How do you get thicker skin? - Page 4

Just an informal poll-

How many nurses would just look at each other and walk out the door? I would.

I'd let her wonder how long we were going to leave her like that. And then, when I was darn well good and ready, we'd clean her up and put a diaper on her.

I reject the excuse of being sick or stressed, in all but the rarest of situations.

The person who is treated this way, whether a professional RN or anyone else, does not own the responsibility to fix this problem - and that includes not making excuses for it. My personal observation is that our recent/current culture of customer service extremes (which absolves patients of any responsibility for anything and everything) has made this problem 10 times WORSE (and more frequent). This is not any random stressed/sick patient who behaves the way the OP describes, this is someone who wants to start trouble in hopes of some sort of secondary gain.

I have a variety of ways of handling these situations, but none of them involve 1) talking to the patient about MY feelings (EVER!) or 2) chastising/reprimanding -- the patient already full well knows the behavior is wrong 3) rewarding the behavior in any way.

I say these types of things, with a decidedly apathetic/neutral tone and facial expression:

"I'll be back when you are ready for my assistance"
"I am here to help you. If you don't need my help right now then I'm going to leave"
"I am not going to become upset by your inappropriate behavior, it has no effect on me. What is it that you need/how can I help you?"
"That doesn't work with me. What can I do to help you?"
"You seem to have concerns about things that are not in my control; I'll ask the supervisor/liason/pt services rep to come and speak with you"
Etc.

I quite frequently quote these behaviors in the medical record, in a neutral/factual manner.

To the OP, I know it isn't easy at first but over time it becomes second-nature. Always remember the patient is the one with the problem, and that s/he does not control you or your feelings. And....at the end of the day, you have your fabulous life and that person is stuck in the misery they create for themselves. I actually find it so pathetic it's hard to feel anything but sorry for them.

God gave me the ability to raise on eyebrow about two inches higher than the other. I figure he expected me to use it. I raise my eyebrow, then raise my head, then I say without smiling, "Is there something you need?"

I seldom encounter behavior like this more than once.

I don't address comments like that. I just say: Is there anything that I can do for you right now? If they continue to talk I start asking them: What do you need? Are you in pain? Are you hungry? Need a blanket? What is it that I can do for you? If they don't want anything and just want to ventilate then I say O.K....and I walk away and act like I never heard them. What a joke, half the time the person insulting you looks like they have one foot in the grave and the other on a puddle of grease. Whatever!

Okay, my philosophy. When people come in the ED, they are generally at their worst. While it makes no excuse for ignorant or aggressive behavior, it is what it is. I know that when people call me Dumb this or fat this or ugly this they are not addressing me. they are addressing an image of a nurse (generic) it's not personal. It took me a good 2-3 years to get to that point. To me now, a good day is if I'm not called the C word.
I don't have high expectations.

I think there are 2 parts to this. the first part, thick skin comes from realizing some people are a****, regardless of whether they won the lottery or just got hit by a car. You can't fix stupid or mean. As far as getting thicker skin, it happens when you realize that that person wasting my time is making the little old lady with dementia able to climb out of bed and fall or that CP go longer without nitro.They become a waste of time, not an emotionally hurtful encounter. Now the second part is about how you deescalate and that is a learned skill. Sometimes, speaking softly, other times go all authoritarian, sometimes security needs to "talk to them", sometimes just let them know calmy they are out of line, you get there, just never take it personally. Put it this way, would you feel bad if someone was whining about an IV and the pain it caused to have one put in? When you start in the ER yes it will, but after a few years you know if that's the worst thing they have to complain about while in the EMERGENCY DEPT they have nothing to complain about.

I agree with the de-escelating thing being learned. there is no one answer for all situations. In our ER we have a no tolerance for rude and belligerent behavior and foul language. It's posted on the wall. So Security always backs us up when some gets really mouthy. I've learned that I don't have to tolerate verbal abuse and I don't. But there are definitely situations that call for special handling and that is where the experience comes in. Somebody coming down off PCP ain't listening to anything you have to say, but an upset husband might. Live and learn. Thick skin comes with confidence and faith in yourself.

I'm not sure a thick skin is going to help... much. I'm not even sure that's the issue...

Rude people are rude people - be they patients or otherwise.
Would you be wondering about this very question if a server at TGIF or your car mechanic spoke to you this way?

Yes, people behave differently when they're sick/scared/anxious.
So then ask yourself this question - whenever you were sick/scared/anxious, did you lash out this way with whoever approached you? Especially someone who was trying to help you?

I don't completely buy into the 'they behave this way because they've lost control' argument. Yes, it is true that when one is in the ER/hospital - there are certain "rules" one has to follow. E.g. "Can't eat or drink anything till the Doctor has seen you" on a pt. complaining of abdominal pain, nausea and vomiting. Or "can't let you walk to the bathroom" on a pt. with cc/o syncope and low BP. etc. Usually most pts. understand once the rationale is explained. But we aren't talking about 'most patients' now, are we?
Besides, when you're in an ER - you're not there for days. No, you're there for a few hours. You seriously can't stand 'losing' your 'freedom of action' for a few hours? Given that you came to the ER seeking my help and not the other way 'round?
If you won't abide by/comply with my interventions - why the heck are you here then?!!

Don't get me wrong - I'm not expecting goody-two-shoes when I interact with patients. I don't particularly care when some of my patients cuss/use vile language/scream because of their condition or because of procedures we are performing on them.

But I donot and will not excuse poor behaviour for no apparent or valid reason.
Especiallyfrom adults who ought to KNOW better!


I give all patients the benefit of the doubt.
I'll be calm. I'll talk. I'll try and reason. Perhaps a compromise or two... whatever works so long as it maintains pt. safety and is within policy.

But I will not subject myself to continual abuse - not just because it's unnecessary but also because I don't deserve it. I'll treat you like a decent human being when you return the courtesy.
Yes, I draw boundaries. Delineate 'lines in the sand'. Sometimes as suggestions... and other times as commands [you'll understand when you deal with a lot of intoxicated patients who will not listen to rhyme or reason].


No, the issue isn't "thicker skin"... it's more along the lines of 'decency' and 'permissible behaviour' (and I deliberately chose 'permissible' over 'acceptable'. People do many things which you and I might not find 'acceptable' but if it's 'permissible' that's none of our concern).
And assaulting staff - verbally or physically for no apparent or valid reason - is completely unacceptable.

cheers,

Oh and by the way:

Good judgment comes from experience, and experience comes from bad judgment.

cheers,

Know that it's not about you, it's about them. Some people are just miserable, nasty people, and sometimes they get sick (or not so sick but wind up in the ER anyway). At first I'd get upset and worried when patients were nasty, mostly because I was concerned that I'd be blamed for their behavior in some way and that maybe it was my fault for not managing the situation well. It just gradually became less personal for me, so I guess a thick skin is something you develop over time like the ability to set boundaries, say no, not make their problems your problems, etc.

I think my general practice is to not engage with the patient. If a patient seems to be escalating beyond verbal nastiness I get security involved, and I'll ask my charge nurse to go speak to them as well. Other than that, nastiness from patients has just started to seem like a waste of my resources than anything else, so I prioritize accordingly Listen to nasty patient in room X or reassess my asthmatic in room Y who hasn't been responding as well as we'd like to the nebs and steroids?