Advice on "setting boundaries" - page 2

by SubSippi

1,496 Views | 14 Comments

Hi! I recently passed the NCLEX, got my license, and will start my very first job in a couple of weeks. Aside from all the other new grad concerns (time management, etc.), I know that I will have a HUGE problem setting boundaries... Read More


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    I had this issue the other day with the adult daughter of my elderly stroke pt. She was so passive aggressive , annoying, rude and over bearing.
    She wanted me to call a code stroke overhead when he mother couldn't get a burp out after lunch. I fixed the burp situation, if u will, but she criticized me and oh so helpfully web MD educated me every moment I was in there. I am putting both shifts mildly cuz I feel a stroke coming on myself just thinking about it.
    So im from Nj but now work in tx. What I would say if I was back home would not fly. Some of these old southern belles dont like the taste of their own dish when i serve it back to them, if u will.
    Also passive aggressive ppl are my nemesis. I consider myself assertive most of the time.
    Master the art of answering annoying people as you are heading and walking out the door and then proceed to close it for " privacy". Don't be mean. Gets you nowhere.
    Don't ever say you had something along the lines of more important/ priority. She came right back at me and said " oh that's odd I didn't hear them call a code blue in this hall" GRRRR WTH. lol
    I say something along the lines of " oh wow sorry that took a bit I just had 3 fires In a row I just put out! Ha-ha, how can I help you now?"
    If that doesn't work and they are belittling me or rude, I call em out.
    " the way you're speaking to me is unacceptable . It may look like I'm wearing pajamas to work, but I am your registered nurse and expect to be treated and spoken to like the well educated professional that I am, with the same respect I give you. so that said ,would u like to try saying that again?"

    They are usually flustered and realize I won't be taken for a fool. If the problem doesn't resolve, tell your charge and or manager, document!!!! And request a different assignment next shift. My director said it is professional to acknowledge and accept when their is simply no therapeutic nurse pt relationship and the care if suffering, either that patient or your others. Some pts are rough but respond better to someone else. Sometimes it really isn't you it's them.

    I hate to say it , but I handle my patients the way I envision dealing with my future children. I am firm but funny, always thinking of their safety and my time, tell them why matter of factly when they ask and always throw a splash of guilt and fear in the mix if my not so subtle joke failed to send my message.

    Example ) post cabg pt refuses / ' forgets" to practice his incentive spirometer.
    "Sir! No one told me what a rebellious soul u are. Why have I not seen you practice your breathing? I know it hurts but we can work through the pain easier than pneumonia.....you don't really want me to have to tell your surgeon you haven't been following his treatment plan, right? * insert comical pouty face and then quick smile and put it in their hands*
    Bottom line is that humans are blessed and flawed by being autonomous . if they aren't following the plan let the DR know to see if there is an alternative instead but it isn't your job to keep someone's bipap on for 12 he's straight. You have stuff to do for people who enjoy getting well :-)
    Kill em with kidness then walk away baby.
    Last edit by SNB1014 on Jul 4, '13 : Reason: spelling
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    and oops i earlier typed out this whole answer but answered to a different topic whoops!
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    Quote from SubSippi
    Ok. So if someone is being combative,
    annoying? urg okay. needy? hey aren't we all? combative, though? not cool, wont be tolerated.

    firstly, since you seem concerned, let me say that the majority of my days do not include having to set these boundaries, etc. i dont look for conflict. it also helps to laugh about it with your coworkers/complain to your husband at night lol

    butttt that said, COMBATIVE is different. someone who is having dementia and "attempting" to kick me i wont call a "code grey" (aka secuirty) to the room. i will call another person into the room and usually the confused will be temp. distracted by the new face, new voice, new smiles and stop.
    if not, i stay with another staff member in the room while i call the dr for a stat 1x dose or stat/prn IM/IV antipsychotic/sedative, etc. and have them stay in a Geri-chair at the nurses station.

    if a family member (aka not the patient and someone i have no actual patient responsibility to) starts doing this, my charge, my fellow nurses and the security team will be called. its a cold day in Texas when i tolerate that nonsense.

    if you reallllllllly want to be informed, look into your policy handbook. some facilities, believe it or not, do not allow their staff to press criminal charges on a patient or visitor.

    mine thankfully does, and God forbid that i am ever physically threatened or serious verbal abuse, i will call 911 right after i call security. our security guys are off duty cops. we also take a class in "defensive maneuvers" and non violent crisis intervention
    you will find a lot of cops, fire and ems workers have a kinship towards nurses.

    nurses, you are professionals and at your place of employment. no different than when my husband wears his suit to the office. if his client did that, they would be "escorted" out in a heartbeat and no one would feel guilty.
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    Being calm and assertive is something I still struggle with, but it's a 'fake it til you make it' skill. My helpful hints are don't blather on and don't apologize if the request is unreasonable.

    Scenario: A 15 year old patient's mom is staying with him the night. She asks for applesauce, apple juice, orange juice, toast, and if we have any sandwiches, that would be GREAT. No please, thank you, or alternatives sought (ie, "are there any vending machines or places open in town where I could get XY and Z?")

    Old me: "Ummm... sure. Let me just get those for you." *goes, gets the stuff, complains about them at the nurses' station*

    New, calm, more assertive me: "We don't, unfortunately. There is a vending machine on the ground floor". *leaves*

    Fight the urge to apologize or blather away excuses. The more you do it, the easier it gets.

    BY THE WAY this doesn't apply to reasonable requests of the actual patient.
    loriangel14 likes this.
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    Quote from meanmaryjean
    I think the BEST approach is to run these scenarios and responses past your new manager- and say "What is acceptable on this unit? How would you like me to respond when these types of situations arise?"

    You did an excellent job of presenting your issue in writing, analytically and with good self-awareness - do the same verbally to your manager. If you respond in a manner he/she has already said is OK- you will always be backed up.

    Good advice.
    And seeking the counsel of other reasonable clinicians is never a bad idea.


    to OP:

    It's OK to say no, but a brief explanation and offering an alternative is a great way to handle it. And by brief, I mean ~15 words or less. "No, I'm sorry I can't do _______, because_______, but perhaps (you/I/visitor/the doctor) could _________"

    Somebody is mildy rude, ignore it. They're sick, scared, angry, under a lot of stress, whatever. They're reacting to what's going on, and it has nothing to do with you.


    Very rude? I just say, I'll try to help you to resolve this issue, but I would never speak to you that way, and would appreciate it if you would do the same.

    Continuing rude? You're upset right now, I'll come back when you are feeling calmer


    Keep in mind that acting out may also be due, in part, to pain or anxiety, so an offer of medication may be appropriate.


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