Nasty/aggressive patients

[Kugrad2018]

Hi nurses,

so, I recently graduated from my rn program and have accepted a job in the emergency department at my local hospital. Seeing as how I always had wonderful and interesting patients in nursing school, I've been very excited to start my new job. (Less than 10 days! Woohoo!) however, tonight while at a convenient store obtaining a powerball ticket I encountered the most unpleasant person I've ever come in contact with. I was getting off the phone with my husband when she started going off on me for bothering her while trying to fill out her ticket. Insulted me up and down called me names the whole nine yards, over nothing! And it got me thinking, if this person can attack me like this for no reason at all I can only imagine how it will be in the ED. So now, I'm doubting my ability to deal with those patients who are super mean and aggressive. My approach in school was to be as nice and understanding as possible to all the patients and for the most part, it worked, but now I'm doubting that approach and that I may be too sensitive. How have your experiences been? Are these people the majority or the few? Do you ever get used to it? TIA

[Emergent, RN]

Love that!

Mr. Ruby Jane started his career as an ED nurse. His motto: "Kill 'em with kindness." So far he's been successful.

Yep, works for me. Warm blankets and sympathetic demeanor really goes a long ways toward avoiding these problems.

[rnhopeful82, ASN, RN]

Also, I was shadowing the ER Saturday and the nurse said something that can be easily applied in every unit. People aren't feeling their best at the hospital (obviously) and as anyone who has been waiting in the waiting room just to go back to a smaller room and wait some more and have no idea whats going on, this makes perfect sense: fill them in. check in on them. say hi we are waiting for your test results (dont say the results are back and the dr needs to review them, because this makes the busy dr look bad), we will be coming back to get your for the scan soon, this is whats happening, etc. Try to give them a time frame and an update whenever possible. I feel like that alone can make the person feel unforgotten and help resolve some anxiety/tension/anger/frustration. Good luck, you got this!

[NightNerd, MSN, RN]

There are some patients with whom killing with kindness works, and some with whom it decidedly doesn't. It's never okay for us to be mean as nurses, but some people simply require a firmer approach. Sometimes it will help them check their attitude, but it is also a way of protecting yourself from their nastiness. Don't forget that you are worthy of respect, even though there will be people who do not give you respect. You should not expect yourself to be perfectly docile and saintly with people who can't manage to act like human beings; just don't sink to their level.

[amzyRN]

Don't you have security in your ER? If patients get aggressive and hostile, they are asked to stop if they don't they are escorted out by security. Some people have ALOC due to psych issues, hepatic encephalopathy, drugs etc...that make them act in ways they normally wouldn't. Clear boundaries are important.

[humerusRN]

It's not just in the ED. I work in pediatrics. We are assaulted often.

[K9lover, ASN, RN]

Love that!

Mr. Ruby Jane started his career as an ED nurse. His motto: "Kill 'em with kindness." So far he's been successful.

That does not always work, I have worked at county hospital. people who ran low on heroin or money knew just what to do; feigning symptoms of TB bought them 3 days in iso and Dilaudid (amazing, they were allergic to every other opiate.) Anyhoo more than a few told me they were just there for Dilaudid and threw a tantrum of epic proportions if it was not ordered stat...then charge comes in and fretting over a bad Press-Ganey score starts freaking out over Dilaudid not yet ordered. Of course I had already called the doc a few times however one would think I should pound the pavement and track the doc down (or hit the streets for a dime bag, grab some take-out for patient, invite family in for a group freak out because hey, I have the time as the script goes.) Scripting, another mind-numbing exercise but getting off topic. Not everyone can be killed with kindness but best to let it go when you clock out lest you are letting rude patients live 'rent-free' in your head.