What do you do with extremely mean/disrespectful patients?

smf0903 · Dec 13, 2016

It kind of depends on the patient. Sometimes you can just call them out on it ("I'm trying to help you, there's no need to be nasty.") Sometimes letting them get out whatever is bugging them (feeling trapped in the hospital, maybe angry about a new bad diagnosis...) Sometimes you have to walk away and simply state ("I'll be back when you can treat me with the respect I deserve.")

You have to get good at feeling out the situation. Above everything else, just don't take it to heart. Some people are just a$$hats. I know this probably doesn't help because it's not a cut-and-dry answer! Good luck...remember to let it roll off of you :)

Lev, MSN, RN, NP · Dec 13, 2016

You have to play it by ear. You don't want to rile them up enough for them to get violent. That is another thing to be watchful of. Sometimes I will call them out on it, but usually I just ignore them. If they keep making requests, I will give get them what they need, within reason. However, I will not let them manipulate me into having to fulfill multiple requests. I will make them comfortable, offer blankets, given them a urinal, make sure they have the remote. This takes less than 5 minutes, but it does help. I ask them what they need, tell them what I can get them now, and tell them I will be back later. Regarding the verbal insults..."Mr. "Pottymouth"/Sir, if you would like me to help you, you will have to speak a little nicer." I am also friends with police and security if things get hairy.

FolksBtrippin, BSN, RN · Dec 20, 2016

How would you feel if a patient called you a stinky polar bear?

Really think about how you would feel.

Now think about the comments you heard that influenced you to feel disrespected.

How are those comments different from stinky polar bear?

You seem to be okay when psychotic/disoriented patients say mean things. Is it because you know it has nothing to do with you?

How is it any different when the patient is not psychotic?

ArtClassRN, ADN, RN · Dec 20, 2016

I set clear boundaries and expectations for behavior and I'm quick to call security. When patients figure out I won't tolerate abuse, they either get with the program or fire me. They know many nurses are willing to serve as doormats and punching bags and hope they get one of those.

One of my coworkers was being ordered around like a waitress by a large group of visiting family members. She was spending all her time addressing their demands. Finally, she just started hiding from them, and family would come out of the room and started demanding the same from me. I told them clearly I would be happy to take care of the patient but that was it, I was not their concierge.

My coworker said, "Aren't they horrible??" I said, "Not really, they are just trying to see how much they can get away with. They are acting that way because you are placating them and that makes it very difficult for your coworkers. You have to set boundaries."She sighed and said, "I just can't".

Avid reader · Dec 20, 2016

Super Duper reply! Difficult patients need immediate boundary settings and have another staff present. Then chart the difficulties, your boundary settings and witness name. CYA! Always be professional and considerate. A hospital is a scary environment with scary monitors, noises and invasive Txs. Make pt aware that you know he may be responding to the environment and you can allay their anxiety through reassurance or chemicals. It always helps to let them know that this is not their home or the street and therefore only appropriate behaviors will be acceptable. Good luck!

Avid reader · Dec 20, 2016

Invitale, there is a difference when a pt is obnoxious without reason. It alerts you to how your future interactions should proceed. If obnoxious, then it's professionalism by the book because they generally are complainers and blamers!

Libby1987 · Dec 20, 2016

I don't think I've ever told a patient or anyone that they had to speak to me with respect, my style is more to the point.

I usually say 1-3 of the next statements (less is best): "You're alienating the staff and I'm running out of nurses who will attend to you. They're not going to tolerate you talking to them like that. That is not the way to get what you want or need."

Libby1987 · Dec 20, 2016

I don't think I've ever told a patient or anyone that they had to speak to me with respect, my style is more to the point.

I usually say 1-3 of the next statements (less is best): "You're alienating the staff and I'm running out of nurses who will attend to you. They're and/or I are not going to tolerate you talking to them like that. That is not the way to get what you want or need."

Ruby Vee, BSN · Dec 20, 2016

Hi guys! I'm a new graduate nurse in a level 1 trauma center ED. I'm just asking for learning purposes, what do you guys say to extremely disrespectful and even verbally abusive patients?
I'm not referring to altered mental status patients, psychotic patients or anyone of that nature. I mean those who are aware of what they're doing and saying, and are intentionally malicious. I can deal with rude patients, but it's the nasty and mean ones that I'm not sure the best approach.
For example, I was with my preceptor the other night. We had a mean older man who while we were in his room, getting him changed, repositioning, etc. was just hurling insults and verbal abuse at us from the time we walked in the room. My preceptor didn't say anything about his behavior, just continued doing what she was doing and trying to meet his requests. What do you guys do in this type of situation, when it isn't a situation that warrants calling security, but you feel extremely disrespected ? Thanks!

Yes, I feel disrespected -- such behavior is disrespectful. But it really isn't personal. They don't know you, they're not lashing out at you personally. They're mistreating the nurse because they can. You're the nurse.

Each situation is different, and each person deals with the situation in her/his own way. I've been up front with patients: "This behavior isn't going to get you what you want." "Why would you believe that being nasty to me is going to make me want to go out of my way to get you something extra?"

If it's safe to defer what they're asking for until later (extra water, extra food vs. pain meds or a urinal) I may have told someone that "I'd be happy to do so as you as you are more civil". I've frequently been known to respond to a list of demands with "Is there a 'please' in there somewhere?" (Works with physicians, too.) Or "I'm sure you meant 'Please get me a drink of water'" in response to someone's profanely worded demands, name calling or insulting tirade on why he didn't already have a drink of water. Some folks it works with, others it just escalates. It takes experience to know the difference.

I had an orientee I'll call Nia, and on her very first day on the unit, we were given one of the nastiest patients I've cared for in 40 years. The woman whined, cried, demanded, name called, swore, insulted and carried on all day long. Nia handled it with grace, doing some setting of limits and some benign ignoring. At the end of the day, I praised her forbearance. Nia was a second career nurse; her first career was military. "After you've dealt with 18 year olds in a war zone with bombs falling all around you, this is no big deal." Nia's statement comes to mind whenever I have to deal with similar patients.

AliNajaCat · Dec 20, 2016

My coworker said, "Aren't they horrible??" I said, "Not really, they are just trying to see how much they can get away with. They are acting that way because you are placating them and that makes it very difficult for your coworkers. You have to set boundaries."She sighed and said, "I just can't".

I knew a very wise therapist once who used to say,"Don't ever say 'Can't,' say 'Won't.' " Puts a whole 'nother perspective out there, doesn't it?

FolksBtrippin, BSN, RN · Dec 21, 2016

Invitale, there is a difference when a pt is obnoxious without reason. It alerts you to how your future interactions should proceed. If obnoxious, then it's professionalism by the book because they generally are complainers and blamers!

Most of the time when you think someone is being obnoxious, that person doesn't think they're being obnoxious. That person usually has a problem with you.