The Abuse of Nurses By Patients

[Melano]

Hi all

I am going into my last year of nursing school and I currently work as a CNA at a major hospital in my area. I’ve been at this job for over a year, but I am growing tired of the verbal (and sometimes physical) abuse by patients. I have had to hide quite a few times to cry over attempts to punch or assault me and most recently last week due to humiliation by a patient. Most of my job is doing 1:1 and I find almost everyone has some psychiatric issue! You try to be compassionate to the best of your ability but 8 hours of being called every name of the book and cursed out gets tiring. Last week I had a middle age woman on a 1:1 for elopement scream at me, call me any and every vulgar word I could imagine, and when I reported it to the nurse she just goes “she’s being verbally abusive?” When I of course answered yes she just said okay. I did not want to cut the chain of command so I let her know then the charge nurse who just responded “she’s crazy”. Fast forward she runs out to the nursing station and begins screaming calling me a “dumb f’in tech who doesn’t know sh-“ and how I’m a “b-“.

I know they say don’t take it personal but to be called those things in front of other staff and to just hear that for hours without end becomes exhausting.

I feel a lack of support and am looking for a new job but am fully self supportive and need the job to pay my bills. Could any nurses or CNA give guidance on how to put my best foot forward for the time being and/or how to deal with such patients?

Do you kill them with kindness (think Mormon style) or completely ignore them (can’t leave the room because of a 1:1) or put your foot down and say you’re not allowed to do that? I’m not sure how to beat handle these kinds of situations?

Is this an issue you’d bring to nursing management? I don’t want to be known as a complainer!

Side note: the doctors wouldn’t give her medication (Ex: Ativan) to calm her down until she became “physical” (their wording) with me.

[JKL33]

39 minutes ago, Melano said:

Could any nurses or CNA give guidance on how to put my best foot forward for the time being and/or how to deal with such patients?

Do you kill them with kindness (think Mormon style) or completely ignore them (can’t leave the room because of a 1:1) or put your foot down and say you’re not allowed to do that? I’m not sure how to beat handle these kinds of situations?

I'm sorry. It indeed is not pleasant to deal with these situations, but probably much worse when you are frequently assigned this way because there is little opportunity for reprieve.

39 minutes ago, Melano said:

I know they say don’t take it personal but to be called those things in front of other staff and to just hear that for hours without end becomes exhausting.

Not taking it personally is key.

I would advise continuing to work through the mental/emotional process of removing your feelings/pride from the situation. These patients have problems, you are there to help keep them (and others) safe - - but the simple truth is that their problems are not your problems. Their words are not specific to you; they would be saying those things regardless who is tasked with your role or who is standing/sitting in front of them at the moment. You could be replaced and they would carry on. Any vile thing they can think of to say to you is simply not about you. Therefore, while these terrible words might be hurtful if they were said by someone with whom you have a personal relationship (a family member, a friend, a loved one, etc.) they should not be hurtful in the same way coming from a patient who is experiencing extreme difficulty. I'm sure you realize all of this but you need to really internalize it. Believe it.

The second part of this is to always remain professional. Keep yourself together. This serves to not exacerbate the situation (and to possibly improve it) but also so that you have nothing to be ashamed of in your interactions - - therefore all the more when the patient comes up with the string of worst vulgar insults they can think to say, you are confident that you have treated them with absolute professionalism - - this reinforces in your own mind that the words have nothing to do with you.

Quote

Do you kill them with kindness (think Mormon style) or completely ignore them (can’t leave the room because of a 1:1) or put your foot down and say you’re not allowed to do that?

If you aren't allowed to do something, then killing them with kindness can't involve that thing anyway.

You should be neutral and pleasant as far as you possibly can. From the way you're thinking/describing, no I don't think killing with kindness is a good way for you to look at it, although basic kindness (as it relates to being neutral and professional) is never wrong. But "kindness" as in trying to appease? No. Boundaries are very important.

