New grad dealing with angry/yelling patients - page 4

Hi all, I am a new grad of 4 months working on a busy Ortho/Trauma floor. It has gotten to be an almost daily occurence that I come home crying because a patient/family has decided to take out... Read More

  1. by   luvbug9956
    I know that patients and their families can be one of the most difficult parts of nursing. I always feel as if I am making excuses by telling my patients that I was held up by something or someone else. A little trick that I have found works pretty well is when the patient is admitted, let them and their families know where the kitchen, linen room, and other important areas are. Many family members feel a sense of accomplishment just by filling their loved one's water pitcher. This gives the family members and patients a sense of control. If a family member asks me for something such as a blanket or water I try to let them know that it may be a few minutes and direct them to where they can find the items. Use this cautiously....extremely overdemanding patients and families may feel that you are giving them your responsibilities. But I find that many families are more than willing to help out!
    I also always try to remember that sick patients and their families are under a lot of stress..many a time a patient will be "difficult" during their stay, and once discharged thank the staff and apologize for their attitudes. I usually see this behavior as a clue to the need for a stress-relieving intervention for patient or family.
  2. by   teeituptom
    Welcome to the wonderfull world of nursing

    aint it grand
  3. by   zacsmimi
    Quote from pumpkin
    Hi all,
    I am a new grad of 4 months working on a busy Ortho/Trauma floor. It has gotten to be an almost daily occurence that I come home crying because a patient/family has decided to take out their frustration on me. When I was in school, I always had the idealized dream that I would get out and help people, and they would be appreciative. At least once in a while, I would get a "thank you". That has yet to happen. The patients/families who I've had problems with are patients who all the nurses have problems with - so I know it's not me. However, this doesn't help me from taking criticism personally. I hate just gritting my teeth and standing there while someone chews me out because it took me 20 minutes to bring in an extra pillow. Sometimes I can understand where they're are coming from - it's a teaching hospital and it can be frustrating trying to deal with the many different interns. But most of the time, these patients are just generally rude, or crazy, people to begin with. If the floor wasn't so busy, I would be able to talk to my colleagues to find out how they're able to deal with these patients. But we rarely get to eat lunch as it is.
    Can anyone give me some advice on how to handle them? How can I not take this so personally? Is there some mental trick I can play in my mind so I'm not thinking "I don't get paid enough for you to yell at me, you crazy old bastard"? Any advice at all would be greatly appreciated.

    Man, do I remember crying all the way to AND from work for the first 6 months!! It wasnt usually patients, but it was sometimes, and often times colleagues that forgot what it was like to be green and scared, and doctors who think they are God (yes there are still some out there....)
    Telling you to toughen up isnt going to help. That, unfortunately, will come with time anyway. Remember why you went into nursing. Remember how badly people behave when they are frightened or threatened or helpless to protect their loved ones. Make sure they know you hear them. Dont get defensive. Answer in a soft voice, smile, and walk away. Dont EVER let anyone chew you for 20 minutes. NO ONE. Thats abuse, pure and simple. THere is a difference between abuse and venting, or just blowing up. You are in control here... this is your turf, this is the hospital, the one place everyone else on earth hates and usually fears. Make eye contact. Reach out and touch your patient, so that they know you care. You may be amazed by how fast attitudes change toward you. And yeah, hon - its true... it really isnt about you. ITs about pain and fear and helplessness. Hang in there.
  4. by   vablueyes
    I work in a busy ER and am probably yelled at at least once a week. I take a deep breath, look the person in the eye, and say "I can understand that you are frustrated (hurt, anxious, concerned...whatever) but we are doing the absolute best we can at this time...you have two choices. You can speak with my nurse manager when she is available, or you can put on your big boy/girl pants and deal with it. I will get to you as quickly as I can." This usually leaves them with a bad taste in their mouths, but leaves me with the upper hand. I refuse to let them get to me.
  5. by   jenruth
    The subject of patients and families lashing out at nurses got me so fired up, I had to register. Personally, I have had very few problems with that kind of behavior from patients and families after my first year of my 17 as an RN, because I simply will not tolerate it. I might also add, I have never been reported or reprimanded for setting down rules when such a situation arises . A persons illness and hospitalization often brings out the worst in family members especially those who are already emotionally troubled, but it does not give license to lash out at staff. This idea that nurses are suppose to silently accept abusive behavior sends a clear message that we are worthless. I might add, that keeping silent has nothing to do with being "professional." It is impossible to work safely and effectively when such people are allowed to act out. It also destroys the morale of the staff, and contributes to staff turnover. Stand up for yourself, your coworkers, and your profession. Learn how to identify troublesome patients or families who are lawsuit prone as soon as possible, and formulate a plan of action. Document all interactions and behaviors, let your supervisor and the patient's physician know what's going on. Many facilities will have social service workers, or risk managers deal with these kinds of patients. The thing is, you have to let them know what's going on. Troubled patients and families create a hostile, uncomfortable environment that prevents nurses from doing their best job. Don't be afraid to speak up; It IS worth it.
  6. by   chris_at_lucas_RN
    Excellently put! I feel coached and rarin' to get at 'em!

