Today in the chart

Hurt People, Hurt People

Getting to the root cause is the key to help our patients and us realize we are not the ones to receive the anger.

I remember the moment I knew I was burned out. After three days in a row of an overflowing ER and staying late every night, I was done. Then, on my third day, I received a screaming patient having an ectopic pregnancy. She was yelling and thrashing around, refusing to let me start her IV. With an 18 gauge needle in my hand, I became furious as she kept yelling at me, pulling her arm away, and refusing to let me help her. After a few episodes of this, I finally threw down my IV supplies on her tray table and sternly stated (some would say I shouted), “We are just trying to help you.” I stomped out of her room, tossing the unused needle into the sharps container, and told my charge nurse I was not going back in. I was done caring for people who would not or could not appreciate me. This was a big realization as I considered leaving the nursing profession altogether. I wondered if this was a pattern in my life outside of nursing, caring for others who did not appreciate me. Yet, looking back on this moment, I can offer myself and this patient compassion. I see a patient who was scared and possibly sad that she was losing a baby; I see a nurse who was exhausted and tired of being mistreated for just trying to help people. 

After this experience, I decided if I stayed in this profession, I needed to do things differently. So, knowing how difficult it was for me not to react to others’ anger at the moment, I created a response that I repeatedly used until it became my authentic reaction.

It went something like this, (deep breath): “I hear you, and I can see you are really upset right now. I can’t even imagine how difficult all this must be for you. I also want you to know that the way you’re treating me is hurting my feelings. I am here to help you. Would you like to share more about why you are frustrated?

I know that this may sound crazy. However, I was surprised at how well my patients responded to me after hearing this. Responses included:

  • I’m sorry, I am just tired of waiting.
  • I am mad that I even have to be here; I’m not mad at you.
  • It’s not you, it’s just everything, and I am so frustrated by it all.

The last response is the best because the reality is it is not us, 99% of the time, the anger we receive from our patients is not because of us. Getting to the root cause is the key to helping our patients, and us, realize we are not the ones to receive the anger. In response to my patients, I would say, “Yes, absolutely, I can’t even imagine all you are going through right now, and it is frustrating. I am here to help you, so let’s start by treating each other with kindness and dignity because I am here to give you the care you deserve. How does that sound to you?”

This response to my frustrated patients was helpful because it simultaneously honors our patients and us. It involves reflecting, empathizing, being honest about our feelings, and then getting curious about the root cause of their frustration. This then leads to deep listening, allowing our patients to feel heard, and just like toddlers, adults also think if no one is listening to them, they need to get louder and louder until someone does.  

Will this work every time? No, and it’s important to remember that your safety is more important than your patients feeling heard. This response did not always work. When I was taking care of psych patients, especially the patient on a 72-hour hold and head-butted the door frame three inches from my head when I was seven months pregnant with twins, no, it won’t always work. However, it is a nice response I saved for when things got intense and I needed to help de-escalate others and create boundaries for my well-being.

Keeping our boundaries while honoring another person and their experience creates a feeling of safety for all parties. The hardest part of this was sharing how my patients’ actions made me feel. This feels vulnerable, yet this is the most impactful part because once people realize they are hurting your feelings, it helps them realize they are putting their anger on someone who did nothing to deserve it. Hurt people, hurt people, and stopping this cycle with compassion, empathy, and curiosity honors, first and foremost, our own well-being as well as the well-being of our patients. 

Tara Rynders, The Dancing Nurse, is the CEO and Founder of The Clinic, an arts and play-based immersive theater company that creates workshops and performances in hospital settings to prevent burnout, decrease secondary traumatic stress, and create more (Re)Brilliant and equitable healthcare systems.

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