New grad dealing with angry/yelling patients

leslie :-D · Jul 8, 2004

hi pumpkin,

i'll be honest and tell you, i really cannot empathize w/your situation, for i have never taken anything personally from a patient. you really need to redirect your sensitivities, as they are in there with some sort of problem. and that's when you'll see people at their most vulnerable.

am i asking you to feel sympathy towards those that treat you like crap? absolutely not. but under no conditions, should you take it personally. if there's any time that you need to develop a thickened skin, it will be with your own colleagues.... :rolleyes: sorry but that's the reality of nursing in many ways. for those patients that get really abusive, there is always limit setting, but if they see that you're being extremely affected, you'll be easy pickings.

leslie

bellehill, RN · Jul 8, 2004

Getting yelled at by patients and their family members is the worst because you can't yell back...just kidding. You really do need to grow a thick skin and let things roll right off your back. Maintain that smile and if you need to tell them that you won't tolerate being disrespected (if that is what is going on). I was the same way when I got out of school...now, I don't care. They have the right to criticize me and I have the right to ignore them. Just make sure you leave the building chanting..."I am an awesome nurse" over and over!

mollyz · Jul 8, 2004

Getting yelled at by patients and their family members is the worst because you can't yell back...just kidding. You really do need to grow a thick skin and let things roll right off your back. Maintain that smile and if you need to tell them that you won't tolerate being disrespected (if that is what is going on). I was the same way when I got out of school...now, I don't care. They have the right to criticize me and I have the right to ignore them. Just make sure you leave the building chanting..."I am an awesome nurse" over and over!

What happens if they family complains about you to the higher ups. Like says you have a "bad attitude"? Will your boss support you or side with the patient and family?

RNPATL, DNP, RN · Jul 8, 2004

Hi all,
I am a new grad of 4 months working on a busy Ortho/Trauma floor. It has gotten to be an almost daily occurence that I come home crying because a patient/family has decided to take out their frustration on me. When I was in school, I always had the idealized dream that I would get out and help people, and they would be appreciative. At least once in a while, I would get a "thank you". That has yet to happen. The patients/families who I've had problems with are patients who all the nurses have problems with - so I know it's not me. However, this doesn't help me from taking criticism personally. I hate just gritting my teeth and standing there while someone chews me out because it took me 20 minutes to bring in an extra pillow. Sometimes I can understand where they're are coming from - it's a teaching hospital and it can be frustrating trying to deal with the many different interns. But most of the time, these patients are just generally rude, or crazy, people to begin with. If the floor wasn't so busy, I would be able to talk to my colleagues to find out how they're able to deal with these patients. But we rarely get to eat lunch as it is.
Can anyone give me some advice on how to handle them? How can I not take this so personally? Is there some mental trick I can play in my mind so I'm not thinking "I don't get paid enough for you to yell at me, you crazy old bastard"? Any advice at all would be greatly appreciated.

This is one area that nursing school fails to give the new grad strategies. If you read some of my threads on the subject, you will see how frustrated I have been with the same thing you are discussing here. I have to agree with the other poster in that you should never take it personally. I have also been a firm believer that I need to always do self inspection and make sure that my presentation and attitude is not impacting my patients. Once I am confident that I am in check with my standards, then I feel comfortable that I am not the cause of the problem.

The other day I had the wife of CABG patient yell at me becuase I did not bring in ice water as quickly as she thought I should have. Of course, what she did not realize is that I had another patient (with their family present) go into rapid, uncontrolled A. Fib and I was dig. loading the patient. I needed to spend the time with the patient to ensure that he was ok. I did not venture to share with her why I was late with the water. None of her business, but I knew in my heart that I did as much as I could and her perception was that I was ignoring her request. Yes, this is frustrating because you have to stand there and listen to this women berate you as if you were an idiot. But the other side of the coin is that this wife is feeling a direct lack of control in her life. Her husband has just had open heart surgery and she is scared. This certainly does not make you feel any better, but there is a reason sometimes for the way families act.

If you take the time to listen, smile and thank them for their suggestions ... it might make the situation better. But I am also a person that believes in setting limits. If I have a family member that is relentless, then I will set limits with them and if they do not like the limits that I have set (usually set so I can attend to my other 948 patients for that day:)) - then I introduce them to my nurse manager and she can deal with the birage of complaints and problems that they present. This usually works pretty well.

Just remember one thing ..... do not take it personally ... once you have mastered this, you will feel a lot better. Good luck!

RN4NICU, LPN, LVN · Jul 9, 2004

This is a wonderful idea -- maybe American hospitals will take notice and follow suit - The sooner the better

Edited to add - it should apply to family members too. They should not be allowed to visit if they can't behave themselves. Family members with disruptive or abusive behavior, even if directed at staff and not the patient, certainly don't contribute to the healing environment for the patient.

