Advice for Nurses Dealing with Difficult Patients

Throughout my professional career, I have dealt with patients or clients who were somewhat of a challenge. Working third shift as a triage nurse in the ER, being in charge of an intensive care psychiatric unit, providing groups in a community setting or seeing clients in a private practice provided an environment for different challenges, but all of these settings have allowed me to experience challenges when interacting with others.

The most important piece of advice I have for any nurse is to understand whatever is occurring is probably not about you, so you do not have to take the other person’s response personally. You just happened to be the person who is in the way of the individual getting what they want; are an easy target when the individual is scared, stressed or experiencing loss; or are experiencing the dynamics linked to a psychiatric disorder. By demonstrating a calm, professional manner that exhibits good personal boundaries and compassion, the potential for patients’ behaviors to change for the positive is increased.

By not taking a patient or client’s actions or comments personally, nurses can be more objective about what is occurring and thus respond to the individual rather than react to what he or she is expressing or demonstrating. In turn, the nurse has the potential to assess the situation and respond in a manner that can de-escalate the situation rather than taking what is happening as a personal attack.

With that being said, safety is of prime importance.  When in doubt, nurses need to do whatever is needed to maintain safety for themselves and those in their care. There have been many times in my career that I was very thankful there was a door nearby that I could lock myself behind or lock to keep others out. Any time I felt the hair stand up on my neck, I knew it was time to assess my surroundings and have a plan of action. With things the way they are of late, it is necessary for nurses to consider safety even when working in areas that are considered to have less potential for personal harm.

The first thing I recommend is to step away from the situation if at all possible. Take a breather and let someone else answer the call bell for five to ten minutes. I may ask the patient or client what prevents he or she from getting what they want. Often times, what they really want is not what they are requesting (strange but true). I try to get detail as specific as possible. “I just want you to do X,” may generate a comment from me as to what I can and cannot do. If I need to collaborate with others to rectify the situation, I certainly will do so.  However, I attempt to handle as many issues as I can comfortably and professionally.

If a nurse truly cannot maintain a professional attitude any longer, then others need to be brought into the mix. For example, a supervisor or social worker may need to be called to handle a specific issue. A nurse may request to switch patients if his or her emotional threshold is at its peak. Or a nurse might simply need to take a break and speak to a colleague about the situation. However, if a nurse is venting or even asking for suggestions, information must be shared in such a manner as to meet HIPAA standards.

About the Author:

Dr. Mary Bemker is the academic coordinator for Sullivan University’s College of Nursing. She has worked as a nurse for over 25 years in hospital, community and academic settings. She has also been involved in four accreditation efforts for nursing programs, three of which she led. Recently, Dr. Bemker conducted two workshops for the Kentucky Counseling Association, and she is an active member of the East Louisville Sunrise Rotary Club. She is currently under contract with the American Nurses Association to edit a text for Doctor of Nursing Practice students, and is on international professional journal boards. In her free time, Dr. Bemker enjoys reading, quilting, gardening and spending time with family.

 

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