2.2.4: Conflicts in the Healthcare Setting

An emerging concern within the Board’s licensee population is the potential for confrontations leading to physical violence and/or verbal abuse between healthcare providers, their patients, and/or third parties, such as patient families or caregivers. This position statement is intended to provide strategies to assist in de-escalating potentially volatile situations and prudent practices in the aftermath of such situations. 

Strategies for De-escalation 

When faced with a potential conflict in the health care setting, the following strategies may help to de-escalate the situation and/or foster a common understanding. 

• Actively listening to the speaker and attempting to understand the nature of the speaker’s concerns. Active listening entails remaining calm, encouraging the speaker’s expression of concerns, asking follow-up questions for clarification, resisting interruptions unless necessary, being respectful towards the speaker, and/or employing attentive body language.
• If possible, it may be helpful to attempt to identify those areas where there could be common ground and potential solutions that are acceptable to all parties.
• Demonstrating empathy for the speaker and acknowledging their perspective. Empathizing with the speaker includes being open to the possibility that the speaker’s concern is valid, and/or a mistake or error may have occurred.
• When appropriate, it may be helpful to apologize to, or accept an apology from, the speaker.
• If there is an agreeable resolution, working with the speaker to identify potential next steps and to clarify responsibilities.

Licensees faced with an emotional and/or physical confrontation with a patient should also consider whether the challenging behavior results from a medical condition and, if so, whether it is possible to treat the patient without putting oneself at risk of harm. 

An Act or Threat of Violence 

In instances where violence is threatened and/or occurs, the top priority of the licensee is to ensure the safety of patients, medical staff, and the licensee themself. If licensees find themselves in an unsafe situation, they should, if possible, immediately leave the physical area and call for help from security and/or law enforcement. Every threat of violence should be documented and reported through appropriate channels, even if efforts to de-escalate the situation have been, or appear to have been, successful. 

The Aftermath 

The Board is aware that there will be times when a licensee’s efforts to de-escalate a conflict will be unsuccessful. In some instances, the confrontation may make it untenable to continue a licensee-patient relationship. If the licensee intends to terminate the licensee-patient relationship, they should do so consistent with the Board’s expectations outlined in the position statement “Licensee-Patient Relationship.” In the event the licensee feels it is unsafe to provide emergency treatment for 30 days following the termination of the licensee-patient relationship, this should be communicated in the termination letter and documented in the patient’s medical record. The licensee should also ensure that the patient has enough medication for 30 days following the termination and that appropriate referrals have been made to allow for continuity of care. 

Conflicts that take place in the context of providing medical care should be documented appropriately. Such documentation should include all factual details of confrontations or abusive situations, including, but not limited to, the following: 

• Names of those involved;
• Location;
• Date and time;
• Nature of the situation;
• Steps taken in response to the situation; and
• The identity of any witnesses present.

The Board encourages licensees who experience a conflict within the healthcare setting to reflect on the event and its impact on the licensee’s own mental health and self-care. Additionally, when appropriate, the licensee should debrief with any other medical staff involved. Doing so may help manage and reduce stress responses after an event, make sense of what happened, and identify areas for improvement. 

Further, the Board urges licensees who have experienced conflicts or other stressors within the healthcare setting to engage with the North Carolina Professionals Health Program or other available mental health resources. A list of some available resources can be found at the Board’s Clinical Wellness - Resources and Links.