As nurses, we all occasionally run into patients that could be described as “difficult.” For any of a variety of reasons, they’re unusually difficult to work with. They may complain constantly, hesitate to comply, or even be aggressive. Sometimes it’s due to a psychiatric or medical condition, like dementia or mental illness. In other cases, they’re just not the most pleasant people.
What can you do when you get assigned that notorious patient that no one else wants to take? As healthcare professionals, we can’t simply “fire” a patient, the way that some professionals can with their clients. The best we can do is to find strategies for managing the patient as best we can, and in worst-case scenarios where the patient may be aggressive, putting our own safety first.
Tips for Dealing with Rude, Demanding, or Otherwise Difficult Patients
The most common type of “difficult patients” are those who, frankly, are just plain rude. They’re unappreciative, demanding, and even downright mean. In some cases, there’s a medical issue at play. Irritability can occur as a side effect of some kinds of medication, or as a result of Alzheimer’s disease and other neurodegenerative conditions. But in other cases, no such organic or psychiatric cause can be identified.
Here are a few tips for diffusing conflict with unusually difficult patients in a healthcare setting.
- Don’t take it personally. Don’t interpret the situation as, “I have personally done something wrong,” or “This person is upset with me, specifically.” Most of the time, this simply isn’t the case. It probably has little or nothing to do with you. It’s important not to let yourself take it personally, or become too emotionally upset due to the way the patient is treating you.
- Look for underlying causes. As we’ve mentioned, irritability can sometimes have an organic cause. Many types of medications can cause irritability as a side effect — as you can see from the link, the list is quite extensive. Mood disturbances and behavioral changes can also occur in elderly patients with Alzheimer’s disease or other cognitive impairment. In some cases, a change in medication can help improve the patient’s mood and outlook.
- Stay calm. Remaining calm is incredibly important in these situations. You have to avoid become too emotionally upset, which can cloud your judgement. It’s important to realize that in most cases, the patient is lashing out at you simply because you happen to be in the way, not because you did anything to deserve it.
- Avoid letting the patient pull you into an argument. Arguments simply perpetuate themselves in a positive feedback cycle when it comes to this type of patient. Try to avoid being pulled into an argument or becoming too defensive, which can exacerbate the situation.
- Set boundaries. In many cases, difficult patients can drive you up the wall by giving you an endless stream of ridiculous demands. In these situations, it is completely acceptable to set some clear boundaries with the patient.
- Prioritize. Irritable, agitated, and difficult patients sometimes harp at you to put their needs first before other patients. It’s important to retain a clear, balanced sense of what is and isn’t important in patient care. If a difficult patient is pressuring you to do something, but it isn’t urgent, it’s okay to tell them you will take care of it in fifteen or twenty minutes after you tend to another patient.
- Don’t accept abuse. It’s difficult to really draw a line between being rude, and being outright verbally abusive. However, it’s not a good idea to establish habits where you’re simply accepting verbally abusive behavior from a patient. If you’ve asked a patient to desist, but they’ve continued to berate you, you may want to consider informing one of your supervisors to figure out an appropriate course of action.
Dealing with Difficult Patients
Dealing with difficult patients is sometimes one of the hardest parts of our jobs. It’s really frustrating when all the empathy, respect, and compassion in the world doesn’t seem to do anything to inspire the patient to treat you better or give you the respect you deserve. But you can do everything you can to try to set boundaries and cope with rudeness and other unpleasant behavior from patients.
How do you deal with a difficult patient? Share in the comments section below.
This article was republished with permission from SCRUBS Magazine.
Great article! Nurses must always keep in mind that they are in a unique field. One that will always come with serving those that can be “difficult”. However, in these situations I’d like to think that this is an opportunity for the nurse to perfect their skill in bedside manner and patience. In many cases, the patient doesn’t want to be there which can put undue stress on them causing them to act out, so it’s important that nurses have proper training.
Before entering the nursing field, schools should prepare students on how to deal with various types of patients. At Sovereign School of Nursing in Miami, FL we are working to do just that. Our goal is to train students to become critical thinkers, so when they face a “difficult” patient, they know how to respond appropriately.
The points outlined in this article are perfect for all nurses no matter how long they’ve been in the field.
Most often, in my experience, it has been difficult families. Setting guidelines and hourly rounding has helped, putting expectations on white board has been a help for those that may be a little confused and setting limits to patient and family. In almost all cases, staying calm at bedside de-escalates the situation, taking time to HEAR them often helps and when you feel anxiety, express it through the correct channels allowing another nurse or manager to intervene. Ignoring the situation is not a plan
Love all the suggestions and would add “just a bit of humor” too! Try to catch the moment when a laugh is good medicine!
Excellent article! Sometimes a group think with all staff helps – that way everyone handles the patient consistently.
Any more with all the insurance controls, a person who is an inpatient is usually pretty sick. Take that into consideration. I find saying “you seem uncomfortable, or unhappy today (not to imply they are always a big crab), is there anything I can do that would help? Most times just the asking is enough but sometimes there really is something up, maybe they are worried about bills to pay, or burdening a spouse, or what will happen if they don’t get well quickly, that can be a good opportunity to network with social services to help them. Or maybe they are scared, never been a patient, or had surgery, or they are sick and tired of being sick and tired, again there might be a good referral opportunity, social services, psyche services, clergy, etc. Or maybe they have no one, and it’s lonely….make them a card, stick a note on their tray each day, tell them everyone here is concerned for you and we hope we can get you to feeling better asap.
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