Dealing with confrontation in nursing

It seems that there is more being said about violence in the workplace in regards to nursing. This is a somewhat understandable trend considering the increasing stresses facing nurses and the health care system with shortages, budget cuts, staff cuts, and yet a continuously expanding role and expectations.
This violence is present at several different levels; nurse to nurse, patient to nurse, nurse to nursing student, and other health care professionals to nurse.
With increased awareness comes increased ability to deal with it through appropriate channels. I have faced a few situations as a student in the clinical setting that have lived up to the saying "nurses eat their young". But does the awareness and resources make a difference? What options are available to assist in making a workplace more tolerable? Any horror stories and how you dealt with them?

I'm sorry you are probably not gonna like what I have to say.. I am soooooooooooooooo tired of hearing nurses eat their young... I heard it in 1979 when I went to LPN school in NC FROM MY PROFESSORS and again in 1992 1993 1994 1995 and 1996...FROM MY PROFESSORS AGAIN....

I think they want to toughen up nurses but they prepetuate fear, anxiety, and hostilties that don't have to be there..

If you look for an attitude I bet you can find one whatever it might be...

Sorry I am getting down....

WR,,, three commas for Becca

I had easy deliveries .. I know I can't work in OB.. I'd stuff a sock in some mom yelling...I am biased...

Don't be biased.

Although I don't particularly like confrontation, I am very straight forward and up fornt.
However, I also am old and wise enought o realize that sometimes I need a cooling down period.

If a situation has made me very angry, I wait untill I have my temper and emotions under control. Then I directly approach the person who has created the situation. I find that works for me. We can then have a calm, rational discussion.

I personally like the chocolate cake trap.. I go to the cafe and buy lunch or whatever and get a big piece of chocolate cake... I go right up to the person who's been in my face and say.."Oh dear, I ate too much and I can't eat this cake. I thought of you and want you to enjoy it.."

These meanies can't handle nice..LOLLL

WR,,, three commas for Becca

If someone confronts me, I usually tie them upside down and put little pieces of ice in their nostrils and let them melt.

You'd be surprised at how quickly they come around.

There might not be any place in the hospital where you can do this unless they are really short and then you can use a traction bar.

Otherwise, you might have to enlist a couple of your fellow coworkers and wait for them in the parking lot.

Loading them up in an SUV works best, but if not, just use a car with a big enough trunk. You'll also need a pillowcase to put over their head.

Make sure you also have plenty of supplies, as you may need to start IV access, and you'll definately need enema supplies, and a cath kit. A razor may also be helpful.

Now, you may or may not choose to use alchohol as a tool, but it can be helpful.

Take them to a dark secluded place, preferably a dirt road if you are in an area where one can be found. Oil pumps in sounding off in the background create a nice effect. Once you reach your destination have a chair available for them to sit in but do not remove the blindfold.

Be sure and have several large scary sounding men available to yell at the top of their lungs at the individual in order to scare the living crap out of them and let them know where they are lacking.

After about an hour or so of yelling at them, they may be loaded up into and taken back to the original location.

You shouldn't have any problems with confrontation from then on with this person, and you'd be surpised how much easier things will go for you at work.

Your patient load may suddenly become lighter. The offgoing nurse may no longer put things off for you to do, and offers of assistance will seem to pop up a bit more often.

If this tactic doesn't work, or you aren't comfortable using it, you may choose to simply communicate more openly with the person confronting you, OR, try giving them a piece of cake.

Aaron... I see you are taking advantage of having a nursing forum......HMMMMMMMMMMMMMM


I told a nephrologist that I used to work with surgeons so I have had my a** reamed by better docs than him...He was so silent you could hear a pin drop. I also like the one on Delphi... When a doc throws a tantrum just tell him you're gonna call his mother...LOLLLL

Not to make light of the issue though.. I have confronted right back and usually it's a question of standing your ground and letting the other person know you don't take sh** from someone...Damn scarey to do that but I have become friends with a couple of people doing that...Respect is a two way street.. When they find you won't tolerate it or crumble they'll back off...These people don't like strong people...They aren't why would they.

