A nurse’s tips for responding to hostile patients

Stocksy | Victor Torres
Stocksy | Victor Torres

This is a follow-up to my “Tips for preventing workplace violence” post. As a quick review, talking about violence against nurses in the workplace:

  • Forty-eight percent of all nonfatal injuries from occupational assaults and violent acts occurred in healthcare and social service settings.
  • Nurses are the most likely of all healthcare workers to be assaulted.
  • Rates of violence are 13.2 physical and 38.8 nonphysical incidents per 100 persons per year.
  • The highest rates of violence are reported by ED nurses.
  • The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as any physical assault, threatening behavior or verbal abuse occurring in the workplace.

From that post, I recommended the following tips:

  • Awareness
  • Don’t be afraid
  • Communicate your feelings
  • Strength in numbers
  • Trust your gut

I thought I’d follow up with some navigational tips for when you’re in the moment. It’s all fine and dandy to create a plan to prevent the violence from happening, but what do you do if all your wonderful plans fail? Or you get caught off guard? It’s you against the perpetrator. It may not be the patient himself. It could be a complete stranger, a friend, a family member or, in some of the more severe cases, someone you know or work with. How do you diffuse the hostile situation? How do you avoid getting “hit” (both for real and in the emotional sense)?

I’d say 80 percent of violent acts are preempted by a verbal disagreement or argument (when the “drama” starts). Here are five tips to follow when that argument starts.

1. Create distance. This will keep you out of harm’s way (but only temporarily). It does a great job of getting you away from the source of harm, but it can also incite more anger. The person can view this distance as an opportunity to yell louder. I think it’s much easier to handle a loud voice than any type of physical violence. Create some distance between the two of you. If you can’t, then put something between the two of you (chair, linen basket, garbage can, IV pole, etc.). All this does is give you some time—time to remove yourself physically from the scenario.

2. Seek clarification. Often it’s miscommunication that lights the fire. Other times it can be the reaction to bad news, or news that the person didn’t like or agree with. Be sure to ask what is angering the perpetrator. Being angry about the news is not a reason to direct the anger toward the person delivering the news. Be cognizant that the intelligence of all parties will matter. You want to make sure everyone understands the message being delivered. Never assume what you are saying is clear and concise.

3. Seek reinforcements. Find a coworker, the charge nurse, an assistant or aide. Find anyone who is part of the healthcare team (yes, that includes providers—MD, DO, NP, PA, etc). After you find someone, seek reinforcements from the aggressor. Find someone the aggressor knows who can help. Sometimes, that’s the patient himself. Be sure to find someone from the healthcare team first. Every so often, the perpetrator will have co-conspirators who are just there to aggravate the situation.

4. Recognize their feelings. Don’t be flippant. Don’t ignore what they are feeling. Don’t scoff at their reaction. Recognize whatever it is they are doing as real and valid. Say it out loud; let them know you recognize what is going on. It shows empathy and it levels the playing field. They are scared, they feel vulnerable and they’re downright mad. Be sure to let them know you are there to help, not hinder the situation, however you can. Just don’t promise you can fix things. Promise you will try, but never make promises you can’t keep.

5. Empower them. Ask them how they would solve the problem. What would make them happy? How could they defuse the situation? You are there to help them figure it out. It’s not your job to solve it. You may never ease their pain, eliminate their fear or extinguish that fire in their belly. But allowing them to feel some sort of control in an uncontrollable situation will most often tame the wildest of tigers.

These are all suggestions, none of which come with a guarantee. Even after all the preventive actions and all the corrective responses, you still may have to deal with a violent act. Ultimately it’s about self-preservation. While I love my job and my profession, my safety comes first. Be sure to take care of yourself first when caring for others.

Best of luck out there.

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4 Responses to A nurse’s tips for responding to hostile patients

  1. Kerrhi

    Why is it that we continue to accept violence from aggressors as an okay practice? Why do we continue to accept our safety being compromised for the sake of customer satisfaction? I am also in EMS in where I was smart enough (and fortunate enough to have the opportunity) to take a tactical training class. I learned that once a patient acts out physically, they are no longer a patient, but an attacker and a threat to my personal well being. I learned how to back up and attempt to diffuse the situation without resorting to violence myself (as EMS providers are ALWAYS being filmed!), unless absolutely necessary to defend myself.
    We are taught “safety first”. But what about our safety? When will it be okay for US to work safely??? Oh yeah..when we pay the administrators salary, and not the other way around.

  2. Also,
    1)Talk in a calm assured what kids call “Inside voice” especially if they are yelling at you.
    2)DO NOT let them get between you and the door.
    3)Move slowly (moving fast is threatening)
    4)Give them choices. “Would you like to go for a walk or take a shower?” Most anger is about them feeling powerless. Giving choices puts decision making and power in their hands.
    5) Can I call a family member/friend/Staff member they like to help you?
    6) Do NOT fight or disagree with them. Many of the angry patients are used to fighting. When you don’t raise your voice, it takes the air out of their balloon.
    7)Try to find a compromise to solving their problem. This goes back to control.

    After working with Cardiac /Cardiac surgery patients for 12+ years who were CEO’s Vice President’s of, Regional Managers of etc. I have learned that many of them fell like they have lost control of the world where they were the boss of everything and they gave the orders. No offense to Sean, but when some 25 year old cheerful female nurse comes in and tells them that they are showering now. These guys think “Who the &^%$ is she and why does she think she can tell me what to do.”

    At this point many of these guys get VERY angry and do stupid things. These men are not powerful, invincible and immortal anymore like they thought they were before their cardiac event. Even if a guy is a farmer or worker bee, he still doesn’t feel like he is the king of his world anymore.

  3. kimdrennen

    Always make sure you place yourself between the door and the patient so they can’t block your exit if the situation turns ugly. You can’t argue with crazy and you won’t do anything but make it worse by trying. I have seen my coworkers hurt by trying .Nobody wins in this scenario.

    • Ruth Pace

      “You can’t argue with crazy” — you are absolutely correct. If your first attempts at trying to diffuse the situation fails, get out as quickly, quietly and safely as you can.
      For myself, as PCA, I can always fall back on that, most people know that we aides can’t do much for whatever they’re angry about. But I still get a lot of backlash from the patients and their family members.