How New Nurses Can Work with Difficult Patients

How New Nurses Can Work with Difficult Patients

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.

In 2021, Take a Pass on Tough Resolutions

In 2021, Take a Pass on Tough Resolutions

As 2021 dawns fresh and new, lots of nurses worldwide feel like they are dragging to the top of the calendar. The COIVD-19 pandemic changed almost everything about the way nurses work, interact with their patients, collaborate with each other and their teams, care for their families, and see their profession. As the pandemic continues to surge through the world, leaving 2020 behind is welcome, but it also brings uncertainty.

January’s typical challenge to commit to and work toward New Year’s resolutions seems tone deaf right now. Just making it through the trauma of 2020 is a victory and maybe the best resolution right now is to change the theme. After all, it is a new year and with that comes new hope, especially as vaccines have begun to roll out across the country. You can honor the calendar change but skip the pressure.

Here’s how to make resolutions work for you this year.

Make Resolutions to Let Go, Not Add

Resolutions don’t always have to be about you doing better, doing more, or taking on additional responsibilities or new habits. Resolutions for 2021 can focus on letting go of the things that you once thought were working for you or that were worthwhile but really aren’t.

Do you have a friend who makes you feel bad about yourself, a goal that was really someone else’s dream for you, or near impossible standards you set for yourself? Is holding onto these things helping you move forward in any way? Letting go of what drags you down will free up time and energy that you can use for what really matters to you.

Focus Where It Counts

You need sleep, nutritious food, connections with loved ones, fresh air, and plenty of water to be the best and most focused nurse you can be. Focus your energy on getting the things that bring you that goal. Maybe 2021 isn’t going to be the year you begin an ambitious fitness or weight loss plan. If you can hardly keep your head above water right now, don’t pressure yourself to start your grad degree, write that book, buy your first house, or land that new job. The world might look different in a few months, so don’t give up on your goals—just make sure they are realistic.

Make Small Changes

This time isn’t going to last forever. Things will change and they will get better. Keep your goals in sight, but take the time to refine them, decide why you want them, and map how to achieve them in small manageable steps. Are you trying to save money? Start cutting out small expenses. Do you want to be more fit? Start with 25 squats or jumping jacks every day or try 15 minutes of yoga three times a week. If you’re delaying an advanced degree, find a couple of webinars to keep you moving forward toward your goal. Clear out one catch-all drawer instead of tackling the whole kitchen. Those small successes lead to bigger ones.

Care for You

Nurses find this to be one of the hardest tasks on their lists. There is always something more important to take care of, more pressing to fix, or more demanding to pay attention to. What makes you feel cared for? As 2021 dawns, it’s going to be essential to find that and fit it into your life in a way that makes sense and doesn’t put more demands on you. It could be as simple as adding a few houseplants to clean the air and offer restful greenery to look at. Maybe it’s having the softest socks to slide into when you get home or finding a funny (or scary or spiritual or just interesting) podcast to lift your spirits. It could be spending quiet time in nature or perfecting your kickboxing moves—you’ll know it when you want more of it in your life. Listen to that and make it happen whenever you can.

The Most Popular Types of Nurses in 2020

The Most Popular Types of Nurses in 2020

Ever wonder what the most popular types of nurses are? As we get ready to ring in the new year, it might seem like frontline workers in health care are the most needed and most popular. Nursing students who will soon be headed out into the workforce may want to know what facets of the field have the most needs looking ahead into 2021.

We spoke with Dina Neilsen, Senior Manager of Learner, Career, and Alumni Services as well as the Emergency Committee Co-Chair at Nightingale College to find out about the most popular types of nurses in 2020.

When you say “popular,” what does this mean? The types that have the most nurses working in them? The types that nurses want to work in? Please explain.

This breaks down into a couple of answers—a prospective nurse might want to know what specialties are in highest demand, while others might want to know which are better paid, and which levels of education would need to be completed to work in a desire field.

Each job comes with its distinct set of responsibilities and has particular attributes: some pay better, others are less stressful, while some have the highest growth potential. To make the most out of a nursing career, each individual must decide which aspects are more relevant to them and pursue the position that best fits their aspirations.

