Laura Lockwood, PA
I had an appointment to meet with a patient in his 80s who was likely to soon pass away. We were going to do advance care planning and make sure our end-of-life care fit his goals. He hadn’t been doing well; he’d needed a 1:1 aide in the room with him to make sure he didn’t pull his lines out or hurt himself.
When I went into his room, his aide, who was Hispanic, started to step out of the room, and he yelled to her to get him a Coke. She said she would after I left. He said, “No — get it now!” As the aide was leaving, he told me, “I used to have a really good aide, but now they have me with these damn Hispanics.”
He made some similar comments after she was gone. I was truly appalled. I said, “Sir, we don’t talk like that here.” Just then the aide came back in with his drink, and he looked at the drink and yelled, “I wanted ice!” His tone was really angry.
I knew what I had to do. I just said, “That’s enough. Sir, first off, you have one of the best aides we have at Intermountain Medical Center, and second, you’re being extremely inappropriate in how you’re talking to her. We’re all here to help you, but everything you’re saying is inappropriate.” The aide was behind my back, and she whispered, “Thank you!”
The patient was taken aback. I told him, “We don’t tolerate racist language and behavior. If you continue to act like this, we’ll put you on a behavioral contract, which means if your behavior doesn’t improve or you break any part of the contract, we’ll discharge you and you can seek care elsewhere.”
My concern was, I needed to stand up for our aide, and then have a pretty intense discussion with the patient about how he wanted to face the end of his life. I had a feel for the kind of person he was; I knew he was intense, and I felt like I could meet him where he was coming from. I was professional and polite, but I was direct; I wasn’t going to back down. I knew that was the kind of behavior he’d respond to.
He said, “I haven’t been rude.” I said, “If that’s what you think, that’s a problem, too. Everything you’ve said is out of line with our values. We don’t tolerate it.”
He quieted down, and I did the planning with him. When I left the room, I grabbed the aide and found the charge nurse. I told them we needed a behavioral contract and he didn’t need a 1:1 aide any more. I told the aide, “You and every other person working here needs to know, you don’t have to put up with being treated like this and be subjected to these disgusting racial comments.”
A behavioral contract is a form for patients who are physically, emotionally, or verbally abusive or violent; copies go to Security and the charge nurse. Usually it’s written by the patient’s primary provider. We review it with the patient and tell them if their behavior doesn’t improve, they’ll be discharged from the hospital and invited to seek care elsewhere. Once it’s in place, I’ve never seen anyone break it.
The patient’s behavior improved and we had no further issues with him.
The aide was very grateful, and she said she’d never heard of a behavioral contract. I think it’s important for people to know about. It’s good to know the hospital will back you up. We all need to feel like we’re protected. I’m just sad people still feel this way about people who are different than they are. We all just need to see each other as human beings.