Dealing with rude patients

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So of course I have dealt with rude patients from time to time. I never take this personally because I know that they are in a difficult spot. I have always been able to gradually build trust and have professional, therapeutic nurse-patient relationship.

But what about patients who are consistently verbally abusive and constantly make rude, sarcastic comments? Sometimes I will even ask questions about his care and he will blatantly ignore me (and others). I have tried everything I can think of with this patient and nothing has worked. I treat them very politely, ask about their preferences, provide options, etc. They treat MANY staff members this way and have a very select few staff members that they will accept. If they're not assigned to one of these staff, they will ask to change the assignment. Usually the charge nurse will not allow this. That usually makes everyone's day miserable as a result. They will take it as far as refusing care sometimes. Or they will avoid using the call light, go out in the hall, and ask someone they "like" to help. To me, this seems like splitting and no one is setting any boundaries. I am just an intern and don't want to cross any lines, but I find it frustrating that everyone allows this behavior and does NOTHING to address it. It's to the point where I am intimidated by this person. Any suggestions on how to handle this?

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It seems like you've characterized the situation accurately according to what you've written (inappropriate behavior with an element of splitting)...can you elaborate more on why you feel intimidated? What I'm getting at is that your awareness gives you the upper hand to some extent. :up:

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I guess it's mostly because I'm still young and in school and haven't had any issues to this extent before. Although some much older, much more experienced nurses have also expressed these feelings. It's just hard to go in the room knowing that your every move will be criticized. Eg. I feel you bring 4 towels and they wanted 3, you will get an "are you serious???" comment. That actually happened. Or if they ask you to close the door and it takes you more than a millisecond they will yell "I SAID CLOSE THE DOOR." Makes it very difficult to have a decent day at work.

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Well that's certainly understandable. Thanks for answering.

Here's what makes it tolerable for me personally:

- I make zero excuses for this kind of *ongoing* behavior under any circumstances except the situation where it is a manifestation of psychiatric illness. Therefore, I am not prone to stressing myself out in hopes of making it stop. I also am not making the problem worse by indicating to the patient (verbally or through actions) that I am bothered by it and will go out of my way/give special treatment in attempts to make it stop.

- I do not view this type of talk (such as the examples you gave) as being "criticism". In reality they are "verbal manifestations of personal misery". They have nothing to do with me. Someone is spewing random verbal misery into the atmosphere and I just happen to overhear it.

- I resolve to deal therapeutically with this type of patient, and never compromise that. This includes appropriate types of kindness, and trust-building wherever possible, along with excellent nursing care (not allowing the level of care to be compromised).

- Repeating what I wrote on another thread recently: My sense of self-worth and my sense of well-being is not derived from patients. Therefore, random verbal attacks or poor treatment by patients doesn't have any effect on those things.

Be encouraged! If possible spend some time thinking through the emotions involved.

Best wishes ~

PS - since you have posted about a specific scenario you are currently dealing with, I will offer a practical answer also: In both of the examples you gave (and likely more of what you deal with from this patient), I personally would ignore. The patient wouldn't even know whether I heard his comment or not. That would be my first attempt at resolution - sending a message that it is not irking me to the extent he hopes it will.

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The Charge Nurse is smart. Catering to this patient's demands for specific staff will only make things worse, despite making everyone miserable. These types of patients are VERY hard...you can read up on all the advice in the world and still freeze up when dealing with this type of behavior.

First of all, please understand that you are not doing anything wrong. You could make note of every little thing and adapt (bring 4 towels for example), and they will STILL find something to nitpick about. Being mindful is one thing, but twisting yourself into a pretzel trying to cater to every whim will only make yourself miserable and give them more ammunition.

I have a similarly hard time with these types of patients, and come across these behaviors often in Psych. It is helpful to center yourself before interacting with them. Maybe step into the supply room and take a few deep breaths before entering the room? Or repeat a mantra. I like "This is their circus, not my circus," but use whatever will help you keep a calm, objective mindset. Often (but not always), these behaviors arise because the person in question enjoys seeing people get upset. Avoid power struggles at all costs. Keep your interactions professional, and extra talk to a minimum.

One other suggestion...talk with your coworkers/interns and see what has worked for them in dealing with this patient. I had a patient once that was incredibly ambivalent about taking her meds. We would stand there for 10 minutes trying to convince her to take them. After a few days, we finally brought it up in shift report, and a tech mentioned that she had success with giving a time limit, and counted down "3-2-1" before taking the pills away. Worked like a charm, and so simple! Patients respond to simple limits like that, but it can be hard to think them up yourself. Communicating with your colleagues and figuring out common strategies is key.

