How to Deal with Difficult Patients as a Nurse

Nurses and other medical professionals are present for patients during good and bad times. Sometimes, it can be the worst day a person has ever had when they encounter a nurse. From rude comments to large-scale outbursts, many things happen in medical facilities that make it challenging for nurses to know how to deal with difficult patients. Of course, in a professional environment, maintaining a level of professionalism is paramount. Finding a way to complete the job at hand with poise and compassion while dealing with a complex emotional situation is a balance that can be hard to strike.

Understanding Challenging Patient Interactions

Not all challenging patients are the same, and, therefore, nurses' responses will likely vary from case to case. However, it is important for nurses and other medical healthcare professionals to maintain composure and behave professionally in all situations.

In the event a patient becomes aggressive, is threatening the health and safety of themselves or those around them, or has any other emergency, it is important to seek help from others. Keep the number for security at the medical facility handy in such events as it needs to be used to keep people safe.

Of course, the vast majority of instances in which nurses are navigating how to deal with difficult patients center around frustration, confusion, or other negative feelings without being unsafe. While there can be an overlap where one patient may be dealing with multiple factors of frustration, there are a few key situations that can influence a patient and their mood.

Problems with the Patient

Patients may have outside factors influencing their moods and how they behave. While this can occur due to several reasons, some to look out for include the following:

  • Language barrier: It is natural to become frustrated when unable to understand important information, especially when it comes to the health and safety of themselves or their loved ones. If unable to resolve the language barrier, seek out someone who can help. Finding a way to communicate, even if it is not through spoken language, helps calm the situation.
  • Not being heard: Some patients may disagree with a diagnosis, treatment plan, or other medical recommendation. If they feel like they are not being heard and the nurse or healthcare provider is not listening to their concerns, they may grow agitated and shut down. Remember to listen to patients and their concerns and try to answer any questions they may have to mitigate those feelings.
  • Embarrassment: Some medical procedures can be embarrassing for patients for one reason or another. While it is not necessary to fully understand the feelings a patient may experience related to embarrassment, reiterate that medical professionals are trained and work with people all day. Explain that they are not alone and that the job of a nurse or doctor is to provide the best care possible.

Problems with the Healthcare Environment

On top of the possible stress and anxiety of being in a medical facility or dealing with a medical concern, many people are influenced by the space around them. Environmental factors that could increase frustration include:

  • Overcrowding: Patients can feel overwhelmed when hospitals and other medical facilities are overcrowded. From long wait times to lack of personal space, it's easy to understand why they might feel frustrated. This is especially true if they are running on a tight schedule.
  • Time of day or night: Morning people and night people are well-known terms for a reason. While it would be great if schedules aligned and patients could go to their appointments during their preferred time of day, it does not always work out with their responsibilities or emergencies.
  • Understaffing or lack of resources: Due to understaffing, limited appointment availability, increased wait times, and slower responsiveness of those working can be a source of irritation for patients.

While nurses are not able to resolve all of the above in full or in part, being aware of them can help ease tension and reduce frustration.

Problems with the Healthcare Provider

It is important to remember that nurses are people, too. Just like patients may be having a bad day or be influenced by a factor outside their control, nurses can also be impacted by unrelated situations. A few things to keep an eye on as a nurse are:

  • Sleep deprivation: Being a nurse is a time-consuming and demanding career to take on, so it is not unheard of for them to be sleep deprived. Try to keep track of sleep schedules and take advantage of any breaks available to mitigate this problem.
  • Hunger: When the shift is busy, and everyone needs something all the time, personal care and bodily needs like food can often be overlooked. Like sleep, it is important to keep track of diet and nutrition intake while working as a nurse to avoid becoming angry or responding negatively due to hunger.
  • Emotionally drained: Seeing and dealing with tough situations on a daily basis is more than just physically demanding. It takes an emotional toll too. Talk to other nurses and medical professionals or seek therapy to help cope. Remember that mental health is part of the bigger health conversation, so it should be prioritized.

Dealing with Difficult Patients with Poise and Compassion

Although it can be challenging, dealing with difficult patients with poise and compassion is the best approach to maintaining a professional relationship when undesired situations arise. Not everyone has a natural ability to remain calm, cool, and collected in challenging situations; however, it is vital to develop those skills for the well-being of everyone involved.

