How to Deal with Unacceptable Patient Behavior

With ROAR having recently partnered with the BeWell behavioral wellness center in Philadelphia, I have seen first hand how improving staff well-being to create safer workplaces within clinical settings is crucial to ensuring the highest levels of care.

It begins with addressing unacceptable patient behavior, and successfully doing this can lead to significantly reduced violent incidents, decreased workers comp claims, and reduced staff sick leave and workplace injuries.

This article is designed to help you identify inappropriate dynamics in high-stress settings or when dealing with patients with mental health or addiction issues. In addition, we will explore the different types of patient behavior that may be termed unacceptable, as well as look at how to prepare your team for dealing with them. Read on to learn more.

Tips for Dealing with Patients

In collaboration with healthcare providers, and by drawing on my own experiences of dealing with unacceptable behaviors, we find that the following tips can be highly effective.

1. Set Physical Boundaries

Our clients suggest that if a patient has touched a staff member inappropriately or made verbal threats or suggestive comments, it can help to set physical boundaries.

Doctors or nurses should tell a patient clearly and firmly that physical contact is not allowed and that their actions are unacceptable. If the behavior continues, calling in security personnel or a co-worker is the next step.

2. Involve Your Co-Workers

Sometimes, patients don't respond to verbal warnings. This is especially common when the person is suffering from a mental health condition or has taken drugs or alcohol.

In these cases, we suggest that two members of staff should attend to the patient instead of one. This will minimize the opportunity for such behavior and make professionals feel safer.

Having two people in the room can also reduce the chances that a patient accuses a professional of malpractice or inappropriate behavior at a later date.

3. Have a Reply Planned

Among the simplest and most effective suggestions from our clients is that all medical professionals should have a short, firm reply ready for patients acting in an unacceptable manner. These replies should be clear and professional and leave no room for misinterpretation.

4. Be Firm with Your Response

It's important to be firm with your response to unacceptable behavior. If the patient doesn't amend their behavior following a warning, security personnel should be called and the patient told that they may be transferred if the behavior continues.

5. Document Patient Behavior

Whenever unacceptable patient behavior occurs, it should be thoroughly documented. This is a key element in tracking individual patients and our clients are able to also use this documentation to help train staff members and to provide evidence in case of criminal prosecution.

Many organizations are now pairing documentation practices with staff duress systems that automatically log the time, location, and nature of an incident when an alert is triggered — creating a reliable record without relying on manual reporting in the moment.

What Types of Behavior Are Unacceptable?

Unacceptable patient behavior takes many forms and is not easily defined. However, I would suggest that it is any dynamic that makes you feel uncomfortable or threatened, and most would agree that situations where caregivers experience this may be considered as inappropriate. The most common types of inappropriate behavior that healthcare professionals experience are:

• Verbal abuse or threats — Direct insults, shouting, or statements intended to intimidate staff
• Physical intimidation — Aggressive posturing, blocking exits, or invading personal space
• Racist or sexist comments — Derogatory remarks directed at a staff member's identity
• Sexual harassment — Unwanted touching, suggestive comments, or inappropriate gestures
• Persistent rudeness or sarcasm — Ongoing disrespect that erodes the care environment

Remember, while not limited to these categories, and though inappropriate comments, rude, threatening, or disrespectful behavior is never acceptable, it's important to try to understand why a patient may be behaving in this way.

Considering possible causes can help you to handle the situation appropriately, and taking the time to see things from your patient's point of view may make it easier to diffuse their anger and treat them effectively.

In some cases, patients and family members may become angry or frustrated if they've had to wait a long time for treatment, or if they feel that their concerns are not being taken seriously. In these instances, you may need to apologize for the wait or sit down with them to show that you're really listening to what they have to say.

In other cases, there could be a medical reason for the disruptive behavior. Mental health issues, and conditions like dementia and Alzheimer's, can cause patients to act aggressively and erratically. Alcohol and drug use can also lead to bad behavior. If you suspect your patient has ingested drugs or alcohol, or has a mental health issue, you may need to call in backup to help you deal with the patient until their treatment takes effect.

If there's no obvious cause for the unacceptable behavior, it might be time to call hospital security or inform your practice manager. Threatening, aggressive or disruptive behavior shouldn't be tolerated, especially if it puts staff or patient safety at risk.

Handling Racism and Bigotry

Hospitals are often very diverse places, with both staff members and patients coming from a wide range of backgrounds. As a result, it's not uncommon for a patient to be treated by a clinician with a totally different heritage or culture.

This can result in patients requesting to see different doctors or even making bigoted or racist comments.

The American Medical Association (AMA) recommends that patients who act in a derogatory manner be transferred to another provider. It also states that, while a patient should be respected, their bigoted or racist views should not be.

Everyone, Including Staff, Deserves to Be Respected

All hospitals and treatment centers should make it clear that everyone using the premises, including staff, deserves to be respected.

This can be done by placing notices around a hospital or medical center stating that there is a zero-tolerance policy on aggressive, violent or otherwise inappropriate behavior and that patients and staff are required to be respectful at all times.

Preparing Your Team

However experienced your team, preparing them for unacceptable behavior and teaching them how to cope with difficult situations is highly important.

I have seen the difference that education and knowledge can make, and by giving all staff the tools they need to manage patient care and deal with challenging patients in a professional manner, your entire facility stands to benefit.

Team members should be trained in the appropriate use of panic buttons and personal alarms. Panic buttons for healthcare workers can be used to quickly and silently call for help if a professional is threatened or assaulted by a patient.

Training workers to use panic buttons properly will ensure the overall performance of the duress system and help team members to feel safer when at work.

A good example of healthcare professionals dealing with unacceptable behavior can be found in the JAMA Internal Medicine essay Inappropriate Behavior by Patients and Their Families—Call It Out by Dr. Amy Nicole Cowan.

In it, Cowan describes how a family she saw didn't want to be cared for by a Muslim medical student or be treated by her because she was a woman.

Cowan used this experience to develop methods of dealing with these types of situations. One of her most important recommendations is to be firm in the face of unacceptable behavior.

She also suggests medical professionals have a short reply ready to warn patients before their behavior deteriorates. Cowan advises that coping strategies be taught to students in medical school.

When and How to Dismiss a Patient

If a patient doesn't respond to warnings and continues to act in an unacceptable manner, it may be necessary to dismiss them. If you find there's no other option but to transfer or dismiss the patient, you should explain the situation to them as calmly and clearly as possible.

Safer hospitals, clinics, and medical practices benefit everyone involved — from the employees that report greater workplace satisfaction to the patients who benefit from better care thanks to calm and productive staff.

Having witnessed the difference safer working spaces have on everyone's well being, it's clear that building this type of working environment should be a priority.

To learn more about coping with violence in the workplace and how our panic button systems are already protecting health service workers across the country, explore our case studies or get in touch with a member of our team.