Professional Nursing: Dealing with Difficult Patients

By Lanette Anderson on Fri, Jul 27, 2012

professional nursingIn professional nursing, we don’t always like the patients that we take care of. It sounds harsh, but let’s be honest. The caveat to that statement is that we don’t have to like them. We do, however, have to provide the best possible patient care that we can, while maintaining an appropriate level of professionalism and compassion.

People in general can be difficult to deal with, and with sick people who are frightened, this quality can intensify. In addition, medications and conditions such as confusion can also make our patients behave in a way that we don’t understand. Some of our patients are just demanding and never seem to be satisfied with anything that we do for them. Sometimes we may want to curse the person who invented the call light. Instead, we need to focus on mechanisms that we can use to help effectively handle a difficult patient.

From a patient care and satisfaction perspective, we should consider the following:

Remember what position the patient is in. He’s sick. He’s uncomfortable. He’s frustrated. He’s frightened. He may feel that he isn’t getting enough attention from caregivers or that people aren’t listening to his concerns. It’s not his choice to be a patient. It is our choice to be a nurse.

 

Don’t just hear what the patient says,professional nursing listen to him. Let him know that you are listening by maintaining eye contact. It’s been said that approximately 80% of our communication is nonverbal. Don’t stand with arms crossed, don’t look at your watch as if you have someplace else more important to be, etc. Also, watch for the patient’s nonverbal cues. Taking these steps will help to establish a level of trust and enhance the effectiveness of our nurse and patient communication.

Be nice. Be caring. Keep your promises. Remember that our role as nurses is not only to provide safe care, but also to provide information, support, and reassurance to our patients. We made a commitment to do these things when we chose nursing.

From a risk management perspective, some other steps are also important:

Adequately document any relevant events. If an adverse event occurs, document it in the appropriate part of the patient record or on an incident report per facility policy. In the event of litigation involving the patient, good objective documentation can increase the chances of a positive outcome for the nurse.

 

Pay attention if a patient threatens toprofessional nursing sue you, the facility, the physician, etc. While in many cases these are only threats, you never know for certain. Inform your nursing supervisor and risk manager that the patient has made this statement, so that steps can be taken to resolve any issues that the patient may have, thereby potentially avoiding litigation. If a patient tells you that they have previously sued a health care provider, pay even closer attention.

Seek the assistance of your supervisor or other appropriate person if you are caring for a patient who makes you feel uncomfortable, either physically or emotionally. There are times when a change in patient assignment is a reasonable step to take.

In professional nursing, do you frequently deal with difficult patients? Leave us a comment sharing how you handle them! 



45 COMMENTS

Anonymous 2 years ago
Hallelujah to Sherry A. & Molly B. As an ER Nurse I always strive to give great care, but the patients and their families that come in do not always make it easy. Common sense seems to have been removed from the genetic line over the years. ER's are for life threatening emergencies. That is why we have walk in clinics and urgent cares. We always say to put ourselves in our patient's shoes, but what about them placing themselves in ours. 12 hrs away from our families to care for yours. Not going to the restroom or getting to eat/drink because I am coding a patient, and yet the other patient I have, who can see we are actively doing CPR, steps out of the curtain to ask for water. Oh, and you say that this is your 211th visit to the ER this year and it's only September? There are the days when you get the patient's who need you, and those are the days that are why I became a nurse. The respect street can go both ways. I have been the pt. in the ER/Hospital. I have had to take my spouse or elderly loved one for care. I know what it is like to be on the other end. I try to be patient and kind, because I don't forget that that nurse/tech/MD/etc. is the one who will be caring for my family member when I'm not there. And a little education about giving meds at a specific time: Most hospital allow for a 1 hr window from the time the med is due, and the doctors know this. Also, a call light may not be answered for 30 or so minutes because the nurse is in an isolation room, passing meds to another pt (during which it is a safety issue to stop and leave), or tending to another pt who they cannot simply stop what they're doing and unsafely leave that pt to go see another. So again, while we nurses put ourselves in your shoes, please put yourselves in ours.

