Experience: Here is How You Should Handle a Difficult Patient!

Have you ever nursed a patient who is more irritating, nagging, and troublesome than actually his disease is? I mean, have you ever come across a patient who is difficult to take care of? