How to deal with and stop abusive patients

Susanna Kahr

Nurses, CNAs, and other healthcare workers often pursue a career in the healthcare industry out of a deep desire to nurture those in greatest need. That desire to help can be life-changing for a delicate premature baby or a patient in need of emergency care, but it can also make it challenging for the caregiver to protect himself or herself when patients become abusive.

How common is abuse against healthcare workers?

Despite continuous improvement in work conditions for Americans over the past century, healthcare workers remain at high risk of abuse at the hands of their patients. In fact, 75% of workplace violence incidents occur in hospitals, nursing homes, and other healthcare settings, putting healthcare workers at highest risk of abuse at work. Making it difficult for healthcare institutions to remedy the situation are patient rights, lack of reporting among workers and the unique circumstances that lead to abuse.

Why do patients abuse?

The reasons patients resort to violence are many and complex:

1. The hospital setting can put patients in extreme distress as they worry about their health, their family members, their responsibilities outside of work, their dignity, and how they’ll pay for their visit. Extreme emotional distress is a leading cause of violent behaviors and exacerbation of mental health issues.

2. Healthcare workers often work with patients who are not in control of their thoughts or behaviors: those with dementia, those under the influence of drugs and alcohol, and those suffering from mental illness.

3. Sometimes family dynamics find their way into the emergency room or labor and delivery floor, putting healthcare workers at risk, too. Perhaps a domestic violent patient seeks treatment in the emergency room while her significant other is looking for her to finish what he started or a mom delivers a newborn amidstan escalated custody battle. Staff often get caught in the middle of these intense and dangerous situations.

4. In addition, some of the abuse healthcare workers experience is at the hands of visitors and family members, who don’t understand the priorities of the organization and worry that their loved ones aren’t receiving the care they need or deserve.

 

“Patient abuse is expected when they do not receive opiates, adderral or diet pills.” – anonymous employer review at Vista Community Clinic

How do we solve it?

Abuse against healthcare workers remains underreported, which fails to shed light on the seriousness of the problem – and understandably so. The same compassionate nurses who breathe life into the sick often take a compassionate and empathetic approach to abusive patients, too. Here’s what you can do to help drive change in the healthcare industry and take control over your own experience at work:

1. Document instances of violence and aggression in the patient’s chart per policy and in a timely manner. Thorough, accurate documentation ensuresthat the next person caring for the patient knows the patient’s history and can take safety measures prior to entering the room and during their encounter with the patient.

2. Review patient history before entering the room so you know which patients have been aggressive in the past and which patients are at risk of aggression due to medications or circumstances and can work to keep yourself as safe as possible.

3. When entering the room of a patient you don’t know well – even if they have not been violent in the past – familiarize yourself with their situation, current treatment plan, and medical history before entering the room. Ensure you have a method of communication handy, such as a panic button, a cellular phone, or a cordless handset.

4. When entering the room of a patient who has been aggressive to other caregivers, bring a second staff member with you.

5. Familiarize yourself with verbal and physical techniques for de-escalation. Aim to de-escalateverbally whenever possible. Recognize the signs of distress early and take them seriously rather than waiting for verbal or physical assault to occur. De-escalation techniques are most effective when they’re deployed at the time of the initial signs of distress.

6. Submit an incident report detailing every incident of verbal of physical assault against an employee, another patient, or a visitor. Reporting builds awareness of both the frequency and severity of abuse in the healthcare industry and drives policy improvement at the governmental and organizational levels.

7. Once you know a patient has reacted to you or is angry with you, consider reassigning care to another provider if staffing levels make it feasible. Sometimes a new face is all it takes to de-escalatea distraught patient and keep you safe in your work.

8. If you’re struggling with the symptoms of post-traumatic stress after an incident, contact your organization’s Employee Assistance Program or ask your director how you can get help.

 

“Suggestion for improvement: Zero-tolerance policy in place as well for verbal abuse and humiliation.” – anonymous employer review at Santa Clara Valley Medical Center

 

Abuse in employment is never acceptable. While it has become the norm in the healthcare industry, the goal is that no employee is ever subject to abuse at the hands of a patient, visitor, or colleague, but we must report all incidents, own the problem, and willingly lead the change in order to prevent it from occurring again.

 

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