Anonymous 2 years ago


All those 'difficult' patients. No 'difficult' nurse then?



sha inguillo 10 months ago
there are too...

Anonymous 2 years ago
All those 'difficult' patients!
Maybe they had 'difficult' nurses?

Anonymous 2 years ago


I wonder how many so-called 'difficult' patients have 'difficult' nurses?



Anonymous 2 years ago


Peter P, I agree with your comment, and did not find any helpful advice that I could apply in a practical situation.



Anonymous 3 years ago
Not to be the bad guy; but in many cases patients do choose to be in the hospital because many of them of them do not take care of themselves. They smoke, the eat the wrong foods, they drink, they do drugs, etc which eventually brings them to the hospital. I'm not saying that all patients do this; but in my practice in the ICU, I see many patients with preventable illnesses. It is not okay for family to abuse nurses. Nurses must always be professional and civilized, but they do not have to put up with abuse. Yes, we did chose this profession; but that doesn't mean we chose to be abused by family members. Sick patients should be treated with kindness even when they can be mean and demanding. Try not to take it personally. Nursing is a very demanding job. On many days, it can be a down right thankless job. But it can also be a very rewarding job. From what I have experienced in this profession is the increase in our workload. Every time I turn around, we are expected to do more work, fill out some new flowsheet or paperwork. The work just keeps adding up. If you think you barely have time to finish everything or to spend time with your patients, just wait a couple months; there will be some new paper added to your already ridiculous amount of paperwork that needs to be filled out for each and every patient. I have yet to see our supervisors take away paperwork or work that needs to be done. And I agree with a previous poster that we need to have our supervisors help us or get them to hire more help. But with most hospitals, it is about the money. They would rather have nurses do the equivalent of 5 peoples jobs than spend more money getting help. They want increased family satisfaction without having to spend more money to do it. They just simply tell us nurses what is expected of us and that's that. I would LOVE more than anything to spend my entire day (12 hours-it really isn't that bad) touching and caring for my patients. That's my favorite part of nursing. But unfortunately, because of all the frivolous lawsuits that have plagued the medical profession, we must spend a HUGE portion of our day documenting everything we've done and filling out paperwork that never seems to end. Though I know many hospitals have computer documentation. As a nurse it can be very frustrating to try and meet all the demands placed on them.

Anonymous 3 years ago
Nurses are amazing and I truly could not be in this profeasion because simply put I could not be as selfless as this position would require. For what it's worth...
Most people do not want to be sick. For example my husband with acute pancreatitis from gallstones. He is currently in ICU at a sutter hospital recovering from the pancreatitis that has taken over 75% of his pancreas.

We have been here for 8 days and have met a few great nurses. The type of people who have not lost the humanity of their job and truly provide care and education to patients. We have also met a few nurses who have become hardened to patient care and lack understanding of their role. For these people please remember you are caring for human beings. People who are more than likely scared, anxious about making uneducated medical decisions about their treatmen plans. Listen to patients, people need specific solutions to specific promblems, be engaged and listen to the patients family. After all you cannot claim to know what a patient needs unless you have heard the patient and family concerns. Expecting patients and their families to blindly trust is unreasonable. Trust must be earned and will greatly improve your standard of care and essentially your ability to be a memorable great nurse.

Anonymous 3 years ago
Nurses are amazing and I truly could not be in this profeasion because simply put I could not be as selfless as this position would require. For what it's worth...
Most people do not want to be sick. For example my husband with acute pancreatitis from gallstones. He is currently in ICU at a sutter hospital recovering from the pancreatitis that has taken over 75% of his pancreas.

We have been here for 8 days and have met a few great nurses. The type of people who have not lost the humanity of their job and truly provide care and education to patients. We have also met a few nurses who have become hardened to patient care and lack understanding of their role. For these people please remember you are caring for human beings. People who are more than likely scared, anxious about making uneducated medical decisions about their treatmen plans. Listen to patients, people need specific solutions to specific promblems, be engaged and listen to the patients family. After all you cannot claim to know what a patient needs unless you have heard the patient and family concerns. Expecting patients and their families to blindly trust is unreasonable. Trust must be earned and will greatly improve your standard of care and essentially your ability to be a memorable great nurse.

Anonymous 3 years ago
think whole article patronising. nurses have to deal with frigtened pts and just generally unpleasant people ,most know the difference

Anonymous 3 years ago
I'm shocked at these comments about nurses feeling abused by patients and complaining about family members trying to advocate on behalf of ill loved ones. I've yet to meet anyone who epitomizes manners when they are physically suffering, so why would any nurse expect patients to be on their best behavior? My mom is currently in a long term acute care facility and believe me she NEEDS her family to fight for her every step of the way. The nurses seem to think it's reasonable to take 30 minutes to over an hour to respond to call lights and constantly remind all of the patients requiring assistance for pain of how many other patients they have. We are told Mom needs an xray and it is ordered "stat" and the nurses find it quite acceptable to allow the patient to writhe in pain (ventilated patients can't scream) and wait up to 48 hours to get the xray, all the while reminding the family of how many patients they have. If they cannot respond to patient needs, nurses need to tell their bosses they need help, and NOT complain to patients and their families. And, the nurses at my Mom's hospital could lose a walking race to a tree sloth. The responsive nurses seem to be only about 10% of the staff. Oh, and these 12 hour shifts are ridiculous. How many folks out there want to have their 30 minute operation scheduled during the doctor and nurses 10th or 11th hour of work? I think the nurses are acting out on patients and families and non responsive or excrutiatingly slow to respond because they are OVER TIRED from absurd scheduling.

Anonymous 3 years ago
first of all i dont know where most of these nurses work, but i can tell you from many of years of experience that nurses in a certain hospital are mostly idiots. there are 2 types of people who want to become a nurse. the 1st one, is some one who is there because they care about people and the 2nd are the ones who are there for the check. i was in the hospital so much with my mom i think i knew just as much as the nurses. and i dont think they liked that. and when you, the nurses complain that a family gets up set because your not there at 1:15 when the pain med is due a 1:00 i can see you getting upset. but things that happened with my mom was not petty stuff like that. if you cant handle some ones family member looking for you for help for there loved one then maybe you need to look for a new job. and maybe if nurses and doctors would start listening to the patients family maybe there would be less deaths and alot more better out comes. treat your patient and there family as you your self would want your family and your self to be treated. think about it. maybe you will learn something. maybe even something that will save that patients life.

Anonymous 3 years ago
Holy crow... reading some of these comments really shock me.. We are NURSES... Ok.. so we get sworn at, hit, or yelled at.... It is our ROLE to be PROFESSIONAL ... We choose this career... the pt did not choose to be your patient or be sick for that matter... To report to management or to your union because you think that patient is rude.. suck it up princess.... ! Sure, its a difficult role but oh well...we just need to be professional, listen to our pts, be kind and understanding .. Dont roll your eyes and get defensive.. Put your 12 hrs in .. go home and be done with it

Anonymous 3 years ago
I find that many patients who are exhibiting negative behaviors just do not want to be alone. They call and ask for unreasonable thing's, or even call and then "forget" why they called. Many times it it simply companionship they are asking for. Unfortunately with healthcare being what it is today we do not have time to sit with a patient and talk for any length of time. We have all had our staffing cut to the bone and certain things have been made almost impossible to do. It is unfortunate though that letting family members stay at the beside is usually NOT a help. Rather than tend to the patient, the family members walk the halls looking for you. They wait outside other patients rooms or even peek in to find you, rather than use the call bell. The institution does not back up nurses. The patient/family member is ALWYAS right, so you cannot correct this behavior.
It is very frustrating...if nursing administration would back us up we would be able to educate visitors and provide them with the necessary rules of etiquette for visiting in the hospital.

Anonymous 3 years ago
wat??????

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Anonymous 3 years ago

I do not think a nurse should have the right to curse a patient who did not say anything negative to the nurse. A family member of mine was in a very bad wreck and lucky to be alive. A month later he was finally released from the hospital. When he went to the Dr. office to have his cast removed the Doctor was very rude and rough. When she left the room he made a comment about it and the nurse cussed him out. I am looking for a way to turn them in.


