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We’ve been there.  The patient is incredibly rude, demeaning, or even saying sexually explicit things to you.  Patient satisfaction has been preached to you constantly.. but what do you do when the patient crosses the line?

I’ve had quite a few experiences of all of the above.  I felt helpless until I figured out the best way to handle this.  I no longer feel helpless.  I feel strong.  I feel empowered.

Bring it on, people.  I can handle it.

I have a few key phrases I am ready to drop with firm confidence.

I usually say…

That is inappropriate.

You will not speak to me in that manner.

Do not curse at me.

I am here to help you as your nurse, not to be disrespected.

I use one or a combination of two, or all three.  It usually shuts the rudeness or the sexually inappropriate stuff down.  You usually don’t need to elaborate any more because it snaps them out of their rudeness.  They usually profusely apologize.

I find it really important for, as a nurse and human being, to know this:

Even though someone is ill or going through something really tough, it does not give them an excuse to be rude, demeaning, demanding, or inappropriate to you.  You deserve respect.  And sometimes when people are being rude as an unhealthy way of dealing with their situation, you need to command respect from them.  There is absolutely no excuse or reason to treat you poorly.  You do NOT deserve it.  

Sometimes when people are going through something tough they lash out at those that are helping them.  It can be a natural way for them to deal with something that’s totally out control.  While that may be how they’re instinctively dealing with something, it does not make it okay.  They may just need a little firm, but respectful, reminder that there are better ways to deal with difficult situations.

Telling these people to stop is step one.  Step two is how you treat them the rest of the shift.  You must still provide great care.  You drop the “you must respect me” bomb, but then you still take really good care of them.

(This also applies to the patient’s loved ones/support system AND coworkers, people!)

You’re basically saying to the patient that’s taking their situation out on you,

“Hey – don’t treat me like that.  It’s cool if you were frustrated with everything and taking it out on me.. that’s okay if that was your instinct, but you need to know that it’s not okay to talk to me like that and we’ve gotta change how you’re dealing with this.  I’m still going to take really good care of you, even though we had this little bump in the road.  Being sick sucks.  I get it.  And if you want to talk about it, I’m here.”

Now there will be your patients that are just mean and going to be disrespectful and demeaning anyway. Those patients will get very short and sweet interactions from me.  I will say and do what I need to do and nothing more.  Patient satisfaction is important, but not so important that you get treated like garbage.  Honestly, in my 6 years of nursing.. I’ve had one guy that was just super mean despite what I did and said.  One.  The rest changed their behavior once I identified the rudeness and asked to be treated more respectfully.

When the patient is confused and mean

When I have patients that are confused and mean, I maintain an extremely strong (strong, not mean!) presence.  I am respectful, but I am extremely firm in every single word I say.  I am the nurse, I am in charge.  I am going to re-direct behaviors, identify and correct abusive language, and provide good care.  These patients need a really strong, yet kind, presence.  I provide structure, try to joke with them, and know when to just exit the situation and try again later.

Know when to call security

If a patient is seriously being abusive (cursing, threatening) – call security.  I will do this quickly and swiftly.  I don’t play games, people.  If I drop my “treat me with respect” bomb and they come back at me hostile or cursing, I immediately lean out of the room and loudly asking to whomever is at the desk to call security.

This person needs a firm reminder about the expected behavior of a human being by someone in a uniform.

Usually the act of me requesting security communicates the “it just got real” message and they chill out.  However, I still talk with security and ask them to explain to the patient how to treat the staff.  I also do this for confused patients that are extremely mean and abusive that I’m unable to control myself.  Even in their confused state, if they see a uniform, it can still get through to them.

I know what you non-nurses/non-CNA’s may be thinking here.. is all of that really necessary?  Yes, good Lord, it is.  I have experienced multiple “call security” situations.  People can go really off-the charts (ha!) in the hospital when they are upset.  These situations happen and we must be empowered to deal with them appropriately to ensure everyone’s safety from both physical and emotional abuse.

Also – shout out to security officers.  I sincerely appreciate you and the support you provide to us nurses. It means a lot to and I feel very safe because of you.

I hope this helps you as you have those tough patients.  I remember feeling so bad and beat down when patients were mean and treated me like the lowliest of the low.  But once I got my mind around the situation, I felt empowered.  I began to feel armed to deal with these situations and therefore didn’t try to avoid them.  I now take them on immediately and address the behavior.  It makes the shift go much better and typically the patient and I have a much deeper, trusting relationship because they know I’ll call them out when they’re being ridiculous and still support them.

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