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.
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.
I agree with the de-escelating thing being learned. there is no one answer for all situations. In our ER we have a no tolerance for rude and belligerent behavior and foul language. It's posted on the wall. So Security always backs us up when some gets really mouthy. I've learned that I don't have to tolerate verbal abuse and I don't. But there are definitely situations that call for special handling and that is where the experience comes in. Somebody coming down off PCP ain't listening to anything you have to say, but an upset husband might. Live and learn. Thick skin comes with confidence and faith in yourself.
I'm not sure a thick skin is going to help... much. I'm not even sure that's the issue...
Rude people are rude people - be they patients or otherwise.
Would you be wondering about this very question if a server at TGIF or your car mechanic spoke to you this way?
Yes, people behave differently when they're sick/scared/anxious.
So then ask yourself this question - whenever you were sick/scared/anxious, did you lash out this way with whoever approached you? Especiallysomeone who was trying to help you?
I don't completely buy into the 'they behave this way because they've lost control' argument. Yes, it is true that when one is in the ER/hospital - there are certain "rules" one has to follow. E.g. "Can't eat or drink anything till the Doctor has seen you" on a pt. complaining of abdominal pain, nausea and vomiting. Or "can't let you walk to the bathroom" on a pt. with cc/o syncope and low BP. etc. Usually most pts. understand once the rationale is explained. But we aren't talking about 'most patients' now, are we?
Besides, when you're in an ER - you're not there for days. No, you're there for a few hours. You seriously can't stand 'losing' your 'freedom of action' for a few hours? Given that you came to the ER seeking my help and not the other way 'round?
If you won't abide by/comply with my interventions - why the heck are you here then?!!
Don't get me wrong - I'm not expecting goody-two-shoes when I interact with patients. I don't particularly care when some of my patients cuss/use vile language/scream because of their condition or because of procedures we are performing on them.
But I donot and will not excuse poor behaviour for no apparent or valid reason.
Especiallyfrom adults who ought to KNOW better!
I give all patients the benefit of the doubt.
I'll be calm. I'll talk. I'll try and reason. Perhaps a compromise or two... whatever works so long as it maintains pt. safety and is within policy.
But I will not subject myself to continual abuse - not just because it's unnecessary but also because I don't deserve it. I'll treat you like a decent human being when you return the courtesy.
Yes, I draw boundaries. Delineate 'lines in the sand'. Sometimes as suggestions... and other times as commands [you'll understand when you deal with a lot of intoxicated patients who will not listen to rhyme or reason].
No, the issue isn't "thicker skin"... it's more along the lines of 'decency' and 'permissible behaviour' (and I deliberately chose 'permissible' over 'acceptable'. People do many things which you and I might not find 'acceptable' but if it's 'permissible' that's none of our concern).
And assaulting staff - verbally or physically for no apparent or valid reason - is completely unacceptable.
Know that it's not about you, it's about them. Some people are just miserable, nasty people, and sometimes they get sick (or not so sick but wind up in the ER anyway). At first I'd get upset and worried when patients were nasty, mostly because I was concerned that I'd be blamed for their behavior in some way and that maybe it was my fault for not managing the situation well. It just gradually became less personal for me, so I guess a thick skin is something you develop over time like the ability to set boundaries, say no, not make their problems your problems, etc.
I think my general practice is to not engage with the patient. If a patient seems to be escalating beyond verbal nastiness I get security involved, and I'll ask my charge nurse to go speak to them as well. Other than that, nastiness from patients has just started to seem like a waste of my resources than anything else, so I prioritize accordingly Listen to nasty patient in room X or reassess my asthmatic in room Y who hasn't been responding as well as we'd like to the nebs and steroids?
after 15yrs in the ER I have no problem telling patients that they're behavior is not acceptable and wont be tolerated. We will do what we can to help them but they need to behave otherwise they can go somewhere else. If they are saying those things to you they are obviously not sick enough to be in the ER. Trust me..the sick ones love you and appreciate you or they cant talk at all. It will take time to get to that point. Ive been in management and know how much the administration wants the perfect patient satisfaction score...truth is...ER WILL NEVER GET GOOD scores because we are so darn busy all the time people think its an episode of ER the TV show and they're visit is over within an hour. HA! You'll get to a point where you will feel free to tell someone who is rude to you to behave. Until then ignore it and use the largest angio you can when starting an IV.You do have some control. Just sayin!
Specializes in emergency, neuroscience and neurosurg..
