One of the most complex emotions, anger is a normal response to certain situational triggers. It’s associated with physiologic changes, including increases in heart rate, blood pressure, and adrenaline level.

How we express anger—and how frequently and intensely it erupts—can be either beneficial or detrimental to yourself, those around you, and the larger community. Some people anger more easily than others. Some are easy to anger from birth, while others eventually develop this trait.
Evidence suggests some children are born irritable and touchy and are perceived that way from an early age. Family background also can play a role. Many easily angered people come from families that are disruptive, chaotic, and unskilled in emotional communications.

Common mental and behavioral health issues that may lead to increased irritability
or difficulty managing anger include:

• untreated depression or anxiety
• bipolar disorder
• chemical dependency
• attention deficit disorder (ADD) or attention deficit-hyperactivity disorder (ADHD).

Less common and more serious psychiatric disorders associated with anger include schizophrenia, borderline personality disorder, oppositional defiant disorder, and antisocial personality disorder. When anger underlies a more serious mental health problem (such as depression or anxiety), assessment and support are essential to address the situation effectively.

Normal vs. pathologic anger

Normal and pathologic anger differ in various aspects.

• Pervasiveness: Does anger occur as a single, isolated incident? Or does the person get angry about many things and with many people?
• Duration: Does the anger subside once the person expresses it? Or does he or she brood afterward about the event that triggered it?
• Communication: Does the person express anger constructively? Or does he or she use sarcasm, insults, threats, or shouting?
• Physicality: Does the person try to injure or physically intimidate the person who triggered the anger? Does he or she throw or break things in a rage?

According to Stephen A. Diamond, PhD, a clinical and forensic psychologist, “For the most part, anger disorders cannot be blamed on bad neurology, genes, or biochemistry. They arise from a failure to recognize and consciously address anger as it arises, before it becomes pathological and dangerous.”

What makes nurses angry?

Sandra Thomas, PhD, RN, FAAN, found these common triggers for anger in nurses:

• feeling overloaded and overwhelmed
• not being treated with respect
• feeling blamed or scapegoated by phy­sicians and other healthcare workers
• feeling powerless and lacking control over the work environment
• feeling they weren’t being heard
• feeling moral distress after witnessing unethical, harmful, or dehumanizing behavior and actions
• not feeling supported by managers or peers.

Being on the receiving end of patients’ or families’ anger also can cause anger or distress in nurses. Such anger may seem unfair or unjustified, especially when triggered by something the nurse can’t control, such as hospital or clinic operational issues, behavior of other staff, or just fear or discomfort.

Bullying and horizontal hostility also can cause anger, to the point that some nurses consider quitting their jobs or even the profession. Sometimes, anger arises out of a nurse’s uncertainty related to healthcare reform, as well as changes in career opportunities.

Regardless of the trigger, a nurse who uses verbal or physical attacks when angry has an anger-management problem—and, by extension, so does the organization where that nurse works. (See How “toxin handlers” can ease organizational anger.)

Preventive medicine: The soothing effect of relaxation

If you finding yourself becoming angry often, you can take steps to manage your anger before it escalates into something toxic that could affect your career and patient safety. Just as anger releases chemicals that tell your body to prepare for fight or flight, intentionally calming your body physically through relaxation or meditation calms your automatic emotional responses and signals your brain to slow down. This, in turn, allows you to engage your thinking brain, which can discover options that benefit you.

There’s no one right way to relax. Find the method that works for you—and if that method stops working over time, try something new. Here are a few highly effective relaxation techniques that take just a few minutes.

