Managing Stress Caused by Challenging Patients

Have you ever dealt with a manic patient, tried to draw blood from a person with dementia experiencing agitation, or had to respond to repetitive call button alarms from a patient suffering from loneliness? Cases like these can test our patience, temperament and empathy as nurses and often act as a trigger to stress. While we typically blame the “challenging patient” triggering this response, it’s often more about us healthcare professionals, than them. Nurses Announcements Archive Article


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Managing Stress Caused by Challenging Patients

There are a lot of reasons a patient can be stressful for a healthcare provider. The diagnosis may be challenging, the situation could be demanding, or the patient is "difficult". Whatever the reason, some patients cause healthcare providers' heart rates to increase and blood pressure to rise. This reaction is totally natural. While many articles advise that people should remove themselves from situations that cause stress, healthcare providers typically don't have that option or luxury during their practice.

In the 2006 study, How Respected Family Physicians Manage Difficult Patient Encounters1, physicians describe successful methods to working with challenging patients. While this study is shared from a physician's perspective, there are several options that can be very helpful for nurses and other healthcare professionals during these stressful encounters:

Acknowledge your emotions

It's okay to feel stressed by a patient, but using that feeling to learn about yourself should be the goal. Discovering which emotions are causing you stress-frustration, anger, sadness, etc.-can help you learn and grow from those situations. Additional research has found that healthcare providers who acknowledge and accept their emotions have improved client relationships. Recognize that you cannot control the patient's behavior and it is not your responsibility to change their emotion, but by acknowledging your own emotion, you have the control over your own reaction3.

Know your professional values

Some describe particular patient encounters as challenging when their professional identity is challenged. For nurses who value punctuality, a patient who is consistently late to their scheduled appointment could be very frustrating. Nurses who value improved health outcome may find a non-compliant patient challenging. Understanding your own professional values can help in identifying why a patient is causing you stress.

Understand your biases and judgments

When a patient gets a reputation as being 'difficult,' subsequent healthcare professionals often develop a similar prejudice. This inherited prejudice can lead others to treat that patient as difficult from the beginning and lead to an undeserved increase in stress. When giving a report to another healthcare professional, avoid using negative adjectives (difficult, needy, etc.) to describe a patient's behavior to stop this stressful cycle.

Talk to the patient

While this point sounds obvious, it is often sadly overlooked. Talking to the patient provides insight into where they are coming from and lays the foundation for empathy. It's easy to assume that a grumpy person is always grumpy, but you won't know otherwise until you learn about them by listening. Try acknowledging the patient's feelings or verifying your observation. You may be drawing a wrong conclusion about your patient's behavior. Maybe the patient is upset because they're in pain, hungry, afraid, or lonely. Assume nothing about a patient, because they'll often surprise you.

While the suggestions above may help at work, there are many ways to manage stress outside of work as well, including: leading a healthy lifestyle of well-balanced meals, regular exercise, and sleep, discussing stressful events with co-workers or family, and acknowledging when you need additional help2.

Managing your stress will never be a smooth road. Some days will be easier than others--just as some patients will be easier than others--but using the tactics above on a regular basis will enrich your coping abilities and lead to improved interactions for both you and your patient.

In addition to better patient encounters, managing your stress can lead to improved health. Stress has been shown to induce headaches, increase fatigue, and contribute to long-term health issues like heart disease and high blood pressure. There are a multitude of reasons to manage your stress, whether it's improved patient interactions, better health, or simply fewer headaches, so choose the reasons that motivate you.

There are new and fascinating challenges everyday in the healthcare field, so consider managing your stress a new challenge. Stress-inducing patients and situations are a struggle in the healthcare field, but you can always strive to control your reaction to them.


1Elder, N., Ricer, R., Tobias, B. (Nov-Dec 2006). How Respected Family Physicians Manage Difficult Patient Encounter. Journal of the American Board of Family Medicine, 19(6). Retrieved from How Respected Family Physicians Manage Difficult Patient Encounters

3Sherman, Rose O, EdD, RN, NEA-BC, FAAN. American Nurse Today, Dealing with Difficult People. May 2014, Vol 9. No. 5. Retrieved from Dealing with difficult people - American Nurse Today

2CDC. (2 Oct 2015). Coping with Stress. Retrieved from Tips for Coping with Stress|Publications|Violence Prevention|Injury Center|CDC

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Specializes in CNA 8 yrs LPN 6 geri, chemical dependency.

Something that has helped me personally: picture the worst day of your life. Image -write down, if you're an overachiever-the emotions, reactions, etc. you exhibited. If you're like me, some of the ones you write down are the ones you find most stress provoking when you're on the receiving end. This helps me -as a perfectionist, this may prove useless to others, sorry+ remember that they didn't set out in the morning

Circumstances with the physical or emotional health of a loved one or themselves have dumped a giant, steaming load in their laps, and they're dealing with the best of their ability. Also, that we're not perfect, sometimes behaviors and physical/emotional traits we've exhibited ourselves are what annoy us most in others. Example -my overly dramatic, needy mother -though I love her lol. Whenever I had a patient with a female relative of the same age that reminded me even a smidge of my mom, I'd fight my brain from going into autopilot in dealing with her. A personal issue of mine -valuing looks over medical emergencies, like painting my nails while awaiting an endoscope or unplugging an IV containing a very needed blood transfusion a few hours before that. It was a rough week lil, but I can only imagine what it looked like to the medical personnel trying to keep me alive vs internally bleeding with a hr of 190. If I see myself in that patient, I have to face the humiliation of facing putting vanity over my body almost falling apart, like an old, rusty car. Yes, I get that it was a coping mechanism. Hopefully, my post I'd somewhat able to be comprehended. I'm on day eight of an eleven day stretch and you KNOW they're not just eight hour shifts.

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Thanks for sharing these comments and for your candor. I'm sure others can relate to the long shifts and struggling with our own personal biases. No matter what work setting we are in, when we finish our shift, whether 8 hours or 12 hours or more, it's hard to shut down that ‘nurse-patient' emotion. There will always be those patients or family that we take home with us. But, hopefully, the more self-aware we are, the better we'll be able to care for our patients and not take it home with us. Thank you for offering some personal insight and for offering some additional tips for navigating stress.

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