Dealing with insults from patients

I'm still a fairly new nurse and I'm struggling with dealing with insults from patients. Just recently I had a patient who I think misunderstood me when I mentioned I needed the CNA to help me get him onto the the toilet as I could not safely transfer them on my own. Told me I should go and take a bandaid off of someone since he was being too much trouble and didn't want me to help him and it just kinda emotionally destroyed me. Other things had been increasing my stress the rest of the day, but after that comment I could barely make it out of the room before breaking down.

People keep telling me I need to build a thick skin, but when I get insults like that, my mind just goes back to when I initially tried nursing school and wasn't allowed to retake a class i got a C- in because they thought I couldn't handle it due to my anxiety disorder. Then it just weighs me down and I just don't know what to do.

Told me I should go and take a bandaid off of someone since he was being too much trouble and didn't want me to help him and it just kinda emotionally destroyed me.

Patient pity party.

What you need to do is very straightforward. You must, absolutely must, get it into your head that very little of any of this is about you. People have their own personal problems, they lash out at others.

This is beyond "you need to get a thicker skin." You are going to destroy your own sense of well-being and happiness by voluntarily choosing to make things about you when they are not about you. Being emotionally destroyed by something like this is not an appropriate response to the situation.

A couple of tools/approaches for dealing with people like this:

1) Limit unnecessary words - - they are looking for a chance to pick apart anything. Guy wants to use the bathroom? Fine. {smile/upbeat} "Sure. I will get the nursing assistant and we'll be right back to take care of that." Sometimes talking is actually just digging yourself into a hole when people are being jerks.

2) Practice being unemotional. You will need to train yourself to hear difficult things without reacting. Think of a few stock phrases that you can manage to say without becoming emotional, and start using them in real time. Practice not emotionally "running away." Use good eye contact, lower your volume, and [emotionally] stand your ground. "Thank you for letting me know about that." "Let me see what I can do about that." "What can I do to help you right now?"

3) If an offense has occurred, [emotionally] stand your ground. The patient says, "You suck. Go find a band-aid to remove!" YOU SAY, "I'll get the nursing assistant and we'll be right back to help you."

That's all there is to it. You have to do it. Your current state of reaction is toxic.

Best wishes ~

Patient pity party.

What you need to do is very straightforward. You must, absolutely must, get it into your head that very little of any of this is about you. People have their own personal problems, they lash out at others.

This is beyond "you need to get a thicker skin." You are going to destroy your own sense of well-being and happiness by voluntarily choosing to make things about you when they are not about you. Being emotionally destroyed by something like this is not an appropriate response to the situation.

A couple of tools/approaches for dealing with people like this:

1) Limit unnecessary words - - they are looking for a chance to pick apart anything. Guy wants to use the bathroom? Fine. {smile/upbeat} "Sure. I will get the nursing assistant and we'll be right back to take care of that." Sometimes talking is actually just digging yourself into a hole when people are being jerks.

2) Practice being unemotional. You will need to train yourself to hear difficult things without reacting. Think of a few stock phrases that you can manage to say without becoming emotional, and start using them in real time. Practice not emotionally "running away." Use good eye contact, lower your volume, and [emotionally] stand your ground. "Thank you for letting me know about that." "Let me see what I can do about that." "What can I do to help you right now?"

3) If an offense has occurred, [emotionally] stand your ground. The patient says, "You suck. Go find a band-aid to remove!" YOU SAY, "I'll get the nursing assistant and we'll be right back to help you."

That's all there is to it. You have to do it. Your current state of reaction is toxic.

Best wishes ~

This is good advice!

...I think misunderstood me when I mentioned I needed the CNA to help me get him onto the the toilet as I could not safely transfer them on my own.

I understand the urge to fully inform patients, but there are things you don't need to tell them. While it's good to inform patients of what you're doing and why, sometimes too much information results in very specific negative reactions.

In this case, all you needed to say was "Let me get my CNA and I'll be right back." (or "back in 5 minutes" or whatever.)

If it was very urgent for him you could either have put him on a bedpan or given him a urinal, THEN told him you'd get your CNA and brb.

Told me I should go and take a bandaid off of someone since he was being too much trouble and didn't want me to help him

As others have said, he was being a jerk.

IMO older male patients are often extremely defensive/angry/frustrated. Being in the hospital is a major assault not only on their bodily integrity, but also on their masculinity and their sense of self. The sudden realization that they are 100% dependent (on women), and that they're basically powerless, often hits them like a ton of bricks.

He lashed out at "his nurse." Not you specifically. If he had been assigned to a different nurse, he would have lashed out the same way to your coworker.