Another tactic is to look at them and imagine them in PJ's...Ratty PJ's and laugh at them...
Oh dear off on a tangent again...Aaron you are like a bad apple...JK>>>>

WR,,, three commas for Becca

*LMAO*.... Aaron if I didn't know better I'd swear you live in Jersey & your last name's actually Soprano. Too funny all of you! Love it!

Workplace violence is a serious issue though...
Ya'll heard about the nurse put into a coma after being attacked by a patient right? She eventually died.. I don't remember specifics, but I think the patient was an elderly patient with dementia or something.. anybody remember that situation??

Shortbus - I like how you think!

FluffyBear - This one day I was working with a nurse who was new to our hospital but hardly new to nursing.

She was in her late forties and it was her first week on the job. I'm twenty-six, graduated three years ago, and have been working in the same hospital since -- on the same medical floor. I'm very familiar with my work environment.

Anyway, this RN comes along on her first week at this hospital, and proceeds to "take control" of the floor! She was trying to delegate tasks to the LPNs who weren't on her team, and even to the other RNs, she decided who should go on break when and presented this to us at report, she ordered the unit clerk to rearrange the organization of the desk, because she said that it worked better the way it was organized at "her" hospital, she would telephone the physicians of patients who weren't hers and demand to change their meds, and even once reviewed my charting and told me that I hadn't done a good enough job! ALL IN HER FIRST WEEK!!!

Well, by the end of the week all of us who worked with her were astounded that she could come in and assume command like that. We decided that something had to be done about her.

I, being the brave, out-spoken one that I am, was nominated to do the initial one-on-one confrontation. So I approached her one morning and said I'd like to meet with her on coffee break to discuss something. So I broached the subject with her, and she was livid! She went on and on about how much experience she had and how I should pay close attention to her because SHE knew more about nursing than I possibly could (I will give her that she HAD more experience in nursing, but that didn't give her the right). She then threatened to report to the nurse manager that I had been treating her unfairly.

Well, that was a COMPLETE disaster. At that point, I knew that this could not be handled this way.

I reported back to my colleagues and together we approached the nurse manager (at our hospital, the nurse manager works medical, surgical, and obstetric floors, so she hadn't witnessed much of the situation). She was shocked that this was happening, and wondered why we didn't report it sooner! I suppose we should have.

Anyway, the nurse manager dealt with it. We hoped that would help, but come the next week and she was back at it again--stating she had to take control of the floor since nobody else was (untrue).

Well, we went through about three weeks all together of this rigamarole...and now she's looking for a new job.

My point - start with the person themselves, if that doesn't work, go to the next level up...and if that doesn't work, fire the b****!

, wow, that lady sounds like she has issues other than with the unit. I really enjoyed reading the last part, it made me crack up!

Glad to have you on the forum.

WOW! What a story...I guess since you had some experience you were elected to tsalk to the "new nurse" I try to dael with things on a 1-1 basis...but I think in your situation it was way beyond that!! Good for your nurse manager for handeling the situation.

I was a new grad and had a preceptor as I was new to the particular facility (not my school) where I was working. My preceptor was a very knowledgable , experienced nurse....who had been known to make new grads run and hide or cry (I do mean that literally!!).
I had to perform a central line drsg change (OK I'm showing my age-this was before they had nice little disposable packs! You had t0o make a sterile field, open all pkgs, etc) She had to observe as she was signing me off for my check list. When we finished (and I had even used a 4x4 to hole the bottle of acetone-yes we did that to maintain sterility!!) she said, "well, you did OK but if you would have done ...you would have broken sterility." My response? Welll, I didn't do that, didn't break sterility, never have, and you can sign me off now!! She quit being such a B I Zitch- to me anyway!!

I was reading through my older site mail and pulled this from the archives because I thought it made interesting reading & a good conversation piece in the case of this topic.. and I think it will give us all food for thought about the state of affairs of healthcare facilities - short staffing etc- we all face. Read this and please share with us all whether you could imagine this happening in the place where you work-- and if so-- what could help prevent it ok?