Because of the pandemic, have frontline workers become one the most popular types of nurses in 2020? If not, why not?

While there isn’t much data given how recently the pandemic hit, it’s likely that there has been a surge in frontline medical workers. However, the pandemic itself will likely not change the overall top nursing careers.

What are the top popular types of nurses in 2020? Why are they? What has changed in the field to make the more popular if they weren’t in the past?  

The top 20 nursing careers, based on salary and according to the Bureau of Labor Statistics, are:

  1. Registered nurse
  2. Pediatric nurse
  3. Nurse practitioner
  4. Oncology nurse
  5. Emergency Dept. nurse
  6. Clinical nurse specialist (working in specialized units focused on a particular area of medicine)
  7. Nurse case manager
  8. ICU nurse
  9. Nurse educator
  10. Travel nurse (short-term assignment)
  11. Certified dialysis nurse
  12. Operating Room nurse (Perioperative nurse)
  13. Surgical nurse practitioner
  14. Psychiatric/mental health nurse practitioner
  15. Cardiac/cardiovascular nurse
  16. Nurse researcher
  17. PACU nurse
  18. Home health nurse
  19. Certified registered nurse anesthetist
  20. Certified nurse midwife

These are the specialties that are sought after by most hospitals, especially in the conditions of the nursing shortage looming ever-so-intensely over the United States.

Nurses Land in Gallup’s Most Trusted Top Spot

Nurses Land in Gallup’s Most Trusted Top Spot

In a year when nurses are on the frontlines of a deadly pandemic, it can’t be a surprise that nurses have once again earned the most-trusted top spot on the annual Gallup poll of the professions with the highest honesty and ethics. This year, nurses landed firmly in the top spot with 89 percent of respondents rating nurses as high or very high on honesty and ethics. The results are higher than ever before, as in 2019, nurses earned a still-outstanding 85 percent.

If you’re a nurse, take pride in knowing the survey results showed an appreciation for the care and professionalism that nurses provide every single day. And that appreciation is based in a public trust that is overwhelming. Since the Gallup poll began in 1999, nurses have earned the top spot as a most trusted profession in all years but one (in 2001, firefighters earned the top spot with a 90 percent rating).

Rounding out the top three spots of the Gallup poll are medical doctors, who earned 77 percent, and grade-school teachers with a 75 percent ethics rating. At the other end of the list, members of Congress received an 8 percent rating (down from last year’s 12 percent), and car salespeople also received 8 percent.

With a divisive political climate permeating the country, the poll seems to unite both major political parties in the way they see specific professions. The majority of respondents in both groups rated nurses, medical doctors, and grade-school teachers in the high/very high categories. Nurses were rated high or very high by 87 percent of Republicans and 91 percent of Democrats.

The survey results reflect a summer 2020 survey of confidence levels in various institutions that found similar rising rates of respect in medical institutions and public school systems. Public school systems enjoyed a rise in confidence levels to 41 percent (12 points higher than last year). Medical institutions received a 51 percent level of high confidence, sweeping past the previous level by 15 percentage points.

The way nurses have handled the emotional, physical, and spiritual load of the pandemic is not lost on the public. These high results are likely based, in part, by the expertise, dedication, empathy, devotion, and professionalism shown by nurses everywhere throughout the difficult last year. As nurses have reported this year, people are finally getting to see the real work of nurses and they are filled with respect for what they do on each shift.

Earning the top spot in the most-trusted survey results is another point of pride for nurses and the nursing profession nationwide.

Maximize Your Employee Benefits

Maximize Your Employee Benefits

If your job offers an employee benefits package, it’s likely that there are some benefits you aren’t taking advantage of. In every job, the benefits package is almost as important (or sometimes equally important) as the salary you’re offered. Benefits cover everything from your health insurance to your vacation time. But in between those common benefits are some that you may overlook because you aren’t quite sure how much of a benefit they really are to you.

As 2020 nears to a close, take a few minutes to review what your organization gives you as part of your employment package. According to the Bureau of Labor Statistics, benefits can add close to another one-third of the employee’s compensation costs.