Luckily, there are specific things nurses can focus on when it comes to handling difficult patients and challenging situations in the medical field. While speaking with coworkers, friends, and family can help identify the areas that require the most improvement, do not underestimate the power of self-awareness. Give grace if there are shortcomings or things that do not come naturally, as learning and growth are part of the process of becoming the better nurse possible. Here are a few areas to focus on as a nurse dealing with challenging patients.

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Practice Active Listening

One of the easiest ways to upset a patient is by making them feel not heard. While they may not have a medical background, most people are receptive to explanations from professionals in the medical field. However, that does not mean they will not have concerns. Practice active listening in which the patient is given the opportunity to speak about their concerns, ask clarification questions, and remove any points of confusion they may have. Focus on eye contact to reinforce the idea that they are being listened to and not coming second to another distraction.

If a patient or their loved ones are particularly challenging, take the help of other nurses or even their doctor. Explain the situation and do everything possible before escalating, but remember that getting help may be the best decision for the patient. Although it can be difficult to find the time in a busy hospital or clinic, being intentional when dealing with patients and ensuring they feel as comfortable and confident as possible in their treatment plan goes a long way.

Acknowledge the Patient's Experiences

Whether it is a bad experience in a medical facility or clinic in the past or general anxiety about health-related situations, patients may act based on a wide array of experiences that are not directly related to the present moment. Give them a chance to explain any situations that they might allude to regarding these experiences and keep them in mind when providing treatment. Although not necessarily relevant to the care they are currently seeking, knowing about concerns or bad experiences can help shape an approach that is best for the patient.

Try to de-escalate the situation by clarifying anything that may impact their visit and overly explaining what is happening and what the medical recommendations are to help make them feel safe. If problems continue to escalate despite best efforts, remain calm and engage with the necessary help to resolve the situation.

Resist Getting Defensive

When put in a combative situation, some people naturally get defensive. This is a human response to feeling attacked or in danger, but it has no place in a professional setting. It is not a productive approach to resolving concerns, nor is it a professional way to behave. Due to many factors, like stress or anxiety, patients may be accusatory in how they speak. They may feel frustrated and believe it is right to take it out on nurses and other staff at the medical facility where they are receiving treatment. This behavior is inappropriate and wrong, but it does not justify a similar response from the medical staff.

In fact, it is that much more crucial for nurses and other medical professionals to try and de-escalate the situation using a calm voice and speaking through any frustrations or concerns someone may be experiencing. Of course, it is also important to avoid dangerous situations whenever possible and to engage the necessary personnel when things escalate past a point of return.

Maintain Clear Boundaries and Communication

Establishing boundaries as a nurse is key. While they will likely vary from person to person, boundaries allow nurses to stay safe and respectful when patients are frustrated or experiencing other negative emotions. Boundaries could include setting limits on the following:

  • Explaining information: One boundary could be that nurses do not repeat themselves or explain the treatment plan more than twice the same way before trying a new method, like involving another professional or pulling up reference material.
  • Physical contact: Physical safety is paramount in all situations but is especially so in combative medical instances. Whether the boundary is physical touch or an invasion of personal space, nurses should have something in mind to know when to step away or find an alternative route to communicate.
  • Language: Nurses can also have a boundary with communication styles. If a patient or loved one yells, a good route is to pursue another form of communication.

While boundaries can vary, remember that nurses and patients are working toward the same goal— patients receiving successful treatment. Keep that in mind when communicating while also enforcing personal boundaries.

Extend Empathy

Although it may be easy to feel angry and lash out after a challenging altercation with a patient or their loved ones, it is important to approach people with empathy while working as a nurse. A few things to remember regarding patients and or their loved ones are:

  • Dealing with a lot: Emotions run rampant when people are in precarious situations. Even though it is not expressly a duty of a nurse, being empathetic toward patients will go a long way.
  • Possibly experiencing tragedy: Many medical situations, specifically emergencies or complications, can be the worst days in someone's life. While it does not excuse inappropriate or aggressive behavior, it does help when communicating with patients and the people who love them.
  • Not taking care of themselves: Specifically for the loved ones taking care of patients who go through medical treatment, self-care is not a top priority when a family member or friend is suffering. People have been known to spend every waking moment in hospitals or even nights to be nearby. This is a kind gesture, but it takes a toll on a person, so grace and empathy are appreciated.

