A nurse’s tips for responding to hostile patients

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.