Nurse yelling at patient

AliNajaCat · Jan 21, 2017

How about saying to her, "Gee, you seem on edge today. Want to talk about it?" They tell me that's therapeutic communication and they do it a lot in psych.

Atl-Murse · Jan 22, 2017

Give it few months, you would be that nurse yelling

Sour Lemon · Jan 22, 2017

I started working on a psychiatric floor in a hospital that is pretty much "the hospital you can't fall below". They get patients that have little to no insurance, homeless, etc.
I just got out of nursing school so I do not have any hospital experience other than my rotation and preceptorship for mental health in two other hospitals.
With psych patients I noticed that they are needy and some will continually come up to the counter which I do expect since I saw that before.
I have been on the floor for only a day and in two separate instances I witnessed two different patients approach the desk where my preceptor and myself were sitting. The patients both were talking in regular voice level, not yelling etc. My preceptor would give some direction and the patient responded still talking in regular voice level, still asking for something or other. In both instances my preceptor yelled (and I mean yelled) at the patient to either go away or argued with them. I think one was asking why they could not take the medication they wanted and the other was asking to be discharged. I know that they ask the same things over and over and I understand it is frustrating for the nurses sometimes.
I would like to know what everyone's stance is on yelling at a psychiatric patient. Is it okay for me to let it go and when do you step in and say something to the nurse or your manager?

One person's "yelling" is another person's "stern" limit-setting. As a new graduate at a new job, I wouldn't look for problems to go running to the manager about. In behavioral health, I've done things that I thought (at the time) were totally inappropriate, but had good outcomes.

I once participated in gently forcing an agitated patient to walk to bed and then participated into gently forcing that same patient into a lying position. The patient screamed and protested the whole time, but as soon as their head hit the pillow, they fell asleep and appeared to stay comfortable throughout the night. The patient had been awake for 24-48 hours and was exhausted, but was apparently too confused to be aware of that fact.

People respond well to different tactics. Being "mean" can sometimes prevent a situation from escalating into one with a worse outcome. My advice is to keep an open mind and learn all you can until you're on your own. If you see something "wrong", ask your preceptor (later and in a non-judgemental way) for clarification of why that was the best way to handle to situation ...assuming the patient is not in immediate danger, of course. The situation may become more reasonable, to you ...or it may not. People do sometimes overreact out of frustration.

MSUOUgirl · Jan 22, 2017

The only way I can describe it is when a mom gets so frustrated with kids acting out that she starts yelling at them to do this and that. I think I was surprised because it happened twice in the span of a few hours.

allnurses Guide · Jan 22, 2017

I have worked psych so I can tell you that sometimes, what looks like

rough treatment, or "yelling", is actually therapeutic for some patients.

That isn't to say that abuse in that setting should be tolerated. Patients

like those are some of the most vulnerable in our society.

However, give yourself some more time in that setting before you

start thinking, oh that nurse is being abusive. Your preceptors

approach may be the only thing that redirects that particular

patient. In the setting that you are working in, patients tend

to come and go often, or come and stay for long periods of

time, so nurses and staff get to know them pretty well.

In addition, you can ask that nurse if that approach was

really the best one, the only thing that works, etc.., but

I realize it is often hard to say "gee, weren't you kinda

hard on that patient" and not sound accusatory or

something.

Davey Do · Jan 22, 2017

Yelling, or raising one's voice, is a indication of a loss of control. Since learning other techniques which have better results, I do not raise my voice. In fact, I often do quite the opposite, lowering my voice. Like Clint Eastwood. Exhibiting a self-assured, in control persona is my goal, even though at times, I am merely playing a part.

MSUOUgirl, if I confronted every coworker who raised their voice at patients, I'd spend more time dealing with coworkers than patients. Acting as a good role model is intrinsically more satisfying and, sometimes, others follow suit.

It's really a not a matter if you win or lose. It's how you look playing the game. And, besides, yelling is disrespectful.

Good luck to you in your endeavor and new position, MSUOUgirl!

twinmommy+2, ADN, BSN, MSN · Jan 22, 2017

There does come a time for raising your voice and speaking to them as you would a child in order to set limits. Giving them option A or option B but they may not have C,D or E. They have so much confusion in their head and start to get the tunnel vision so you have to get their attention. Some patients need someone to be that authority person.

nutella, MSN, RN · Jan 22, 2017

You have been on the floor for a day - give it some time.

The reality of nursing is very different from what we learn in school. And I think it can be some kind of a "culture shock" experience.

I agree with what Davey Do wrote.

Modeling behavior seems to be so much more effective. It is also a way we learn in nursing. I have learned a lot of important skills through observing others or plainly be with them.

Davey Do · Jan 22, 2017

However, give yourself some more time in that setting before you start thinking, oh that nurse is being abusive. Your preceptors
approach may be the only thing that redirects that particular
patient.

You make valid point there, NurseCard. I have intentionally agitated a patient in order to test their limits and/or deal with a controlled explosion.

But it's technique that I don't use too often as it isn't sanctioned, requires a lot of reading of the patient and situation, and it could easily make things worse.

foggnm · Jan 22, 2017

While I think generally you don't yell or escalate things with patients, psych patients do not respond to logic/reason/caring the same way as mentally healthy patients. That is, you can't expect a psych patient to be reasonable just because you speak to them nicely. So sometimes more assertive communication has to be used, but that typically doesn't mean yelling. There are ways to be assertive without raising your voice. Just don't follow your co-workers lead. If you have security/police on staff watch how they deal with people. Often police are very good about being firm with people without yelling or escalating a situation. Sometimes with psych patients you have to trick them in to thinking they are getting what they want by redirecting them or agreeing with them so they don't perseverate on whatever thing they are thinking about.

chacha82, ADN, BSN · Jan 22, 2017

Once a client report chest pain and then explain that it was the only way to get attention. I dropped everything and dragged all the equipment plus the tech in the room. I probably had smoke coming out of my ears. I did not yell but was very stern in my directions to the patient. If I had a new grad with me, they might have questioned why I was brisk with the patient. However, I had been in that room more than any other room that day. When we began to set limits with the patient, this was the response - a false report of chest pain. Watch and listen for a little longer. How are the other nurses on your unit responding to this nurse when she raises her voice? When you meet with your manager or orientation coordinator, just ask about communication techniques with the patients. Do not accuse, but seek to understand.