I recently went to my healthcare provider for an appointment and noticed a sign near the entrance that informed visitors that violent behavior would not be tolerated, and that action would be taken if someone was verbally or physically abusive to the healthcare staff. Sadly, I wasn’t surprised that this type of sign had to be displayed. There have been numerous stories of healthcare providers, including school nurses, being verbally abused, and threatened as a response to anger and frustration over the Covid 19 pandemic.
These threats of violence have also been directed at school personnel and school board members. In response to this increasing concern, the National School Board Association wrote a letter to President Biden in September 2021 asking “federal law enforcement and other assistance to deal with the growing number of threats of violence and acts of intimidation occurring across the nation”.
Ask any school nurse and they will tell you that they have, in the past, had to navigate a difficult conversation with an angry parent but it seems the intensity and frequency of this anger has increased. Not only are school nurses subjected to the anger of parents over the implementation of Covid 19 mitigation methods, such as mask wearing and quarantining, but school nurses must also navigate, the sometimes, harsh backlash from school personnel and school leadership when school nurses advocate for evidence-based strategies that people are tired of having to implement.
As I think about these challenging times that we are all facing, I often find myself searching for the “easy button”, the one or two actions that we can take to make our current situation, in this case, communicating with angry individuals, easy or at least less complicated. Unfortunately, these complex relationships are not easy. These challenging situations require us to be thoughtful and intentional. Below are some suggested strategies to implement when communicating with others who are expressing anger.
Model appropriate behavior– Although you may feel your blood pressure rising and your own emotions turning to anger, try to stay calm, take deep breaths, maintain a relaxed body language, and communicate in a calm, non-threatening tone, and manner.
Use your empathy toolkit– As nurses, we are taught to center the person and their lived experience. We are familiar with the concept of empathy, but it may be difficult to remain empathetic when individuals are expressing anger and resentment towards us. What could be helpful in these situations is to remember that anger is frequently a secondary emotion that is being expressed due to a primary emotion, such as fear or anxiety, that the individual is not comfortable with. Respond to the individual’s concerns by expressing understanding and a willingness and interest in helping.
Allow them to express their emotions but maintain boundaries- It is important for the angry and frustrated individual to feel as though they have been heard and understood. But it is also important for the school nurse to set boundaries and expectations. An individual’s initial communication may be loud and confrontational but hopefully, by modeling appropriate behavior, that individual reciprocates and continues the conversation in a calmer manner. But if that doesn’t occur, it is okay for the school nurse to inform the individual that they will only continue the conversation if the individual speaks in a calm and respectful manner. If the person does not accept the boundaries, it is appropriate for the school nurse to inform them that they are going to end the conversation and reschedule for another time.
Try to not take it personally– This one always seems easier to say than to do. As previously stated, anger can often be a secondary emotion that is being expressed because the individual does not feel comfortable with their primary emotion, such as anxiety or fear. Their anger is a result of their fear and anxiety about the pandemic and they are choosing to express it as anger and you, unfortunately, are who they are choosing to project that anger at.
In addition to being intentional about how we interact and respond to others, we also need to be intentional about how we care for ourselves. There are a number of recommendations on how to manage stress and emotions. This article will focus on two specific actions that school nurses can take.
One of the ways in which we can care for ourselves is to pay attention to our own emotions and work to correctly name them. Many nurses are experiencing anxiety, depression, sadness, and fear. We too may have the desire to deflect our anxiety and fear which can result in anger. Our anger may also result from feelings of sadness or disgust that what we know to be the best course of action is not being implemented by schools, parents, and society. When we are feeling angry, Megan Hays, Ph.D., clinical psychologist and assistant professor in the University of Alabama at Birmingham’s Marnix E. Heersink School of Medicine, recommends acknowledging the anger, stepping away, and allowing yourself time to cool down. She suggests, “instead of aggression or suppression [of anger], practice expressing anger in a healthy way through assertive communication techniques to articulate your feelings, needs and desires.” She also recommends avoiding ruminating on the situation that made you angry but instead to focus on what you have control over.
When engaging in difficult conversations or stressful situations, we may find that our own thoughts and the stories that we are telling ourselves may be making the situation worse. Let’s review the following example.
