There is an article published by Journal of Advanced Nursing, titled Mosaic of verbal abuse experienced by nurses in their everyday work that should be read by every nurse that has tolerated  demeaning or verbally abusive behaviour whilst on duty, and also by every member of the public who has had a nurse care for them.

This was an observational study conducted over 1150 hours at inpatient and emergency department wards in a large acute metropolitan teaching hospital on the outskirts of a major Australian city.

It found an everyday, sustained ‘mosaic’ of non-verbal threatening behaviours, verbal insults, threats and physical assaults.
This mosaic was classified into 3 categories:

  • Verbal abuse that was largely sexual.
  • Ridicule and unreasonable demands
  • Hostility, threats and menacing language.

Verbal abuse:

Patients and less commonly their family and friends were observed to make sexualized insults, judgements, threats, or suggestions that targeted nurses through sexualized demeaning language. The sexualized taunts and insults conveyed stereotypical gendered assumptions about nursing and nurses. The sexualized and strongly pejorative language included descriptions of nurses as ‘c*nts’, ‘-’, ‘bitches’, ‘whores’, and ‘sluts’. The insults were made in public spaces in front of others. By labelling their femininity as deviant, these insults explicitly debased the character of a particular nurse by drawing attention to their supposed sexual worth. The following interaction was observed to occur in a busy waiting room; the outburst was triggered when a nurse did not bring ice quickly enough when requested.
Patients Friend (said about the nurses): ‘All these f*cking lazy c*nts, we pay taxes for this! She’s a f*cking whore’ (directed at the individual nurse).

Ridicule:

Demeaning insults included openly questioning whether ‘they (nurses) know how to do their jobs’ and debasing the character and competence of nurses was observed to occur through such accusations as: ‘You’re lying, you’re falsifying’, and ‘You are animals’, ‘You bastards… this is a joke’. Associated with these insults were attacks on services provided with remarks that they were ‘disgraceful’ and swearing and cursing that was directed at the actions of nurses through comments such as ‘bullshit’ and ‘for God’s sake get it right’. Patients and their visitors demanded nurses act more quickly, fetch the doctor ‘I need the bloody doctor’, or bring food when demanded ‘NOW’. Demands that followed gendered and sexualized attacks had an implied overtone of slovenliness: ‘Hurry up, there’s people waiting here, not only me, everybody else. F*cking hurry up’.

Hostility & threats:

By sustaining the hostile dynamic, these behaviours served to provide further opportunities for an escalation or continuation of the violence. Threats of complaint or legal action followed several incidents of verbal abuse and demand. In one incident, a family member complained: ‘Your hospital is going to be all over the media’ while she filmed staff on her camera phone. Threats of harm were observed to be directed occasionally at other treating staff (ambulance officer and doctor), but were most commonly aimed at nurses, either as a group or individually. The threats included several different types of violence: killing, shooting, blowing up, punching, and stabbing with a needle.

I have provided some short excerpts from this article but it is well worth trying to get hold of the entire study which is far more explicit.

It is interesting to note your own reactions when reading these accounts.
I cannot think of many other environments where this would be tolerated (could you imagine walking into a bank and telling the fucking bitch tellers to get your money out before you fucking job them? Yeah…good luck with that), yet often we consider the correct ‘professional’ response is to absorb or let the comments roll off our backs so we can get on with care delivery. Even when there are direct threats being made.

So. I would be interested in anyone who would like to recount their own experiences with verbal abuse whilst on duty.
What did you feel?
How did you respond?
What acute support were you given from your colleagues and from your hospital?

32 Responses to “Nurses are F*cking C*nts. Verbal abuse in our workplace.”

  1. I have read this article and found it very relevant to me and my own experience.Unfortunately a lot of people think that it is quite OK and acceptable to take out their anger and frustration against a sometimes inadequate health system on nursing staff. I also think that gender is an issue as I often feel that female nurses are targetted more than male nurses. Especially for the sexual insults and the insinuations that nurses are stupid airheads. I hope this article makes people sit up and take notice but feel the situation is unlikely to change anytime soon.