From a nurse who was working for a VA Hospital at the time:

"I began my nursing career at a local VA Hospital in 1993. While providing medical care to a fully competent veteran patient he assaulted me by grabbing my thumb and pulling it up behind my back. He held me in this hold for quite
sometime, I called for assistance at the same time struggling to get away. I was able to finally break free but as I did he grabbed my wrist and also bent it back. At this time, nurses began to arrive in the room and break the hold that he had on me. I was then sent to the Emergency Room where X-rays were taken of my thumb, wrist and hand. The Orthopedic, MD, that that I had torn ligaments and tendons and he placed me in a splint and was told to return in one week. During that week I had severe burning and swelling in my hand and wrist. When I returned in one week he then placed me in a spica cast and sent me on my way. Within two days I returned to his office with burning pain,
swelling and numbness in my fingers. He was not happy with me, he stated tome, " do you know how much these casts cost?" Personally I could have cared less, this was my hand. By the way, this Orthopedic doc only seen patients
for hips and knees!! Well.... he split the cast, moved it around and taped it closed and I wore it like this for another 6 weeks. When he removed it 6 weeks later, my thumb was considerably shorter than the other and it had a
large knot on the joint which he had no explanation for. As my condition was no better, they decided to send me to a hand specialist. ( I should note that I was never advised that I had a choice of physicians from the very beginning). Well, this new physician was no better. He ordered 6 months of physical therapy and after this failed he decided to do surgery. Following this I had extensive scar tissue and severe nerve damage.

I returned to light duty work duty work in an office setting as a program assistant. I did this for three years as best I could coping with the pain. Then my boss in her infinite wisdom decided I could do Home Health work. She
stated that the only patients I would see would be medically stable. Wrong...they sent me to the home of a patient that had just been released from the hospital, and he was completely unstable. During my visit the patient stated to me that he needed to use the bathroom. As he stood up he began to fall forward, I grabbed him with my already weak extremity and pulled him back to a sitting position. In doing so I immediately knew that I had injured my shoulder. Upon returning to the office I advised my supervisor of the incident and was advised to go to employee health. They stated to me that they would try to get me in to an Orthopedic doctor as soon as possible.
That was 10 days later. It would have been even longer if I had not finally got upset and demanded that they do something. It ended up that I had a torn rotator cuff. Well, to make a long story short I had two shoulder surgeries. After the last surgery I developed severe pain and a burning sensation like I had never known. The surgeon then sent me to a Pain Management Specialist who stated that he suspected that I had RSD. When I went back to the surgeon he stated that there was nothing else he could do for me and stated that I should continue to see the Pain doctor which I have been doing and continue to do. The RSD has now spread to my other upper extremity and my right lower extremity. The prognosis is poor. I am now permanently disabled all from this traumatic injury that could have prevented had my employer taken proper action. They had allowed this behavior among patients. They never supported their staff. During my time as a nurse there I had seen many nurses injured as a result of patients with this type of behavior. I hold my employer to blame for my injury, as a matter of fact, I was told to keep my mouth shut and talk to no one regarding this issue. When this incident occurred it should have immediately been turned over to security, which it wasn't. This patient was never held accountable for his actions, nor any of the others that injured any of my coworkers. This is not acceptable. I am sure that until things are corrected it will continue to happen. Workers are afraid to challenge the system in fear that they will lose their jobs."

What are your thoughts after reading that?

Have you ever experienced or known a nurse who received an on the job related injury that was due to patient injuring the staff?

Are staffing conditions giving rise to increased risk to your safety on the job?

What could change things for the better?

Remember that psych nurse who got hurt by a patient that I mentioned? I found a story about her that everybody should read...

"The war against nurses"
http://dir.salon.com/news/feature/2001/07/27/nurses/index.html

This is a sickening excerpt from the piece..
"In the state of Massachusetts, it's a felony to attack an E.R. doctor," workplace violence expert Marilyn Lanza points out, "but only a misdemeanor to assault a nurse."

Wonderful eh?

