Angry, Hostile, Upset Patients

[Wildcard412]

I'm an ER nurse and I've recently had to deal with a number of really angry/upset patients/family members in a short amount of time. Some situations were caused by the unfortunate but unavoidable wait times of a busy ER. Some involved patients who thought I didn't know what I was doing because starting an IV was "too painful" (I had one woman really flip out, throwing my supplies across the room). Some just involved people that were in a bad mood to begin with (who wants to be in the hospital?) and took it out squarely on me.

My concern is that it's somehow my fault that I'm getting yelled at a lot. I feel like maybe I'm not firm enough, or maybe just that I seem like a guy that can be a "punching bag" for patients feeling negative emotions. I always sit patiently with them, try to rationally talk to them (usually doesn't work), and take the abuse. Sometimes staff members stick their heads in the room with questioning looks because I'm getting shouted at, and it makes me feel like they wouldn't accept similar levels of abuse.

I mean, what else can I do but say, "I understand why you're upset, help me work with you to make things better/explain to you what's been going on." Should I say, "ma'am, your shouting is unacceptable and I'm going to leave if you persist"? Should I fight back? I just don't know what to do in those situations other than what I normally do, which is be calm and empathetic. But really, sometimes just being calm and empathetic in the face of anger and hostility makes me feel like a coward.

And then there's the issue of where do I go with these feelings that people dump on me? By the end of their tirade, they calm down, but now I have to go down feeling like there's an anvil in my chest. I don't want to do the same thing to others to get it out of me, so usually I just bury it deep down. I feel like I need to find an outlet, or some way to clear my conscience of these experiences. If you think about it, getting yelled at/threatened/watching someone get upset and cry activates the fight or flight response. If you do neither (don't fight back, don't leave), it will eventually become a psychological burden, right?

I've been doing this for a few years and I do have relatively thick skin. But sometimes, these things still really bother me. Is there a way to resolve these feelings? Is there a better way to deal with hostile patients? Any advice would be helpful.

[bigsyis]

I've been doing this for a few years and I do have relatively thick skin. But sometimes, these things still really bother me. Is there a way to resolve these feelings? Is there a better way to deal with hostile patients? Any advice would be helpful.

Pardon me, but have you been doing ERnursing for a few years? If so, why haven't you tightened up on these abusive folks? Yes, some are going to rant and rave and act out, no matter what-that is what Security is for. If they start firing at you, without you having done anything offensive, you need to absent yourself from the room. When you return, have another staff person with you "to assist," or straighten the room, or something. If the tirade begins again, do your best to ascertain if there is a problem. If there is, take immediate steps to correct it if you can. If there isn't say something to the pt-"I'm treating you in a respectful manner, and I want you to do the same for me." This can cause one of two things: escalation, or deescalation of their bad behavior. At any rate, you have a witness that can help you relate the situation to the Charge Nurse. If this is happening to you more frequently than anyone else that you know of, ask for the input of a coworker or Charge (or ERP) that you trust, to see what their perceptions of your approach may be.

Go out in the yard and rake, work out at the gym, run, do something physical to release the frustration that is building inside you before it causes health problems! Keep us posted.

[JBudd, MSN]

"Sometimes staff members stick their heads in the room with questioning looks because I'm getting shouted at, and it makes me feel like they wouldn't accept similar levels of abuse. "

Lord no, we stick our heads in to see if you need help and to protect you! Anybody shouting at any of my staff gets lots of attention, and not as a put down to my coworker.

You are taking a lot of this wayyy too personally. There are frustrated, upset and hurting people everywhere, and even more who think they deserve special treatment from your lowly person, and even more that have no manners whatsoever.

They don't see "Wildcard", they see a figure in a uniform and a badge that stands for the hospital. You need to remember that, its not ME, its the SITUATION.

That said, you may not be setting limits very well. I look people in the eye and don't answer their nasty comments, I just say "we are trying our best to get everyone seen as quickly as possible" and go on with "What made you come in tonight". Redirecting them to why they are there. Try asking some coworkers that you trust and that seem to handle it better than you do if they have any feedback for you, and tips for how they deal with these things; also if the next time they hear you being shouted at if they will come give you a hand.

[Zookeeper3]

What JBUDD said!

you've stated you've been doing this a few years, so I'm thinking, in the nicest of ways that you're missing out on some of the skills of limit setting that your peers have, ASK for ideas.

It's so situational dependent that I could give you 10 ways to handle a screaming patient, and unless I was right there with you, I couldn't read it right. does that make sense??

sometimes I'll simply stand there hands at my sides, blank look, let them finish, then let a loooong ackward silence ensue, then say, "are you ready to discuss why you're here and what I can do for you?"

-"you're obviously angry what is the first thing you'd like me to address?"

-"I can tell by the tone in your voice that you're upset, this is what we've planned, let me explain and tell me what you think"

-"When you raise your voice and shout, it's difficult to hear what you're really upset about, tell me in one calm sentence what you need FIRST"

-"when you're able to calm yourself and speak rationally, I'll be in a better position to meet your needs, use the call bell when you're ready and I'll be into assist you. (then really do walk out, even though they protest)"

-"profanity is not an acceptable way of speaking your needs or to me, are you able to say what you need and not be insulting, because I'm willing to wait until you are!"

-"yelling is only upsetting the other sick patients here and making their wait as lousy as yours, it will not speed up your wait or resolve the issue, spoken very softly, almost hard to hear.

when someone is yelling, speak softer, so they have to stop and listen.

When the patient or family calms, thank them, THEN you can be empathetic, I'm sorry you've waited, and it will be longer, how can I make you more comfortable while you wait.

there are hundreds more, just again, situational dependent. try a few out, and again, ask your peers!

[TRAMA1RN]

The previous ER I worked at expected their nurses to tolerate the abuse. The management was more concerned with survey numbers and did not accept nurses responding in any way to abuse. I was abused verbally every night for 4 1/2 years I worked 40 hour weeks with 30 hours of weekly mandatory overtime, so figure it out. I finally left that ER and went to a level 1 trauma center where nurses were expected to walk away from abusive patients and notify security so that the patients could be escorted out.

[gdsgrl]

Wow, I'm a new nurse and I was face to face with a very angry pt the other night, all I did was walk in the room with her medications, this woman was livid, I didn't get her meds to her when she thought I should have, then there were some new meds the doc had ordered and she was even more mad about those and refused them. To top it all off a med wasn't marked off on the MAR, I thought it was late so I brought it in, guess what, she was already given that med.... The MAR had it on there twice... She accused me of trying to harm her and went on and on. I couldn't win, no matter what I said, I apoligized, I explained I was her advocate and I was there for her... NOTHING worked, I mean NOTHING, she just kept yelling at me. I left the room so flustered and fighting back tears. ( she did NOT take the med twice, it was caught before that happened). This woman was evil, apparently she hated the fact that I was breathing, I have NEVER been treated like this, I get compliments from my patients all the time. I wanted to just simply leave and never go back. I'm so glad I found this post, now I'm thinking maybe it wasn't just me she hated?? I was certainly the one that took the heat..... I still feel defeated as a nurse, wondering why I ever went into this profession.