"Difficult" Patients

[Vespertinas]

I love getting report when the RN tells me about how unmanageable a particular patient is because then I make sure that they're not going to ruin my day and it feels like an accomplishment when I've won those patients over. VERY rarely does it not work out for me. I can't even say I'm acting much different than I normally would with any other patient.

If I had to think about it, what I think I'm doing probably amounts to:

-being SUPER patient

-checking in frequently and updating with progress

-sometimes mimicking their style of communication (when patient is calm)

-offering extras

-making small talk

-sympathizing

-asking about preferences and honoring them

How do you you deal with "difficult" attitudes?

[CVmursenary]

treat them like any patient; assess them and givem their meds and shut the door; call it a night

[NDXUFan]

When we had people would not behave in the jail, we took their shirt away, pants away, shoes away, and left them only with t-shirt and socks, in confinement. One night, had a very bad fever that would not go away, went to the ER, this couple was yelling at the Nurse. I had a bad headache and did not want to hear it. I told them, if they did not speak at a reasonable level, they were going to jail for disorderly conduct.

[M/B-RN]

It depends, some are difficult and super crabby but you can tell that they are mad at the world, so I just leave them alone. I assure them that I will check on them at least 2 more times during the night, but if they are sleeping I will not wake them and if they need anything to not hesitate to call.

If they are difficult and needy, then that's another story. I try to give them everything they may need, but if their wants are excessive I try to set limits. I don't want them to have the idea that I will do whatever they want, however I don't want to be rude either. I also try to figure out if there are any problems or underlying reasons for them being super nervous and abusing their call light.

If all else fails, I give them Benadryl and tell them I have no problem watching their babies so they can sleep and then I stay clear of that room lol

[Sadala, ADN, RN]

More often I find family members who are impossible.

I find the main problem isn't something nursing does but a problem with times. Especially when the doctor will round.

That really is the crux of it. Pt/family/whomever feels they have no control. I never really know how to handle these. I don't usually have control of the things about which they are upset.

[AmberKC]

*knock on wood* I haven't had a difficult pt yet! I'm sure the day will come. I'm up for it. I think my overall approach with all pts is thorough, attentive, make my intentions clear, and I generally don't put up with bs. Ok, my husband says I'm a hard@$$ lol! But I throw in some nursing TLC, and I never forget common courtesy. Here in the south we say ma'am, sir, please, and thank you--it goes a long way!

[sunnybabe]

I find that many patients are difficult because there is a misunderstanding between the nurse/cna and the patient. I have had to tell patients (those who are alert and oriented), that they should tell me how to help them because I can't read minds. Goal setting and being on the same page from the start of the shift is a good way to develop trust. Hourly rounding helps and just spending a little more time in the room more than usual helps too.

Family members tend to annoy me the most because my main focus is on the patient and they are taking that focus away with their antics. I just recognize their concern and just tell them how it is and what can and cannot be done. Right now, I'm a tech but I see even the best nurses get complaints. Sometimes, you just can't win and I always look at whether the customer service at hand is even worth trying to remedy because some people just can't be pleased and will not change their mind.

[ZenLover, MSN, RN, NP]

Some patients will only beat up on you more when you try to be "nice" and placate. Sometimes it is better to call out the white elephant in the room. I had a difficult patient that told me she didn't like me and I had only been in the room 2 seconds! I don't know, maybe someone who looked just like me cheated with her husband or ran over her cat. Who knows, but I didn't take it personal. I told her that I was sorry that she felt that way, but I had a job to do and I was committed to caring for her so she could feel better and get home as soon as possible. I told her she had every right to feel the way she did and I wouldn't waste her time trying to convince her otherwise, simply do my job and be out of her hair. She told me she respected that. I will take respect over "liking" me any day.

It really isn't a problem until a patient rattles your cage or if you are a person that can't stand the idea of someone not liking you...in which case I would say, get over that...be confident and be real. If someone rubbed you the wrong way and you had to work with them, how would you like it to go or be handled?

[nurseontheway]

Since I work at a dialysis clinic I have the blessing of being graced by the same patients over and over. Most of them are fabulous but some of them not so much... One patient in particular always has a rude comment to say every time he sees me. I try not to let it bother me but it gets to me. Especially since I see how nice he is to my other coworkers. As they say, 'You can't win them all.' Also, some of the patients are very arrogant and bossy and they like to order us around. It irks me to my core and I am not a good actress....

[CharleeFoxtrot, BSN, RN]

I've found that some of the most difficult patients are those who are really insecure and feeling they cannot control their circumstances so they lash out. Well, I give them choices which gives them a measure of control. For instance, before I go get meds for the pass I go in and ask the patient how they would like to take them...with water, juice, ice, no ice, etc. Then when I bring the meds I say something like "well how would you like to do this, a few at a time oh look this one is pretty big I'll cut it in half for you" all the while I never give them an inch and get the job done. Same thing with getting cleaned up, I offer a choice if I can so that they feel a part of their own care. Doesn't really take extra time, and it gets good results.

Of course, there are those you just cannot please and to help cope with the hard cases I remind myself that after all is said and done I get to go home today, these people don't and no matter how bad my worst day is...you get the idea.