You’re in the exam room meeting with a patient when, suddenly, the patient becomes verbally aggressive. You’re alone with the increasingly hostile patient. Why can’t the patient just cooperate? You have so much to do before your shift ends in 30 minutes. You’re probably thinking, “This is not what I signed up for.” Yet, here you are. So what do you do?

Unfortunately, situations such as these are becoming everyday occurrences for nurses across the nation and have only gotten worse since the pandemic in 2020. Patients’ use of words as weapons is something that is rarely discussed in nursing school or training, which results in nurses not having the knowledge or skill to effectively and professionally diffuse these situations.

To further exacerbate the problem, healthcare executives often fail to provide nurses with the opportunities to develop these skills as they’re insulated from the daily challenges nurses face and, thus, do not view it as an urgent need. So, what are nurses supposed to do in hostile situations?

The Conflict: Verbal Abuse in Nursing

Physically violent incidents have received much attention, but they are relatively rare.; the probability of verbal assaults against nurses is much higher. Verbal assaults can come from patients who are angry, upset, confused, and frustrated. In addition, hostilities could also come from patient friends or family members and nursing colleagues.

Nurses exposed to these types of assaults can experience many forms of psychological trauma, such as depression, low self-esteem, burn-out, post-traumatic stress disorder, compassion fatigue, and anxiety. As a result, nurses experiencing these conditions may have increased absences from work, reduced quality of patient care, lack of care or concern for the patient, reduced bedside manners, and increased irritability…which may all contribute to future acts of patient hostility.

The Tools: De-escalation Techniques

Consider this: what is our natural response whenever a patient, their family, or even a co-worker gets verbally aggressive with us? While we may initially feel shocked, we may soon come back with an equally aggressive or sarcastic statement.

At some point, we’ve learned to respond to resistance by increasing our resistance and to aggression by escalating our aggression. Unfortunately, this rarely works and often only escalates the conflict. There are better ways to approach hostilities to de-escalate the situation more effectively and professionally. Some strategies can even proactively reduce conflict before it even arises.

Active Listening

In conflict, we tend to filter others’ words through our rebuttal. Try instead to make a deliberate attempt at understanding the other person’s perspective. Through active listening, you pay attention to the other person to understand and can repeat what you heard them say. In many conflicts, the aggressive person simply wants to be heard as they feel their voice is often silent or overlooked.

Empathy

Additionally, many aggressive individuals feel that others do not understand, value, or consider their desires, feelings, and wants as relevant. By showing empathy, you assure them that you truly hear and understand their concerns. Through this, you also validate their feelings, which often goes a long way to resolving the situation.

Clear Communication

In conflict, the aggressor may not think clearly because emotions are controlling their thought patterns. As such, it’s critical that when talking to them, you have crystal-clear communication. Avoid technical terms, medical jargon, or long, confusing sentences. Keep things simple and understandable.

This is not the time to impress the patient, their family, or your co-worker with your immense knowledge of hemodynamic monitoring and titration of vasoactive medications. Talking over the hostile person’s head will only agitate the situation.

Setting Boundaries

I often prefer to let the aggressive person talk and to continue to voice his/her frustrations. Why? If they keep talking, they’ll eventually start to calm down somewhat, at which point I can better reason with them. In other words, their hostile fire seems to burn out. At the same time, they need to know what you will and will not allow to continue working with them.

It’s best to let them know that if they aren’t making any threats, yelling, speaking loudly to cause a scene, speaking profanities, or displaying any aggressive physical behavior, you are willing to work with them to find a solution. But the moment they do any of those prohibited things, the discussion is off. This helps to establish the framework of the conversation to contain the frustrations.

The Debrief: Self-Care Essentials

Nursing is a demanding profession: not just because of long hours at work and staff shortages, but also because of the emotional bonds that you may build with patients and their families while they’re going through some injury or illness. You’re working to try to make the patient better, only to see them succumb to their injury or illness. You’re with the patient and their families when delivering bad news.

On top of all of that, you may now face frequent assaults at the hands of patients, patient family members, and co-workers. All of this takes a toll on nurses’ well-being. Of these, being verbally abused on the job has perhaps the most emotionally draining impact.

Nurses often put their patients first. As important as this is, nurses must carve out time for themselves.

Without proper self-care, a nurse will eventually be unable to care for their patients. This is why nurses must develop proper stress management techniques, such as mindfulness practices, deep breathing, meditation, etc.

In addition, nurses must not underestimate the importance of developing a solid, dependable support system of friends, family, and co-workers. We need people who will be there when times are tough, who will simply listen as we discuss our struggles, and who will help support us so we can be the best version of ourselves.

Lastly, there may be times when you need something more than these. As such, nurses shouldn’t be hesitant to reach out for professional help to reduce the stress and anxiety of their work challenges.

The Power of Calm

When faced with a hostile situation, the most important thing one can do is remain calm. Don’t let emotions cloud your judgment and thinking. In these moments, you may only have mere seconds to decide what to do, but there are strategies that you can utilize that will help you resolve the hostility more effectively and professionally while potentially preserving the relationship between you and the aggressor.

By using effective communication and de-escalation techniques, nurses can proactively fight against aggression at the hands of patients, their families, and co-workers. Nurses have always been the backbone of healthcare, weathering verbal storms with unwavering compassion and the steely resolve to advocate for their patients. Their resilience is a testament to the immense power of calm in the face of chaos.

Bio: Dr. McIntyre is an expert who works with organizations to reduce toxicity, conflict, and drama. With healthcare quickly becoming the most violent profession nationally, Dr. McIntyre uses his knowledge of human and organizational behavior to develop tactics and strategies to make healthcare a safer environment. Everyone deals with conflict. Not everyone can resolve it amicably. I develop high-performing teams by facilitating productive conflict de-escalation and removal of toxicity.

I have helped hundreds of individuals and organizations resolve toxicity, drama, and conflict over the past 20 years. My vast knowledge of sociology and human behavior enables me to have a keen understanding of group dynamics and human response. I achieve proactive results that internal teams and security groups can't. Together, my experience and knowledge position me to be the expert that your organization needs to transform your culture and ensure a safer work environment while dramatically improving your performance.

To learn more about or to contact Dr. McIntyre, please visit www.nealmcintyreconsulting.com.