    Thanks! (and welcome to the BB!)
  7. by   passing thru
    Pumpkin: Someone may have already written this, I didn't read all the posts.
    But here is my advice and the way I handle it.
    I don't stand there for 20 minutes and "Let" someone chew me out.
    (I know the 20 minutes is an exaggeration.)

    If I were delivering the pillow, and they started to complain, I'd say, "Gotta go, I've got 2 I.V.'s to start and a doctor waiting for me at the desk..." And I skeddaddle outa there.

    You must take control.
    You do not "Let" the patient be in control.

    I've actually been in the position of cleaning an incontinent b.m. patient ...with another nurse or aide and the patient is complaining
    like crazy. !!!!
    One day I said to the patient, "You think it is bad from your side, you oughta be where we are ! "
    I said it with a light tone and a laugh.....

    The patient got the point and shut up.

    Since then, I have used that line a lot......
    like, "Hello !! Do you think WE are enjoying this??"

    A little reality reminder goes a long way sometimes.

    The reality in this situation is: Two healthworkers assisting and cleaning a patient in a room that smells so bad it is asphyxiating, and we are elbow deep in feces and the patient is COMPLAINING ??

    Hello !!
    It is time to take control.....when you are assisting and they complain.

    NEVER stay in the room and 'TAKE IT'.

    Use any excuse and depart ...at once..
  8. by   LuLu123NY
    [QUOTE=pumpkin]Hi all,
    I am a new grad of 4 months working on a busy Ortho/Trauma floor. It has gotten to be an almost daily occurence that I come home crying because a patient/family has decided to take out their frustration on me. When I was in school, I always had the idealized dream that I would get out and help people, and they would be appreciative. At least once in a while, I would get a "thank you". That has yet to happen. The patients/families who I've had problems with are patients who all the nurses have problems with - so I know it's not me. However, this doesn't help me from taking criticism personally. I hate just gritting my teeth and standing there while someone chews me out because it took me 20 minutes to bring in an extra pillow. Sometimes I can understand where they're are coming from - it's a teaching hospital and it can be frustrating trying to deal with the many different interns. But most of the time, these patients are just generally rude, or crazy, people to begin with. If the floor wasn't so busy, I would be able to talk to my colleagues to find out how they're able to deal with these patients. But we rarely get to eat lunch as it is.
    Can anyone give me some advice on how to handle them? How can I not take this so personally? Is there some mental trick I can play in my mind so I'm not thinking "I don't get paid enough for you to yell at me, you crazy old bastard"? Any advice at all would be greatly appreciated


