Tips for Dealing with Difficult Patients...

[Joe V]

Have you ever had to deal with a difficult patient?

It's challenging to say the least, but did you know that they help you become a better nurse?

It's not always easy to find the reason behind unruly patients but if you can manage then you can successfully deal with every patient.

How do you deal with difficult patients? Do you have any tips you can share with the community?

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[qestout, ASN, RN]

The first thing I try is acknowledging their feelings/frustrations. Then, if I can leave them alone for a little while, I do. This usually decreases their surliness when I return.

[msjellybean]

Oh, if only I could have said this to a couple patients from last week. Too bad I'd get dinged for my lack of customer service.

[msgirl68]

Nurses have very stressful and demanding jobs while dealing with our own life issues.

[Meriwhen, ASN, BSN, MSN, RN]

Being emphatic, conveying that I understand that they are feeling the way they do while at the same time setting and enforcing boundaries, and not taking anything personally.

[smurfynursey]

ask them about the problem and listen!...I know this sounds stupid and simple but allow me to explain...

As a student, I worked as a CNA on a hem/onc unit. We had a patient that came to us a few times...this particular time, she was dying...slowly. All the other CNAs hated having her because she was OCD HARDCORE! Everything had to be at a certain angle, made a certain way, ect.

One night I was talking with her and she was super doped up on pain meds and she asked if I wanted to know "how it had to be". I said yes! The tray table had to be at a 45 angle so she could see it, the cups had to be in a straight line with the writing facing her (so she knew what she was drinking) the PCA button had to be clipped to her pillow (so she could find it) the IV pump and the trash can had to be at a 45 angle (so she could know how to push the pump, and see to aim) and the foley had to not pull (duh!) Also she wanted a different wash rag for each extremity. After she told me "her secret" we understood each other and she often talked to me about her former career as a nurse! She taught me a great many lessons and I think of her family often.

Funny story...one night she told me that you (I) should never go into OB as a new grad. She did, and because of her OCD she had to have everything just so and at exactly the right time...and well, we all know babies don't always wait for the exact right time for the sterile field to be set up the exact right way the particular Dr wanted it by the OCD nurse :) (It was funnier when she told it)

When I was a new grad and I used to get asked about a patient I found to be memorable, difficult, and/or taught me a lot, I always talked about her.

[DutchRN09]

I usually give them something to eat, drink, pain pill and leave them alone for a while. It seems to help. But perhaps they become bored and decide they are ready to go home...

[Hygiene Queen]

Never let them see you sweat.

Some are seeking a reaction and I try not to give it.

Usually, I try to convey empathy and this is sometimes difficult as I do not always actually feel it.

You need to do a bit of acting, sometimes.

However...

Sometimes, I just have to be very direct, blunt and to the point... no sugar-coating... no acting.

So many many things I could suggest but each situation requires a unique response.

I've learned over many years and there is no one way to deal with difficult patients.

I do know they can (usually) be won over.

[imintrouble, BSN, RN]

If, after all attempts to satisfy the pt has failed, I reliquish control. I acknowledge that they are the boss. They want to control everything about their hospital stay and that includes me. I do not try to butt heads with them. In a war of wills, the nurse will always lose. At least they'll lose in my hospital where the pt is always right.

On days when I have one of those pts, I tell myself I can do anything for 12 hrs....11 hrs....10 hrs....9 hrs.....

It works. Until I have to come back the next day and take care of them again.

[VivaLasViejas, ASN, RN]

A strategy that's almost always worked for me is to invest some quality time in the most "challenging" patients at the very beginning of the shift, especially if they're new to me. A lot of times, that ten minutes or so of sitting down with them, discussing their goals for the day, and actively listening to them saves a thousand steps later when they're not hitting the call light every 5 minutes. It also shows them that their concerns matter to you; and when they believe they've been heard, the vast majority will calm down, feeling more confident that their needs will be met and thus becoming less anxious.

I'll never forget one woman, a thirty-something frequent flyer who came in with vague abdominal pain for which no cause was ever found. She was notorious on our Med/Surg floor for being a PITA---on the call light constantly, yelling at nurses and aides who reminded her that she could not have Pepsi when she was NPO, freaking out when she got a roommate and so on. I'd never had her before, but I drew the short straw one evening when she'd just arrived on the floor and needed to be admitted.

So I went in right away, put the paperwork down and pulled a chair over to her bedside as if I had all the time in the world. She was suspicious at first, but quickly warmed up to me and then proceeded to confide some of her darkest fears. By the time fifteen minutes had gone by, I'd earned her trust and a pretty good concept of what her real issues were; and do you know, she rang that call bell maybe four times all night---a couple of times for pain medication, which I gave promptly, and once or twice to ask questions. That was it. My co-workers noticed and asked me how much Ativan I'd given her, because they'd never seen her that mellow; but she didn't need any at all during that shift. :)

[kizeemimi]

I have noticed that SOME people in general, whether or not they are a patient in a health care setting, have to have it be all about them. They have to be the boss, call the shots, etc. When I have these people as patients, I let them do just that. I am friendly, receptive and listen to what they want. If I let them "be the boss" they usually become easy patients and prefer me over other PCAs. Its not a matter of letting them walk over me, or not doing my job, etc, its learning how to communicate with different personality types. Whether this will work or not once I finish school and become an RN, I do not know! lol

[VivaLasViejas, ASN, RN]

Oh, yes....it most certainly will help you as an RN. You're already way ahead of most of the planet on that score---you have great instincts that will serve you AND your patients well. =)