OK, so the title is funny, but the situation isn’t. We have all been there you are trying to help a patient, but they are getting increasingly frustrated and angrier. They are in pain, and probably very worried, and you can see in their eyes that they have had enough of waiting. You know that things are going to escalate and that the patient is going to turn nasty.
If you have ever worked in the emergency department, over the weekend, you know exactly what I mean and have seen this situation many times. A mix of long waiting time, pain, fear and the effects of drugs and alcohol is a cocktail for trouble, sometimes violence.
Nurses are facing this situation more and more, especially in emergency departments. Something the statistics back up. In the UK, eight NHS workers are attacked every hour and the number of attacks is rising by 8.7% per year.
So what is being done to keep your safe? And what can you do to diffuse the situation?
Changes in the workplace
Often the things that keep us safe when things go wrong and a patient gets a bit aggressive are subtle. For example, lanyards for those working in the NHS have been adapted so they breakaway if someone grabs them. It is an important safety feature, but don’t show a young patient that trick. I did once with a four year old and every time I saw him, he yanked my lanyard off and squealed with delight. Funny the first few times, less so weeks later.
The introduction of security staff in key areas is also helping. People think twice before becoming violent when they know there is someone there who is equipped to deal with violence.
More surveillance cameras are also being introduced, which is helping to prosecute more of those who do hurt staff or others in clinical settings. The introduction of zero tolerance policies is helping people to realise that nursing staff are not fair game. The word gets out and the mindset of those arriving in A&E is changing, which is helping.
What you can do
It is important to get things in perspective. Whilst there are more attacks on staff, we are still talking about less than 20 in 1000 healthcare workers being attacked in the UK, so the danger is there, but it is limited. It is important to keep things in perspective, so that you can remain confident, calm and relaxed while at work. The more relaxed you are the less likely patients are to be defensive. People tend to mirror the behaviour of those around them.
Take advantage of conflict training
Conflict training is definitely the best way to gain the skills you need to recognise the danger signals and quickly diffuse the situation.
Often an angry patient is frightened and finding it hard to accept what is often bad news. Recognising the patient’s agitation and asking them about it gives them a healthy way to vent. Using reflective statements like “I understand your frustration/concern/distress” helps to calm many patients down.
You may still have to tell them the wait is going to be long, but doing so in this way helps to calm the patient. Remaining calm and non-judgemental also helps people tend to mirror your behaviour speaking harshly or raising your voice will only escalate the situation.
Keep your distance
Staying back a little from an agitated patient will allow you to simply take two steps back and get out of their reach if they attack. When people are agitated they can interpret the close physical proximity of a person as threatening.