  2. I have seen way too much abuse and inappropriate behaviour in my years as a nurse and feel there is a lot that can be done to reduce the abuse that goes on at work. One thing is to be consistent in refusing to put up with it. It is bad enough when from patients but totally unacceptable from relatives or others accompanying patients and they should be charged or barred from the hospital if they behave abusively or aggressively.

  3. I have to say there are some nurses that just attract this sort of behaviour as well. I remember inwardly groaning whenever on shift with one particular collegue because she had a real skill for working people up. Not deliberately, it just seemed to come naturally to her, partially because she’d worked in correctional services in the past and was frequently recognised!

    There are a multitude of factors that we as nurses can have some control over as Greg has mentioned. But unfortunately we can’t pick and choose our patients.

    Would clearer and ‘narrower’ definitions of our duty of care to obnoxious persons give ED’s more power to remove abusive clients? Would that necessarily be a good thing?

  4. I work in inpatient psych, which on this topic has its ups and downs. On the one hand, we can see more than our share of unpleasant speech and behavior. On the other hand, we have the training, experience, and infrastructure to manage it. We can set and enforce limits. We can diffuse misunderstandings. We can address threats with real teeth, and while we must not abuse it, there it is. We have some power. Of course, much of our power depends on years of history, building rules and procedures to systematically deal with abuse and threats. There is no reason any Nurse should have to deal with such people alone, or without effective tools. We can and should learn to become fully prepared, and keep our clinical milieus safe for everyone.
    Also keep in mind: its not all about sticks. Carrots work very well, and should be used most often. Be very good to people, give them every reason to appreciate and respect you, and far fewer problems will arise. Far too many times I have seen patient crises where the staff bore primary responsibility, with disrespect, neglect, abuse, laziness, or poor planning. Trying to save time often wastes much of it, when people react with anger or distrust. We all need to never stop working on our people skills. Its not about blaming the victim, its about each of us gathering power: we can only become more effective if we acknowledge and learn from our mistakes. Diplomacy, a wise man once said, is making someone insist on having things your way. Sadly, there is no systematic education or training in such skills in health care, and we pay for it.

  5. Having worked in EDs from 1989 -1999, I finally left (after 3 assaults # ribs/ huge chest wall haematomas, verbal abuse etc. ) after being phoned at home by someone who threatening to kill me.
    One of the hospitals I worked at during this period refused to read the incident reports in the OHSW meetings, because the committee found it ‘upsetting’. It was very difficult to get more staff/support/security when the only route of change couldn’t be accessed!!
    There was no support from the hospital, and our only recourse was to make a police complaint in our own time.
    It is good to see there has now been a move by politicians in South Australia to protect medical and Nursing staff from worksite violence. But from my point of view – far too late.

  6. I feel for the nurses who are abused and treated badly by patients. It’s nice to know that patients don’t have similar complaints about nurses. It’s a comfort.

    • I agree that nurses, in fact anyone, should never be subject to abusive behavior. With respect, however, I must disagree that patients don’t have similar complaints about nurses. While I have never been physically attacked by a nurse, I have been abused by a handful in an Adult Mental health hospital. The doctor had prescribed a particular medication for me that the pharmacy did not supply (it was called Stalevo 125, for restless legs syndrome). The nurse crossed it off the list, thereby “unprescribing” it without consulting the prescribing physician. It was up to me to suggest alternative medications, the combination of Sinemet and Comtan, which are the two ingredients of the original Stalevo. The nurse was offended that I would do this, so another nurse at a different time made the call to ask the physician who indeed approved it. However, the pharmacy did not prescribe those medications either, and it was once again crossed off the list without doctor consultation.
      To this I became angry and mentioned Mirapex to the abusive nurse. She refused to make any call, and once again the next day I asked a different nurse who made the call and got it approved in five minutes.
      The abusive nurse seemed intent on taking out her frustrations from other patients on me and engaged me in an argument, something about telling her how to do her job. Well, she wasn’t doing it, and was also in violation of a few of my patient’s rights.
      Ultimately I wrote an eight page complaint through the proper channels, and things changed according to a more recent visit to that hospital. Having a mental illness makes it all too easy for me to relive the intense moments of that abusive behavior for as long as I am able to remember it. I was treated as if I were unintelligent and not allowed to ask questions. For me this was traumatic, but I gave a copy of the eight page complaint to my psychiatrist who, at my following appointment, commented with a smile stating that I had some very real points that were taken seriously by the hospital administration. My psychiatrist’s words, and seeing for myself at the more recent hospital visit that the nursing staff was structured and not lax, are my only two reasons to feel consoled by the nurse’s abusive behavior which resulted in being escorted to my room by a security guard… one who seemed to take my side in a very sublime and unspoken manner.
      My point is that I recognize and understand that a nursing position is stressful, but the “flip side of the coin” has multiple experiences in which some nurses are automatically “on guard” to put patients in their place before they have reason to do so. I am very impressed by the earlier comment my a Greg Mercer, MSN, as it is so clear to me that his comment was very well though out.