Now here's another key that people seem to struggle mightily with: You are not tasked with responding to the patient's every word. If they are being appropriate and begin to make appropriate, basic conversation with you because you're there and they're bored/lonely, then it is not wrong to hold pleasant, basic conversation within appropriate boundaries. BUT - If they are being inappropriate or trying to provoke you to conflict - - you are not required to carry on this way, and I strongly suggest that you do not get into verbal spats with patients. You don't need to respond to every provocative thing they say. One of the biggest mistakes I see others making!! The first thing to try is simply being non-reactive. And DO NOT trade verbal jabs back and forth. You aren't there to parent or to correct or to chastise or to say things like "that wasn't very nice and you will not talk to me that way!!!" If they're looking to provoke you, don't be provoked. Remember, this is not about you. You are there to do a role; nothing less, and nothing more.

Okay, moving on. What safety plans, procedures, processes, policies and assistance is/are in place in order to keep staff safe? If these are not in order or are not being followed, this needs to be reported. You need to be safe at all times and have solid back-up.

Secondly, it may be worth talking with your manager/supervisor about trading out roles every now and then. Could you sometimes work in the CNA role so that you have at least a little reprieve? Even when someone's own emotions are in proper order, this role is just one that deserves to rotate in and out, from time to time, IMO. There is a limit to what even well-adjusted people can take for hours on end, day in and day out.

Recap:

1. Aim for professionalism and safety.

2. Really, truly, believe that these vile outbursts are not about you. They say nothing about you and have nothing to do with you. They should not make you ashamed or anything else. Think of them as nothing more than someone's mouth moving. ?

Does that help?

Take care ~ ???

[Crash_Cart]

The reason they are "acting out" is because the first step in the crisis intervention process, is to determine what the problem is exactly. ...Always.

This might sound strange to you but they become angry and verbally abusive simply because they feel no one is listening to them. No one is paying attention or taking the time.

So instead of trying to constantly run and get away from them all the time, try to effectively engage them instead.

This is where the active listening process is very important. Make direct eye contact, be respectful and use body language appropriately. Don't cross your arms - roll your eyes, don't appear threatening, don't try to pull authority rank over them or anything like that etc. For example, I like to use what I call the "casual stance." Basically you just lean up against the door post in a relaxed manner while engaging with them, instead of standing there at attention like a tin soldier. If you want them to relax, you have to appear relaxed. If you appear anxious, they will appear anxious. Funny how that works huh? ?

Next, it's very important to repeat back some of the things they have told you when responding to them.

This does a few things. First, this kind of repeated feedback provides them with positive confirmation they are being heard and understood.

Secondly, they are now provided with an uninterrupted opportunity to discuss something with someone of importance at the facility. This provides instant "release" of their pent up frustration and it helps to significantly lower their anxiety level.

This process helps establish a connection between yourself and the client and will continue to work in your favor in any future encounters.

Once you get inside their head, you can start "bargaining" with them for things you want them to do. They will cooperate with you because you have already established a connection with them in the past.

So in a nutshell, this is the sort of approach that will effectively de-escalate the behaviour they are exhibiting.

I would suggest asking someone if there's any crisis intervention classes you can take to learn about many different techniques. Trust me, it will pay off and significantly reduce a great deal of your current frustrations while working with these kind of clients.

Hey, good luck and don't hesitate to ask any other questions.

[iluvivt, BSN, RN]

You are going to need to work on this skill set.Right now you do not have psychological armour or verbal skills and tactics to handle these situations.It does take studying various techniques and then practicing them as the situations occur.If you Google , "dealing with difficult or abusive patients" or strategies to deal with difficult patients of verbally abusive patients you will get all kinds of resources.Read through them until you find some good techniques.Write then down and study them then start implementing them.You will be surprised how effective they are.Many times a patient will make a complete turnaround. You also have to make a quick assessment on what is causing so much anger---it's often loss of control ..so acknowledge their upset, show concern and empathy and really listen to their concerns.Sometimes patients are so out of control your priority is just keep them and yourself safe.Keep in mind too that abuse should never be tolerated as just part of your job.Also see if you can actually find a class that teaches deescalation techniques.