long post:
I’m a male nurse and 3 days ago, my female colleagues had to deal with an asocial, violent family: the patient’s daughter, her very big and tall husband and 4 other family members that weren’t that aggressive, but said nothing and did nothing to stop the violent family members.
Cardiac unit, they wanted to take the patient for a walk, except that the patient was under monitoring, meaning you cannot.
The nurse in charge, a small woman told the family they couldn’t take the patient out of the unit and the daughter and her husband lost it. Literally. They turned to pure karen mode, started yelling and insulting my colleague, words I’m not going to repeat but it was very denigrating and happened repeatedly, like they were trying to elicit an aggressive response from my colleague so they would have an excuse to get physical, they got 3 inches off her face, the man told her in a very aggressive way he would be waiting for her when she finishes her shift, the woman told her if her father dies, she would hunt her down, also insulted her some more.
All my colleague did was telling them that the patient is under monitoring and cannot leave the unit. My colleague tried to calmly repeat the same line another 2 times, but these 2 people just wouldn’t listen, they started being that aggressive directly.
Security was called, but they never reached the unit on time, cops were not called, a doctor was called as well who came running, repeated what my colleague said, the doctor informed the family the patient could leave against medical advice, the patient refused, the family left, complaining about my colleague, didn’t apologize to her, my colleague needed 30 minutes alone to cry.
Now I’m a male and I have no idea how to react, should that happen during my shift. I have the feeling my female colleagues expect me to intervene, because I’m a man, but I’m not a strong person and I don’t know how to react when an intimidating and aggressive, bigger man than could easily punch me unconscious tells me 3 inches from my face he is going to wait for me when I finish my shift.
I have thought about several scenarios:
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I simply say ‘I’ll call the doctor’, disengage, call security, call the police saying I fear for my security and for my patients’ security and ignore them till they come. Then I tell security and the cops to escort the violent family from the unit. Document. Call the union.
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I confront the violent family: ‘Im not gonna talk to you unless you behave like an adult, call me when you’re ready to do that’. I disengage, call security and the cops and ask for them to come silently because, even though there is no violence, the situation can escalate very quickly and unpredictably and I fear for my safety, my coworkers’ safety and that of my patients. Document, call the union.
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I try calming the violent family: 'calm down, you don’t let me talk, repeat that twice at most. If they don’t behave, I stop engaging, call security and the cops, because I fear for my safety. Document, call the union.
I also don’t know what could I say or do if they keep pestering and goading me when I disengage. Do I try to ignore that? Tell them to stop, looking them in the eye? Repeat ‘I’ll only talk to you when you act like an adult? Repeat ‘leave me alone’? Say ‘I don’t want any trouble with you, but if you attack me I’m going to defend myself?
I also need help to stay safe for the 10 minutes our internal security sometimes need to reach our unit and whatever time the police needs to reach us. Do I make the aggressive person focus on me so my female coworkers are safer? Do I ignore them? This must be one of the creepiest experiences a person has to live.
thank you for your help
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Call security. It’s not your job to be a hero.
Agreed, while I wrote a much more elaborate response, doing whatever it takes to make sure no-one is hurt is priority one. Your own safety included.
Included? First. It’s like the oxygen mask on airplanes.
I don’t entirely agree. If you can help, you should. Not the to the point of suicidal martyrdom, but a small shared risk is better than making a single person alone bear much more.
The reason you put your own mask on in an airplane first, is that without it you lose consciousness very quickly.
The low oxygen environment won’t instantly kill, either, so you’re not actually trading in their chances for yours. After you get your own mask on, the person next to you will be perfectly fine even if unconscious, as you can now get their mask on in their stead.
It’s simply the most logical thing to do, all factors considered.
There are plenty of emotional reasons for people to take a bullet for someone else.
But even beyond that, there are cases where a bit of self-sacrifice makes logical sense, and is the right thing to do. Prioritising your own chances even over a win-win scenario, would be kind of a dick move.
The workplace should have a zero tolerance policy about abuse of the staff. If the particular location is one where there is a significantly non-zero chance of such incidents happening, then there should be a big red button on the wall that sounds and alarm, and summons security and possibly triggers a police response.
Employees should be trained to hit the button at the first hint of abuse. The employer should support them.
At our hospital we have vocera badges for voip. If you double tap the call button it will call security for you and give them your location, they come running.
I’m sorry this happened to your colleague and you. Unfortunately healthcare takes a lot of abuse
Over the past decades I’ve had several different women (girlfriends, mother-in-laws, coworkers) complain that I “acted too softly” in some situation or another, saying I should have raised my voice or made threats or stuff like that. If I could go back in time I wouldn’t act differently in any of those situations.
In your case I would probably complain to someone about security not showing up though. In a hospital setting it is their responsibility.
Violence is only ever a legitimate option for defense. In response to threats, all that I’ve ever felt is necessary, is to simply state “if you try, you will fail” with as much confidence as I can muster.
