Verbally Abusing a Nurse

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It drives me crazy when Administration basically tells patients it's ok to abuse your nurse. People come in totally alert and oriented demanding things we cant give , yell, scream, call you names. Then when you call security because they refuse to be transferred to another floor and are carrying on abusing the NA's have the nerve to file a complaint for having security called on them. Of course the patient advocate is kissing thier butt like they had every right to act like a tantrum throwing child. But my question is WHERE IS THE STAFF SUPPORT? WHY ARENT THEY LETTING THE PATIENTS KNOW ITS UNACCEPTABLE TO ACT THIS WAY IN THE HOSPITAL?! It makes me sick.

Makes me grateful that at my hospital, one of the written pt responsibilities is that the patient will "accept their room assignment." Refusing transfer is not an option.

Especially when you are no longer in need of monitoring and we have people in the ER who are. That's an idea to ask for a written pt responsibilities list! That's awesome and I am going to suggest this if our administration.

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Hk, I have a couple of thoughts. I'm with you, but for your own sanity it'll be good to look at this a little differently. I hope you will hear me out. I'm not about making excuses for this kind of thing.

  • Consider learning to separate self from other. This removes the personal offense aspect of this. Irrational behaviors almost by definition are not about the person witnessing them. We all will do very well to tamp down that immediate reactionary "offense" feeling and just look at the situation for what it is. It improves our thinking, protects our sense of well-being, and leaves room in our brain to consider the best ways to de-escalate the situation.


  • Speaking of de-escalation, this is something for which every one of us could/do benefit from training. Consider asking your manager about it; open up a conversation about how you (and maybe other staff members) would like to learn more about 1) maintaining safety while 2) serving the patients' needs when there is a conflict.

  • Reconsider your goals. What I'm hearing you say is that you don't appreciate feeling unsupported and/or blamed. I'm with you. In fact, placing blame isn't going to help a lot of these situations (whether it is the nurse or the patient who is blamed). Work towards moving away from needing the patient to be "put in place"/chastised/blamed in order for you to feel validated. Additionally, when you show that you are remaining in control of your emotions you are much less likely to be blamed by your peers or superiors. I'll admit, I like to let these situations showcase themselves without any help from me. They speak for themselves. Refuse to contribute to the drama.

  • At the same time that you are carefully not escalating the situation, you don't have to "tolerate" it. But you absolutely do have to maintain composure. There are quite a few interpersonal tools for these scenarios, but you also should have an out. Mine is this (spoken calmly): "It sounds like you have some concerns that [my manager, my supervisor] could help address; I'm going to give them a call." [start dialing/make the call]. If a patient is being verbally abusive, irrational, the situation appears to be escalating, and/or preventing/delaying the care of other patients, I request that a member of administration assist. And I don't really take no for an answer on that.

Lastly if the behavior is unacceptable, irrational, ridiculous in your mind - - then don't react/reply in kind. Definitely don't get down and roll in the mud. Rise above.

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Hk, I have a couple of thoughts. I'm with you, but for your own sanity it'll be good to look at this a little differently. I hope you will hear me out. I'm not about making excuses for this kind of thing.

  • Consider learning to separate self from other. This removes the personal offense aspect of this. Irrational behaviors almost by definition are not about the person witnessing them. We all will do very well to tamp down that immediate reactionary "offense" feeling and just look at the situation for what it is. It improves our thinking, protects our sense of well-being, and leaves room in our brain to consider the best ways to de-escalate the situation.


  • Speaking of de-escalation, this is something for which every one of us could/do benefit from training. Consider asking your manager about it; open up a conversation about how you (and maybe other staff members) would like to learn more about 1) maintaining safety while 2) serving the patients' needs when there is a conflict.

  • Reconsider your goals. What I'm hearing you say is that you don't appreciate feeling unsupported and/or blamed. I'm with you. In fact, placing blame isn't going to help a lot of these situations (whether it is the nurse or the patient who is blamed). Work towards moving away from needing the patient to be "put in place"/chastised/blamed in order for you to feel validated. Additionally, when you show that you are remaining in control of your emotions you are much less likely to be blamed by your peers or superiors. I'll admit, I like to let these situations showcase themselves without any help from me. They speak for themselves. Refuse to contribute to the drama.

  • At the same time that you are carefully not escalating the situation, you don't have to "tolerate" it. But you absolutely do have to maintain composure. There are quite a few interpersonal tools for these scenarios, but you also should have an out. Mine is this (spoken calmly): "It sounds like you have some concerns that [my manager, my supervisor] could help address; I'm going to give them a call." [start dialing/make the call]. If a patient is being verbally abusive, irrational, the situation appears to be escalating, and/or preventing/delaying the care of other patients, I request that a member of administration assist. And I don't really take no for an answer on that.

