Displaced Anger From Patients, Visitors, And Others

Unfortunately, nurses and other staff members who provide direct care are the frequent recipients of displaced anger from patients, families, doctors, and others. The purpose of this article is to further explore the issue of displaced anger in healthcare facilities.

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Displaced Anger From Patients, Visitors, And Others

Displaced anger is the mental process of redirecting one's anger away from the real target onto an unrelated target that seems safer. Once vented, that anger can swiftly explode and set the stage for an unstable situation.

Unfortunately, bedside nurses are common recipients of displaced anger from patients, visitors, coworkers, and others, because the public views us as nonthreatening targets. For instance, the young adult patient is seething with rage because the surgeon has refused to increase the scheduled dose of Dilaudid, so he verbally abuses the nurse and loudly yells obscenities. Although the nurse in the aforementioned scenario is not the real target of the patient's anger, he has mentally determined that he can safely unleash his rage onto nursing staff.

According to Pecci (2009), patients or family members often get angry when they've been waiting for a long time; if they don't like the information that they're getting-or not getting-from staff; or if they aren't receiving the medical treatments that they want or expect. Even though these frustrating experiences might not be the direct fault of nursing staff, patients and families often direct their anger toward the nurse. In settings where pediatric patients are treated, parents who secretly resent the fact that their child is disabled and multi-handicapped may displace their anger onto nursing staff by screaming, criticizing their actions, 'firing' nurses from their child's care, and making false allegations.

Physicians are under tremendous stress because, due to constraints caused by managed care and insurance companies, they feel increasingly unable to provide much-needed care to patients. Rather, they must seek/beg for permission from some non-physician (MBA) at the other end of an 800 line to approve or disapprove of each procedure based on cost (Anderson, 2009). Hence, some physicians displace their anger and frustration on nursing staff members because they see us as a much safer target than the people who work for the insurance company. For instance, the doctor is angry that the patient's managed care plan will not pay for an elective procedure, so (s)he abruptly slams a chart onto the nurses station.

How do we deal with displaced anger? First of all, people need to be held accountable for their actions. Patients, family members, coworkers, and physicians must personally recognize and handle their own anger instead of displacing it onto others or allowing it to explode. But perhaps most importantly, nurses are learning to recognize which patients may become disruptive and how to de-escalate situations so they don't turn violent in the first place (Pecci, 2012). Crisis prevention training equips nursing staff with tools to recognize when patients, visitors, and colleagues might explode with rage, and to de-escalate potentially challenging situations.

Of course, therapeutic communication can go a long way. When someone is displacing anger and you know you're not the intended target, presenting reality is a form of therapeutic communication: "You called me an idiot. I am a nurse, not an idiot." Also, you can therapeutically communicate by encouraging the patient to form a plan of action: "I will return to your room when you are ready to behave." Another therapeutically communicative technique involves the use of broad openings to get the person to open up about the true object of his or her displaced anger: "Tell me what you'd like to talk about."

Keep in mind that the expression of anger varies from person to person, and that most people learned their current methods for dealing with anger during their growing-up years. While you cannot change the manner in which another individual manages their anger, perhaps you can affect the person's treatment of you. Good luck, and stay safe.

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TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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VickyRN, MSN, DNP, RN

105 Articles; 5,349 Posts

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

The therapeutic communication stuff really does work, if used with genuine concern and caring. Once there was the wife of a patient who was giving the nursing staff heck, being derisive and questioning with open hostility everthing they did with her husband. Now it was my turn and she started in on me at the beginning of my shift. I gently took her aside and said, "You seem to be very unhappy with the care we are providing your husband. Would you like to talk about it?" She immediately started crying and told me how terrified she was that her husband would die (he had a very poor prognosis) and that she just couldn't face living without him. I listened to everything she had to say without interrupting. Afterwards, we hugged and then the most amazing transformation took place. She seemed a lot more peaceful and was no longer hostile to the nursing staff.

DizzyLizzyNurse

1,024 Posts

Specializes in Peds Medical Floor. Has 12 years experience.

I've been known to use the "I'll be back later when you've calmed down/stop treating me this way/etc" approach. Works well. I'm not going to just stand there and get abused.

merlee

1,246 Posts

Has 36 years experience.

Years ago, I had a patient who was very demanding and somewhat abusive. It was her way of maintaining control in a place where she had so little control. It was my turn to care for her, and she started as soon as I walked in - I hadn't even said 'Hello' yet!

After she stopped talking, I told her I would try to do everything she wanted and I would check on her frequently. I didn't argue with her or offer explanations about why I couldn't do any particular thing she might want. As different things happened, I adjusted things they way she wanted whenever I possibly could, and smoothed things over when I couldn't. I did my best to check on her frequently and she used her call bell much less that day. I requested her the next day, and no one could believe it. She was so relieved that she didn't have to 'break in' another nurse that she cried.

Now that I have diabetic neuropathy I can understand some of her requests, and can only hope that I can maintain a civil attitude when I am hospitalized.

It is essential that we remain cool and calm in these situations so they do not escalate.

nurseprnRN, BSN, RN

2 Articles; 5,114 Posts

it is almost always true that when someone is angry it is because he is afraid of something. it might not be what he's yelling about, but it's in there. figure out what it could be-- loss of control, pain, loss of love, unclear future, bad diagnosis... look at it (and deal with it) on that basis. it works a lot better. even saying, "what scares you most about all this?" is enough to get started.

TheCommuter, BSN, RN

226 Articles; 27,608 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 17 years experience.
It is essential that we remain cool and calm in these situations so they do not escalate.
In addition, we must keep in mind that the person with displaced anger is not really mad at us, but for some reason he/she cannot or will not openly express his/her true emotions toward the real target. The nurse who realizes that the patient is displacing the anger should be less likely to take it personal and more likely to reach out in a beneficial manner.

DizzyLizzyNurse

1,024 Posts

Specializes in Peds Medical Floor. Has 12 years experience.
I've been known to use the "I'll be back later when you've calmed down/stop treating me this way/etc" approach. Works well. I'm not going to just stand there and get abused.

I forgot to add that when I walk back in, if they are receptive, I have a little speech. "I understand that it isn't fun to be in the hospital, and I wish I could spend more 1:1 with each patient. Unfortunately I have several patients and everyone is sick. I want to make sure your experience is as good as it can be, and for that we have to work together. I will get you anything I can, within reason, but you have to treat me decent." Then I'll smile or wink or something and say, "Trust me, you'll get better service if we all work together." Something like that. Makes them feel I understand that the hospital sucks, and they'd rather be home, and that I'm trying to work with them. It's "us" not them vs the nurse who doesn't work hard enough for them. IDK seems to work.

blondesareeasy

61 Posts

Don't tolerate abuse. Zero tolerance, and no "touchy-feely" response. Prosecute assaultive behaviour.

TheCommuter, BSN, RN

226 Articles; 27,608 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 17 years experience.
Don't tolerate abuse. Zero tolerance, and no "touchy-feely" response. Prosecute assaultive behaviour.
I feel that battery of healthcare workers should be a felony, and that people need to be held accountable for their behaviors.

Unfortunately, management and administration at many healthcare facilities seem to strongly discourage staff from pressing charges against AOx4 patients and visitors who become physically violent. To some managers, the hospital's public image of 'safety' is more important than the actual safety of its workers.