Responding to aggression with aggression, even as a deterrence, just risks turning it into a shit-talking-dick-measuring-contest.
As for using my physical presence to force my will if logic wont do the trick, that would just be bullying.
You and your first colleague did all what probably could’ve been called the best case scenario. I would then go on to say I wouldn’t blame the hospital for banning the family. Would that not be the preferable next step?
Now, I have the benefit of being a tall man. That said…
In my experience emotionally compromised people cannot be dealt with in a “correct” way. People get high strung for a variety of reasons and will go looking for a fight without reasoned thought ever being involved. It doesn’t help that there are a lot of people out there in need of anger management skills they do not have.
Doing that anger management for them, is impossible at best.
All you can do is your best to keep anything that matters out of the firing line. Your colleagues, your patient, yourself, your job. Being at a disadvantage when it comes to size, physical strength, authority, experience with such situations, makes this much, much harder.
It’s difficult to say how much success someone else might have with it, but I like to answer implied threats like the ones you mentioned with feigned confusion. In reply to “I’m gonna be waiting for you later” I might reply “no need, we can talk this through right now, I am ready to answer all your questions as best I can”. This is somewhat passive-aggressive, but the intention is to refuse to acknowledge or entertain that there is a possibility of the situation escalating beyond civil behaviour (although it already has). By behaving as if their outburst was a reasonable thing to say, you also allow them to save face, but doing so without coming across condescending is an acquired skill. For me, acting just dumb enough to have them wondering if I’m even capable of saying one thing while intending another has proven most defusing.
In all but the worst cases, such implied threats are a desperate effort to force one’s will. If someone actually throws a punch, that will immediately make them the aggressor in the eyes of any observer, which in a civilized setting is total self-sabotage. People want to feel as if they are in control, and usually, people know that turning to violence is an admission of already losing it, and an attempt to regain it using underhanded means. Hence the implied threat of violence, instead of actual violence. At least for a start, if a person is backed into a corner using words, they may lash out physically exactly because they feel they must regain control at all costs.
If there’s a way to effectively de-escalate, it’s often only possible to identify by intuition, and an attempt to execute may as likely set off another fuse. But usually it involves appealing to something the person out of control cares about, something that throws them off the track of hot rage and onto something calmer. Instead of “you are scaring me” you might say “you are scaring your family”. But, when even people experienced with the person in question are at a loss and are doing nothing, the behaviour is either an exception they’ve not dealt with before, or the norm, which they’ve no clue what to do about.
When dealing with groups of irate people, there’s a bit of mob mentality involved. If there’s no clear “head” on the mob it can be quite easy to give it one, by asking only of the people in the group a question, or forcing them to organize with something like “I can’t hear all of you at once”.
But you can’t talk down a storm. The best way is to find shelter and wait, give the person out of control time to sit with their thoughts and let them spin down as they tire out. If a group is involved they can talk each other up and get even more mad, so if you have a way to prevent them from speaking to each other for a bit, use it, let their trains of though diverge even a little and they’ll have to put energy into coming back to agreement. Rage burns calories like few other things. It’s possible to do these things while standing right there, but it’s difficult and seldom more than an unnecessary risk.
If you feel that closure is important, a calm moment much, much later, is the best time IMO.
If the person seems the type to accept some calm words once their head has cooled, not hold a grudge (and are still within speaking distance), I make an effort to achieve some kind of a reconciliation. Something like “I realize you had a lot on your mind at the time, and felt things that aren’t meant to be controlled, but the way you behaved insert situation was not fair. It made the situation worse, and added to everyone else’s burden. I would like you to apologize in some way to insert relevant parties, they were deeply affected by having to deal with this.” Being too “blamey” can spark a hot guilt that flames into another outburst, so I try to allow them to save as much face as I can stomach. Besides, a forced apology is no apology at all.
Again, it can depend, but I like to go with treating their behaviour as somewhat inevitable, and that making up for it now is the logical next phase. Not all people are open to feedback on their character, and how to grow. Even people who are, can still get pissed when told off, before privately coming around while mulling it over, long after parting with you.
Even if the offender learns nothing, getting an apology out of them can do a lot for the people they hurt, and is worth some effort as long as they are likely to never have to deal with the same individual again.
If no apology occurs. Voice your discontent, even if only to the party that most deserves an apology. Such solidarity does wonders to quell the self-doubt a situation like this can provoke. The target of their ire, the female nurse in your experience, is likely to be asking herself how she could have dealt with the situation better, and even if she could have, it’s a travesty that she was forced into a situation where such skills would have been useful. She did not put herself there, the patients family did. In general, discussing such experiences with your peers can be extremely cathartic and helpful.
When it comes to whether you should pull the heat onto yourself to keep it off others, here I don’t agree. When someone is “under attack” and I feel I could help, I try to “join” the fight, not “take over”. A joint front is three times as strong as a two fighting alone. If you pull all the heat onto yourself, you’ll still be just one person against a storm. An individual is easy to single out, even if that individual is swapped out for another. But being angry at two people at the same time, takes twice the effort at least.