Also, saying you needed help to move a patient safely, may make him feel fat and shamed /embarrassed. He could've reacted to that as well.

and it just kinda emotionally destroyed me. Other things had been increasing my stress the rest of the day, but after that comment I could barely make it out of the room before breaking down.

Again, he would have lashed out like this to any RN. While it was directed at you, it's only because you were his assigned nurse and you were there. He would have probably done that to any other nurse who said what you said.

It wasn't directed at who you really are inside. This was about your role as a nurse, not you personally.

People keep telling me I need to build a thick skin, but when I get insults like that, my mind just goes back to when I initially tried nursing school and wasn't allowed to retake a class i got a C- in because they thought I couldn't handle it due to my anxiety disorder. Then it just weighs me down and I just don't know what to do.

Realize that to patients, a nurse often isn't an individual so much as she is a role. You are getting lumped in with all the other RNs this patient's ever had.

We all do the same thing when we deal with people in uniform, whether it's military or law enforcement. The uniform de-individualizes an officer and visually represents him as a member of a group with special powers. Most people react to any/every cop in stereotyped ways.

Your scrubs and title do the same. We are, to many patients, de-individualized members of a large group.

And we do have special powers over patients. They may have stereotypical assumptions of our role. And they may have had lousy experiences with other nurses.

Yes, it can definitely increase your stress and press your anxiety buttons. Doubts about yourself and your competence may surface.

But many times a hurt animal will lash out at the very people who are trying to rescue it.

You wouldn't take it personally if an injured or sick animal lashed out at you while you tried to help it, would you? You would know it was because the animal was very fearful and threatened.

It's the same with people. They usually don't do it on purpose and may not even be able to articulate why they're lashing out. Illness and vulnerability reduce them to reacting with resistance and fear.

Humans are animals too. And as nurses we often see humans in their very worst, most stressful moments. So if you wouldn't take it personally from an injured animal, why take it personally from patients who are essentially the same?

It's truly not about you. Their situation threatens to their bodily integrity and sense of autonomy. This can be devastating.

Try to remember that when you're getting a patient's invective: "Sick/hurt animal lashing out at its rescuer."

If you have an anxiety disorder, and you're a nurse, you probably need counseling. First, research has shown that mood disorders are best treated by a combination of medication and counseling.

Second there is no shame in talking to a therapist about the insane stuff we see and the vast amounts of crap we take. If you don't find some way to vent and de-stress, you will eventually burn yourself out and leave the profession.

Do you really want to do that? Do you feel good/better when you can help another person? When things go very well with patients and they're happily about to be discharged, do you feel good, knowing you really helped get them back on their feet and on their way home?

These are rhetorical questions. But if those aspects of the profession are rewarding for you, recognize that there are also aspects of it that are stressful.

My mother had a framed cross-stitch on our breakfast room wall. It said, "If I enjoy the sunshine and warmth, then I must also accept the thunder and the lightning."

Nursing is a lot like that.

Take your meds, get some counseling (CBT/DBT can be quite helpful and of relatively short duration), allow yourself to vent to a counselor, or during drinks with coworkers after work.

Only other nurses (or helping professions like counselors/therapists/psychologists) really understand what we go through, so you need to vent to people who "get it" and stop building up stress.

But just do your best, and when patients lash out, try to remember that usually has little or nothing to do with you as an individual, and everything to do with your role as nurse.

Just get some counseling, someone you can see periodically to get all this stuff out of your system. If you have an anxiety disorder, you are more vulnerable to job stress already, so you need extra support.

There's nothing wrong with that. You have a chemical imbalance you can't change any more than a Type I diabetic can. And you might be surprised how many of your coworkers are on RX psychotropics.

Also: perfect is the enemy of good.

Meaning, don't strive for perfection. To err is human.

Just like you can't be a perfect mother but you can be a good mother, you can be a good nurse for your patients even if you don't do your job perfectly all day, every day.

No one can maintain that level of perfection. And if you try to, you will quickly burn yourself out and leave the profession.

Just strive to be good, not perfect. Your patients will still be okay.

I just want to second the excellent advice to see a trained counselor. Not even necessarily to treat your anxiety disorder, though that sounds like a good idea. Professional counselors are bound by confidentiality just like we are, so it is not a violation of HIPAA to disclose to them so that they can help treat you. We deal with a lot. There's no shame in needing help. At all.

I agree with pretty much everything others have said. The only thing I will add is to change "grow a thicker skin" to "don't take it personally." Pretty much all patients who hurl insult are:

a. Ill--you are meeting them at their worst, and sometimes they will be more "crusty" than usual.

b. Miserable people all the time, and you shouldn't expect them not to be miserable, even if you are doing a good job caring for them.

c. Mistaking the hospital for a hotel.

d. A combination of some or all of the above.

If a pt is insulting, be polite and to the point. Don't take it personally, and move on with your day.