Should we put up with verbally aggressive relatives ?

dec2007 · Dec 27, 2015

In the olden days, you could say no and management supported you. Now it's all about customer service. If you say no, that's bad customer service, and in some workplaces, there are consequences for that.

As you say, it is all about "customer service" or "patient satisfaction" which really translates to "family satisfaction". Sadly, patient dignity and outcomes get lip service from administration, but it's the popularity contest that really counts!

Txldy · Dec 27, 2015

I have said, more than once, "Pardon me, did you have something important to tell me that might help in your loved one's care?" That usually causes a pause in the action, and most people stop the crazy immediately. Especially if you ask them to help you with their loved one"s care. They will either run, gagging or jump right in, asking for instruction. A pitcher of water or a vase or even a straw to help them drink more usually breaks the tension. A kind, smiling "thank you for saving me those moments best served helping your Aunt, will help ease their anxiety and feelings of helplessness. Most often that's what it is.Most people were never given the tools to deal with it. Kick back, fellow nurses. You can stop the crazy without making yourselves crazy and adding more stress to your day.

neuron · Dec 27, 2015

Way I see it is, a relative should not interfere with passing meds. Period. If a relative gets nasty, I will say don't interfere with me passing meds. Even if you are in a room, discussing meds (or a nurse discussing tube feeding/I.V./meds), that is still interferring if you are preparing to administer. You shouldn't be taking a verbal assault when preparing to administer something that could be life-threatening. That could be against the law, because there could be a medication error.

Conqueror+, BSN, RN · Dec 27, 2015

As soon as the volume/language becomes bad I turn and walk away. I have never had someone stand there and curse at themselves. I also walk away and through a door where they cannot follow me. I wait a minute or so and ususally come out to find them waiting for me. When they ask about my leaving, I explain that I felt threatened so i went somewhere safe. The men always feel like $%^& and the women usually just feel silly. If they are still too aggressive I have them removed. I'd rather lose my job than my life. .Letting someone escalate unchecked is a bad idea.

Kooky Korky, BSN, RN · Dec 27, 2015

I like the advice above to get the relative to help, also the one about walking away for a couple of minutes.

Another technique is to say, "Ms. Smith, when people speak to me the way you are speaking to me now, I get very nervous and I feel like I have to get away before the person becomes violent or I have to call Security". Then wait a moment to see if the person calms down and go from there. "It's hard for me to think straight when I fear for my safety, so for the best interest of your loved one, you need to be courteous to me".

I personally see not a thing wrong with telling people the truth - the pharmacy has not yet delivered the med, the ice machine is broken, or whatever. Or "I'll be in as soon as I am done helping another patient with the toilet/bedpan".

evolvingrn, BSN, RN · Dec 27, 2015

So working the Christmas season has been difficult and fulfilling. The best part making someone smile on Christmas day the bad parts ... Nasty relatives.
When you are trying your hardest and having to put up with constant put downs. It's difficult because on the one hand their loved one is unwell and that must be awful on the other hand we as nurses can only do what we can do as it isn't a one to one service. I often find patients that do have vocal and at times nasty relatives tend to get the better care as we are scared to say no ...So at what point is enough enough ?

I try to forge a team aspect with families. Yes..... They are difficult, but usually it's out of love and fear . We let patients "fire" nurses and cnas . I'm sure it's controversial but giving people that control makes them feel more in control. We rarely deal with threatening behavior, for that we call security

FolksBtrippin, BSN, RN · Dec 27, 2015

Nurses should be able to defuse minor situations and not escalate every disagreement into an issue for security to handle. I disagree that the standard for communication should be comparable to what you would find in a bank or at walmart. People are not running errands at the hospital. They are often facing the most devastating situations in their lives. The emotions run very high, as they should. If someone is freaking out in the hospital it's not because their coupon wasn't accepted or they were charged an overdraft fee. They could be losing a loved one. They could be facing permanent disability of the breadwinner in their family.

It behooves us to develop excellent interpersonal skills, far above those of a bank teller or a walmart cashier. Validating frustrations, educating, letting family members help with care, these are good skills. Don't try to move challenging behavior into the category of violence just so you can pass off a problem to security. If someone is truly at the point of imminent violence there is never a reason to say You need to calm down or I'm going to call security, you just call them and protect yourself. If you are telling people to calm down or else in order to embarrass them or make them feel guilty, know that there are better ways to handle challenging behavior.

marie.rn2419, RN · Dec 27, 2015

I'm wondering if you might be able to clarifyâ€¦ Do you feel as though saying no to requests from family will make your shift miserable? Or are you afraid that your management will not back you up if you set limits?

On my unit, I regularly have patient assignments where one patient is more heavyâ€ in terms of acuity and another patient (or their family) are more heavyâ€ with regards to emotional / spiritual needs. Though I try to be generous with my time and support for the latter type, I have to remain focused on ensuring safe care for less stable patients.

Unfortunately, you won't make everyone happy all the timeâ€¦And that's completely okay.

Txldy · Dec 28, 2015

We nurses are professionals. We must stop trying to please everyone all the time. We do, however, need to learn diplomacy and tact. While we may rightfully feel threatened enough by certain people we cannot calm, we can employ techniques to diffuse a situation. Unfortunately, conflict resolution is STILL not taught in nursing school.

Dikid · Dec 28, 2015

You may not take abuse from anyone. Just because they are angry, scared, concerned, tired etc... Does not give anyone a reason to lash out at you. It may be an explanation but is not an excuse.

You need to tell them that in no uncertain terms they may not speak to you that way. If it continues tell them you will be calling security. And if they fail to be respectful than call security.

Chances are are if they are harassing you and won't take no as an answer they might also be harassing the patient.

Maybe the patient is tired and they are talking, or maybe they force the patient to eat because they think it will best for the patient. Or maybe they are just rude and are not giving the patient the space he needs.

A good rule, especially ehen dealing will obnoxious family members, is to respectfully ask them to leave when you do your assesmant.

Tell them it's your policy and than ask the patient if they really want their family there. You will be surprised.

Conqueror+, BSN, RN · Dec 28, 2015

A sick relative does not make you a loud mouthed bully. It may give you an excuse to act naturally but it does NOT change your personality.

PMFB-RN, RN · Dec 29, 2015

Nurses should be able to defuse minor situations and not escalate every disagreement into an issue for security to handle. I disagree that the standard for communication should be comparable to what you would find in a bank or at walmart.

In my previous reply where I said I don't tolerate abuse from anyone, I was assuming that normal de-escalation techniques that nurses use every day had been used and we were already beyond that. I thought it was a given.