Workplace violence towards health care workers is a major issue. Nurses commonly are exposed to aggressive and violent patient behavior. Health care organizations are now starting to acknowledge this trend and work towards combating it. As a nurse, one of the best things you can do to protect yourself and protect your patient from doing something they might regret is to learn how to utilize de-escalation techniques effectively.
Before you utilize those de-escalation techniques you must pick up on cues that a patient is becoming agitated or aggressive. This could include verbal threats, physical signs such as pacing, anxiety, or even confusion. It’s important to recognize that violence can come from patients regardless of gender, age, or size and health care professionals should protect themselves regardless of these factors. If you find a patient is becoming increasingly agitated, use these techniques to help de-escalate the situation.
Patients in the hospital setting are often experiencing a significant loss of control over their body and this can lead them to feelings of helplessness and loss of control. Physicians, nurses, and social workers come in and out of their room to make life-altering decisions for them in a relatively short amount of time. Feeling that you cannot control what is going on can cause patients to get aggressive. Taking the time to hear your patient while being actively engaged with their concerns can go a long way in not only de-escalating their feelings and emotions but helping to build rapport with them. People still long for someone to put down their phone and pull up a chair and listen to them. Before emotions get out of control, active listening is an easy technique to utilize.
Aggressive patients often don’t feel understood and this can lead to aggression. Hospitals are a place where frustration can trigger someone to act out who already doesn’t feel well. Day-time commotion, interrupted sleep, long waits, and uncertain outcomes is a lot to manage emotionally, and sometimes they receive little support from family or friends. Simply being able to acknowledge the difficulty of the situation can go a long way to help de-escalate your patient’s emotions. It is amazing how feeling understood can bring a sense of peace to patients.
Create Firm Boundaries
When patients are escalating the last thing you want to do is to promise something and not deliver. When patients become aggressive they can become demanding and push you to do things that you might not be able to do. Be sure to frame responses in ways that are non-committal. Use phrases like, “I’ll check with the doctor and see about that,” or “I’ll do my best to get that for you, but I cannot guarantee it.” Going back on your word and killing their expectation could lead to further aggression.
Creating a safe work environment is extremely important. Keep yourself and your coworkers safe by deploying these simple yet effective techniques to de-escalate aggressive patients.
Nursing assessments are taught thoroughly in nursing school and utilized at the bedside every day for many nurses. Nurses use their senses to gather important information regarding the status of their patients. They are trained to pick up on seemingly insignificant changes in the patient’s status and incorporating it into their overall assessment. Whether it is a change in the patient’s complexion, swelling in their ankles, the new onset of a cough, or the slightest change in a patient’s vital signs, nurses process more information that can be caught by a keen observer.
Yet when taken out of the patient room, nurses often feel like a fish out of water. With an increase in technology utilization, nurses are more commonly taken away from the bedside. Telehealth is becoming more common for nurses to utilize in a variety of care settings. Whether you are looking to improve your assessment skills or are considering a job that requires telehealth, below are a few tips for assessing patients over the phone.
Many aspects of a nursing assessment are often contained within the mind. Given the fact that you are on the phone, you must translate the normal assessment at the bedside to a verbal conversation. Nurses often don’t understand how much of their assessment isn’t verbal but is visual at the bedside. When mentally working through your telehealth assessment, start to verbalize your assessment to your patient over the phone, especially regarding assessments of things that you would visualize (e.g., appearance, behavioral changes, swelling).
When assessing a patient over the phone, you must be descriptive. Often patients have difficulty describing things. As a nurse, you have many adjectives that you use that are helpful. Plus, you need to get into the details. You cannot settle for vague generalities such as, “I had a loose bowel movement” or “I’m in pain.” You can facilitate the conversation by asking things like, “Was your pain sharp and stabbing or was it dull and achy?” and, “When you passed blood in your stool was it black and tarry or bright red?” The better you can describe common descriptors relating to what the patient is telling you, the better you can accurately assess what they are actually experiencing.
Listening intently can uncover many valuable details that
otherwise might get overlooked. Since patients can have difficulty explaining
their symptoms, giving them space and time to get out what they are trying to
say can go a long way in understanding what is actually going on. Remember, you
are the assessment expert, not the patient.
You are completely dependent on what you can get from the patient during a telehealth assessment. Be sure to speak out loud, use descriptors, and when all else fails, let the patient talk in order to get a thorough assessment.