  7. The ED environment may well precipitate more abusive situations due to the acute nature of stressful scenarios and the like (as well as the ability of anyone to just roll up and be obnoxious). Nonetheless, other bits of the hospital have their fair share of high stress, high acuity situations that mimic what you see in ED.

    The level of accountability for one’s actions probably makes some difference. In ED, your interactions with patients is transitory, so people may feel like they can hurl any abuse they want at you with impunity because they’ll never see you again, unlike the wards wherein the relationship is ongoing over days, weeks or months – so many probably toe the line when there’s something at stake for them. Obviously the flipside of this on the wards is when people don’t feel self-conscious about being unpleasant to the staff, day in, day out – for as long as the admission lasts. Building and maintaining a clinical rapport with patients is impossible if the relationship is based on the premise that it’s okay to abuse staff at will. At least in the ED they move on (albeit to simply be replaced by a similarly-minded cretin the next day).

  8. Well I can’t say that I have never been insulted or verbally abused- 10 years in an ED certainly brings a fair share of this. I do however think that outside of that setting this type of treatment is far less common. After a decade in inner city ER’s I have worked in a variety of settings and dealt with much less abuse and it often in the form of phone rather than the “in your face” type. It is so challenging to handle such high stress situations AND the public’s abuse.

  9. I think what is sad is that the institution itself can condone bad behaviour towards staff. I once lost my sh*t completely at a support staff member who took the side of a family member who had been removed from the hospital for verbally and physically threatening a number of nursing and medical staff. The position of said staff member was that the offending person was “naturally upset” and “it is our job to understand and support them in their time of distress”.

    Last I looked, “understanding and supporting” someone does not include being insulted, ridiculed and threatened. Furthermore, it’s not “natural” to pull out a weapon and brandish it when you’re upset, nor threaten to follow someone home at the end of their shift and kill them. It’s just p*ss poor that abuse has become so normalised that it’s not recognised for what it is.

  10. What irks me a lot more is the people that believe they can abuse me based on the colour of my skin, yet if I was to do the same, I’d be called a racist and probably lose my job.

  11. I was called a ‘putana’ once by an angry older woman, i just smiled – didn’t know what it meant and when i found out i thought hmm, now i know why her daughter was laughing. not cute

  12. I have certainly had it happen to me. I don’t have to put up with that crap. Anyone who is abusive to me gets told that I will not be treated in that way and I don’t actually have to look after them and if they continue to act this way I will be withdrawing my care from them. I am yet to have one that didn’t toe the line after the speech

  13. There is something to be said about the delivery of care. By that I mean how nursing care is packaged. Offcourse you continue to do your best to ensure the physical needs are met, but here is a thought for all. One could almost turn this into a mathematical equation.

    Arsehole behaviour displayed by patients and friends
    _____________________________________________ = Care received
    Resilience of nursing staff x density of presentations

    having said that, when you really look at those that carry on like pork chops there is always a sad element of powerlessness on their part. Understanding what need is unmet goes a long way, however sometimes their needs are so great not even Frued could sort it.

    • Ha ha, love it Anja!