    Pumpkin,

    Remember these pts. are in pain ( some are) and many resent being helpless on this kind of floor where they don't move. They have NO idea what YOUR duties are for the shift and only can focus on THEIR needs . It is a hard floor to work on ( I have done it) and they don't mean it personally at all, they merely are venting their frustrations for not having their needs met when they want. Try to remember to have your charge nurse or med nurse medicate them before moving them or getting them OOB. I can't think of a more difficult floor for the pts. in the summer when it comes to comfort, r/t casts and aces galore , not to mention SCD's, as these are hot to wear and positioning is a feat in itself. You will " blow this off" with time and the realization of what they're feeling. Remember, they don't know you as a person, so therefore they don't mean it personally. Try to give them as much comfort as possible and realize that for some, being cleaned up form a bowel movement can be demeaning for some patients. Always try to put yourself in their shoes, as someday YOU will be on the other side of the bed. As for me, I set limits and tell them not to address me in some ways. " My name is not HEY" , My name is... or you can just call me nurse." I also am not a dog and don't respond to whistles. Sometimes we have to teach people how we like to be treated. Hang in there.

    LuLu
  9. by   teeituptom
    Kust walk away from those people

    smiling sweetly and singing


    "Hit the road Jack"
    dont you come back
    no more no more
  10. by   leslie :-D
    Quote from teeituptom
    Kust walk away from those people

    smiling sweetly and singing


    "Hit the road Jack"
    dont you come back
    no more no more
    desparate times call for desparate measures, yes tom? go get 'em tiger.

    leslie
  11. by   teeituptom
    Im too old too fight or fuss

    waste of time and energy
  12. by   nerdse
    Quote from RN4NICU
    This is a wonderful idea -- maybe American hospitals will take notice and follow suit - The sooner the better

    Edited to add - it should apply to family members too. They should not be allowed to visit if they can't behave themselves. Family members with disruptive or abusive behavior, even if directed at staff and not the patient, certainly don't contribute to the healing environment for the patient.

    -----------------------------------------------------------

    Abusive patients face zero tolerance

    Patients who are violent towards NHS staff are to be barred from treatment for up to a year under new guidelines.

    Health Secretary Alan Milburn says he wants to create a "zero tolerance zone" for abusive behaviour within NHS hospitals and clinics.

    Patients could also face treatment bans for verbal abuse of staff, threats, vandalism and drug or alcohol abuse on hospital premises.

    The guidelines, first trailed in June and due for publication later this week, will balance the duty to provide health care with the need to protect staff, Mr Milburn says.

    Some 65,000 assaults on NHS staff are reported each year.

    Two London hospitals - Bart's and the Royal London - have introduced their own yellow and red card system to warn abusive patients that treatment may be withheld.

    In 1998, the Government announced a target of reducing violent incidents against NHS staff by 20% by 2001 and 30% by 2003.

    Under the new guidelines, NHS trusts will each draw up their own local policies on what behaviour is to be regarded as meriting denial of treatment.

    Mr Milburn is due to outline the plans during a speech to the Community Practitioners and Health Visitors Association conference in Bournemouth.

    Patients will normally be given a verbal warning, followed by a written warning before being denied treatment, but in exceptional cases, when staff feel under imminent threat, care can be withheld immediately.