Anonymous 4 years ago

Hostility and belligerence seem to be the way of the world today. There are health issues and financila concerns that add to the stress of every day living. I agree health care providers are not to be disrespected, but think about it. when we are stressed, we all take it out on somebody. I've been a nurse, critical care, pre op and PACU, Risk Management. Even though you can't "fix" the problem, when a patient realizes you are really listening to him/her, their attitude improves tremendously. My secret is no matter how out of control a person is in a situation, when you continuously speak to them in not only a calm voice, but also almost so softly they have to strain to hear you, they actually stop to listen to what you have to say. What ever you do "DO NOT TAKE IT PERSONALLY!" Believe me this is a life long lesson for me as I am even after 40 years very sensitive.


Anonymous 4 years ago

Sounds to me like Peter P. should leave nursing. He is burned out


Anonymous 4 years ago

Patietns do not have the right to disrespect nurses, however. Just because they are going though things so is everyone in this world and they need to be sensitive to that. Just because they are having a hard time coping doesnt give them the right to treat someone poorly, BS (as someone stated earlier), that continues the process.


Anonymous 4 years ago

I have worked many years as a nurse. I have seen the best and the worse. In today's climate, nursing isn't about taking care of the patient but taking care of the family. I liked when families were only allowed to come certain times of the day so the PATIENT would be cared for and rest. Now anything goes including not abiding by the rules and becoming hostile if you dare enforce them. I will retire next year after 40 years. I have mixed fellings about leaving because I do like caring for patients but I hate the way nursing is taken such a demeaning path. It's the same at every hospital. My wish would be that hosptials would realize how lucky there are to have nurses.


Anonymous 4 years ago

A lot of you are freightening me. Now I know why a pt. told me she was afraid of retribution if she said something negative about her RN. As the author said we did choose to become RNs. They did not choose to be patients


Anonymous 4 years ago

I work in a Family Practice setting. I greet every patient by calling them Mr./Mrs; and they are greeted with a smile. Most have become irrate because they have waited to be called back to the exam rooms after a 15-30 minute waiting room wait.I am the first contact and the person who is given an "ear-full" about the long wait time.I apologize for the inconvience they may have encountered, and ask them if they had to fill out paperwork(required) by the company or if they had to have their insurance verified? Usually tose are the reasons for the delays. Once they see I am concerned, they are smiling too. Patients only need to have answers, not attitude from the staff. That just adds fuel-to-the-fire, and gives them more reason to be uncooperable and belligerant towards you. We must defuse as much anger as we are able to, to make the patients feel they are not just"cattle" being hearded through the gates.


Anonymous 4 years ago

When patient or anyone complains, dissatisfied, or just irrate, they are telling us "I RATE too".


Anonymous 4 years ago

as a recent patient of a major surgery and an RN... I can tell you that most of my nurses SUCKED!!!! lazy, eye rolling idiots who did not even know how little they knew about nursing. My goal is to never be as bad as the nurses I had during my stay.


Anonymous 4 years ago

I totally agree with the writer... but the Question LIES WHO is CARING for the CARER ( THE NURSES) YOU Try very Hard everytime you go to work... AND YOU GET ALL THE ABUSE YOU HAVE TO ENDURE SIMPLY BEC. YOU ARE A NURSE... IS LIFE REALLY FAIR!


Anonymous 4 years ago

I feel that the problem is that people today have this sense of entitlement as if we are supposed to stand outside their door with everything that they need in our pocket! No one expects to wait and they do not care if you are helping someone else. It is my biggest pet peeve for a patient to call out at 9:02 for a med due at 9:00 or call two to three times to tell me to empty a bedside commode. Management does not help the matter when they are SO focused on patient satisfaction while not providing proper staff-patient ratios to support this. They continuously add more documentation, procedures and expectations while not adding additional staff. I barely have enough time to provide for patients basic needs let alone provide resort like care. H is for hospital not the Hilton.


Anonymous 4 years ago

to Bobbie E. ,you did hit the target,e-x-a-c-t-l-y.....


