Managing Patient Anger

Recently, I received an invitation to submit jpegs of my paintings to a juried art exhibition. While looking over the gallery’s past exhibits on their website, I wondered why they invited me.

Punch & Judy (detail) by jparadisi

Punch & Judy (detail) by jparadisi

The paintings I make don’t reflect the style of work this particular gallery exhibits. The mismatch started me thinking about the concept of curation, and how it applies not only to art, but also to nursing.

The definition of curate is:

Verb [with obj.] select, organize, and look after the items in a collection or exhibition.

Nurses curate insofar as we organize the care, and advocate for, a random collection of patients during our shifts. Usually, we do not select (jury in) these patients. Instead they are admitted by a physician or nurse practitioner, and assigned by a charge nurse, or whoever makes assignments on the unit.

The bedside nurse takes this collection of patients and curates (organizes) the mêlée. Most  shifts it works, but occasionally, a mismatch of personalities occurs.

I’m talking about those times when a patient doesn’t like me. If I don’t take immediate steps towards alleviating the situation, they become patients I don’t like either, and I am never pleased with this outcome.

Not every patient is a nice person. Disease and trauma are kind of blind in that regard. However, most patients are so kind, and patient, that it always catches me off guard when one is downright rude.

Here’s a list of things I’ve observed about angry patients:

  • No one is a voluntary patient. Anger is a normal response to an unexpected trauma or diagnosis.
  • No matter how personal their words, they are mad at their predicament, or at life in general, not you. Don’t take or make it personal.
  • Often anger expresses helplessness. For example, many elderly patients are also caring for a spouse or adult child with disabilities. Their anger often expresses anxiety that they are now unable to provide for that family member’s welfare.
  • Transportation to and from appointments contributes to the anxiety of patients dependent on other people for transportation. This may be expressed as anger if follow up appointments or ongoing treatment are prescribed.

Here are a few suggestions for coping with patient anger:

  • Often, simply arranging for the needs of the patient’s disabled charge diffuses the situation.
  • Call in spiritual care and social services to counsel the patient, and help arrange transportation needs.
  • Effective communication requires a clear message. Evaluate your approach. If a patient reacts during their assessment, consider re-wording the questions. You may be using words or a tone of voice they consider offensive, and are reacting to that. They actually may not understand, and are not trying to be difficult. The patient doesn’t know you’ve worked three 12-hour shifts in a row, and haven’t had a meal break yet. The reality is, that’s not a patient’s responsibility.
  • Frame disagreements regarding an angry patient’s care on the foundation of their safety. By keep this perspective and remaining professional, it is easier for your manager to support and defend you from unreasonable patient complaints.
  • Do not placate angry patients by promising special treatment outside of patient safety or professional boundaries. This sets up the next nurse for trouble. Care plans for any patient need to be sustainable for everyone providing care.
  • Never start an IV or access a port on a patient when you are angry.
  • If all else fails, request another assignment. Some clashes can’t be settled rationally.

What suggestions do you have for managing personality conflicts with patients?