    http://www.ananova.com/news/story/sm_438301.html
    So cool an idea! We really DO need it here, our pts are so spoiled compared to the NHS pts in GB.
    Having seen the NHS up close I can see how they get abusive, really, some operations that you can get here in a month or less have a 5 - 10 yr waiting list there & if you "contribute" to your illness you don't get the surgery - one example is a knee replacement isn't given to anyone who's ever been overweight, they have to pay for it, or did when I was over there (it may have changed for the better but I wouldn't count on it). So I am not surprised there is violence; powerless people are usually violent at some point & often adapt it as a habit.
    But w/ our spoiled (spoilt?) pts here getting whatever they want, I think we definitely need to do something similar. They aren't getting denied care when they are swinging at you. I was once told that if someone tried to hit me I could not hit back so I said what about blocking the hit & was told that was the same as hitting back. And we wonder why we have a health care professional shortage...needless to say I ignored that and did block pt's "haymakers" when they got violent (usually b/c they got something on the tray they didn't like, or the water tasted bad, or they wanted a name brand soda and not a generic one; sometimes, tho', they were in the DTs & didn't really know what they were doing so I cut them some slack).
    The demanding people usually take time away from pts who really need us. I think that's what our young friend is upset most about. And what NHS is trying to prevent from happening in their facilities.
    My grandma used to say, "Consider the source." She explained to me that if the person was hurt or angry, they were lashing out at you b/c you were safe & you could defuse the situation by zeroing in on its source - "It must be really hard being here trying to cope with this situation." Then laying down the law - "I will do what I can to make it easier for you, BUT we have a unit full of people with similar problems and I have to make sure all of them get their share of my time & attention in accordance with what is wrong with them. I am sure that you would not want me to ignore you for someone else, especially if your needs were urgent, so I am sure that in future you can find it in your heart to understand that we're all doing the best we can in difficult circumstances. Thanks for understanding." Even if they don't right away, you may find that later on they will come to you privately & apologize & if they don't they will stop acting out so much. Keep really good eye contact, open posture, professional tone of voice, and remember that most of the time they are not angry at you but at their situation.
    For the ones who are twits, Grandma's advice means not taking offense at an idiot but pitying them instead. She used to say pity was worse than hate b/c it assumes you are incompetent. I have found that an attitude of pity is actually a potent weapon. People would rather be hated. I have even said to people that I feel sorry for them b/c they have no other way to cope with problems than to yell at someone.
    Hope some of that helps.
  13. by   Farkinott
    Quote from nerdse
    So cool an idea! We really DO need it here, our pts are so spoiled compared to the NHS pts in GB.
    Having seen the NHS up close I can see how they get abusive, really, some operations that you can get here in a month or less have a 5 - 10 yr waiting list there & if you "contribute" to your illness you don't get the surgery - one example is a knee replacement isn't given to anyone who's ever been overweight, they have to pay for it, or did when I was over there (it may have changed for the better but I wouldn't count on it). So I am not surprised there is violence; powerless people are usually violent at some point & often adapt it as a habit.
    But w/ our spoiled (spoilt?) pts here getting whatever they want, I think we definitely need to do something similar. They aren't getting denied care when they are swinging at you. I was once told that if someone tried to hit me I could not hit back so I said what about blocking the hit & was told that was the same as hitting back. And we wonder why we have a health care professional shortage...needless to say I ignored that and did block pt's "haymakers" when they got violent (usually b/c they got something on the tray they didn't like, or the water tasted bad, or they wanted a name brand soda and not a generic one; sometimes, tho', they were in the DTs & didn't really know what they were doing so I cut them some slack).
    The demanding people usually take time away from pts who really need us. I think that's what our young friend is upset most about. And what NHS is trying to prevent from happening in their facilities.
    My grandma used to say, "Consider the source." She explained to me that if the person was hurt or angry, they were lashing out at you b/c you were safe & you could defuse the situation by zeroing in on its source - "It must be really hard being here trying to cope with this situation." Then laying down the law - "I will do what I can to make it easier for you, BUT we have a unit full of people with similar problems and I have to make sure all of them get their share of my time & attention in accordance with what is wrong with them. I am sure that you would not want me to ignore you for someone else, especially if your needs were urgent, so I am sure that in future you can find it in your heart to understand that we're all doing the best we can in difficult circumstances. Thanks for understanding." Even if they don't right away, you may find that later on they will come to you privately & apologize & if they don't they will stop acting out so much. Keep really good eye contact, open posture, professional tone of voice, and remember that most of the time they are not angry at you but at their situation.
    For the ones who are twits, Grandma's advice means not taking offense at an idiot but pitying them instead. She used to say pity was worse than hate b/c it assumes you are incompetent. I have found that an attitude of pity is actually a potent weapon. People would rather be hated. I have even said to people that I feel sorry for them b/c they have no other way to cope with problems than to yell at someone.
    Hope some of that helps.

    nerdse,
    You do make some salient points but the crux of the matter is that nurses should not and will not be exposed to violence at work. Could you imagine a social security office or bank or supermarket accepting the violence because there is a "root cause" and if they come up and apologise later it is all alright?
    I work in a workplace that defends my right to an abuse/aggression free workplace. Abuse/aggression is NEVER ok!

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