When you decided to become a nurse, you knew it wouldn’t always be easy. You expected the long nights, the grueling shifts, the heartbreak of losing a patient. But something you probably didn’t think much about the possibility of not getting along with your patients. After all, you entered this profession because you wanted to care for your patients, not clash with them.
The fact is, though, that nursing means caring even when it’s hard. It means loving your patients even when you don’t like them. And that’s perhaps the most difficult and most important lesson that nursing school can never teach, the lesson that only your most challenging patients can teach. This article provides tangible strategies for new nurses dealing with difficult patients, without losing your sanity, your health, or your professional passion.
Seeing Through Your Patients’ Eyes
The first step to dealing with a difficult patient is to try to understand what’s causing their behavior. It’s highly unlikely that a patient is going to be difficult just for the fun of it. Chances are far greater that something has gone wrong and that’s fueling the problem.
Many patients’ behavior, for example, may be explained by their particular medical condition. Those with dementia, Alzheimer’s, end-stage renal disease (ESRD), or certain mental health disorders, may react aggressively, irrationally, or non-compliantly simply because their illnesses have impaired their ability to understand their circumstances or respond appropriately.
In addition to physical and mental health challenges, environmental and situational factors may also be driving your patients’ contrarian behaviors. Patients who have been recently diagnosed with a catastrophic or terminal illness may be grieving the loss of their health and function.
Or they may have experienced the loss of a loved one, the loss of a job, a divorce, or some other significant trauma that is causing them to be hyperreactive. Likewise, cultural and language differences may be limiting the patients’ ability to understand, ask questions, or express themselves effectively, and a frustrated patient is far more likely to act out in negative ways.
An important strategy for understanding your patients’ perspective is to practice active and empathetic listening. Ask questions and reflect your patients’ views back to them accurately and without judgment. This will not only ensure your own understanding, but will also reassure your patients that they’re being accepted, heard, and understood.
How to Respond
Once you have a better understanding of your patients’ perspective, you can then begin to formulate a response that is productive and beneficial to the patient and your relationship with them. But that’s going to require you to be self-reflective as well.
After all, nurses are only human, and there’s no such thing as complete, unimpeachable objectivity. Just as with your patients, your own responses may be influenced by factors that you’re not even aware of. We all have our own internal biases, not to mention the ordinary stressors of daily life, that may make us respond in inappropriate or ineffective ways to some patients.
Your patient, for example, might remind you of a contentious relationship in your own life, and you may project negative emotions regarding that person onto your patient. At the same time, if you are feeling overwhelmed by a particularly stressful day, you might find yourself feeling short-tempered, unsympathetic, and ready to lash out at any patient who adds yet more problems to your day. So, when you’re figuring out how to respond to a challenging patient, you have to determine, first, whether it’s the patient or whether it’s you and, above all, try not to take it personally.
Another key to managing difficult patients is to focus on de-escalation. That means focusing on remaining calm and non-defensive and, ideally, on allowing your patient to express themselves freely. This includes giving your patients a safe place to vent when needed.
De-escalation strategies can also be employed at the organizational level. For example, in the wake of the COVID-19 pandemic, health systems nationwide are facing significant reductions in revenues and staffing. That’s leading to a surge in patient wait times and perhaps unprecedented levels of stress on health care providers. Using hospital resource management strategies (HRM) can help your organization run more efficiently in the face of the current crisis and beyond. And that’s going to improve your patients’ experience and decrease your workplace stress.
Another important tool for dealing with tough patients is to help them become more educated about their condition and to feel more empowered to take charge of their health. One of the most significant stressors associated with a difficult diagnosis is the patients’ sense of lost autonomy.
Equipping patients with the resources they need to make informed decisions about their own lives, and their own care, can be a tremendous benefit in reducing negative behaviors. Mobile apps, for instance, can be used to help patients with their meal planning, lifestyle choices, and treatment plans. Connected patients can even access online communities reserved for other patients, their families, and health care providers.
The Takeaway
Nursing can be more rewarding than you ever dreamed. But it can also be more challenging than you ever imagined. The key to dealing with difficult patients, though, is to not take it personally, to focus on understanding the roots of their behavior and figuring out a response that is productive for and protective of you both.