Lastly if the behavior is unacceptable, irrational, ridiculous in your mind - - then don't react/reply in kind. Definitely don't get down and roll in the mud. Rise above.

I agree with most of what you said. However I do not feel like I have to be validated for a patient being "put in thier place". I do want staffs safety concerns validated by putting policies in place to keep patients accountable for thier actions and to keep staff safe. I do feel that there has to be a change in what is accepted as far as treatment of staff by the public when they come into the hospital. Alot of people think it is a free for all and that they have the right to be abusive especially to nurses. Some people just dont want to follow the hospital rules or feel that they are entitled to do whatever they want and that is just not true. When I spoke to this patient with security for my safety and for the staffs due to the irratic behavior I most certainly did maintain my composure. I never raise my voice or am rude or mean to patients. I did like the previous suggestion of someone's hospital having a list of patient responsibilities to give when they come into the hospital. I agree that talking and listening are effective most of the time but every once in a while you just get the luck of the drawl and end up with someone who is totally rude and abusive no matter what you do. Believe it or not there are alot of people out there like that. My beef is that these types of people are encouraged to act this way. It is no secret that this happens in every hospital.

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Specializes in CMSRN, hospice.

When it's a one-time deal of someone completely losing their cool and going off verbally, a lot of the strategies above are generally all you need. At my hospital, when it's clear that the patient is going to habitually act like this, the team draws up a behavior contract. Generally the physician, primary nurse, nurse manager, and maybe another person are involved in presenting the issue and the solution to the patient. They sign it, and if they do not comply after that point they may be administratively discharged from the hospital.

I am totally with you, it should never be an expectation that nurses, techs, or really anyone in any helping or service profession, field verbal abuse day in and day out. However, there is no one-size-fits-all approach to this; it really depends on the scenario and the patient/family member. As distrustful as I am of nursing administration on a lot of issues, I feel like they usually make an effort to be fair in these situations. Working with people is ultimately always going to suck; it's the unfortunate nature of helping and service professions that people are going to be nasty sometimes, even if we've done nothing wrong. Like I said, if it's habitual, that's one thing, but if it's a one-time freakout, it's easiest for everyone to treat it like NBD. Usually some sweet talking, deescalation, and time are all that are needed. We can also use these opportunities to educate people about realistic expectations of the hospital (e.g., "I'm happy to bring you more Diet Coke...if we're stocked after the three you've already had...but I can't do that in the middle of a patient emergency").

Speaking of emergencies (and veering a little off-topic), is anyone else's hospital moving toward not announcing codes and rapids over the intercom? If yours is already not doing that anymore, how's it going? Mine is making an attempt at this, and I'm not sure how I feel about it; seems like if your pager malfunctions, you're going to be a no-show to something pretty important. I know it's got to be disconcerting for patients and families, but...IDK why that is a high priority during an emergency.

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When it's a one-time deal of someone completely losing their cool and going off verbally, a lot of the strategies above are generally all you need. At my hospital, when it's clear that the patient is going to habitually act like this, the team draws up a behavior contract. Generally the physician, primary nurse, nurse manager, and maybe another person are involved in presenting the issue and the solution to the patient. They sign it, and if they do not comply after that point they may be administratively discharged from the hospital.

I am totally with you, it should never be an expectation that nurses, techs, or really anyone in any helping or service profession, field verbal abuse day in and day out. However, there is no one-size-fits-all approach to this; it really depends on the scenario and the patient/family member. As distrustful as I am of nursing administration on a lot of issues, I feel like they usually make an effort to be fair in these situations. Working with people is ultimately always going to suck; it's the unfortunate nature of helping and service professions that people are going to be nasty sometimes, even if we've done nothing wrong. Like I said, if it's habitual, that's one thing, but if it's a one-time freakout, it's easiest for everyone to treat it like NBD. Usually some sweet talking, deescalation, and time are all that are needed. We can also use these opportunities to educate people about realistic expectations of the hospital (e.g., "I'm happy to bring you more Diet Coke...if we're stocked after the three you've already had...but I can't do that in the middle of a patient emergency").

Speaking of emergencies (and veering a little off-topic), is anyone else's hospital moving toward not announcing codes and rapids over the intercom? If yours is already not doing that anymore, how's it going? Mine is making an attempt at this, and I'm not sure how I feel about it; seems like if your pager malfunctions, you're going to be a no-show to something pretty important. I know it's got to be disconcerting for patients and families, but...IDK why that is a high priority during an emergency.

I like the idea of a behavior contract! This patient was def in need of one. I havent heard of not calling codes overhead, I dont think the alternative of pagers is a good idea for the reason you have listed.

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Specializes in SICU, trauma, neuro.

My hospital actually has a specific behavioral emergency code, for when a pt is being belligerent and staff safety compromised. The response team includes security staff and a psych RN.

