How do you get thicker skin?

systoly · Dec 1, 2011

There's only ONE person in this world that you can control, and that is yourself. Try as you might you can't control anyone else, nor can you please everyone. Granted I'm still a nursing student until march, I have had plenty of experiences in other environments to know that the only outcome that truly matters is how you handle yourself in each situation. Pt in the hospital feel as though they have no control, we tell them when to eat, set their diets, often tell them when they are getting their baths, when their beds are made, when they go for tests, etc.........in the ER we tell them to sit here, wear that, now sit Here and wait until the doctor comes. They could wait ten minutes or two hours.......all of which they have no control over. The only thing they have control over at that point is their actions and their mouths. So I feel like they use them, often out of spite due to lack of control in the situation. I believe this is where the soiled sheets and rude comments from those alert and oriented, seemingly non psych pre come from. They express themselves because its the only thing they still have control over.
Most of those people under normal circumstances probably aren't rude and inconsiderate, but due to lapse of judgment and loss of control they lash out. And although it definitely isn't in any nursing policy that the nurse should be subjective to verbal abuse, we still have to care for those people to the best of our abilities. The tough skin comes when you realize at the end of the day, in a bad situation, you handled it professionally and to the best of your ability. The tough skin comes when you watch that patient get discharged knowing that even though they were rude, you did your part to see him through his care. Once that feeling has set in the negative xomments, the rude demands, though they still stun you at first, the sting isn't near as bad...
Live in the fact that you survived nursing school, passed boards, and work in an environment that is like no other. Continue working hard and focusing on your career and the care that you provide. And learn to accept that people can say anything they want, but at the end of the day feeling successful with yourself is the only thoughts that matter. Again, however, know that there is no policy that says a nurse should be verbally abused, and I'd a comment crosses the line, there is no harm in making the patient aware of the fact that the comment was not appreciated, nor is it acceptable. Be polite but stern. Set clear limits that offensive comments are not necessary, and in order to provide excellent care that you have to work together.
At the end of the day you are a competent nurse, a successful woman, and a mother. Nothing else really matters.

Please print this, file it, and read it after you get your first year of nursing under your belt.

TinyRNgrl · Dec 1, 2011

It is hard not to take things pt's say personal....but you really can't take it personal. I am sorry he said that to you.

Hugs to you....

:hug:

Creamsoda, ASN, RN · Dec 2, 2011

"Yeah you, the ugly one". Why do people think that when they walk through the doors of the ED, all of the rules of general society and common decency, morals, manners, etc go flying out the window?

Say exactly that to him, or a future moron. But I can almost garaunte you they act like that outside the hospital. But if they are alert and oriented, call them on it! Its no different in the hospital than anywhere else.

Creamsoda, ASN, RN · Dec 2, 2011

I complettly disagree with anyone who would say that just because they are sick they would say rude, mean things to the person that is taking care of them. Like I just said, if they said it and are completely with it, they are likely idiots to begin with. Yes people are not pleasant when they are sick, but usually they decent.

Art_Vandelay · Dec 2, 2011

So, I am a relatively newer ED nurse, started in Feb 2010. I generally don't have problems when psych pts or older pts with demetia are mean and hateful because, obviously, they have issues. But yesterday, an older man (who was totally alert and oriented) was not satisfied with his care (I wasn't even his nurse, I answered his call light) called me a "fat ***** and when I stood there stunned he said "Yeah you, the ugly one". Why do people think that when they walk through the doors of the ED, all of the rules of general society and common decency, morals, manners, etc go flying out the window? I mean, it really hurt my feelings and I don't know how to grow that thick skin to make it possible to deal with these people. I am embarrassed to say I shed a few tears (I have had 2 babies in the past 3 years and my body image sucks right now). It also just irks me that afterwards the man just gets coddled by the charge nurse to make HIM feel better.
So, my question is, how do you all deal?

Hi Loves2Lurk,

Sorry, I have to put my in "two cents" because people(pt or not) like this "boil my blood."

Let's look at the facts: 1) the guy was alert and oriented. 2) He treated you like crap.

If one is alert and oriented, I do not subscribe to the excuse that the person is "sick." It is one thing to be generally crabby; it is another to belittle another person, which is what he did to you. There is a famous saying by Eleanor Roosevelt, "Noone can make you feel inferior without your consent." I try to remind myself of this saying quite often. Whoever you are dealing with, be it patient, doctor, co-worker, etc., there should be common decency in communication. In dealing with these situations, I have called pts on the behavior and I have also used sarcasm. Personally, calling the pt out on the behavior hasn't worked for me because the pt has always denied the behavior. In your situation, I might have said, "Wow, you must read Miss Manners on a daily basis" and walked out. Or, "Your behavior is what is ugly." Sorry, but verbally abusive people drive me nuts, and noone deserves to be treated like that. :twocents:

Life is too short to let someone you don't know (or know, for that matter) make you feel less than awesome; well, unless you really are a dirt bag which is what this guy sounds like.

emmanewgrad · Dec 2, 2011

I have this tech that has an attitude with me; she taps on the desk and keeps tapping until the pt chart is given to her to transport a pt to the floor. Yes, I take my time on purpose. She gives me the ugly eye when she talks to me and I just look at her in the eyes, I passively let her know she doesn't intimate me. I don't let people issues of me, be my issues. I have a responsibility with my pts and my family. Bringing a check home is of my interest , she's that last one I care for at the end of my shift, after that, I forget about her.