There are currently nearly 4 million nurses working within the health care industry of the United States. It is the largest health care profession in the country, and for good reason. Nurses make a difference. They are often the first point of contact for anyone seeking medical attention, and they tend to go above and beyond what is typically asked or required of them.
Even though it is the top health care profession, there is always a growing need for nurses. Thankfully, it’s one of the easiest careers to pursue. Nursing courses are offered almost everywhere, including online, and once you’ve completed your coursework you can enter the workforce quickly. Plus, you can choose your own specialty, depending on your interests or passion.
Nurses also have the opportunity to work almost anywhere in the world, and job security will always be there. But, if you’re already interested in pursuing a career in nursing, you likely already have your own reasons to make it your life’s work.
The better question is, how should you get started? What should you expect as you go through your undergraduate studies, and which career path should you take when it’s time to make that choice?
Getting the Education You Need
The amount of education and training you’ll need to become a nurse depends on what type of nurse you’d like to be. For example, to become a Registered Nurse (RN), you’ll need a minimum of an Associate’s Degree.
If you’re already an RN or if you want to pursue something higher, consider getting your BSN (Bachelor of Science in Nursing) at a four-year university or institution. No matter what degree completion you go through, everyone entering the nursing field needs to complete the NCLEX. This is an exam that is required by the National Council of State Boards of Nursing. You’ll need to apply to take the exam through the state in which you plan on working. A passing grade is required to become an RN, and the categories include:
Safe, effective care environment
Psychosocial integrity
Physiology integrity
Health promotion
Once you are an RN or have received your BSN, you can decide whether you’d like to choose a specialty or continue your education to become a nurse practitioner. Nurse practitioners must complete a Master of Science in Nursing program (MSN). On top of your previous education, the entire timeline can take anywhere from 6-8 years. If you haven’t yet started your educational journey toward becoming a nurse, it’s never too early. Some nursing programs are available online (at least partially). If you know nursing is your passion, you can begin to take courses early and gain experience that will help you once you find yourself in the workforce.
Facing the Realities of Nursing
No matter what level or area of nursing you decide to pursue, there are a few truths you’ll need to understand before you get started. Maybe you’ve been passionate about becoming a nurse since you were a child. Those passions and dreams don’t have to be “squashed,” but knowing as much as possible about the realities of nursing before you break into the field can help you determine if it’s really the right career for you.
First, it’s important to understand that you will always come second. That’s actually one of the reasons many people become nurses: to provide service to others. Doing so can help you to feel fulfilled and satisfied with your work. But, that doesn’t mean it will always be easy. Some potential “drawbacks” to keep in mind about a nursing career include:
You’re constantly on your feet, which can cause muscle aches and pains, or even lead to varicose veins.
If you work in a busy hospital, you may have irregular hours.
Nurses are at a high risk of experiencing workplace burnout.
It can sometimes be a “thankless job”.
Entry-level RNs only make an average of $41,000 per year.
Nursing can be a demanding profession, depending on where you work. But, most people stay in that profession for years because the rewards outweigh any of the disadvantages. It helps to have certain traits and characteristics to enjoy nursing as a long-term career. You have to enjoy working with different types of people every day and be willing to be a major component in a functional team.
How to Land a Great Nursing Job
Once you’ve completed your education and received your certification to become a nurse, the next step is to find the right job. Thankfully, due to the high demand for nurses across the country, your qualifications will often be enough for you to get hired quickly. Nurses are needed in a variety of settings, including:
Hospitals
Clinics
Nursing homes
Local government agencies
Think about the type of setting that would be a good fit for you before applying to different open positions. You may want to start somewhere small to gain experience, especially if you eventually want to continue your training toward a specialty.
Networking is just as important in the health care industry as it is in other business sectors. If you know anyone in the industry, don’t be afraid to reach out to them and market yourself to land a job. Many times, getting the job you want is about “who you know”, so use your connections wisely.
Finally, think about some of the most common questions you could be asked during a job interview. While it’s important to practice your answers for the interview itself, you can also gain more insight into what you really want to achieve out of your career. What are your goals? Why did you want to become a nurse? What are your biggest strengths and weaknesses? By understanding some of those things about yourself, you will have more direction in where you want to take your career.