• Deep breathing: This technique engages the abdominal muscles. To start, breathe in through your nose and let your abdomen expand fully. Contract your abdomen to expel your breath; then release your abdomen and let the air rush back in. On inhalation, your belly, lower ribcage, and lower back expand, drawing your diaphragm down deeper into the abdomen. On exhalation, they retract, allowing the diaphragm to move upward toward the heart.
• Progressive calming: Starting at the top of your head and working your way down to your toes, consciously let go of tension in each part of your body—one part at a time. Concentrate on each area. Start with your scalp and proceed down to your eyes, cheeks, chin, neck, shoulders, arms, chest, back, pelvis, hips, thighs, calves, ankles, and finally your feet and toes.
• Guided imagery and meditation: Using calming background music if desired, imagine yourself in your favorite peaceful place. This technique usually is most effective if you start with deep breathing or progressive calming, which helps you enter a meditative state.
• Group meditation: Joining a meditation group helps ensure you’ll make time for meditation on a regular basis and sit still long enough (10 to 20 minutes) to experience benefits.

Although you might balk at having to make time for relaxation or meditation, you’ll find the investment worthwhile because these activities can enhance your productivity throughout the day.

Other ways to harness your anger

Monitoring your reactivity, establishing boundaries, and improving your communication skills can help you deal with anger more effectively.

Monitor your reactivity

Become aware of your own early signs of reactivity, which can perpetuate an ineffective anger response. Notice, for instance, if your heart races or you feel tightness in your chest or throat in response to a trigger. If these early signs appear, decreasing your reactivity will make it easier to stop an emotional reaction. Otherwise, you’ll most likely revert to “automatic pilot” in trigger situations, rather than thoughtfully and strategically exploring options that will meet your needs and others’ in more effective ways.

If you’re aware of tension building inside you, you may be able to understand more clearly what’s upsetting you. For example, you might say to yourself, “I’m so frustrated! Sally seems to do no wrong in my supervisor’s eyes. Yet I know she does personal online shopping at work, finds excuses to have the lightest caseload, and isn’t a team player.” If you realize this anger has been building over time and you’ve avoided taking action, you can consider your options thoughtfully instead of succumbing to the overwhelming and counterproductive urge to react emotionally. Sometimes it’s not easy to clarify what’s really causing your anger. Identifying the core issue that triggers your anger helps generate effective solutions.

Determine what you can and can’t control

Trying to control something you have no control over is a recipe for anger. As nurses, many of us feel tremendous responsibility and get upset when others act less responsibly. If you’re angry over something that’s outside your control, generating options for the things you can control helps you let go of the rest. If you’re clear about what you can and can’t control, you may still be disappointed if nothing changes, but you’ll no longer feel as helpless about it.

Improving your communication skills

When you’re angry, you may perceive only two options—hold the anger in or speak in anger. Holding it in is caustic to you; speaking in anger is caustic to others.

Although you and your colleagues probably have the same healthcare delivery goals, how you reach those goals can create conflict. Effective communication skills enable you to share your emotions in an honest, kind, firm way, increasing the chance of achieving your goal. For example, instead of telling a colleague, “You need to do it this way,” state, “I’ve found that doing it this way is more effective because….” This builds understanding and opens the door for further collaboration.

By implementing these strategies, you’ll increase opportunities to build relationships and a stronger team. If you hold your anger inside, you’ll eventually deplete your energy, become dissatisfied, and feel increasingly tense.

Teams can accomplish far more than an individual can, so putting your energy into building a good team makes nurses’ work more rewarding and motivating. Feeling rewarded and motivated lifts your energy, mood, and attitude—and this helps improve patient care.

Selected references

Diamond SA. Anger disorder: what it is and what we can do about it. Psychology Today. April 3, 2009. https://www.psychologytoday.com/blog/evil-deeds/200904/anger-disorder-what-it-is-and-what-we-can-do-about-it

Frost PJ. Toxic Emotions at Work and What You Can Do About Them. Boston, MA: Harvard Business Review Press: 2007.

Thomas SP. Transforming Nurses’ Stress and Anger: Steps Toward Healing. 3rd ed. New York, NY: Springer; 2009.

Julie Boertje is a nurse peer coach at Midwest EAP Solutions, a division of VITAL WorkLife (formerly Workplace Behavioral Solutions, Inc.), in Minneapolis, Minnesota.