You are meeting with a school leader to discuss the fact that the number of student cases of Covid have doubled in the past week, and you would like to make some changes to the mitigation measures that are being implemented. The school leader seems frustrated, and their tone and body language demonstrate that they are getting angry. Although you don’t know why the school leader is angry you begin to craft a story about their emotions. You tell yourself that the school leader doesn’t agree with your recommendation. You go on to tell yourself that the school leader doesn’t think that you know what you are talking about. You might even begin to pull out past experiences with this individual and layer them on to the current situation by saying to yourself, “This person didn’t like how I handled this other situation in the past, so now they don’t trust my guidance and they are angry at me for making this suggestion”. The truth about this situation is that you don’t know how this person is feeling or if they are even mad. Unfortunately, the conversation is cut short because the school leader is called off to an emergency. You walk away telling yourself that this leader is not going to make any of the changes that you have suggested, and you become angry. You stop by a colleague’s office and vent your frustrations to them, telling them how mad you are that nothing is going to change and that more and more kids and teachers are going to get sick. You leave work that day feeling frustrated, sad, angry, and anxious about the future.
When we start to tell ourselves these stories, we begin to make decisions based on the story not on the reality. In the example above, that nurse left work that day coming up with a plan on how they are going to deal with the school leader’s anger and the nurse was convinced that nothing was going to change. The nurse is enforcing a self-inflicted perception that they have no control, and they were crafting a plan based on that false perception.
Cy Wakeman has developed a number of tools that could be helpful in these situations. One of Cy’s tools that school nurses may find helpful is the Ego Bypass Tool. In short, the Ego Bypass Tool walks the individual through a process of naming the truths about their current situation. The tool helps individuals disentangle the story that they are telling themselves from the facts that they know.
From the example illustrated above, the school nurse could use the tool to name the truths:
- Increased rate of Covid 19 cases.
- School leader’s body language and tone of voice changed when the school nurse shared this information with them.
- The school nurse has recommendations on what the school’s next steps should be based on the increased cases of Covid 19.
- The school nurse shared some of these recommendations with the school leader.
- The conversation about the increase in Covid 19 cases was cut short.
Based on the truths named above, the next steps seem somewhat obvious. The school nurse needs to set up another time to talk with the school leader and finish the conversation about the increased cases of Covid 19. The school nurse may or may not choose to bring up the change in body language that they perceived the first time they engaged in this conversation with the school leader. If the conversation goes smoothly and the school leader seems receptive to the recommendations, the school nurse may not need to mention that they perceived the school leader to be upset last time they spoke. If the school nurse was to perceive a change in body language and tone that suggested the school leader was becoming upset, the school nurse could discuss these perceived changes with the leader and create an opportunity for discussion and clarity about the school leader’s emotions.
Many times, our emotions are a result of the story that we tell ourselves. Combining Megan Hayes suggestion and Cy Wakeman’s, if we stop the cycle of ruminating on the story we are telling ourselves and allow ourselves to name the truths we know to be certain, we can develop a plan based on our current reality. Our realities most likely are still complex and messy but pulling out the facts can at least make the path a little clearer.
Resources for managing and responding to anger:
CDC: https://www.cdc.gov/howrightnow/emotion/anger/index.html
Psychological First Aid: Supporting Yourself and Others During COVID-19 Online Course: https://www.redcross.org/take-a-class/classes/psychological-first-aid%3A-supporting-yourself-and-others-during-covid-19/a6R3o0000014ZIg.html
American Psychological Association. Controlling anger before it controls you. https://www.apa.org/topics/anger/control
National Association of Social Workers. Managing Clients Who Present with Anger https://www.socialworkers.org/assets/secured/documents/practice/managingangerinclients.pdf
National Association of School Nurses. How to manage difficult conversations. https://schoolnursenet.nasn.org/covid19ref/featured-content/interactive-difficult-conversations
References
Confident Counselors. (2018). 7 simple ways to calm an angry parent and improve parent communication. Available at: https://confidentcounselors.com/2017/11/27/calm-angry-parent/
Hoge, B. (2021, September 30). Feeling COVID rage? Five strategies for managing pandemic anger. Available at: https://www.uab.edu/news/youcanuse/item/12313-feeling-covid-rage-five-strategies-for-managing-pandemic-anger
Reality Based Leadership. (n.d.). Ego bypass tool. New story exercise. Available at: https://www.realitybasedleadership.com/wp-content/uploads/2015/08/Ego-Bypass-Tool-New-Story-Exercise.pdf
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