Employee Assistance Program

Commonly called an EAP, this option allows you to talk to a counselor when you need some guidance getting through a period of personal or work-related stress. Commonly, the EAP covers a set amount of free counseling sessions for each different issue you want to discuss (family members may also receive this same benefit for the same amounts of time). If, after the three sessions, you and the therapist feel like you would benefit from longer-term treatment, you can find those resources. But you may just have needed a new perspective and this benefit gives you that for no cost.

Financial Advice

If you have a retirement plan, you might have access to financial counselors as well. They can give you some guidance on your finances, steps you might need to take for a more secure retirement, or some guidance around saving for a home, educational costs, or a long-awaited vacation. And if your company offers any kind of retirement match, be sure you are taking full advantage of that benefit.

Additional Insurance

Organizations offer employees all kinds of additional insurance as employee benefits options. If you’re looking for life insurance or long-term care insurance options, you may be able to get it through your company. If you want the security of short or long-term disability insurance, find out what your company offers just so you’ll know if you need it. The amounts you are likely to pay through your insurer will be competitive (some organizations may offer life insurance for free up to a certain amount—take advantage of that) and it’s helpful to know you’re protected.

Wellness Reimbursement and Activities

Do you have a membership at the local gym? Do you take lunchtime yoga at work (a nice benefit in itself!) or use acupuncture to help with a sore neck? All of those services may be reimbursed or compensated in part by your benefits package. You may get a set dollar amount per quarter for health classes or gym memberships. More companies are also offering reimbursement for therapies and practices that were preciously not covered—for instance, chiropractic visits with designated providers. Your employer invests in these benefits because healthy employees are better employees. According to the Society for Human Resources Management, in 2019 employers shelled out an average of $15,000 per employee for health insurance benefits (that’s in addition to your annual costs), so keeping employees healthy keeps that number down.

Pull out your benefits package before the end of the year and commit to using at least one benefit you haven’t taken advantage of yet. You could save money, boost your wellness goals, and plan for a more secure future. Don’t let those benefits slip by you.

Holding Safe Holiday Celebrations

Holding Safe Holiday Celebrations

In 2020, COVID-19 has made a lot of changes. So as the holidays are rolling around, it’s not surprising that it would change how they are celebrated.

Oftentimes, nurses would have potlucks during various shifts at work, hold present exchanges, and play games. But life has changed.

We reached out to get some tips on how nurses can hold safe holiday celebrations while at work.

From Jenna Liphart Rhoads, PhD, RN:

  • Have a toy drive for children in need: in exchange for bringing in a brand-new toy for a child in need, nurses could be given a raffle ticket to win something like a massage, an extra 8 hours of PTO, or a gift certificate for a new set of scrubs.
  • Staff nurses could bring in an ornament to help decorate the unit Christmas tree
  • A snowman decorating contest: nurses could anonymously color or decorate a snowman (or snowwoman). Staff could then vote on their favorites, and a winner gets a prize.

From Alaina Ross, BSN, RN:

  • On the floor of the hospital where she works, the nurses are having a catered lunch from a local restaurant. “[This] reduces the risk you’d get with a potluck of 20+ different dishes being cooked in 20+ households. The lunch comes from a clean and safe kitchen at a restaurant—and has the double bonus of supporting a local business,” says Ross.
  • Secret Santa Gift Exchange: “The Secret Santa style gift exchange reduces exposure and interpersonal contact, as there isn’t a large group get-together like you’d have with a white elephant exchange or party. It’s just one person secretly delivering a small gift to another by leaving it in their locker.”

From Thomas Uzuegbunem, BSN, RN:

  • He also suggests that instead of having a potluck to order from a restaurant that does individual servings (for example, Chinese food, etc.). “One person can take responsibility for ordering, and everyone can reimburse that person through PayPal or Venmo,” Uzuegbunem says.
  • Play Fantasy Sports or a unit game on smartphones: “These are good options to get a group of people involved while still social distancing.”
  • Digital Secret Santa: This is like regular Secret Santa—except for the large gathering. “You’ll pair people up and then the purchases will be either digital or mailed to their homes.”

Have a wonderful holiday season!