I've done some searching on sites to see if there is any information on this sort of thing. I found an article at the international nursing site that is a Framework for addressing health sector violence. I feel it is a great starting point for finding better ways of dealing with the many potential violent situations, but that it isn't very realistic in its need for resources that are not available in today's Canadian health care systems. I could not even begin to comment about other countries health care systems.
If anyone is interested in this .pdf file, you can find it at http://www.icn.ch/proof3b.screen.pdf . I would be curious as to what others think of this framework.
One of the points that were made to stop workplace violence was to create a job design that would decrease the potential. A few of the ways this could be acheived are (and I am quoting directly here):
• job planning is improved
• work overload should be avoided
• pace of work is not excessive
Having only gotten to the point where I am now doing my clinical practice on a surgical floor, and seeing the low morale of the nurses there, I wonder how much would have to be done to make it an environment that worked for the nurses, the patients, and all the other members of the health care team.

Hi Everyone,

Found this article on the Nursing Spectrum website. It's one of their Continuing Education modules, free to read:

Surviving and Thriving with Conflict on the Job Valerie Restifo, RN, MA, MS, NursingSpectrum.com:"The goal of this program is to enhance nurses’ abilities to effectively deal with conflict on the job. After you study the information presented here, you will be able to —
Analyze the dynamics of conflict in the workplace.
Identify behavioral responses to conflict and their outcomes.
Apply five conflict resolution strategies to specific situations."
http://nsweb.nursingspectrum.com/ce/ce112.htm

Sheds a lot of light on the topic.

Andrew Lopez, RN
http://www.4nursing.com

Where I work we have had increased staff on staff attacks during stressful times. Most recent was a doctor who grabbed a (smart-but)male nurse by the throat and choked him fro 3-4 sec. He still works here and the prosecuting attorney will not touch the case. If we do not hold people responsible for their actions, can this happen again?

I guess the state of Arizona is good for something. In our E.R. there is a huge sign that states, 'it is a felony to harm any health care personnel.' I take that to mean ANYONE working for the Hospital gets the same protection by the law.

We have that law also. I was assulted when I worked ER. Got the person 90 Days when I pressed charges. Mind you, the hospital does not like us pressing charges.

When I was a young new grad, a physician threw a bottle of IV fluid at me because, according to him, it didn't matter what he asked for, I should have known what he meant.

He missed hitting me with the bottle, but it scattered and cracked a glass window next to me and I got wet and there was glass in my hair.

I didn't prosecute, but the hospital banned him from admitting patients to the ICU and reassigned his existing patients to other physicians for a month or until I accepted his apology, which ever came first.

A month later he regained his priviledges and to my knowledge didn't try that commando tactic again........

We put up with enough verbal crap from the Doc's without having to be physically acousted....Don't they realize we are on the same team?

HemoStat

This story sounds like its fit to print. Unbelivable. Did someone turn in a formal complaint about this MD's conduct to the board of medical quality assurance?

What about the elderly or confused patients who beat the crap out of you when you are trying to help them up out of the floor/off the bedside commode/into their beds/out of the hallway/off the elevator/out of other patient's beds? Do nurses have any recourse when they are injured by these folks? I have been a nurse for 12 years, but have always been told that there is nothing that can be done if the patient didn't know what they were doing/had altered mental status.

Ooops sorry about the sig

[ QUOTE ]
WindingRoad said:
I personally like the chocolate cake trap.. I go to the cafe and buy lunch or whatever and get a big piece of chocolate cake... I go right up to the person who's been in my face and say.."Oh dear, I ate too much and I can't eat this cake. I thought of you and want you to enjoy it.."

These meanies can't handle nice..LOLLL

WR,,, three commas for Becca

[/ QUOTE ]

WindingRoad:

Back in 2000, I was hired as a computer professional by a company that I think just wanted me to do a short project. When I was over, I was done.

I'm thankful though because my wife told me that the company she works for (a medical supply firm) needed a driver. This is the job that helped me come to the persuasion of changing professions.

The guy who was president of this company had a severe temper problem, liked to swear at his employees, call them his "minions" and motivate them via intimidation. At one point, he had even been arrested AT WORK for assault; he was poised to deck someone. He had someone call the police to have someone else hauled off, but by the time they showed up, he started getting violent. I remember watching him being escored out of the building to the local public safety building...hoisted on his own petard. Remember, this guy is in the healthcare profession!!! He's a licensed Pharmacist.