Nursing is one of the oldest, most stable professions in the country, and it’s still seeing continuous growth. If you are pursuing a career in nursing, keep these ideas in mind to continue your forward progress, and know what to expect as you start your first job.
Nursing can be one of the most rewarding professions available to people today. Few other positions offer practitioners the ability to help people so directly and make such a large impact in their quality of life. It’s no wonder that nurses are some of the most trusted and highly thought-of professionals in our world today and have been for much of our lives.
Though nursing offers a lot of opportunity to help those in need, actually becoming a nurse can be challenging and filled with barriers that make entry into the profession quite difficult. Many aspiring nurses find themselves struggling with at least one of these barriers to entry.
Fortunately, there are ways to prepare, avoid, and fight these barriers at every curve in the road. It takes preparation and verve, but becoming a nurse is completely attainable for those with the drive to make it happen.
Financial Barriers
Perhaps one of the biggest challenges that many young aspiring nurses face is getting their finances in order. Student loan rates in the United States today are out of control, and nursing school is no exception. The average nurse will leave nursing school with upwards of $20,000 in debt. This amount doesn’t necessarily cover the debt acquired in any other associate’s or bachelor’s degree program prior to entering nursing school either.
Student loan debt is a significant challenge that a significant portion of the younger generation is facing. Few things can be done to resolve the larger issue without government regulation or debt relief programs, but there are some actions you can take individually. These include measures such as saving money before nursing school to avoid taking loans, working a part-time job, paying down interest while still in school, and refinancing loans for a lower interest rate.
Educational Barriers
Beyond financial barriers, there are still lingering educational barriers that could prevent aspiring nurses from attaining their goals. For instance, getting into a quality nursing school can be a real challenge. Even after getting into school, balancing rigorous coursework, homework, studying, and clinicals can be difficult, especially if you are already dealing with financial barriers that may require you to have a part-time job.
Time management is the best way to get around this barrier. Work on setting up your study schedule and sticking to it. Your days may feel full, but you should still build in time for breaks, exercise, and fun activities that will keep you from burning out. For better or worse, there still may be a time or two when you need to stay up all night — there are good (moderate doses of caffeine, exercise), and bad (energy drinks) ways to go about doing this, so be sure to take some steps to be successful.
Physical Barriers
Once you’re starting clinicals you may quickly realize that there is a lot more to helping people than originally advertised. There are long days, demanding patients, complicated treatments, and lots of stress. Many nurses will start to experience caregiver burnout, which is the feeling of being unable to care for yourself after caring for others all day.
Nursing is not an easy job and many people start to burn out relatively quickly if they don’t have a great work-life balance. Unfortunately, there are still plenty of workplace stressors that nurses bring home. This being the case, job stress leads to a high divorce rate for nurses.
The key here is to find some way to make time for yourself every day. Go for a walk on your breaks, exercise before work, read on the subway — do whatever it is that you need to do to relax and feel like you’ve had a little bit of “me” time. It goes a long way when the going gets tough.
Minority Barriers
Being a minority in the health care system isn’t necessarily easy either. Racism is still a lingering problem in health care in general. Though nursing as a profession has made many leaps and bounds, other specialties have not necessarily kept up. Chances are minority nurses will work in an environment where leadership isn’t necessarily representative of the country’s racial makeup.
Conquering these barriers takes organization and forcing greater attention to be brought to a lack of representation in the workplace. Policy change isn’t always easy to come by and many critiques have been made about policies that make it more challenging for minority students to succeed. Ultimately, greater pressure on leaders to implement reasonable changes is what is needed to continue to push the needle towards greater equality and representation in the workplace.
There are a lot of real barriers that work to prevent some aspiring nurses from achieving their goals. The barriers range from finance and education ones to physical workplace demands and social structure barriers. There is no easy way to solve all of these problems but making a plan, making time for yourself, and making people realize a need for a change is a good start.
While industries attempt to address the spread of COVID-19, nurses have been working long hours, many times with insufficient personal protective equipment (PPE) and constantly changing state and federal requirements. They are also having to make ethical decisions about patient privacy, informing others of likely exposure, and patient treatment, and as the fight against the virus continues, we are seeing new and changing ethical issues arise.