As far as non-threatening verbal abuse, heck yeah I'm going to advise the pt that that is unacceptable. I'll carry out critical duties in silence, or exit the room if I don't have anything pressing.

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It drives me crazy when Administration basically tells patients it's ok to abuse your nurse.

My beef is that these types of people are encouraged to act this way. It is no secret that this happens in every hospital.

It's just annoying that instead of having that talk with the pt they reward the behavior with kissing thier butt. In that way I feel they leave staff open for continuous abuse by not saying hey it's not ok to act like this and it wont be accepted.

In that way I feel they leave staff open for continuous abuse by not saying hey it's not ok to act like this and it wont be accepted.

The lack of saying hey, this isnt appropriate behavior from administration who actually have power to make a difference is what is bothering me.

But my question is WHERE IS THE STAFF SUPPORT? WHY ARENT THEY LETTING THE PATIENTS KNOW ITS UNACCEPTABLE TO ACT THIS WAY IN THE HOSPITAL?! It makes me sick.

I have the feeling that you didn't really appreciate my first two posts, but I'm nothing if not stubborn and persistent, so I'll give it one more try :) Believe it or not, but I'm actually trying to help you.

If I'm honest with you, reading your posts I perceive an air of helplessness. To me, it's like you're looking only to someone else to fix your problems (administration), and you seem to view yourself as completely powerless, at the mercy of whatever admin does or doesn't do.

I'm also challenging your position that administration encourage and reward abuse of nurses. I completely agree that management should support their staff when they are treated in an unacceptable manner but the failure to do so, is not the same as actively encouraging and rewarding abuse. I'm seeing a bit of a victim mindset instead of a "take charge" mindset.

I'm reminded of giving relationship advice to some of my girlfriends when they're complaining about husband/fiance/partner problems. My first question is usually, have you told him that this behavior of his upsets you and have you spelled it out to him what you do expect of him? (As you might have guessed, they are normally initially about as thrilled about my advice as I'm guessing that you are...). Most of the time they haven't told him what they want and reply to me that if he loves them, he should understand how they feel and treat her as she wants to be treated. (That notion drives me nuts by the way, it's one of my pet peeves. Why expect that people be mindreaders?)

Well, admin isn't anyone's husband but the same principle kind of applies. If you're unhappy with how you're treated, I think you need to let them know and just be clear about what you'd like to see change. What you're asking for is extremely reasonable. Abuse in the workplace is not okay.

People come in totally alert and oriented demanding things we cant give , yell, scream, call you names.

I'm obviously not talking about a run if the mill jerky person which you could as a nurse say hey that type of behavior wont be tolerated....

Your statements in this post at times appear to contradict each other. It makes it more difficult to offer advice. To me yelling and name calling is a run of the mill jerky person.

Anytime a patient is being out of line verbally abusing staff or calling staff names getting rowdy yelling and threatening you in the hospital you absolutely should call security for everyone's safety patient and staff.

....and def not saying everytime you should call them.

Should security be called every time or not? Again, I'm having trouble understanding your position. As I've already mentioned I think that sometimes calling security is definitely the correct choice but other times I think a situation that could be competently managed by a skilled nurse, is unnecessarily escalated.

I think it's interesting other nurses would rather try to reason with an irrational person than to protect themselves and your ancillary staff from an unruly patient. Guess that's why the numbers of nurse and hospital staff abuse are so high in this country and why it's so accepted by the people who run the hospital.

I think that sometimes attempting to reason with an irate person is the best form of protection as it can defuse the situation. I think that you believe so too, so don't you agree that these situations have to be judged and handled on a case-by-case basis?

I do feel that there has to be a change in what is accepted as far as treatment of staff by the public when they come into the hospital. Alot of people think it is a free for all and that they have the right to be abusive especially to nurses. Some people just dont want to follow the hospital rules or feel that they are entitled to do whatever they want and that is just not true.

I think that we see things a little differently here. If I interpret you correctly, and please tell me if I got this wrong, you seem to think that the only mindset and attitude that matters, is that of the patients/general public.

I view this as my own mindset having an equal, if not larger, bearing. Why should I care if a small group of the public feels that nurses are there to be abused. I don't accept that. And what I think actually has a larger impact on my everyday life than what others think. I think when you realize that, you'll feel empowered.

I guess what I'm talking about is primarily assertiveness. Since I make it very clear that I don't accept being treated poorly, the result seems to be that a) people don't seem to treat me poorly as often as they do someone who's less assertive and b) management is affected by the way I view myself and tend to agree with the fact that I don't deserve to be treated poorly and they actively support me.

In an ideal world, people would automatically be nice and supportive to someone who's nice to them, but in this world sometimes you just need to teach people how to treat you.