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Abusive patients face zero tolerance

Patients who are violent towards NHS staff are to be barred from treatment for up to a year under new guidelines.

Health Secretary Alan Milburn says he wants to create a "zero tolerance zone" for abusive behaviour within NHS hospitals and clinics.

Patients could also face treatment bans for verbal abuse of staff, threats, vandalism and drug or alcohol abuse on hospital premises.

The guidelines, first trailed in June and due for publication later this week, will balance the duty to provide health care with the need to protect staff, Mr Milburn says.

Some 65,000 assaults on NHS staff are reported each year.

Two London hospitals - Bart's and the Royal London - have introduced their own yellow and red card system to warn abusive patients that treatment may be withheld.

In 1998, the Government announced a target of reducing violent incidents against NHS staff by 20% by 2001 and 30% by 2003.

Under the new guidelines, NHS trusts will each draw up their own local policies on what behaviour is to be regarded as meriting denial of treatment.

Mr Milburn is due to outline the plans during a speech to the Community Practitioners and Health Visitors Association conference in Bournemouth.

Patients will normally be given a verbal warning, followed by a written warning before being denied treatment, but in exceptional cases, when staff feel under imminent threat, care can be withheld immediately.

http://www.ananova.com/news/story/sm_438301.html

KacyLynnRN · Jul 9, 2004

This is a very hard part of my job as well...I am on a med/surg floor that is usually 3-4 nurses short (and that might be a 'good day' sometimes!) and it seems that family members are really a force to be reckoned with! A few weeks ago, a family member was upset about the way his dying mother was treated at the NURSING HOME she had come from the day before she came to us, so he threatened to kill all the nurses on our floor. He was promptly arrested and security has been very closely monitoring our floor ever since. My coworkers and I sat around after that and discussed how it seems like in the last year or so, patient's family members have gotten nastier than ever. They are hateful and disrespectful a lot of times to staff. I feel like as much as the nursing shortage is talked about in the media, and I'm sure most people realize what a difficult job we have, that family members would be more sympathetic if we are 15 minutes late bringing a patient ice water or a blanket. Unfortunately, they're not. It is hard for me to understand, because at least when the patient is nasty to me, I can tell myself "they're hurting, they're in pain, they don't mean it, etc." and not take it personally. I have yet to figure out how to not let a nasty family member personally. It seems like they would be more appreciative of our hard work in caring for their family member. Sorry I don't have any advice for you, but know that you are not alone in your feelings. A lot of us are going through the same thing and don't know what to do.

NiteShiftNut · Jul 9, 2004

just remember, we are there to take care of the patient first and foremost. the most important thing is that the patient is cared for to the best of our ability. yes, we should try to accomodate the family/visitors also, but there have been many times when i have gone into a room and had a family member attack me verbally, my solution, i ignore the family member completely and focus all my attention on the patient. making sure the patient is comfortable, their fears and concerns are addressed, if the patient is satisfied then my job is done, i could give a crap about the verbally abusive family member. i've had patients thank and praise me in front of the family member who 5 seconds earlier was ripping me a new one. if you concentrate on the patient and let the rest fall on deaf ears you will soon have that thick skin. and believe me, the thicker the better in this job. :rolleyes:

RN92 · Jul 9, 2004

I have been a nurse for 12 years. You will notice, after time, that the family members making the largest complaints, are the ones who are feeling the most vulnerable/guilty or out of control of the situation. Family and friends of the patient (who havent had much to do with the patient at all until now) all of a sudden want to feel in charge...like they are somehow stepping in to "take care of Aunt So and So. You do not have to take verbal abuse, though. Threats are not acceptable in any situation.

nurseygrrl, LPN · Jul 9, 2004

What you described is one of the most difficult parts of nursing. I have learned that allowing people to treat you poorly without saying anything (keeping it inside and gritting your teeth) causes stress and anxiety that can lead to health problems. You don't have to take abuse from anyone. I think it's perfectly acceptable for a nurse to tell a patient/family member to treat you with the same respect that you show them. If you get your point across tactfully, there shouldn't be a problem. We are professionals, not doormats. If management doesn't back you up, you can always find another place to work. Good luck. I'm sorry you're having to deal with this. I know what it feels llike.

zenman · Jul 9, 2004

In Dr. Bernie Siegel's book, "Prescriptions for Living," he tells physicians that if patients, family and nurses criticize you, you are a good doctor. He says that criticism should not be seen as a problem but as an opportunity to become a better person. When I've had difficult families, I would get the entire lot together and ask them what they would like me to do. If at all possible do what they wish and they can't complain too much after that. They usually appreciate you doing so instead of telling them what to do. It will save you time and grief and you may get more cookies and candy out of the deal!

teeituptom, BSN, RN · Jul 9, 2004

welcome to the wonderfull world of nursing

aint life grand