The Code of Ethics for Nurses is the standard for ethical training and decision making, and is a resource that nurses are taught to know and implement. However, as the day to day operations of hospitals continue to be fraught with unexpected challenges, it is up to the frontline workers to fight for the ethical treatment of patients, families, and even themselves. As the front line personnel most intimately familiar with COVID-19 cases, nurses have a unique perspective on the effects that this pandemic is having on their communities and patients.
Knowing the available ethics resources, standing as an example of ethical conduct, and staying as up to date as possible on regulatory changes, are just the first steps in fighting for quality of care during this turbulent time. As a nurse in the midst of it, you can use the following tools to hold yourself, your colleagues, and your organization accountable.
Know Your Code of Ethics and Related Resources
The first step in being able to fight for strong ethical standards is knowing those standards yourself. Ethical nursing practices are taught using The Code of Ethics for Nurses, and there are now supplemental texts to deepen your understanding of how to apply them. Among them, The Code of Ethics for Nurses with Interpretive Statements, published in 2015, addresses especially difficult ethical situations such as crisis management and pandemics.
Staying up to date with the standardized documentation available will provide you with a framework for addressing new situations in conjunction with the help of your hospital or organization’s ethical resources. Organizational ethical support for nurses is a major necessity that your organization is obligated to provide, and institutions are not allowed to retaliate against nurses who bring concerns about their working conditions to management. These concerns may include unsafe exposure risks, physical safety, and the quality of ethical decision making by other personnel.
While simply knowing your ethical code cannot prepare you for all of the possible decisions you will have to make as a nurse, make sure to utilize the resources you can and bring any concerns to the attention of your organization’s management. By continuing to develop your understanding of ethical standards as they apply to the crises we are experiencing, you are better prepared to argue for both your and your patients’ safety.
Stay Up to Date and be Vocal
By staying as up to date as you can on your hospital’s current regulations, as well as government regulations, you can foster transparent communication between yourself and the organizations you interface with, making sure that you are working with the most recent information available. It is a difficult task as these regulations are changing daily, but keeping an eye on current regulatory requirements is important. This knowledge is the main factor in staying vocal in the workplace.
Addressing the ethical decisions of your colleagues can help save a patient’s life, limit spread to others in the hospital, and evaluate new symptoms of the virus. In the high-tension, high-stress situations that we are seeing right now, nurses are in a position to utilize strong ethical convictions and honesty to uphold their obligation to their patients and themselves. By staying vocal when you see a questionable decision made, bringing the information to management, and holding others accountable, you can be a force in maintaining an ethical workplace.
Part of ensuring the safety and well-being of patients is to ensure that those you work with are not endangering them. This could be simply a matter of fatigue, or of an inexperienced person attempting to complete a new procedure, but either could lead to a patient being injured or worse. Being aware of the ethical practices of those around you as well as their level of experience, is another way to help ensure that high-quality ethical practices are in place.
Stand as an Example
If you are working as a CNA, or in any other advanced position, new employees will look to you as an example of how to conduct themselves. After all, the codes of ethics apply not only to patient care, but to a nurse’s responsibilities to themselves and their team. By setting an active example for your colleagues, you can help create an environment founded on ethics that support the well-being of both patients and nurses.
There are basics of care that all nurses are trained in, including ways to protect a patient’s privacy, but we are experiencing a massive event that has taxed our medical system and its practitioners beyond any in recent history. Organizations are experiencing a lack of resources, personnel are working extremely long hours in high-risk environments, exhaustion is at a high, and newly trained medical professionals are being called on to make difficult decisions. In this environment, holding yourself to high ethical standards can help provide a path for others to follow.
Education, training, understanding, and action are all required to ensure the health and safety of patients, communities, and staff alike. While the mainstays of health and wellness are still important, the environment and stakes that medical professionals are working with have changed drastically. By fighting for ethical practices, you can become a part of the solution, and help ensure that patients, both yours and future ones, get the treatment that they deserve.