While people may not always be polite or rational, being kind and extending empathy can help make a rough situation that much better.

Recovering from Difficult Patient Encounters

Of course, the event of dealing with a difficult patient or their loved ones is not the end of the road for nurses. There are repercussions of actions or negative experiences that long outlive the moments themselves.

While not every negative interaction can yield a productive or encouraging lesson, most have something that is worth hanging on to. The unfortunate reality is that virtually all healthcare providers would deal with difficult situations at one point or another in their careers. Despite being hardworking and seeking a solution that is best for the patient and their health, these things happen.

However, the impact they have on nurses and other healthcare providers should reinforce good habits, like self-care, and discourage negative ones, like being reactionary. Here are a few things to do after dealing with a difficult patient situation.

Practicing Good Self-Care

People are more likely to manage their emotional and physical reactions to tough situations when they are taking good care of themselves. Remember the benefits of practicing good self-care and incorporating it into routine life as much as possible. Self-care can be:

  • Getting rest: Sleep deprivation can cause people to lash out more than they would if they slept enough. Try to maintain a consistent sleep schedule as much as possible.
  • Eating well: Nutritious food fuels the body and allows people to be energized. However, junk food that has limited nutritious value can have the opposite effect. Prioritize eating food that is packed with nutrients to keep a level head in tough encounters.
  • Work-life balance: Although challenging, trying to focus on work while at the hospital and life outside work is a huge help in a field as demanding as nursing. Set boundaries whenever possible and stick to them for the best results.
  • Monitoring mental health: Whether through grounding activities like standing barefoot in the grass for a few minutes each day or routine therapy, mental health is huge to maintaining self-care and balance in life. If something is out of balance, seek help or try to find resources to help.

What are some of the most helpful self-care tips for nurses during challenging times, from a tough case to supporting patients during COVID-19?

Rachel Ann Loukota

Washington Adventist University

"Sleep, getting enough sleep is very important. Making time for 6 to 8 hours is so important. Also, making time for your family and down time, with out that time, you will go crazy."

Emily Cheshire, DNP, FNP-BC

University of Colorado Denver - Anshutz Medical Campus

"Use a timer and take 30 seconds minimum between patients. Get a simple mantra and breathe/repeat your mantra. Mine is 'I have the ability to create peace' before I walk into the next patient's room. AND learn to say no - if you say 'yes' to everything - you will inherently say 'no' - sometimes unconsciously given you are a being with a certain amount of energy."

Marlene Call

Brenau University

"Recognize stress BEFORE you get to the point of burnout or shut down. Make time for yourself daily. Schedule breaks and vacations (even if you don't go anywhere). It is ok to cry. Try to eat healthy, even when you're working those over night shifts. If you work with critically ill patients (or in my case critically ill children) spend time around people (and children) who are WELL. Our worldviews get skewed working with so much sadness and struggle."

Katrina Embrey, DNS, RN

Georgia Southern University - Armstrong

"I tell my students and mentees "Your health is your number one priority". We are taught that being selfish is a bad thing but in the case of making self care a priority, selfishness is a necessity. My tips for taking care of oneself include finding those things that connect you to your inner being and practicing them regularly. Take time to pause and "just be". Listen to your inner guidance and follow the path to what brings you joy because it is never wrong. For example, my daily self care routine includes getting up early, meditating, and exercising. On weekends I spend time at the beach and having fun. Taking the time to learn to be mindful of our thoughts moment by moment and finding joy in the simple moments of life is the recipe for happily ever after."

Carol Braungart

George Washington University

"It is important to care for yourself and your own mental health. Rest, reflect, and step back when feeling overwhelmed. This is not just for COVID times, but the role of a nurse at any time can be overwhelming. Feel comfortable with admitting you are overwhelmed and get the care you need."

Pi-Ming Yeh

East Tennessee State University

"Exercise, follow a schedule to do the tasks, Listen some inspiring sermons and hymns. Eat well."

Annie Boehning, RN, PHN, FNP-BC, DNP, CHSE

California State University - Bakersfield

"Self-care is utmost important for everyone. 'If you do not take care of yourself, how can you take care of anyone?' I remind myself this statement from time to time. First, I treasure my 8-hour of sleeping daily. I keep a good sleeping hygiene habit. Second, I eat balanced meals. I know myself well that low glycemic may affect my mental state. Third, I wear protective gears as much as possible when I am working with patients. 'Every day is a new day and it is a beautiful day tomorrow' is my answer to anyone asking me how my day is going."

