"Difficult" Patients

  1. 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
    -asking about preferences and honoring them

    How do you you deal with "difficult" attitudes?
    Last edit by Vespertinas on Mar 16, '13 : Reason: hubris
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    About Vespertinas

    Joined: Nov '09; Posts: 678; Likes: 1,219
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  3. by   RNgrad2012
    If I'm told by the outgoing nurse that a Pt. has been difficult, I try to really do my best to come across as friendly, attentive, and approachable. Sometimes it's not enough to placate the Pt., but I'll give it my best shot.
  4. by   not.done.yet
    I often will talk with the patient about the goals for the day. I find out theirs, they find out mine, we discuss priority of care and usually this results in a compliant and more pleasant patient. Often the challemging patient is difficult due to unrealistic expectations, a sense that they are not kept "in the loop" and a feeling that they do not matter and have not been heard. A conversation about goals for care helps alleviate all of that in one conversation.
  5. by   eatmysoxRN
    Alghough excellent people skills go a long way, sometimes there are patients who absolutely cannot be pleased. 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.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
  6. by   turnforthenurse
    Kill them with kindness.

    eatmysox is right, though. There are some patients out there that no matter what you do, won't be pleased. I still try to kill them with kindness.
  7. by   CodeteamB
    I will go the "kill them with kindness" route right up to when they break one of my hard limits (shouting, swearing at another person, violence/throwing) then I inform them of exactly what they did wrong and that the behavior will not be tolerated and if possible leave the room to let them think about it. Then it's back to sweetness and light when I return, no mention of previous transgressions. If the behavior continues that's when I put on my scary nurse pants.
  8. by   Morainey
    Sometimes I enjoy the challenge of difficult patients... usually I can get things smoothed over because in most cases it is one specific thing that they are upset about. A couple of other posters covered it well, but I have a couple things to add:

    Find out what exactly is bothering them. Sometimes it's one specific thing or a lot of things that are going on in their lives beyond hospitalization. On night shift I can usually spend a few minutes talking with people and sometimes it's surprising the things people come out with.

    Set limits. No swearing, no yelling, no unnecessary meanness.

    Always being a smiling face each and every time I go back in the room. It's a fine line between being accomodating and a doormat.

    Killing with kindness is the best
  9. by   Nurse_
    I get reports of difficult patients all the time. I listen but to be honest, I take it with a grain of salt.

    From my experience, Patients who seem agitated or difficult result into failure to communicate with their nurse. Before I come in to assess my patients, I make sure to know what the plan is for the day. Informing them of what to expect, empowers them. I also leave my unit number in the board or desk, so they can contact me when they need something.

    If the patient is reported to be difficult,
    - I tell them our plan for the day
    - Round every hour (even if I'm not in the ICU) to check if they need anything
    - Tell them I'll be leaving for lunch, but if they need something, someone's covering me
    - Routinely inform them about what I'm doing regarding their care ("I spoke with your GI Dr..., we care changing your meds to...)
    - For pain med seekers, I write on the board the hours they can get their meds and cross it out once I gave the medication for that hour (so they'll know). Also, I come in 5-to-10 minutes before the scheduled time if I can.

    In short, I bug them instead of them hunting me.
  10. by   noyesno
    I'm pretty good at winning these peeps over but it takes a lot of effort and drains the life out of me. Sometimes, I feel rewarded and pat myself on the back. Other times, I get mad at myself for giving so much and put the patient on the rotate list.
  11. by   DawnJ
    I'm a student and my instructor always gives me the "difficult" patients because she says the other students aren't ready to handle them. By that, I think she means that they will cry when the patient is mean to them. My previous career gave me thick skin and a polite but no-nonsense attitude and so far I haven't had a patient be outright nasty to me, even when they are throwing things at the other staff. Most of the time they sigh and give impatient body language, or in one case, refuse to speak to me at all except for name/birthdate. And that's just fine with me as long as we get done what needs to be gotten done.

    Granted, this is for med pass or treatments, not as a daily assignment. For a daily assignment I'd try to get them to talk about what is driving the behavior
  12. by   bebbercorn
    Sometimes, a change in nurse is all it takes. I find most of the time when I was expected to receive a "difficult" patient, they turned out to be fine. Could be either the nurse or the pt that was having a bad day... Nonetheless, I agree with above posters that going in with a friendly attitude makes all the difference and works most of the time.
  13. by   ABitterPill
    CodeTeamB: Do you have a "sane" nurse manager?! Cause, if we try the "scary nurse pants" thing on our floor and a patient or family member expresses the least little thing about it, we're reprimanded...leaving me to wonder, just how much abuse is a nurse expected to take---from pts, family members and my nurse manager?! I'm about at my ultimate limit sadly.
  14. by   VivaLasViejas
    I've always tried to invest time in the 'difficult' patient at the beginning of the shift, before I see anyone else. A lot of times, that 10-15 minutes of talking and goal-setting establishes the tone for the entire day, assures the patient that his/her needs will be met, and usually halts the leaning-on-the-call-light process.