At any rate, do not beat yourself up if you have a bad shift. Interacting with people and their unique psychology day after day is challenging and we do our best. Hope you get some good advice on this thread, and consider checking out Psych nursing forum for some other tips.

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Patient (45 mins after giving IV morphine as ordered): PRN means as needed. I want it now!! You are not doing your job right and I'll get your ass in trouble."

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Specializes in CMSRN, hospice.

Really good suggestions above. I think everyone needs to get on the same page about how to deal with this patient when he seeks out his favorites to help. Maybe bring it up in your next staff meeting and decide on a blanket response?

I absolutely agree that limits need to be set. People have a right to refuse, so I would just calmly make sure he understands the risks of refusal and walk away. If he's being rude and yelling/berating you, I would CALMLY tell him to please lower his voice, then CALMLY excuse myself for a few minutes if he did not comply. Sometimes this feels excruciating, but no one gets paid enough to accept this behavior from people who know better.

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Well that's certainly understandable. Thanks for answering.

Here's what makes it tolerable for me personally:

- I make zero excuses for this kind of *ongoing* behavior under any circumstances except the situation where it is a manifestation of psychiatric illness. Therefore, I am not prone to stressing myself out in hopes of making it stop. I also am not making the problem worse by indicating to the patient (verbally or through actions) that I am bothered by it and will go out of my way/give special treatment in attempts to make it stop.

- I do not view this type of talk (such as the examples you gave) as being "criticism". In reality they are "verbal manifestations of personal misery". They have nothing to do with me. Someone is spewing random verbal misery into the atmosphere and I just happen to overhear it.

- I resolve to deal therapeutically with this type of patient, and never compromise that. This includes appropriate types of kindness, and trust-building wherever possible, along with excellent nursing care (not allowing the level of care to be compromised).

- Repeating what I wrote on another thread recently: My sense of self-worth and my sense of well-being is not derived from patients. Therefore, random verbal attacks or poor treatment by patients doesn't have any effect on those things.

Be encouraged! If possible spend some time thinking through the emotions involved.

Best wishes ~

PS - since you have posted about a specific scenario you are currently dealing with, I will offer a practical answer also: In both of the examples you gave (and likely more of what you deal with from this patient), I personally would ignore. The patient wouldn't even know whether I heard his comment or not. That would be my first attempt at resolution - sending a message that it is not irking me to the extent he hopes it will.

This is an excellent response - and I second everything she has written.

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Specializes in Pediatric Critical Care.

Here's what makes it tolerable for me personally...

[insert brilliance here]

JKL33, you save me so much typing because you consistently post great responses. Then all I have to do is go "like" them!

To the OP: I remember being a new nurse/intern, and I had a really hard time managing difficult nurse-patient relationships because I didn't see myself as an authority figure. I felt like a kid! It got easier once I started to see the relationship differently - I am the one with the upper hand, not the crabby or manipulative sick person in the bed. I can set limits and behave professionally, irrespective of how THEY choose to behave. Once you get more comfortable with the new role of "nurse" and realize the authority that you carry in that role, it will hopefully get easier to manage the sometimes difficult dynamics. Just practice professionalism and being in control of your own behavior and responses. :up:

Also, everything that JKL33 said. Yeah.

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JKL33, you save me so much typing because you consistently post great responses. Then all I have to do is go "like" them!

I appreciate your comment and this seems like a good juncture for me to admit that I haven't always handled things the way I do now. Earlier in my career I was threatened, offended and outraged at these "audacities" from patients. I would sometimes huff and puff, not make ANY attempt to control my non-verbals, engage in some sort of snippy retort or try to tell them "how it is", etc. This wasn't my M.O., per se, but it was how I reacted to some situations like what the OP is experiencing right now.

And what I eventually learned was that *I* was making myself miserable by allowing myself to be so provoked by these things. Slowly I realized that one can't be an excellent nurse while taking on and internalizing others' misery 24/7. At least I can't. So hey, I'll type it all out if it could save anyone else from spending too much time on the same mistake. :up:

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Thanks for your suggestions, your post was helpful. Sadly, I was repeatedly assigned to this patient since I first posted and the charge nurse eventually gave up and let the patient pick who they wanted to do each task. Made things much much worse!

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Specializes in SICU, trauma, neuro.
Thanks for your suggestions, your post was helpful. Sadly, I was repeatedly assigned to this patient since I first posted and the charge nurse eventually gave up and let the patient pick who they wanted to do each task. Made things much much worse!

:facepalm: way to show him that he can behave like a toddler and be rewarded for it.

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