I agree that talking and listening are effective most of the time but every once in a while you just get the luck of the drawl and end up with someone who is totally rude and abusive no matter what you do. Believe it or not there are alot of people out there like that.

Yes. Some people are definitely just complete unredeemable jerks.

How we let jerks affect our lives is in our control.

OP, I hope that you, together with your coworkers and admin, can implement policies and even more importantly, come up with strategies that minimize the amount of abuse occurring in the workplace.

OP, I'll end my third post to you the same way I did my first.

Best wishes!

Speaking of emergencies (and veering a little off-topic), is anyone else's hospital moving toward not announcing codes and rapids over the intercom? If yours is already not doing that anymore, how's it going? Mine is making an attempt at this, and I'm not sure how I feel about it; seems like if your pager malfunctions, you're going to be a no-show to something pretty important. I know it's got to be disconcerting for patients and families, but...IDK why that is a high priority during an emergency.

I've only been a nurse for ~11 years but in my hospital we haven't had intercom announcements for codes/rapids for about 20-25 years. The only place that had it until relatively recently was the building that houses the CTICU and some other acute coronary units.

Until a couple of years ago the rest of the hospital (large univeristy hospital in a foreign land :)) called a phone number (an easy one, like 55555 and it didn't matter if you accidently pressed the "5" four times or six times or whatever) and you reached the code coordinator and all the correct resources were paged.

Now each floor has several tablets with touchscreens mounted on the walls and when you press/touch it, it gives you three options. Adult, pediatric or pregnant. These three options are large enough to together cover the entire screen so even with adrenaline-shaky :) fingers you will press the right one. Then the screen changes and all the resources that are being paged are listed. Like Physician1, Anesthesiologist1, Nurse anesthetist1, Nurse1, Physician2 etc. As these individuals confirm their page, the bar with their function/name changes color and turns green. The screen basically goes blip, blip, blip for the first 30 seconds or so as you stand there watching it. There's a phone right next to each tablet in case you need to call the code coordinator, but so far the technology seems to work.

I personally like it because I think those code announcements are a huge stressor for many patients, plus I really detest noisy environments :)

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Specializes in Gerontology, Med surg, Home Health.

I work in a SNF and though customer service is important, we don't let residents or family members yell at us. I've had more than one irate family member scream in my face. I say: "You have two choices. You can leave or I can call the police and they will escort you out." I'm all for trying to fix issues, but don't raise you voice to me or the staff.

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CAHPS.

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Specializes in Psych, Addictions, SOL (Student of Life).
The fact that noone has talked to the patient about thier actions and how it wont be accepted in the hospital is BS.

I find that this kind of behavior is easily remidied if the nurse takes a strong stand from the beginning. You quote indicates that no one including yourself has told this patient that the behavior is unacceptable. Like Macawake I find simple firm redirection calms almost all situations down.

Anytime a patient is being out of line verbally abusing staff or calling staff names getting rowdy yelling and threatening you in the hospital you absolutely should call security for everyone's safety patient and staff.

.........and no I would not call security for verbal behavior even up to the point of yelling and making verbal threats. If they tried to put their hands on me that's another story but it rarely comes to that. I would not want to be the one who cried wolf over a situation that could be handled by nursing and floor staff. Perhaps some CEU is verbal de-escalation would help.

Hppy

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Specializes in Psych, Addictions, SOL (Student of Life).
Not a punishment but at least have someone make it clear that the behavior will not be tolerated or some sort of changes in policy. I wasnt repremanded. The lack of saying hey, this isnt appropriate behavior from administration who actually have power to make a difference is what is bothering me. Because it's not just this one patient it is continuously the case.

What power do they actually have if the behavior does not change? Kick a sick pt out the door and have the news vans roll up. Physically or chemically restrain the patient which is illegal? The hands of admiration are tied plus you discussion has now moved to a clearly irrational patient which is a Psych matter, originally you were talking about alert and oriented people capable of reason! Both situations are handled differently.

Hppy

Gotta go deal with the irrational threatening parents of my adolescent psych patients

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THAT would be reason #1 I do not work in hospitals anymore. Among my 800 reasons when CMS wrapped up patient satisfaction into reimbursement I saw this coming.

Alert/oriented patient tantrums. I had one manager who: patient freaks out because they are not getting their drug of choice administered stat when they don't yet have an order for it and manager in room also having a tantrum over same. I've worked everything from high end hospitals to county and the entitlement attitude is alive and well among the wealthy and the poor.

I don't buy it that not feeling good is all it is. Feeling lousy should not give one carte blanche to be an abusive tantrum-thrower and those who abuse hospital staff, I suspect, are same ones who abuse retail etc... staff.

When I switched to working corrections some years back I actually found the majority of patients to be quite polite. If they are rude they go back to their cell, that and they generally appreciate medical staff over custody staff.

Amazingly most people can behave if they have to.

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