Nursing and the Verbally Abusive Patient


While on your nursing job, have you ever had that patient so verbally abusive that it was almost impossible to provide them care? As a student nurse I was assigned an older woman who was in for testing to determine the cause of her abdominal pain. Other nurses had warned me that she could be very nasty so I should be aware that it was not me but her.

I entered her room to introduce myself and let her know that I would be helping her through out the day. She responded with a reply that she didn’t think that I or anyone else could help her using insulting and vulgar language. At noon time, I went in with her food tray and was helping her to open the containers. She then grabbed my wrist and dug her fingernail into my skin causing it to bleed. I was able to free my arm and reported it to my nurse manager and my instructor. I was able to finish out the day with no further incidents after the hospital social worker had a conversation with her.

Since those days many hospitals and medical practices have devised a behavior agreement for care. By having difficult patients sign a behavior agreement patients and staff respond better to these kinds of situations. Here are some tips to follow on how to handle verbally abusive patient while nursing.

Nurses Have a Right to Polite Treatment 

No one should have to tolerate the abuse that angry, intoxicated and mentally-ill patients heap upon them. Many of these agreements normally outline:

  • Inappropriate patient behaviors
  • The impact these behaviors have on nurses, doctors and other staff
  • How the behavior can impact healthcare delivery
  • Consequences delivered if behavior continues

Travel nurse | patient behavior agreementWhen you have a patient sign,  explain that this behavior agreement is a tool to help both the patient and you as the staff nurse, rather than a punitive measure, patients generally respond well. Most patients do not have a good understanding of the impact their behavior on others.

Due to  their own emotions, they act out to dispel feelings in a way that is inappropriate. You can remind them that their medical professionals are vulnerable, too, they may then gain a new outlook.

The types of patient behaviors nurses should not tolerate include:

  • Demanding, controlling or manipulative statements and requests
  • A patient’s refusal to listen
  • Lack of cooperation
  • Verbal or physical abuse
  • Threats

All of these fall short of violence, which requires more aggressive responses, including the “Code Gray” call for an out-of-control, combative patient. Still, the nurse may not be able to handle this patient alone and shouldn’t feel the need to do so.

Travel Nursing: How to handle verbally abusive patient?

Every hospital has harassment and anti-violence policies that travel nurses will probably review during orientation or before. Travel nurses should confer with other nurses, their supervisor or nurse manager for specific questions.

Reviewing these policies empowers nurses to know when patients cross the line and what steps to take. These policies also help nurse case managers quickly determine how to respond to a nurse’s complaint, while being backed up by administration. The prepared nurse can then approach each patient with confidence.

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Cheryl Roby, RN

Cheryl J. Roby is a Registered Nurse and retired US Army Reserve Nurse Major. She has more than 30 years of nursing experience and 26 years of military experience in the Army Nurse Corp. During her nursing career, she has traveled as part of her military experience visiting many of the 50 states and to South Korea. She was trained as an Army Medic during the Vietnam era and later as an OR tec. She went on to become a Licensed Practical Nurse and then completed her nursing training as a Registered Nurse. She was then commissioned as an officer in the Army Reserves. She appreciated the challenge of working in various specialties and expanding her clinical and professional skill sets. Her time in the Army Reserves and California National Guard gave her the opportunity to travel to most of the 50 states and work in other medical facilities. During her career, she had the opportunity to work in several specialties to include, OR, Occupational Health, Hospice, Sexual Assault Team, Forensic/ Correctional Nurse, Nurse Case Manager for developmental disabilities, Parish Nursing as well as a Nurse Entrepreneur.

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