the admitted patient (as in, this disruptive behavior can come from a visitor or a family member).

I heard remarks that administration doesn't care. They said, "I went home exhausted and I cried - because I failed my other patients trying to manage this one patient." It is clearly evident that not only do we not give our team the tools they need to manage these behaviors, we fail to intervene, to develop a process, or to create an environment where our team members feel safe and empowered.

As leaders, failing to build a process that includes guidelines, limit setting with patients/families, and then holding them accountable for their behaviors results in increased caregiver stress - Random legislative bodies around the country are passing laws to protect our nurses from violence, however...

There is a lot of disruption that doesn't turn violent, that causes just as much distress on a much more frequent basis!

There is so much you can do as a leader to end patient/family incivility. Just like managing disruptive behavior among your team, managing patient/family incivility requires acknowledgement, commitment, and follow-thru (*Please note that in no way am I referring to a patient with dementia or any other altered mental status who is saying/doing things they are incapable of controlling). I am referring to the daily disruptors who are demanding, who want more pain medication than ordered, the ones who demand one-to-one care when it is not warranted, the ones who threaten your employees, etc.! Even if the patient has a valid complaint, never is incivility justified!

QUICK TIPS :

Below are some basics to implement as you build your culture so that this behavior is quickly identified and professionally addressed:

1. Your team should know that they are never expected to tolerate uncivil behavior. They should know who to call for help.

2. Your organization should have a multi-disciplinary team approach to managing disruptive patient/family behaviors. This should include leadership, case management, social work, nursing, pharmacy, physicians, chaplains, and security... (and whomever else your team thinks could contribute).

3. The approach - Identify the uncivil behaviors, communicate this information to the patient/family, hold a crucial conversation that includes limit setting, behavioral expectations, and next steps if the behaviors do not improve. Put it in writing what you expect in terms of appropriate behaviors and provide the patient/family with a copy.

4. And then the hard part - ENFORCE IT. Remember, patients are not entitled to abuse your staff merely because they have a medical condition that warrants hospital admission! Family members who can not act respectful and follow rules are not entitled to visit.

5. Realize that every repeat admission is NOT a "fresh-start" where you should wait to see if the patient/family acts out again. Disruptive/uncivil patients and their family members should be notified at the beginning of a repeat admission that as an organization, you are still committed to ensuring safe patient care and still equally committed to providing a safe healthy work environment for your team!

As leaders, it is our job to end incivility in the workplace and create the best work environment for our incredible teams! #YourTeamDeservesBetter! #EndIncivilityToday, #EndIT