How to diffuse a situation involving dissatisfied/angry patients

Esme12, ASN, BSN, RN · Sep 29, 2014

Well first thing is...you don't put your foot down.

people will rant and rave they want to know someone is LISTENING. Simply put...as a nurse I say...I hear what you are saying....I am sorry you feel this way....I will bring that to managers attention. Would you like me to call the supervisor? What can I do for you.

AS the supervisor...I hear what you are saying....I am sorry/apologize you feel this way....I will bring that to ADMINISTRATIONS attention. What can I do for you. Is there anything I can do to help this be better for you? Would you like the patient advocate come see you in the morning?

Do not throw another staff member under the bus. Do not criticize staffing other than I am sorry we are short tonight or we have a lot of sick patients. DO NOT admit wrong doing unless you are clearly in the wrong but call the supervisor first.

PASS THE BUCK! and SMILE. Have a concerned look...lean forward in an active listening position. SMILE. I pretend I am on stage and acting out a scene...it helps me.

Mr. Murse · Sep 29, 2014

So much of how nurses handle these kinds of situations is based purely on their demeanor and personality type and there's not a whole lot to recommend that would be effective for everyone. There are a few things I consciously do on stressful nights though. For one thing, learn to step off by yourself for a few minutes and breath, no matter how busy you think you are. If none of your patients are coding, then you have time to step into the bathroom or wherever and spend a minute or two just breathing deep and slow and conscientiously. Don't go in the bathroom and hit the wall and pull your hair out, just stand there and pay attention only to your breathing for a minute or two. It's basically abbreviated meditation.

Another thing I try to do is to keep in mind that nothing is personal in the hospital. Your patients that throw fits probably have far deeper issues than you are aware of and you're the person that's there while they're going through a difficult situation, and though they may direct their problems at you, it's not you. Don't take anything personally.

Also, keep in mind that your shift will always end eventually, and you will be able to walk away. Practice leaving your patients at your work.

Finally, keep in mind the nature of our jobs is demanding on your whole being physically, emotionally, and spiritually. Take care of your body and mind. Eat well, exercise, practice discipline, then in difficult situations you will have the over all health and tools to handle them.

I've only had about 2 patients that completely pushed me to the limit. One was a Muslim guy that used his religion as an excuse to argue with you about absolutely every single thing we tried to do for him. It was absolutely ridiculous. Another was a guy that tried to accuse me of taking his pain meds 10 minutes after I'd given him 2mg of Dilaudid.

Lev, MSN, RN, NP · Sep 30, 2014

I echo Esme's post. Let them know that you understand their concern and ask them what they would like you to do to fix the situation. Usually they have a clear expectation that is not difficult to fulfill. I also offer that I will bring it to the attention of the manager. Let their comments roll off you.

**canoehead, BSN, RN** · Sep 30, 2014

"I'm sorry this has upset you."

"would you like to speak with a different nurse (or the supervisor)"

"it's annoying, but that's what we're stuck with."

"A lot of people have the same concerns."

"I see exactly what you're saying. It would really help us if you wrote to the manager with your concerns."

"I'll do my best, it may not be perfect, but I'll do everything I can."

"Let me double check" with policy, or with a coworker, it gives you a breather, and a minute to think of possible solutions.

"when I have more, you'll have more." Information, pain meds, Jello, whatever.

firstinfamily, RN · Sep 30, 2014

ESDME 12 has the best idea, when I had a dissatisfied patient I would first listen to the reason they were unhappy and then see if I could fix it. If I could not fix it or I had pressing issues with another patient, I referred it to the supervisor. Usually the supervisor could resolve the issue and if not it would be taken care of by the unit manager the next day. We have to learn that we cannot make everyone happy, and they are sick, they are miserable most of the time. For family type issues I would usually refer them to the case manager or social worker. Usually patients just want to be told what is happening, they should be totally involved in their care and any decisions being made about their care. If they disagree with the way things are being done, that is OK, they do have the right to refuse treatment and then you let the MD know. Different strokes for different folks!!!

dudette10, MSN, RN · Sep 30, 2014

As others have stated, it depends on the pt/family, their *real* issue, and the nurse's personality. Some nurses are good at diffusing, and some, quite frankly, are good at exacerbating the problem.

