De-escalating Agitated Patients

You've been trained to provide excellent patient care. But "excellent patient care" training rarely covers what to do when a patient is screaming in your face, blocking the door, or making threats.

The standard advice — "stay calm," "use a soft voice," "validate their feelings" — isn't wrong. But it's incomplete. It doesn't account for your safety. It doesn't give you a framework for when de-escalation isn't working. And it doesn't acknowledge that some situations can't be talked down.

Before You Enter the Room

Know what you're walking into. Check the chart for behavioral alerts. Ask colleagues about recent incidents. If there's a history of aggression, don't enter alone.

Position yourself for exit. Never let the patient get between you and the door. If the room layout makes this impossible, leave the door open or bring a colleague.

Remove potential weapons. This includes your stethoscope around your neck, loose jewelry, or anything that could be grabbed and used against you.

Verbal Techniques That Work

Lower Your Volume, Slow Your Speech

When someone is escalating, matching their energy makes things worse. Speak slightly slower and quieter than normal. This often unconsciously prompts them to do the same.

Validate Without Agreeing

Try: "I can see you're frustrated" rather than "You have every right to be angry." The first acknowledges their emotion. The second can feel like you're taking sides.

Offer Limited Choices

"Would you like to sit down, or would you prefer to stand while we talk?" This gives them a sense of control without giving them actual control over the situation.

Use "We" Language

"Let's figure this out together" is less confrontational than "I need you to calm down."

When to Call for Backup

Trust your gut. If something feels wrong, it probably is. You don't need to wait for a specific threat to ask for help.

Have a code word. Work with your team to establish a phrase that means "I need help but don't want to escalate this." Something like "Can you bring me the blue folder?" that sounds normal to the patient but alerts your colleague.

Know where your panic button is. Every time you enter a room, note its location. You may not have time to look for it later.

If You Need to Leave

Sometimes the best de-escalation is removing yourself. There's no shame in this — it's smart.

Use a non-confrontational exit. "I'm going to step out and get some supplies. I'll be right back." This gives you a reason to leave without making them feel rejected or abandoned.

Don't turn your back. Move toward the door while keeping them in your peripheral vision.

Don't run. Running can trigger a chase response. Walk purposefully but calmly.