Anonymous 4 years ago

Pt's and families have changed over the years. I agree with alot of the comments, but yet I do agree the nature of our get it now world has changed attitudes as well. The fact that we are trying to get to get the best pt satisfaction scores is there as well, but I think also with the fact that if pts understand that we are taking care of them as well as maybe 3-4 other pts, and I believe the hourly rounding has been better as well in planning the pts day, I also tell my pts we have a time before and after before our meds are considered early or late. And always ask your pt what you can do for them because you do have time. Nursing is still a rewarding field, but management can sometimes not have a clue.


Anonymous 4 years ago

While I am in complete agreement with the writer that our manifesting a professional, warm, and caring attitude with those placed in our care will usually decrease some difficulties, I am weary from nurses being blamed for "difficult patients". Nurses are made the scapegoats for whatever is ailing the patient or their family members. It doesn't matter if their complaint is with their physician, environmental services, dietary, etc.--the nurse gets the complaints and the blame. Until hospital culture is changed so that nurses are treated with the same respect that everyone else is given, "difficult patients" will continue to be downright abusive to the nurse.


Anonymous 4 years ago

I want Royce O to be my nurse! I agree with what everyone has said. There is a difference between fear and belligerence though. I have been told that certain (yes, it's usually the family members)pts and relatives act rude because they think they are suppose to because then they will get special attention because nobody wants them to complain to administration. Sometimes they just have totally unrealistic expectations about what is suppose to happen. Like the doctor will tell them he/she are going to write an order for something, and then 30 minutes later the patient or family member "just can't understand" why they don't have whatever was requested. I just wish those in charge would "back up" the nurse sometimes. One time I had an irate family member complain to the Director of Nursing because I was totally incompetent. I had walked in his adult (27 yr) son's room at 1:08 with a medication that was due at 1:00. "The doctor wrote for the medicine to be given at 1:00!" he ranted,"What kind of nurse is she! Does she want to kill my son?" (true story) I had been to the room at 12:45, but no one was there so I went to see another patient and then had come back. What did the DON tell them. "We will make sure that your son will get his medicine exactly when the doctor orders it." To that the man pointed at me and declared, "I don't want her any where near my son!" The ones with the real attitude problems aren't the pts or relatives, it's about 75% of the nursing assistants/ pt care tech! Anybody second that?


Anonymous 4 years ago

I have been a nurse for many many years, and I do think that the belligerent attitude is getting worse. I am not a sex object, a punching bag, nor a substitute authority figure. I can't count the number of times I've been hit, slapped, pinched, punched, spat on, cursed and not always by patients. Yes, a confused patient is one thing, but a family and/or patient who seem to think that they are the only ones in the world are really trying. People in groups have to have rules...and visiting hours, number of visitors, etc. are rules. Do you let your family members sleep on the floor? Do you let them wash their underwear in the patient's sink and dry it on the air register? Both of those have happened to me within the last month. (Different patients, by the way). I spite of it all, I enjoy nursing and could not wish for a more fulfilling career, but I sure wish, also, that a tablespoon of manners was given to every patient and visitor when they walked through the door.


Anonymous 4 years ago

I agree w/ all remarks posted. One solution: I, having worked in hospitals with and without a patient representatives, would rather work in a hospital with a patient rep. It takes some of the trivial c/o out of the picture and allows staff to worry about the primary concern....patient needs/ wellness. Not their wantness.


Anonymous 4 years ago

Unacceptable behaviors have to be addressed with all your available resources (security, psych, MD's). In order to provide safe and effective patient care these "difficulties" have to be eliminated. Try it next time, and see your patient’s behavior change.


Anonymous 4 years ago

I believe all in all its called manners and a lot of people dont have a clue as to what they are. Being sick is no fun at all but the nurse standing in front of you is there to help you and he/she deserves the respect and courtesy to do their job.