At one point in my time at his firm, he informed me that between 8:30 and 5, he was my "lord and master" . No, I don't think so.

Well, about 6 months after that, I was making appointments with concentrator patients to do routine checks on the units. What happened was a P.R. crisis when one woman said (angrily and understandibly) that "It'll be difficult for you to check my husband's unit because he's been dead two months." Oh. Oh. Anyway. I apologized profusely and explained that our communications needed to be fixed and that I'd take it to the boss.

His response? Yelling, of course. "We can't know when our patients die!" Yeah. Right. And I always wondered why we put on clown suits and randomly picked up oxygen equipment for no good reason. Plus too, the pick-up forms require a REASON why it was picked up.

Anyway, he fed me a stream of profanity and personal abuse, to which I calmly said (over the cel phone) "You know, as adults, I think we both deserve more respect than to talk this way". That was the last straw for him. Of course I wasn't surprised. He had been trying to get me to quit for some time. Unfortunately though, I had to go back to turn in my keys, etc. It seems like I sat there an hour (probably less) listening to him rant, spitting through his clenched teeth, and POUNDING his fists . And as I kept my cool (Praise God!) he only got worse.

He even demanded some things of me, threatening me (as a FORMER employee) to fire my wife (who works in payroll) unless I did what he wanted. The silliness of it is that the D.O.N. was there as was my supervisor who could have been witnesses to a blackmail lawsuit. And of course, his door was open and plenty of others in cubicles could hear him.

I pity him. One of the last things I did before I left was I stared him right between the eyes and told him that. He's nothing more than a "school yard bully in a mid-fifties body".

I'm not kidding; God gets the glory for my being able to remain detached from this mess. A few years ago I wouldn't have been able to handle it...and ten years ago I was much like him.

And now I can look back and KNOW that I really am interested in healthcare because I was able to stick it out through all his nonsense. I've recently been interviewed for a CNA position at a nursing home maybe 6 blocks from here. They asked me to explain the big change in career. To my pleasure I could explain truthfully and convincingly that I was interested in the profession for what it is, and that I wasn't looking for an easy ride. And I learned to keep my focus on the positives of my job and not let the "nasties" drag me down.

But I'll never forget how he got so much madder as I got quieter. He wanted control and couldn't have it.

tim

Hi all,

I am a new grad (May 2004) working in a telemetry unit. I had a preceptor who is a real bully and constantly nagged me for the way I spoke with the doctors and my pump handling skills. She rarely encouraged me and ridiculed me most of the time. After about 14 weeks of this torture, I confronted her in the nursing station when she asked me to change my so-called "high-strung" personality. She took this personally and took a bunch of other nurses who supported her to our unit director. The issue was settled by the director through asking me to continue my rest of the orientation with another nurse who still supported my original preceptor, but, who also agreed to take me under her wing. My orientation is over now and recently, the second preceptor jumped on me for an innocent comment that I passed to my 12 hour working partner (another co-worker). The issue was this - A month back, she called my home and yelled at me for not having started an antecubital IV for a patient who was supposed to go for a Sprial CT scan of her chest. I apologized since it slipped my mind (I work nights and she called me when I was off work and sleeping at around 1030 a.m.) and everything went normal till the recent conflict. My partner in the 12 hour shift gave me her cell phone number to reach her at any time during the night if I had any questions regarding the patients. One morning, while I was reporting about her patients, my partner jokingly asked as to why I did not call her on her cell phone and I jokingly replied that it was not my policy to call my fellow workers during their off time unless or otherwise there was a dire emergency to do so. This second preceptor who overheard my reply presumed that I was digging on her for having called me at my residence regarding the IV start for CT scan. She went to the charge nurse for the night and started complaining about my attitude and irresponsible reply and how she thought that I was picking on her. I was right there when she talked to the charge nurse and I said to her, "Can we talk about this in the medication room?" and followed her to the med room. I explained that my reply was impersonal and not targeted on anyone and she burst off saying "You do not get along with any co-worker and da da da...." I broke out crying since I had a stressful night on the floor and sincerely, did not know as to why she took it so personally. The night charge nurse stood there and tried to resolve the issue when this preceptor of mine said,"Let's drop it" and I had to walk away. She has told the other nurses about this problem and everyone looks at me like I am an enemy. I do not know how to deal with this. I already have had a bad start and they have labelled me as "stubborn and strong willed". How can I prove them that I am not the kind that they have labelled me to be? Please help