      Sometimes you can understand where the behaviour is coming from, but nothing EVER makes it acceptable. Other times it’s just plain old booze or drugs, and other times it’s just an arsehole of a person trying to make themselves seem big and macho. I wish we were allowed to give back exactly as they give to us :-O

  14. I was just talking to my hair stylist about this yesterday. I had just cared for a particularly verbally abusive teenaged (drug-seeking) patient whose parent seemed to find nothing wrong with her behavior, and I asked, “Do you talk like this at Wal-Mart? Or the gas station? Or ANYWHERE else?” I asked the parent, “Do you let her talk like this anywhere else?” My stylist said, “Well, I never thought about it like that either.” Why not? I’m done with putting up with this stuff. And management is no help. In a recent staff meeting my boss said we need to be more polite even when patients are assaulting us! I’m totally serious. Apparently a patient complained that a nurse was overly harsh when telling him to “stop spitting!” These people are not eggshells. I’m not going to handle them with kid gloves when they’re trying to hit me, spit on me, or tell me I “fucking suck” (the teenager referenced above). They KNOW we need high patient satisfaction scores and will remind you about it. “I’m the customer,” one patient said as he deliberately directed charcoal diarrhea through his bed rails and on to the floor. “You have to clean my shit up because you’re just a stupid fucking PAWN.” Sorry. I’m not going to be polite when responding to this type of behavior. I am a highly educated, hard-working, integral part of the health care system, and I deserve at LEAST the same amount of respect your average grocery store checker gets.

    • Well said. It always amazes me that patients and their friends/families leave their manners at the door when the enter a hospital/health care facility.

  15. Well well well .. I am just waiting for the day that a patient or family member can come up with an insult and abusive comments that I haven’t heard before .. It always amazes me that patients can be nice to each other as well as their family members but treat us like we are useless and deserve it . But at no time can we retort back as that is seen a threat and against their rights .. We do not seem to have any rights ..

  16. A daily occurrence in my workplace too. Agree totally with your comment, Ian. These behaviours would not be tolerated in a bank, shopping centre or office, but people seem to think hospital staff are fair game. We do call security, but find it is often to placate the offender and move them through quickly rather than to get them to leave. I’m sick of pandering to these people. A cohesive,supported management strategy needs to be put in place!

  17. We have a lot of verbal and physical abuse in aged care facilities as well. More often than the other way around staff get abused by the elderly and/or their relatives. I think abuse of nursing and care staff should be made a public issue.

  18. I clearly remember an event that happened a few years ago. A police officer lost her husband on our SICU. She threatened to get her gun and shoot everybody down. After that she was arrested by her own coworkers at the department while getting her gun!
    Here in Germany the people are not that aggressive to nurses like you article describes. Threats are very uncommon. You will see a lot of disrespect to nurses, like people saying that you are just there to wipe patients arses.

  19. As an emergency nurse my day would not be complete with out being called a F*@ning Bitch at least once a day or being physically threatened. I have been nursing for 30 years and have observed the increasing bad behavior of the public. Strangely enough it is not just from drunks. I find relatives to be particularly nasty towards staff. I think the public have forgotten that we are someones son or daughter, someones mother or father, someones brother or sister. How would they feel if their loved one was abused when they are only trying to do their job. We tend to take it because we care about them and “they are unwell”. May be there needs to be some adds run on “no more abuse to health care workers”.

  20. I’ve copped my fair share of abuse and it’s not on!

    I’ve also found that telling people that sometimes helps. I was nursing a very drunk, physically and verbally abusive woman in an ED, I told her calmly that we were trying to help her and that it wasn’t ok for her to act like that. She shut down and was calm and compliant for the rest of the evening, surprised the hell out of me, she even apologised!
    Another shift I had a middle aged man who was making inappropriate comments to the female staff. I told him that this is where we work and that it wasn’t ok to make those kind of comments. Same response, he was really taken back and suddenly became quite pleasant!

    I don’t think that I get abused as much because I’m a male nurse but I wish I could wave a magic wand and make my workplaces safer for my teammates.

  21. Sadly I’m not so sure nurses are the only profession abused. Police. Ambos. Staff at correctional facilities. And you know who else, teachers. I went to a “rough” high school in a rural NSW town, and your summary of behavior above sounds sadly similar to an average day. My MIL is a primary teacher in a supposedly much more civilised community, and she reports similar (though less frequent) events. And I reckon the bank tellers from my home town probably cop it as well.

    I wonder what would be found from a similar study at a private hospital?

  22. One of the many reasons that I have chosen to leave the bedside.

    the abuse, both physical and verbal
    the lack of acceptable response or strategy by management to deal with it
    the lack of community ownership of the problem
    why is it now acceptable that c*nt and f*ck are used in everyday conversations?