Anonymous 4 years ago

I always try to ask myself, "How would I want someone to react to me or my family member in this situation?" One most important thoughts I keep at the front of my mind is. "Patients do not see this (their illness or health crisis) everyday." What I am used to is not what the public is used to. We as health care providers have dealt with illnesses and diseases. I think we forget we have see the situation before the patient probably has not. They do not know what "normal" is for that situation. We can help by telling them what to expect. Educate them as to what might happen. This may calm some of the fear of the unknown. We need have to remember this is new to most of them. They are ill, frightened, upset and unsure of what is happening. Be that calm reassuring person that takes 5 minutes to calm those fears and make them feel important and like a person and not a chart or condition that just needs to be treated.


Anonymous 4 years ago

It's more often the family of the patient that creates the most problems. But I must agree, we can kiss their butts all day long and not get anywhere. It would really help if people would just realize the "H" on the big street sign outside does not stand for Hilton! To come into a hospital with the expectation to be treated as though you are that nurse's only patient is rediculous and impossible to live up to. I agree with the importance of keeping your promises. If you say "I will return in a half hour to check on your pain level after this medication has had a chance to work" then you better move heaven and earth to be back in that room in a half hour. That alone will teach the patient they can trust what you say and will keep them off the call light.


Anonymous 4 years ago

The sad fact is that the level of hostility and belligerent behavior has become almost endemic. One might think that everyone having a camera in their phone with the ability to broadcast bad behavior might contribute to more courteous behaivor, but this has not proven true. Time was when only mentally ill or demented patients were belligerent...now it seems everyone feels it is their right to strike out, curse and threaten professionals and service personnel. Personally, from years of experience, I use humor, compassion and athletic quickness to deflect tough situations, trying to find the "God within" everyone I encounter.


sha inguillo 10 months ago
impressive

Anonymous 4 years ago

As having been a nurse for many years I am astonished at the behaviors of many patients and their family members. It has appeared that with the current "patient satisfaction" focus more and more care givers seem to be in a position of being at the other end of abuse. I do believe that one has to look at the patient as someone that is going through turmoil in their lives, physically as well as emotionally however, there is no excuse for taking that situation and targeting your care givers. As hospitals are pushing the "satisfaction" issue they are creating a situation among their staff and making them feel less and less valued. I believe in educating staff as well as patients to enhance a more positive atmosphere for healing.


Anonymous 4 years ago

Listen, listen, listen to your patients. It can not be said enough. They need to know that they are in charge of their care. When they give us information, it is incumbent that we don't think that we always know better than them. Remember they know their bodies better than we do and have possibly had past experiences that lead to hesitancy or even fear. Also educate as much as possible to help them have a better understanding of their illness and everything associated with it. Once they understand, they are more likely to be more compliant, will relax, and fears are dispelled. Don't be afraid to reach out. It's the little extras that will make the difference and will show how much you care.


Anonymous 4 years ago

This thought process of nursing brings us back 30 years. We are professionals and expect to be treated as such. A confused elderly patient is one thing but a beligerent hostile patient is completely not acceptabl!


Anonymous 4 years ago

Your initial approach expression, body stance, and tone of voice are all cues which the cognitively compromised patient bases his/her reaction to you. It is extremely important to come across in a positive way. As Maya Angelou, the famous poet has stated, " People won't remember what you did or what you said, but they will remember how you made them feel." Remember the first impression is the strongest, make it positive.


Anonymous 4 years ago

This author sounds really out of touch with hands on nursing care. Just more BS that is repeated from nursing school.


Anonymous 10 months ago
I am writing from Australia and my nursing is due to finish soon as I am 62 yers of age. my opinion regarding a lot of the comments above, by nurses, and my own experience her in nursing is that unfortunately, I think patients have become a lot more educated- from the internet etc. Time was when they were in awe of nurses. These days things have been explained to them a lot more. They no longer fall into believing that nurses are underpaid or over worked, leastwise no more than anyone else. Certainly nurses suffer the same fate as say a checkout-chick. Hours on their feet, trying to be helpful but met with constant abuse from their (client) customers. No proper meal breaks, no adequate staff rooms and no relief from heavy surges of client requirements for attention. However, I tell my colleagues, we can moan just like those checkout chicks but we have job security and far better wages and, because we are so professional and intelligent, we can accept our fate so much easier. Also, for all the ungrateful patients we have, they are far outnumbered by the very grateful patients we have.