Hospitals are constantly in flux as patients come in and
out. As patients are admitted to the hospital, nursing staff must perform
detailed assessments and gather a significant amount of information as part of
the admission process. As you can imagine, this can be a time-consuming
Think of an 80-year-old patient who is on 17 prescription medications, has numerous comorbidities, and can’t recall their past medical history. It might take a while to gather the necessary information. Add this admission onto an already difficult patient load where the nurse is currently managing three or four sick patients and it’s easy to understand why the admissions nurse role was created.
An admissions nurse was created with the thought of reducing the burden on admitting units. They often operate hospital-wide and will go from unit to unit to complete patient admissions. The admissions nurse will come to the room of the newly admitted patient to perform a complete head-to-toe assessment, gather important contact information, review and document that patient’s medication list and pertinent medical history; next they will orient the patient to their room and unit and complete all other admission documentation. Then they will discuss any necessary information with the nurse who will be taking care of the patient.
The admissions nurse role is a unique opportunity for nurses to familiarize themselves with the hospital and to work with staff outside their normal unit. They often work part of their FTE as an admissions nurse and the rest of their FTE on their dedicated unit. This role can get mundane at times, but it does allow for nurses to gain valuable experience with numerous patient populations and helps them to build relationships with staff outside their home unit.
Admissions nurses serve as an important part of workflow management by taking on much of the burden of the admission process. They quickly become experts on the admission process and are valued by all the units they serve.
A medical review specialist is a unique role where nurses help to ensure that health care services are delivered in a manner that balances high-quality, efficient care that is also fairly priced and compliant. Nurses in this role will review patient charts, billing, and documentation to ensure a variety of different things important to health care organizations.
In order to be competent in this role, a different set of skills will be crucial for success and can be a great option, especially in certain states and areas. Let’s discuss three important skills that are paramount for the medical review specialist role.
A medical review specialist will have numerous tasks and projects they are working on at one time. In this role, you could expect to be working with numerous different individuals and multiple different deadlines. Given these realities, the ability to stay organized and manage workload will be of vital importance. The ability to manage a significant amount of work at the same time will be a daily task that you must be proficient in to succeed in the role.
In this role, a period in the wrong place or a missing sentence could mean the organization doesn’t get reimbursed for the care they provided. A medical review specialist will be expected to review doctor’s notes, coding, billing, and other data within a patient’s chart. This requires a strong attention to detail because seemingly insignificant things can cause serious consequences. Without this skill, you will struggle to be effective in this role.
Medical review specialists must think in a way that is unusual for most nurses. While bedside nurses tend to have a broad focus on the care of the patient, a medical review specialist is focused on small but significant behind-the-scenes factors such as coding and regulations. This role requires a new set of knowledge not needed by other nursing roles. In essence, a medical review specialist completes the work for the care given by other nurses, doctors, and practitioners by ensuring the charting was proper and accurately encapsulates all the care given. If elements are missing, individuals in this role will reach out to members of the care team to have them correct their charting.
To be successful as a medical review specialist, one must be competent in workload management, pay attention to the details, and have in-depth knowledge of coding and other regulations.
A nurse manager position is a career path that can be as
equally rewarding as it is challenging. The decisions made by the nurse manager
can drastically impact the staff on the unit. Attending important meetings,
hiring staff, leading change, and addressing ongoing staff development and
accountability are just a few examples of what a nurse manager does. If you
find these daily tasks are of interest in your career path, then a nurse
manager job might be right for you. Other responsibilities include not being
afraid to take ownership of a decision while having the confidence and
knowledge to feel comfortable making a decision and dealing with the
Ultimately, the decisions a nurse manager makes affects the
whole staff and there will undoubtedly be those who disagree with the decision.
The nurse manager must move forward confidently to earn the trust and respect
of their staff and have the ability to influence colleagues. If you currently
find your colleagues coming to you for help and they respond well to your
decisions, you might have the personality and the natural ability to influence
your colleagues for the better. This ability is a vital skill for any nurse
manager to have.
Every decision in health care impacts numerous other individuals. Maybe you find that you have the ability to see how one decision impacts another and possess the forethought to better manage patient workflow. The ability to know and understand how a unit functions as part of the whole hospital is also a crucial skill for a nurse manager.
A successful nurse manager must be a dynamic influencer and nursing expert. If you find the role intriguing and possess these skills, you might find the nurse manager role to be a perfect fit!
For more information on leadership roles in nursing check out DailyNurse.com, MinorityNurse.com, or other useful resources available to medical professionals on springerpub.com.