The chronic pain pts that are ticked off: their issue is pain mgmt. Always. It sometimes bleeds over into food, temp, medical procedures. This has always worked for me...medicate them on time, use the white board for their next dose, ask them to call you 10 minutes prior as a reminder. My last one's only complaint to me--near the end of shift--was that she had to call me 10 minutes prior. I do this with every single q2 IV push chronic pain pt, and I've never had a pain mgmt complaint from any of them. Of course, I check on them between meds, but they need to help me too for on-the-dot meds.

The anxious/polite family member with repeated, frequent requests: What works for me is approaching them when they arrive on the floor that day, updating them on the plan of care, estimating timing of procedures, informing them about clustering care for efficiency, answering questions, addressing specific concerns. The 20 minutes I spend at the beginning saves me an hour for the rest of shift. They want to trust you. You need to show them that you know what you're doing and you know the heck is going on with their family member.

The anxious/demanding family member that believes Dr. Google and makes tweaks to the nursing and medical plan of care at every opportunity: What works for me is doing what they want, as long as it doesn't cause harm. Just do it. They want oral care done with a washcloth instead of a Toothette? Fine. They want two pillows instead of one for turning, fine. They want the dressing change done at end of shift rather than beginning of shift? Fine. They want the g-tube flushed with 50 mls instead of the ordered 250 mls. NOT FINE. Educate with authority and move on. They want control in a difficult situation. Show them that they do have control, until it has the potential to harm the patient.

The anxious/certifiable family member who is constantly dissatisfied no matter what you do: Sorry, but nothing works. Seriously, there may be an underlying mental illness. (I have a family members of my patients in mind for all these scenarios, but this for one it is two family members of two separate patients with the same behaviors.) They talk in circles, asking the same questions over and over again, but insist you're not answering the questions. They have no regard for you or other patients, often following you around, sometimes right into another patient's room. They call every hour for an update when they aren't bedside. To maintain your sanity, you must set firm limits, and don't let them railroad you into attending to their every whim at any time. For one, who refused to leave the entrance of another patient's room despite multiple requests with a promise to address his issues within the hour, I literally closed the door in his face.

Hope this helps.

psu_213, BSN, RN · Sep 30, 2014

I think the biggest thing is to let them talk without interrupting them. I have seen when nurse let the talk and the pt./family member usually feels better. I have seen situations where the nurse interrupts and tries to counter everything the pt./family says right as they say it. Usually doesn't work out that well.

Next, apologize. Even if you didn't do anything wrong. "I'm sorry this isn't going as you expected." "I'm sorry that you feel that way." If you word it like this, they hear "I'm sorry," but you never really did admit that you were wrong. Obviously if you did do something wrong, admit it and promise to correct it (and follow through on that promise: "I'm sorry I forgot to bring in your ice water. I'll get it right now." At the same time, don't throw yourself "under the bus" (boy, I hate that saying). For example, don't say "I'm sorry I was careless and gave you husband a lethal dose of levophed." (Ok, so that is a bit extreme, but you get the idea.)

Don't get frustrated, and don't sound dismissive--even if the voice in your head is saying "I had enough of you, you silly **&(*#&. Be quiet and let me get on with me day."

If they are still upset, offer for them to talk to your charge nurse. Don't do this all the time, as the charge nurse going to think either you don't take very good care of patient and/or you can't solve problems on your own. But, you do need to move on and care for other patients on your assignment.

jadelpn, LPN, EMT-B · Oct 1, 2014

"Let me see if I understand what you are saying"....and repeat what they told you to be sure you are both on the same page.

"I understand, and here's what I can do in an attempt to resolve your concern"----and give them concrete thoughts on what you can do--even if it is going higher up on the food chain then yourself.

"So the plan going forward is"----and give them the top 2 or 3 things that you will take care of immediately.

"I will be in tomorrow at 2pm and we will discuss my findings/my discussions/resolutions".

"Does that sound fair?"

Do not internalize, personalize....it is often a reflection of the patient/family need to control. And exposing vulnerability that is not something any of us particularly like to do when a patient.