There is NO excuse for ANY patient speaking to you this way. You are an educated professional. The size of your hips, buttocks or any other body part is irrelevant to your ability to give care. It is time we nurses stopped making excuses for bad behavior. It plays a large part into turn over in emergency nursing. It has everything to do with respect. Unfortunately in this setting we see a population of patients that have become increasingly demanding with a sense of entitlement. They have the expectation that we are there to serve instead of treat. Previous posters were correct when they state that this type of patient would not go into a bank and verbally abuse/assault the employees there. He knows that if he behaved or spoke in that manner then he would be held accountable for it. Not so in health care. Some feel as if there are no repercussions for their actions. They are the patient. We have to treat them so in a twisted logic we have to tolerate the abuse/assault. This comes from many misguided tools to gain patient satisfaction. Reimbursement is tied to keeping the customer happy. (I don't when my patients became customers but they did, which is kinda funny since I work in the not for profit hospital that sees most of the indigent care which means they're not paying anyway). HCAPS and Press Gainey scores have erroneously made patients feel that they have the right to demand care and treatment and we HAVE to render this; including free medication, food, drink, phones, blankets, work excuses for the entire family, etc., etc. Some of their demands are ridiculous in nature. When you add a lack of self respect or respect for anything else in the mix then you have the verbally abusive and insulting patient. (BTW if you had told this same patient that he needed to lose weight or was obese he would have been insulted and or filed a complaint against you.... it is definitely a one way street.)
There has to be a stopping point. It is not OK to treat any person in this manner. Do not quietly ignore the behavior or make excuses for it. While remaining professional, quietly but clearly inform him that it is not appropriate for him to speak to you or any other staff member that way. You will be glad to address his needs, what ever those may be, but you will not tolerate being treated like that. Most of the time that works for me. Some even offer an apology when they realize just what they said or how they acted. For those that continue, inform them you will return to the room when they are more in control.... and LEAVE!!!! Make sure the patient is safe i.e. side rails up and call light in reach, not in acute distress-- consider ABC'S (airway, breathing, and circulation) and LEAVE. Do not argue, coerce, cajole, excuse or anything else with this patient, just leave. Take yourself out of the environment. Return to the room in 10-15 minutes and re-evaluate the situation. If the patient continues with his behavior... repeat, only this time either call security, charge nurse, house supervisor, etc to go with you when you return to the bedside. For your protection and as a witness if nothing else. I believe swapping or changing assignments should be a last resort. Patients in the emergency setting do not get to dictate which provider is caring for them whether it's the physician or the nurse. Another patient may actually suffer unintentionally because of this. Each nurse has a patient assignment, and the assignments are based on experience and acuity, and those patients' care should not be altered because of one person's bad behavior. If the behavior escalates to verbal threats and/or physical violence then you have the the right and should file criminal charges. Regardless make sure you document EVERYTHING!!!!!!!!!! Be as specific as possible including quoting the patient, and what measures you attempted to rectify the situation (yourself and following chain of command). Make sure you keep your own notes as well.
An addition resource is the ENA website. They have conducted studies and research (some is ongoing) on nurse violence and have many pamphlets, articles and other information available for use regarding this. Good luck and keep your chin up!
i feel lucky that i work in an er that has an officer assigned- who would step in if the patient behavior escalated and i work with physicians who i have actually heard tell patients that they would not tolerate them talking to the staff badly.
i think that all the staff should be on the same page and not tolerate such behavior. i understand trying to de-escalate the situation but your charge nurse should have supported you by telling the patient that his behavior would not be acceptable. while we might be expected to deliver patient care- we should not be expected to be verbally abused in the process.
When I have had this happen to me, (after making sure there were not contraindications) I told the pt that she walked in here, she could walk into the bathroom and clean herself up, and gave her washcloth and towel. The bed was clean when she got back and she was reminded that she now knew where the bathroom was if she needed to use it again. There are some things I just can't put up with, ERitis is one of them.
I am a fatgirl... I look in the mirror everyday and have no illusions regarding my body shape. When I am called fat in the ED by whomever, I say "yep, ain't it grand". "What can I do for you?" Kill em with kindness... just be aware that for some people, the nicer you are, the nastier they get... just trying to get you ******.
Know that what is important is for you to be able to look yourself in the mirror before you go to bed and be able to honestly say that you did your best to do your job well. If you can do that you are doing ok.
Listen to nasty patient in room X or reassess my asthmatic in room Y who hasn't been responding as well as we'd like to the nebs and steroids?
sirendip
8 Posts
I agree with the de-escelating thing being learned. there is no one answer for all situations. In our ER we have a no tolerance for rude and belligerent behavior and foul language. It's posted on the wall. So Security always backs us up when some gets really mouthy. I've learned that I don't have to tolerate verbal abuse and I don't. But there are definitely situations that call for special handling and that is where the experience comes in. Somebody coming down off PCP ain't listening to anything you have to say, but an upset husband might. Live and learn. Thick skin comes with confidence and faith in yourself.