7 Ways to Recognize and Deal With Abusive Patients
Key takeaways:
Workplace violence (WPV) and abusive behavior by patients, families, and visitors toward healthcare providers (HCPs) is on the rise, with female and ethnic minorities affected at a higher rate.
Abusive treatment by patients and visitors raises the risk of burnout among HCPs.
HCPs who remain calm and professional can often diffuse volatile situations before they escalate. Still, when WPV does occur, it should be reported and can even lead to criminal charges in some states.
Healthcare providers (HCPs) are at high risk for experiencing workplace violence (WPV). In fact, WPV rates have risen since the beginning of the COVID-19 pandemic. Patients and visitors are more anxious and angrier. Waiting rooms are fuller and have longer wait times. HCPs are working while short on staff. These factors have created a volatile environment, where HCPs often become targets for verbal and physical abuse.
In 2018, 24% of HCPs have experienced work-related physical violence worldwide, and 37% of North American HCPs have been affected. HCP injuries account for 73% of all nonfatal WPV injuries, with a 95% rise in the injury rate since 2010.
But, some groups of HCPs experience mistreatment by patients at a higher rate. Female and ethnic minorities report more mistreatment and discrimination than their white male colleagues. Also, HCPs who have negative interactions with patients, families, and visitors have a higher burnout rate.
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Burnout is linked with many negative outcomes for HCPs, including:
Lower job satisfaction leading to leaving the profession
Lower quality of care
Greater alcohol use
When is a patient considered “abusive”?
WPV in healthcare settings lacks a standard definition. Many HCPs have come to expect abusive behavior from patients to be just “part of the job.” Because of this, WPV in healthcare is often underreported.
Abusive behavior includes the following:
Physical assault: This can look like spitting, biting, pulling hair, or any other types of unwanted physical contact with the intent to cause harm.
Sexual harassment: Examples include unwelcome sexual advances, insulting gestures, and verbal or physical contact of a sexual nature.
Verbal threats and harassment: Verbal abuse includes racial slurs, comments on physical appearance or perceived sexual orientation, cursing, yelling, or berating. It can also include verbal statements with the intent to cause harm or threatening body language and gestures.
That said, the highest rate of healthcare WPV occurs in paramedics, emergency departments, and inpatient psychiatric facilities. Strong predictors of violent behavior include male gender and age 35 or younger.
7 tips for dealing with abusive patients
With cases of WPV on the rise, what can you do to prevent or lessen the chances that you’ll be involved in an incident?
1. Be aware of your body language
Body language that comes across as aggressive can add to a heated situation. Avoid entering the patient’s personal space, leaning towards them, or crossing your arms. Direct eye contact and standing toe-to-toe may be seen as aggressive. Standing off to the side at an angle can be less threatening and less likely to provoke aggressive behavior.
2. Maintain appropriate distance
Make sure you can exit the room easily. Consider where you sit or stand in an exam room to make sure you have quick access to the door. Avoid entering the patient’s personal space. But position yourself to make it harder for them to enter your personal space. If a patient becomes aggressive, you want to move out of striking range and closer to the exit.
3. Try to ignore threatening questions or remarks
If you are challenged on your authority or an organizational policy, try to redirect their attention to the policy. For example, suppose a visitor becomes angry that they are asked to wear a mask and challenges what authority you have to make them comply. It’s best to ignore the challenge. Instead, simply restate calmly and respectfully to keep the focus on following the policy.
4. Keep your composure and do not react
Remaining calm and displaying a willingness to help the patient can often defuse a situation. Avoid raising your voice. Try not to take comments personally and remain calm and professional.
5. Allow the patient to vent their frustrations
Allowing a patient to talk and listening to them often helps. Acknowledge their feelings and perspective even if you disagree with them. You may want to ask open questions or let the patient speak without interruption. If you find any legitimate concerns, and it’s appropriate, you can apologize and offer to discuss and address the issues.
6. Set and enforce reasonable limits
If patients or visitors become disruptive, set limits with clear, concise choices and consequences. Make sure the consequences are reasonable and enforceable. For example, if a family member tries to enter an exam room, you can say, “Please wait in the waiting area until we call you back to the exam room. If you try to force your way into the exam room again, I’ll have to call security.”
7. Find the reason behind the behavior
Often, the reason for the anger may not be what it seems to be. Abusive patients or visitors are often acting out of fear and helplessness. Understanding the underlying concern and offering empathy can sometimes help to diffuse outbursts.
What should you do if a patient hits you?
If you have been hit or assaulted by a patient, remove yourself to a safe area and ask a coworker to take over for you. If you need backup assistance, call security or the police. You’ll also need to report the incident to your supervisor. Ask them to arrange for any immediate medical attention you might need.
After the event, you may need additional care for counseling. HCPs who have experienced WPV often suffer from post-traumatic stress disorder (PTSD). Counseling makes sure that you are supported and can return to work once you have recovered.
If you get injured during work, you are entitled to worker’s compensation benefits. Keep copies of all documents filed about the incident and your treatment. Worker’s compensation benefits will usually cover the cost of medical care, including psychological care and missed wages.
Also, many HCPs are unaware that WPV can be prosecuted. Many states have laws that make WPV against an HCP a criminal offense and can be prosecuted as a felony. To pursue criminal charges after WPV, you’ll need to report the incident to law enforcement. You can also file a civil suit for personal injury, which would require you to hire a personal injury lawyer.
Can you refuse to care for an abusive patient?
HCPs can refuse to care for abusive patients. But in an emergency, the HCP must give life-saving care before handing the patient off to another qualified provider. Abusive patients can be discharged from an outpatient practice. And your state will have guidelines for formally dismissing a patient from your practice. Nurses may also refuse a patient assignment that they feel places them at serious risk for harm.
What policies protect HCPs from patient abuse?
Current policies on WPV and patient abuse are often created at an organizational level. While states have laws that allow those who have assaulted an HCP to be prosecuted, there is no federal law protecting HCPs. But in June 2022, the Safety from Violence for Healthcare Employees (SAVE) Act was introduced to the house of representatives. The act would offer HCPs federal protections through a nationally implemented law against WPV, like that of aircraft and airport workers.
The bottom line
Workplace violence (WPV) against healthcare providers (HCPs) is on the rise, and female and ethnic minorities experience even higher WPV rates than others. There is no federal legislation that protects HCPs. But, state laws allow those who commit WPV against an HCP to be prosecuted. By staying alert, aware, calm, and professional, HCPs can often diffuse a disruptive situation before it escalates to the point of violence.
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