  23. This is such a regular occurrence in ER serving approx 80k per year, I don’t know where to begin. Not two weeks ago, I had to go back to an older gentleman to repeat blood after replacing some K. I pulled back the curtain, he looked at me and said “What are you doin’ back here you dumb c*nt?” At the top of my lungs, so I’m certain EVERYONE heard, I said “Did you just call me a dumb c*nt?” He looked very sheepish. “I’ll have you know I’m not dumb!” And the sad thing is, I’m a guy. But that’s our population and you grow numb to it after awhile…

  24. Speaking as a nurse of 23 years I can say that I have only ever been treated like this by antisocial elements who are inappropriately placed in various units of the hospital instead of gaol! If this group is dealt with effectively where damage is limited, then this will greatly decrease this terribly irresponsibly behaviour.

  25. This is my daily job. I’ve had patients try to kick me in the face, I’ve had various threats of violence screamed across the room at me, I’ve been told that I caused my patients to have ESRD, had a patient threaten to “give me” hepatitis C, and patients have pulled their own dialysis needles out and threatened to stab me. I am frequently insulted (as are other stuff) eg., “you look fat today”, as well as the usual “do you even know what you’re doing” and various profanities.

    Our policy is to call security immediately, and depending on the level of aggression, remove the patient from the unit. I always file a workplace incident report, clinical incident report (any workplace incident involving a patient requires a clinical incident report as well where I work), and a complaint, because it just is not acceptable in any circumstance, and management supports this.

    I have found however, that other staff do not always follow this policy, and will give the patient whatever ridiculous request they are screaming at us to calm them down. Unfortunately, it makes it that much harder on the rest of us to deal with this behaviour.

    • To add, calling security is for behaviour that has escalated. If the patient is swearing or making other inappropriate comments, usually I will say something along the lines of “that sort of language is unacceptable” and often walk away to see if the patient calms down, to then come back and re-address the patients concerns when they are less hostile.

  26. What a coincidence, I was just commenting to some colleagues about the range of things I get called at work, all in one day I received: Lou, Louise, nurse, sister, maam, and f*cking c*nt. I was called the last by a patient who I asked if he could talk to me instead of grunting so I knew what the problem was, so he decided that the appropriate response was a tirade of abuse and profanities. This is not an uncommon occurrence. I have one approach, I inform the patient that there is zero tolerance for their behaviour and if they continue to behave in that fashion they will be asked to leave and escorted from the premises. There is no excuse for talking to anyone like that!

  27. A day in the life of my work place…..most of my patients are initially drunk or high so anything goes

    • I work in a detox so most of my patients are drunk or high on admission too, but i disagree that anything goes.They are not forced to be there, they sign a contract which includes understanding they may be discharged if they behave in abusive ways,( depending on the circumstances, funding, politics etc) this may be enforced, even if they are not discharged, they are always pulled up on unacceptable behaviours including verbal abuse. They are advised what is expected before they come in and most people manage to behave respectfully despite intoxication on admission.
      Of course setting out expectations in advance is easier with planned admissions but i think expecting certain standards of behaviour goes a long way, management support to enforce the withdrawl/suspension of care to those who are abusive is vital, Most of my patients are frequent attenders at A and E, yes, usually the ones who complain about waiting times while insisting they can’t possibly have an ecg/blood gases taken/any other urgent intervention until they’ve been taken out for a cig. Expecting them to behave badly and putting up with it doesn’t help, mental health issues, withdrawal, drugs and alcohol and the impact of the social stigma that goes along with it all might make people less motivated to refrain from taking out their fear and frustration on nurses but these factors rarely make anyone truly unable to behave respectfully.

      Personally i have quite a high tolerance for people swearing descriptively about how bad their pain/life/self esteem is, if they start swearing at me or being abusive towards others, i point out that this makes it very difficult for people to help them.
      I also agree that focusing on unmet need helps keep things in perspective and maintain a theraputic relationship that can be seen as worth kerbing bad behaviour to maintain.

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  • impactednurse.com will soon be gone. (3)
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    • jelly said: Just work a few more hundred Sundays!

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