**canoehead, BSN, RN** · Dec 2, 2011

Just remember that when a lot of people walk into the ER, their sense of civility or the normal rules of society can go right out the window.
When I was a student, I had a middle age women (no hx of psych issues), who walked herself into the ER and the bed, without any problems decide to defacate on herself in bed. I understand an acident is an acident and you are probably in an ER, becasue you aren't feeling well, but just wait... After the nurse and I cleaned her up (with the pt acting like she was bedridden, wouldn't even roll over to her side on her own), we offered to get her a bedside commode in case she felt the urge to go again. She tells us "no thanks, right here is fine" smiles and then procededes to ruin the new sheets.
Moral of the story... expect to get **** on and try not to take it personally...

Just an informal poll-

How many nurses would just look at each other and walk out the door? I would.

I'd let her wonder how long we were going to leave her like that. And then, when I was darn well good and ready, we'd clean her up and put a diaper on her.

JKL33 · Dec 4, 2011

I reject the excuse of being sick or stressed, in all but the rarest of situations.

The person who is treated this way, whether a professional RN or anyone else, does not own the responsibility to fix this problem - and that includes not making excuses for it. My personal observation is that our recent/current culture of customer service extremes (which absolves patients of any responsibility for anything and everything) has made this problem 10 times WORSE (and more frequent). This is not any random stressed/sick patient who behaves the way the OP describes, this is someone who wants to start trouble in hopes of some sort of secondary gain.

I have a variety of ways of handling these situations, but none of them involve 1) talking to the patient about MY feelings (EVER!) or 2) chastising/reprimanding -- the patient already full well knows the behavior is wrong 3) rewarding the behavior in any way.

I say these types of things, with a decidedly apathetic/neutral tone and facial expression:

"I'll be back when you are ready for my assistance"

"I am here to help you. If you don't need my help right now then I'm going to leave"

"I am not going to become upset by your inappropriate behavior, it has no effect on me. What is it that you need/how can I help you?"

"That doesn't work with me. What can I do to help you?"

"You seem to have concerns about things that are not in my control; I'll ask the supervisor/liason/pt services rep to come and speak with you"

Etc.

I quite frequently quote these behaviors in the medical record, in a neutral/factual manner.

To the OP, I know it isn't easy at first but over time it becomes second-nature. Always remember the patient is the one with the problem, and that s/he does not control you or your feelings. And....at the end of the day, you have your fabulous life and that person is stuck in the misery they create for themselves. I actually find it so pathetic it's hard to feel anything but sorry for them.

DixieRedHead, ASN, RN · Dec 4, 2011

I have this tech that has an attitude with me; she taps on the desk and keeps tapping until the pt chart is given to her to transport a pt to the floor. Yes, I take my time on purpose. She gives me the ugly eye when she talks to me and I just look at her in the eyes, I passively let her know she doesn't intimate me. I don't let people issues of me, be my issues. I have a responsibility with my pts and my family. Bringing a check home is of my interest , she's that last one I care for at the end of my shift, after that, I forget about her.

God gave me the ability to raise on eyebrow about two inches higher than the other. I figure he expected me to use it. I raise my eyebrow, then raise my head, then I say without smiling, "Is there something you need?"

I seldom encounter behavior like this more than once.

Lovely_RN, MSN · Dec 4, 2011

I don't address comments like that. I just say: Is there anything that I can do for you right now? If they continue to talk I start asking them: What do you need? Are you in pain? Are you hungry? Need a blanket? What is it that I can do for you? If they don't want anything and just want to ventilate then I say O.K....and I walk away and act like I never heard them. What a joke, half the time the person insulting you looks like they have one foot in the grave and the other on a puddle of grease. Whatever!

ErinBSN · Dec 4, 2011

Okay, my philosophy. When people come in the ED, they are generally at their worst. While it makes no excuse for ignorant or aggressive behavior, it is what it is. I know that when people call me Dumb this or fat this or ugly this they are not addressing me. they are addressing an image of a nurse (generic) it's not personal. It took me a good 2-3 years to get to that point. To me now, a good day is if I'm not called the C word.

I don't have high expectations.

nightbrightener · Dec 8, 2011

I think there are 2 parts to this. the first part, thick skin comes from realizing some people are a****, regardless of whether they won the lottery or just got hit by a car. You can't fix stupid or mean. As far as getting thicker skin, it happens when you realize that that person wasting my time is making the little old lady with dementia able to climb out of bed and fall or that CP go longer without nitro.They become a waste of time, not an emotionally hurtful encounter. Now the second part is about how you deescalate and that is a learned skill. Sometimes, speaking softly, other times go all authoritarian, sometimes security needs to "talk to them", sometimes just let them know calmy they are out of line, you get there, just never take it personally. Put it this way, would you feel bad if someone was whining about an IV and the pain it caused to have one put in? When you start in the ER yes it will, but after a few years you know if that's the worst thing they have to complain about while in the EMERGENCY DEPT they have nothing to complain about.