Hi! I'm starting as a psych intake RN and understand that i'll be dealing with people on their worst day. I expect to be cursed at, or verbally abused as a part of the job - and would like to know how other seasoned nurses handle this. What works best? Are there things that you have said/done that didn't work and/or made the situation worse? Thanks!
When I first meet a Patient, when they are brought up to the floor, I introduce myself and then ask them what they like to be called, after referring to them as Mr. or Ms. Then I ask them if they'd like a snack or refreshment. Patients are often in the ER for hours, and are tired and cranky.
If they are cranky enough to be verbally abusive, I will say something like, "I understand that this is your worse day. However, I am requesting that you not use profanity. Please give me as much respect as I give you.
Now- what can I do for you that will make you happy?"
Some Patients have mistook my pleasantness as weakness and have pushed the envelope. I have said to Patients, "Look- I can be your best friend or your biggest stumbling block to you getting what you want. The choice is yours: work with me and I'll do everything I can to help you. Work against me and my only responsibility toward you is your safety."
I've had pretty good results with these techniques.
Good luck to you, mmjp!
Davey summed up a lot of what I would have said, so let me just add... There will come a day when you really, truly don't care what they just called you because you're more frustrated with them than they are with you. It won't be all the time; that "conditionally thick skin" can be situational. It is rarely a good idea to tell them this. I've been guilty of that when I'm getting tired of the same behaviors over and over from my adolescent patients, when they call me names..."You know I don't care, right?" Protip: that never helps the situation. Do recognize when you're getting to this point and try to "tap out" with a co-worker, if that's possible. Or take a deep breath and center yourself if it's not.
You'll hear "set firm limits and enforce them" in this field a lot. Part of that is reminding them what behavior is appropriate and what isn't, as Davey noted, without taking a personal stake in it. And if they continue to goad you, don't feed into it. Ignore what you safely can and gently but firmly intervene in the rest. It's hard to describe theoretically, but you'll get the hang of it as you get experience. And always remember - it's about what's going on with them, not you. That can be the hardest part...
safety first always
You are not likely going to change people much if at all. But do what you can, give their meds, use therapeutic interactions.
Be courteous, use humor, be fair, keep safe.
I work primarily with dementia patients, so have been called every name in the book. I find on most days, it really doesn't bother me. Then, for whatever reason, there are days that for whatever reason, I start to get emotional. That's when I look to a coworker to step in so I can get control back. No idea why some days are like that, but luckily it's not many.
I was a K-12 public school teacher in some very rough areas and my job is psych is very, very similar in that we are trying to get people to do things that they don't want to do and sometimes can't do, their mood and emotions are not able to be managed well by them, many are suffering from PTSD, etc. I've been told to f*** off in every way possible as a teacher, was a few times as a med-surg nurse and have been several times in my few months in psych. In every single casein both careers it was in reaction to reinforcing a rule/policy/order or setting a limit. I don't care at all. You learn to remain calm, follow the rules and CYA.
I would recommend getting out of med-surg and finding something else. Psych is interesting and overall better and luckily there are lots of things out there for us to do.
I work with severe dementia patient on a memory care ward so it not exactly psych nursing in the same sense. I never take things personally regarding insults and profanity. However, some of the repeat behaviors, especially questions, become annoying AF. I try to find humor in what they say and go along with narrative. I also tend to extrapolate on their stories, gently point out logical fallacies, and redirect with 'what if...' questions depending on the patient.
If you can get down on their level and understand their perception of 'reality', instead of trying to enforce yours', you can often find a middle ground even with irrational people.
I'd recommend picking up a copy of Verbal Judo by Dr. George Thompson. The techniques in his book have been utilized by law enforcement professionals for years to diffuse and deescalate potentially abusive and violent confrontations. Sometimes local martial arts studios offer self defense course which incorporate 'adrenal based stress conditioning' through physical training and scenario drills. A scenario typically consists of an aggressor 'call you out' with names and profanity in order to get a response. The aggressor may or may not follow it up with an attack depending upon your verbal skills and reaction. Either way you'll develop a confidence to work under pressure and react in a way to diffuse or avoid a confrontation.
"Please do not speak to me that way. I am taking my time to ___ (i.e help you, make you more comfortable, sort out your medication regimen in this case >.>). In most cases (usually it is the oriented ones), I find that this causes many patients to reflect back on their behavior and apologize later.
Last edit by Workitinurfava on Jul 4
Teach them how to respect you (last thing you want them to feel is that they can jump you or you are scared of them) judge the individual behavior and have an action based on it. Some stuff you will have to let go and some stuff you can't (some-one throwing a year is an excusable). I had a patient tell me she was going to kick my butt and I told her she would not talk to me in that manner. After that she came and got her medication without a fight. I had one girl tell the staff she was going to hurt them and she told me she would not take an IM but she came to the window and took her oral meds. Some of the nurses tried to get her to stop yelling but could not. At that time I knew that she would not listen so I could accept her taking her meds over her yelling. She did calm down and later acted like a whole new person. At the same time you must understand that some are so psychotic that they need medication to calm down and so they can fully understand what you are asking them to do. As a psych nurse you must understand the place that they are at mentally in order to deal with them. Sometimes you just need to get the medication in their system and working. You will often find that once this occurs you can reason with them more. I respect the patients and have a rapport with them so that helps. You an often talk them down a lot easier if you have a respectful relationship.
Last edit by Workitinurfava on Jul 4
So when you tell a patient "You will not talk to me that way"- I mean, what can you do?
Thanks, everyone. I just went for orientation, and now am more afraid of being physically attacked than being yelled at! It will definitely be a learning experience, and empathy is definitely key, as many of you have mentioned!
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