By all means, step in to take a punch someone else cannot. But when it comes to words, we all hurt the same, and taking them together halves the pain.
are you a wizard?
i pride myself on handling challenging interactions, and i see a lot of my own behaviors in your words.
i am stunned by your articulation and detailed attention to the subject. i also learned more. thank you!
Thanks. I have a perhaps obsessive desire to understand both myself and others, so I also think about these things a lot.
I’m personally far beyond the point of diminishing returns, but some things hold true in general, enough that they are worth sharing. We’ll all still end up meeting individuals that make no sense to us and leave us utterly stumped, and while the right call is often to just get out, away, and to safety, putting some effort into understanding others before and after we encounter them, is still worth it to me.
This is an excellent post.
So do not say to them I’ll talk to you when you’re acting like an adult. Patronizing a patient or family member will always end up badly. Just like it is not your responsibility to go into a burning room to save a patient, it is not your responsibility to endure physical and sexual abuse. Unfortunately, physical and sexual abuse is rampant in the healthcare sector and is something that every health care professional needs to learn to work with. That said, your facility should have a policy in place for just such an occasion. They should have educated you on it and you should never have any worries about when you use it. You should talk to your supervisor, the senior nurses, or your union rep so they can show you what to do. You shouldn’t be making decisions when that happens, you should be just following protocol.
First off, Midas (or whatever your facility’s equivalent is) this event, get eyes on it. Patients and families getting violent is a safety event.
De-escalate however you can, but it should be stated that you’re in a place of healing and anyone preventing the necessary care for the patient is not to be allowed in your facility.
Staff and patients need to feel safe.
If you are in a union (you should strongly consider joining a union to better balance capital’s power) make sure you reach out to your union rep on this, as well.
It’s important that the employer ensure a safe work environment for their employees. Employees are required to be there, it’s on the employer to make sure anyone threatening their safety is immediately removed from the premisis.
No employer should be putting the primary responsibility for safety on employees who are not trained for it. There should not have been a situation where security could not respond in a timely manner.
you dont do anything. if you have security, it’s their job. if you dont have security, quit immediately
If someone gets unreasonably confrontational over something like that then you are in a pretty shit situation. There isn’t much you can beyond looking out for your safety and then your colleagues safety.
When I worked retail I would manage aggressive customers by pretending I was about to bend the rules to get them what they want. I’d first explain the policy reasons why they cannot have what they want. Then after they got upset I’d give them a bit and then say look I know it’s annoying/unreasonable give me a few minutes and I’ll see what I can do.
Then I’d come back with security and the manager and get them kicked out. Unfortunately this probably won’t work since they will return to see their family and you’ll be fucked.
If you’re average sized guy 5’8 - 5’10 then taking up MMA will give you the confidence to stand up knowing that you can protect yourself if someone tried to get physical. Even smaller guys can get this benefit but they will probably still get pushed around by massive size differences.
OP, my partner works with the public (education) and they have regular de-escalation training sessions to know how to respond to similar situations. He says it’s very helpful.
If you do not currently have the option to take something like that, could you request that it be offered to you and your colleagues?
If you are offered it and have taken it, could you reach out to the instructors asking about your specific situation here?
I’m sorry I don’t have better advice. My partner routinely has to break up fights, calm people down (adults and minors), police are often involved, and he brings up that training a lot when he tells me the story and how he handled the situation.
Welcome to life in American medicine, there’s basically nothing you can do because administration doesn’t really care, and anythingyou do will likely be viewed as wrong. These situations are a when, not if in the current landscape. You find a way to deal or you leave medicine.
I’d like to be more optimistic, but the system is broken and it’s going to take something significant to create the will to fix it.
Ah, hospitals. I feel for you.
I haven’t read the comments here yet, but scenario 1 and a modified scenario 2 in combo sound like the best approach. DO NOT TELL PEOPLE TO CALM DOWN, IT WILL ALWAYS MAKE THEM ANGRIER. The best way to do it IMO is to model the behaviour you want to see - remain calm. Explain (to the degree that you’re authorized to as a nurse) why they can’t do the thing, and the potential outcome of doing the thing. While trying to calm them down, have the more vulnerable target disengage and make the call to security. Remember that your duty is to your patients’ health and safety - make it as clear as possible that you’re not doing this to be a power-tripping douchebag, but to make sure their kid gets the best possible care they can so they can go home ASAP.
My work experiences are not exactly the same, but similar in some respects. I’ve found it useful to consider the following - in a healthcare-related scenario, the person who is super pissed and aggressive is usually more scared/freaked out than angry. If you address the fear they will usually calm down pretty quick (or at least the anger turns to other, less dangerous expressions of fear).
Does your hospital/union offer any training on descalation techniques? They’re not a cure-all but it’s vital stuff to know in a high-tension environment like a hospital.
Because what the medical care system needs is more trauma for its workforce and more people leaving front line services. What reprehensible people.