Some times a units culture is so resistant to change that wanting to prove something to them can make it worse. Working critical care for a long time I can tell you. There are some real jerks that work there. I have seen new nurses come in and I felt they were doing well. But, I would see them beaten down I have seen new nurses chased out of units and leave to other positions and do well. Leaving is not giving up. Some times you have to try something else.

And in Nursing, we still eat our young, and kill our wounded.

That was putting it simple and elegant. (mmmmmmm fresh meat)

You think we would have learned by now. Now more than ever we need to give new graduates every chance possible to succeed.

Andrew Lopez, RN
http://www.4nursing.com

I have a friend who was hit in the chest by a chart thrown by a doctor. She had a bruise on her chest which her husband noticed. She reported it to her nurse manager who accused her of being insubordinate to the doctor (not true).
I think the important thing is to have a plan: If something like this should happen, make a big deal out of it (fall to the floor writhing in pain), stop working immediately, make sure you have plenty of witnesses, seek treatment (preferably not in your own hospital because whose side do you think they'll take?), report it to the police right then and there and file charges, write him up to the chief of staff, and if things are not settled amicably (a letter of apology at least) without any repercussions on you and your job, then hire the biggest badass lawyer and sue the doctor AND your institution. Another important thing in being prepared is to have documented previous bad behavior (keep a notebook with day/date/time/witnesses/description
of what happened). The folks that act up usually have a history. I say enough is enough.

I guess confrontation is in the job description, it is to be expected. I don't expect it from coworkers though. I do have mine and my wife's last name blocked out on the name tag. It is unnerving to run in to released patients while out shopping, especially the psych ones. I guess the ol' cop reflexes are still with me, I keep my distance until I determine the level of cooperation in a patient. I try to position myself in a way that even if they turn uncooperative, I am not there. Some Juijitsu/self defense training might be a good idea.

Occasionally you might have to deal with the violent patient. The bulk of the "confrontation" is verbal and emotional abuse directed to you from patients, doctors and other nurses.

Unless you see it, recognize it and nip it in the bud, it can make life extremely unpleasant.

For newer nurses see our section on "Eating Our Young."
http://www.nursefriendly.com/young

Also interesting are Nurses Views of The Nursing Profession:
http://www.nursefriendly.com/views

Andrew Lopez, RN
http://www.4nursing.com

I am convinced the best way to deal with hostilities is to ignore direct insults and refuse to react. Like the Christian verse, " Overcome evil with good." It may hurt to meet criticism or anger with offers to help the offender, but eventually the other person will feel so guilty they will be won over. If you play into anger, or refusals to help by by returning the anger and by being unwulling yourself to help others you make te prblem worse.
My experience in nursing has been great. I've not run into angry nurse or a hostile work environment.

Assault is a crime and it should be reported to the police. Nurses need to use ANA and their state nurses association for bargaining power. Also, report to your local representatives. Violence described here will result in a death if left unchecked. No person has a right to assault another. It is always a crime and should be reported as such. If it's a patient they might not be accountible depending on their diagnoses. Still the employer does have a responsibility to keep the work place safe. If its unsafe for one nurse, its unsafe for all. I'd be contacting an attorney and asking him/her to send hospital administration a letter reminding them they can be held accountible for an unsafe work environment.

I have read many of your e-mails and wonder why some nurses still have the idea to "eat their young"? We are undergoing a nursing shortage, so shouldn't you want to take new nurses under your wing and help retain them?
As for confrontations, I have always thought to smother people with kindness and eventually they will come around. If it gets to the point where it is affecting your work and your patients care, then by all means go to your manager (a neutral party always helps). I think no matter where you work there will always be people that do not mesh well together, but you still need to find a way to foster a professional working relationship. Nursing and teamwork go hand in hand. We need to leave our differences at the door and come together for the good of the patient(s).

Hope that helps!