When you were in nursing school, your professors and your mentors undoubtedly warned you about the hard times. They said you’d be tested. They told you there would be times when you wanted to quit, times when you just didn’t think you had the strength to go on.
But no one could have prepared you for the test that is COVID-19. In your worst dreams, you never could have seen this coming.
Now it’s here, though. And you’re slogging through one day, one hour, sometimes one minute at a time. But with infection rates surging, there doesn’t seem to be an end in sight, at least not anytime soon.
If you’re going to make it, then you’re going to have to take care of you. And that begins by setting boundaries, even with your precious COVID patients and their families.
Claiming Your Right to Self-Care
As a nurse, it probably feels only natural to put other people first. It’s what you do every working day of your life, after all. And that habit likely doesn’t change when you’re off the clock.
That’s not a healthy or sustainable way to live in the best of circumstances. Lack of self-care, especially as a result of overwork, can take a devastating toll not only on your physical health but also on your mental and emotional health. It’s also debilitating to your relationships, those emotional support systems that keep you strong in body, mind, and spirit.
One of the greatest risks, of course, is that the demands placed on you as a pandemic nurse is that you might easily lapse into work addiction. You might find yourself unwilling, or even unable, to leave your work behind you when you come home. You might feel as if the only “right” or “noble” thing to do is to work yourself beyond all reason, giving yourself wholly to your work, supposedly for the sake of your patients but, really, for the sake of your addiction.
But whether you are simply facing extreme overwork, or you are falling into a full-fledged work addiction, as a nurse in the age of coronavirus, failure to practice self-care by nurturing your mental health isn’t just hurtful, it’s downright destructive. Right now, you are bearing physical, mental, and emotional burdens that you never thought possible.
Recognizing the signs that you are struggling and you need help is neither weakness nor selfishness. It means valuing yourself as much as you value those under your care. It means allowing yourself the right to the same kind of love and care that you give your patients. It means taking care of yourself so that you can take care of them.
But How?
You’ve probably been taking care of others for so long that you’ve forgotten how to prioritize your own needs. You might never have learned how to protect your well-being by setting boundaries. When you have boundaries, you’re going to have more emotional energy and a stronger sense of agency and power, something that this pandemic has taken from far too many of us.
Setting boundaries, though, is not rocket science and it doesn’t have to be hard. You can start simply, by ensuring that when you’re off the clock, you’re actually off the clock. That means that when you get home, you need to turn off all the COVID coverage and you need to let yourself be taken care of for a while.
If you’ve been working with COVID patients, unfortunately, you’re probably not going to be comfortable being physically close to your family and loved ones. But you can still let them nurture you from a distance. Get your kids to make dinner and do the laundry. Have your spouse draw you a warm bath and turn your bathroom into the perfect spa retreat.
Above all, make it clear that no pandemic talk is allowed unless and until you want and are ready to share. And that also means resisting the urge to constantly check on your patients. For the sake of your physical and mental health, when you are off duty, you must do your utmost to get away from thoughts of the virus and to nurture yourself, instead, with the things that you love in the best way you can.
Get Out(side)
Setting boundaries as a COVID nurse means standing up for your right to take time away. Scheduling a weekend getaway to the outdoors is good for your physical health, reducing your stress, and boosting your immunity. But it’s also ideal for your mental health, helping you to rest and decompress, to calm your mind and regroup.
Studies show that spending time in nature can help nurses build resiliency and avoid burnout. And there’s never been a greater need for that than right now.
Seeking Help
No one needs to tell you that the pandemic is one of the worst health crises in modern history. You’ve been on the frontlines for months now. You know the score. And because you know the score, you also know that this crisis isn’t something you can, or should, handle alone.
If you are 65 or older and have Medicare, you likely qualify for mental health care coverage. And if you’re covered under your employer, then mental health benefits are also likely included in your group insurance plan. On the other hand, if you’re uninsured or your plan doesn’t include mental health benefits, you can still reach out for free or low-cost care in your community.
The Takeaway
Nurses are superheroes and the world knows it now more than ever. But even superheroes need caring for. And that begins, above all, with recognizing your right to self-nurturing and setting the boundaries you need to ensure that the one who cares for everyone else finally gets the TLC she or he deserves.
