4 Types of Difficult Patients and Tips for Dealing With Them

J.Adderton, BSN, MSN

It is inevitable. Your path will intersect with difficult patients over your nursing career. Angry, manipulative or overly needy patients can quickly wash away your already strained patience. Patient emotions surrounding loss of independence, stress and fear are often the driving factor behind difficult behavior. Difficult patients generally fall within four common types, which are often dependent on the driving factor. Understanding these types will help you remain compassionate and keep the lines of communication open.

The Dependent Clinger

Dependent clingers begin the patient-nurse relationship with a healthy dose of praise. Clingers often make statements such as: “What an angel, I knew you could help.”, or “You are such a wonderful nurse”. While we all like to get compliments, clingers use flattery as a way to manipulate. Clingers may have an endless stream of needs and demand chunks of your time. Unfortunately, we often over-extend ourselves and feel drained at the end of the day. We resort to avoiding the patient and they will act out to regain your time and attention.

The Entitled Demander

This patient type knows exactly what they want, when they want it and how they want it done. Instead of flattery, the demander will use anger and intimidation. Examples may include demands for:

Unnecessary lab work
Immediate appointments or notification of physician
Certain medications and treatments
Unnecessary referrals or consults

It is not uncommon for demanders to threaten attorney contact or lawsuits. In reality, all the posturing is just a smoke screen for feelings of powerlessness and helplessness.

Help-Rejectors

This frustrating type has many physical or other complaints but rejects help when it is offered. The relentless “complain and reject” cycle may make this the most difficult type to manage. You may successfully put out one fire, but help-rejectors quickly replace it with another. A medication may be prescribed for an issue and you notify the patient. The patient’s response? “I have already tried that and it won’t help”.

The Noncompliant

How many times have you witnessed someone smoking with oxygen, drinking alcohol with liver cirrhosis or a patient refusing to take needed medications? The noncompliant often seems to be completely unaware of how their poor health decisions are going to play out. According to the Journal Neurology Clinical Practice, underlying anxiety or depression disorders could be contributing to noncompliant behavior and keeping them from good health. It is frustrating when we, as nurses, are unable to educate or persuade the patient into complying with the treatment plan.

Tips for Dealing With Difficult Patients

When a patient is angry, frustrated and acting out emotions, it is hard not to take it personally. However, it really isn’t about you, but more about their unpleasant set of circumstances. Nurse consultant, Julianne Haydel, advises “Continue to do your job and don’t let their negativity get in your head. Just knowing that the nastiness is not about you is a good start.”. After this first step, there are other tips to help you move forward with a difficult patient.

Recognize Early Signs

You may be able to avoid or deescalate a situation by picking up on early signs of upset or anger. These signs may include a change in behavior, tightened jaw, furrowed brow or other outward signs of building frustration. Also, consider other sources for the behavior, such as, pain, uncomfortable symptoms or other underlying problems.

Gain Your Own Emotional Control

It is easy for our own emotions to become heightened when faced with another person’s anger, frustration and dissatisfaction. However, you will be able to better address the situation if you don’t react, be proactive and think about your body language.

Listen Empathetically

A quick way to calm a difficult patient is to listen and react with empathy. It may be the patient just needs to vent and tell “their story”. Rather than being defensive, listen respectfully and remind yourself the patient is in an unfortunate situation. Everyone one likes feeling important and knowing they are cared for.

Avoid Arguing

This can be a hard one, especially if you are taking the patient’s behavior personally. Our first response is to go into a detailed explanation of why their medications are late or their needs are not being met. Try simply apologizing and reassure the patient you will address the problem.

Set Boundaries

Sometimes patients may have unrealistic or seemingly endless demands. In these cases, set consistent and clear boundaries and keep interactions standard. It is also helpful to have consistent boundaries set across the interdisciplinary team.

Don’t Accept Abusive Behavior

It is sometimes difficult to draw the line between abrasive and abusive behaviors and may depend on your work environment. Always alert your immediate supervisor if a patient continues abusive behavior after being told it is unacceptable. Implement your facilities protocol immediately If you feel a patient's behavior is placing you, or others, in physical danger.

A Part of Nursing

You will deal with difficult patients throughout your nursing career, it is unavoidable. And, even the most difficult patients deserve our best care. By practicing these tips, we can focus on providing quality care while setting boundaries for ourselves.

Additional Resources

6 Tips for Dealing with Difficult Patients

Dealing with the Difficult Patient