Being a nurse is tough, especially when your patients are aggressive and not accepting of your care. Let’s break down how to handle aggressive patients so when they come your way, you’re prepared.
Stay Calm
It’s easy to let aggressive patients rattle you, especially as a new nurse, but don’t let it get to you. Always stay calm. Aggressive patients usually are having a mental health crisis or are simply feeling misunderstood and not heard, so try to not take it personally.
Inform Your Breaker
Let your breaker know what’s going on. They’ll likely have already heard the commotion, but if not, they need the heads up so they can have your back. Let them know when you’re going into the patients’ room and what for. This way they can stand outside the door or nearby to help you de-escalate the situation if needed.
Give the Patient a Chance to Calm Down
If a patient is starting to become aggressive, try your best to de-escalate the situation. Don’t talk over them and never raise your voice. Let them know that it is not okay to speak to staff in that manor and let them know you will give them a chance to collect themselves and come back in about 10 minutes.
Make sure you follow through and check on your patient again in 10 minutes with enough time carved out to really listen to them. By now, your patient has hopefully calmed down some to the point where they can properly communicate their concerns with you in a more respectful manor.
Visit How to Organize Your 12-Hour Nursing Shift for time management tips.
Repeat Back Their Concerns
Once your patient has conveyed their concerns to you in a calm manor, voice back what you believe their biggest concern is. This way the patient feels heard and respected as an individual. If you aren’t able to get to this point, you may need to call in some help from your breaker.
Ask What You Can Do
Now that you know your patients concerns, you can attempt to do something about it. Maybe it’s as simple as getting them a blanket because they’ve already asked for one but never received it. Or maybe it’s something a little more complicated. If you are unsure how to fix the situation, and a blanket just won’t cut it, ask the patient what you can personably do to make their hospital stay better.
At this point they will hopefully be able to have a productive conversation with you and the two of you can get to the root of the problem. If you don’t feel like your de-escalation attempts are getting you anywhere and/or the patient is becoming increasingly agitated, then you’re going to need to get security and upper management involved.
Call Security
Security is there for a reason and if you feel unsafe or if a patient is threatening you, then you’re going to need to call security. Often with aggressive patients, its best to remove yourself from the patients’ room and let them know that security is being called after you have tried de-escalating the situation with your floor resources.
Unfortunately, sometimes there isn’t another option other than calling security, so make sure you always have their phone number handy. You never know when you, or a co-worker, is going to need it.
Be sure to visit How to Raise Awareness on Workplace Violence in the Nursing and Healthcare Field for more info.
Patients That Aren’t Yours
Luckily, not all aggressive patients are going to be assigned to you! But when you do get one, you’re going to want back up from other staff nurses. So make sure you’re there for your fellow nurses!
When you hear another patient being aggressive, go stand by the door and listen in. Make sure that the nurse has the situation under control and if they don’t or it looks like they’re being backed into a corner, call security. As a new nurse you may not feel comfortable stepping in, so going straight for security is the safest thing to do. As you become a more seasoned nurse, you may find that stepping in on these situations before calling security is best. But until you get that experience, just call security.
Document
If security is called on your patient for any reason, always be sure to document this event. Check with your hospital to see where the best place is to document this and chart away. State what happened, what de-escalation tactics you used, what time security was called, and what the outcome of the situation was. Is the patient better? Did you have to call the doctor for physical or chemical restraints? Are the restraints still on your patient? When do the restraint orders need to be renewed?
Also visit Tips for New Nurses on Calling the Doctor, Charting Tips for New Nurses, and A Nursing Guide to Patient Restraints for more information.
Be Present
In the end, the best way to avoid aggressive patients is to be present with them. Patients are people too and they just need to be heard. Their anger and frustration has likely built up over a few shifts and you’re just getting the brunt of it. Take time with each of your patients to really ask them how they are doing and check in on them during your hourly rounding to see if they need anything. Let them know that they can call you at any time on their call light and that you’re there for them.
Taking this time to be present with your patient is going to improve patient satisfaction, nurse satisfaction and overall hospital satisfaction. Sometimes we as nurses can become task oriented, because let’s face it, we have a million things to do! But it’s important to take a step back and remember that these patients aren’t in the hospital because they want to be, they’re there because they have to be. And in crazy pandemic times they may not have any visitors or anyone to talk to. So as a nurse, give each patient an extra 5 or so minutes to check on their mental health. It doesn’t take much time and it’s a great check in on your patients overall health. And trust me, they’re going to appreciate it.
What are your go to de-escalation moves when handling aggressive patients? Comment below!
Also be sure to visit Imposter Syndrome as a New Nurse for more helpful tips.