Are patients getting more aggressive and violent?

[darcsyde, BSN, MSN, RN]

I'm a new grad RN about 4 months in to my program and work nights in a busy med-surg unit. I've been noticing that patients are acting out much more frequently and violently against nurses and other staff who are genuinely trying to help them. Some behaviors that are common are patients responding very sarcastically and condescendingly to basic questions. Then, they complain and get verbally and sometimes physically aggressive when they don't get what they want (e.g. a 2nd dinner tray or early PRN pain meds).

I've asked the other seasoned nurses on our unit if this is the norm. There is a general consensus that patient attitudes and behaviors have gotten worse since COVID. These patients have forced me to use my de-escalation skills. But, truth be told, it's getting old and frustrating quick. What gets me the most is how their attitude prevents other patients from getting the rest and recovery they need. Just wondering if this trend is being seen in other hospitals as well. What has helped you deal with these type of patients? I work in California if that helps. Thanks in advance!

[barcode120x, RN, NP]

Hm, I haven't really noticed an increase, but we have noticed that patients are coming in sicker and sicker with more and more co-morbidities or worsening of them and we get way more total care patients (tele nurse here). If anything, I would say there's in an increase in more confused patients, typically elderly that end up being aggressive and combative.

How to deal with it? Usually get a nurse that is really good at using  a communication to de-escalate the patient. Sometimes a male nurse can calm the situation. Also remember to distinguish between a patient who is alert and aggressive/violent versus a person that is confused and aggressive/violent. If they're alert and aggressive, don't hesitate to call security and your charge nurse/house supervisor. If it's a confused patient and if they're appropriate, anti-anxiety medications, sitter, and/or restraints. I'd say most of us deal with more confused-aggressive patients. I'm one that doesn't like to waste time by talking to the patient. I'm on the phone right away getting medications and/or restraint orders. 

[darcsyde, BSN, MSN, RN]

On 8/21/2022 at 11:23 PM, barcode120x said:

Hm, I haven't really noticed an increase, but we have noticed that patients are coming in sicker and sicker with more and more co-morbidities or worsening of them and we get way more total care patients (tele nurse here). If anything, I would say there's in an increase in more confused patients, typically elderly that end up being aggressive and combative.

How to deal with it? Usually get a nurse that is really good at using  a communication to de-escalate the patient. Sometimes a male nurse can calm the situation. Also remember to distinguish between a patient who is alert and aggressive/violent versus a person that is confused and aggressive/violent. If they're alert and aggressive, don't hesitate to call security and your charge nurse/house supervisor. If it's a confused patient and if they're appropriate, anti-anxiety medications, sitter, and/or restraints. I'd say most of us deal with more confused-aggressive patients. I'm one that doesn't like to waste time by talking to the patient. I'm on the phone right away getting medications and/or restraint orders. 

Thanks for the response and advice! I actually just had another patient who was confused and was verbally and physically combative. Tried to de-escalate, but he physically tried to grab me and other nurses who came in to help. Called the provider in, and he even tried to grab the provider and then pulled out his IV. At that point, we just all backed out of the room and left a sitter to watch him. He later claimed that we hit him and now his family is filing a complaint against me and our hospital. Lucky for me, there were multiple witnesses to the incident, and I documented everything that happened on his chart afterwards.

Starting to realize that this unit is not really for me. 

[londonflo]

On 8/19/2022 at 6:50 PM, darcsyde said:

There is a general consensus that patient attitudes and behaviors have gotten worse since COVID.

My husband and I were just talking about the aggressiveness, anger and total disregard for others that we see when 'out and about'...like in the grocery store, for example. When out driving, I can't figure out if I have become more critical of other drivers or others' driving is getting worse -- cars passing in no passing zones, running red lights - stuff like that. Did Covid just bring out the worst in all of us? Have we (including me)  become disillusioned with our fellow man?