Lauren Jerige

West Texas A&M University

"Make time for yourself. Mental health is a priority."

Deborah Becker, PhD, AGACNP, BC, CHSE, FAAN

University of Pennsylvania

"Patient Responses to treatment are varied and often times unpredictable, despite health care providers thinking that they are doing the right thing for the patient. Acknowledging that this is not a failure of the healthcare system, but that this is life is extremely important. Considering the extreme amount of responsibility placed on nurses in usual times, and the extraordinary amount of pressure placed on nurses during the pandemic and emergency situations, your feelings regarding the outcomes, the effort you put forth, the exhaustion you feel when the situation or the shift is over, should be embraced and not disregarded. Your feelings, whether positive or negative, are your feelings - you have them, acknowledge them and reflect on them. If you did the best you could during the time you were involved in the care of a patient, then you have to understand and appreciate that there are other factors that are involved but usually beyond your control. Learn to accept that. Make the changes to those things you want to do differently and are under your control and then the rest has to be left for higher powers or others to change."

Talking Through the Situation

Sometimes talking through experiences is the best way to avoid pent-up anger and frustration, especially in the workplace. Find a trusted colleague, mentor, friend, or even a therapist to discuss the situation with. Remember to keep doctor-patient confidentiality in mind when doing so. Topics to cover could be:

  • What went well: Each situation will likely have some things that were done extremely well and others that were not. Take credit for the use of good techniques like remaining calm, explaining the treatment plan as clearly as possible, and trying to de-escalate the situation.
  • What did not go well: Naturally, some things did not go well, too. Try to identify things that could have been done differently to impact the outcome and make a note to try and incorporate those things sooner if a similar situation were to arise.

Even though it cannot resolve the situation or erase it from memory, talking about feelings and experiences can make it easier to learn and grow as a person and a nurse.

Learning from Bad Experiences

Whenever possible, try to find the lesson in the event that can help inform a reaction if a similar event were to happen in the future. This can be done by:

  • Dissecting the encounter: While talking through and venting about the scenario to a loved one or therapist can be a great starting point, moving forward from the event with a difficult patient requires more in-depth analysis. Think about what caused the situation to escalate and the part each party played in the eventual outcome.
  • Brainstorm different approaches: When reliving the event, make a note of anything that caused a particularly strong reaction or really escalated the situation. For those moments, think about anything that could have been done differently and keep it in mind for the future.

Remember that only some factors are within the control of healthcare professionals, and sometimes people are having a bad day and do not know how to manage their emotions. While this is a negative aspect of working with the public, navigating difficulties like this is an opportunity for growth. If a situation turns unsafe, reporting it may be worthwhile. Consult managers to determine the best course of action if this is the case.

Letting Go and Moving On

Ultimately, finding a way to learn, grow, and move forward is in the best interest of all parties involved unless the situation is extreme and requires further review and analysis. However, most difficult situations that went badly are not worth dwelling on. Holding grudges or feeling low over any mistakes that may have been made does not do anyone any good. Take what is possible to learn from the situation while also identifying the things that are not under control, and try to move forward as best as possible.

The main focal point of being a nurse is to give the best care to the patient and inform them of medical recommendations to help remedy their concerns. However, working closely with people is also a part of that role. So, grant empathy when possible and try to refocus on the goal at hand when issues arise. Future patients will be grateful for that.

Frequently Asked Questions

  • How do nurses deal with difficult patients?

    While each situation is unique, nurses understand and resolve the problem as quickly as possible. If necessary, nurses should seek help from other medical professionals.

  • How to respond to a rude patient?

    Maintaining professionalism and composure is essential when dealing with patients. If a patient is rude, remain calm and respond to their statement or question as neutrally as possible. If necessary, seek help from other nurses or medical professionals.

  • How can one set boundaries with difficult patients?

    Although it can be challenging, reinforcing professional boundaries with difficult patients may be necessary. Communicate if something they say or do crosses the line and explain how it is unacceptable. If the behavior persists, exit from the situation and document the encounter.