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.
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.