There is no denying the fact that nursing is one of the most personally rewarding professions out there, but it also doesn’t come without certain challenges. Whichever field you go into, there will inevitably be hurdles you will have to overcome; the same is true for nursing.
From long shifts to emotionally disturbing experiences and difficult patients, there is a lot you learn to juggle. Since nurses are frontline workers and most often the ones interacting with patients and their families directly, they are the healthcare workers most exposed to the threat of assault by aggressive patients.
The US department of labor reported that of all workplace assaults that lead to loss of work days, 45% were against nurses. In fact, of all the workplace hazards a nurse is exposed to, the American Nurses’ Association identifies workplace violence as the most significant.
If you find yourself in such a situation, the typical response is fight or flight; however, nurses are expected to respond with greater care, confidence, and compassion. Fight or flight is not always suitable in nursing or any other career in medicine.
That said, the following are some tips to help you deal with aggression on your job.
1. Remain calm and respectful
Dealing with an aggressive patient or family member requires self-control and careful judgment. Don’t let your fear or anger show, maintain neutral facial expressions, and don’t let your tone of voice waver. Remaining calm is the best way to go about the situation because the other person is not thinking rationally, and letting your own emotions conquer you will never help.
It is also crucial that you stay respectful. At the same time, this does not mean you take workplace violence without objection. You have a legal right to file a complaint if need be. Some service providers also offer a free complimentary case review to evaluate whether your case meets the requirements.
Your body language says a lot about your intentions, so try to maintain eye contact (but don’t stare), maintain adequate distance, and escape if things escalate.
2. Make sure you position yourself safely
The best position to be in when you feel threatened by someone else is between the threat and the escape route. However, make sure not to block the escape route entirely so the patient can escape if they intend to.
It is better not to approach or touch an angered or volatile patient, even if it is compassionate. Respect their personal space and remain within a comfortable distance from them. The ideal distance in such a situation is two arms-length away. In addition to keeping the other person calm, it helps you keep out of harm’s way.
Also, ensure not to face the person in the face because it’s interpreted as a confrontation. Instead, position yourself slightly at an angle, keep your arms at your sides, open and face your hands towards the person, and adopt a relaxed posture.
3. Exercise active listening
Sometimes all a patient needs to de-escalate their aggression is an opportunity to vent it out, and nurses who retaliate don’t help the situation or themselves. Practice active listening by paying close attention to their verbal and non-verbal messages, listening to understand and get information, using all your senses, and providing actionable feedback.
Research shows that we retain only 25%-50% of what we listen to, which is terrible, especially in a profession as sensitive as nursing.
With active listening, you will also be able to communicate to the patient that you care about and understand their dilemma. They are likely baffled and frustrated with the situation, and it helps to have someone who understands them. Use this tool to calm an aggressive patient and be on the lookout for signs of mounting aggression and imminent violent outbursts.
4. Be mindful of behaviors that precede a violent outburst
You must know when to escape and protect yourself from potential harm. Staying and listening attentively can backfire if the patient lashes out; your safety comes first. Spend some effort learning patient behaviors because around 80% of workplace violence incidents against nurses are by patients.
Verbal cues for possible violence include yelling, raised volume, swearing, or threatening. Clenched fists, pacing, heavy breathing, fixed stares, or even a terrified look in the eyes are cues to leave the situation and protect yourself.
5. Know where to find panic alarms
You might find yourself in a situation where it is just you and the volatile patient, and the shift time is such that no one else is around. Whenever in such a condition, your first resort should be the panic alarm system of your organization. You should know where to find it in time if faced with an emergency.
Hospital panic alarms are warning systems that signal the security or the police of an emergency. They are usually situated in hidden places like under desks. Get information about the location of these panic alarms in your building, and don’t hesitate to use them if the need arises.
6. Keep the authorities in the loop
Typically, healthcare organizations have risk assessment tools and are aware of patients that pose a threat to healthcare workers. When dealing with such a patient, ensure your colleagues and authorities know. Find information on potentially volatile situations where disruptive behavior is more common, such as when transporting patients or making shift changes.
7. Look for personal sociocultural biases
Sometimes personal biases interfere with healthcare concerns like workplace aggression and might influence your response. At times, personal bias against a patient or family member might trigger an aggressive reaction from the patient.
For instance, a language barrier or sociocultural misunderstanding could increase the patient’s anxiety and provoke an angry reaction. Therefore, you must identify and rectify any such personal biases.
Workplace violence is a serious threat faced by nurses in their healthcare setting. Fortunately, healthcare organizations ensure proper safety protocols are in place to address these concerns. However, at the time of the aggressive interaction, your response to the situation has a significant influence.
Remain calm, give respect, position yourself carefully, practice active listening, look out for cues that indicate an imminent outburst.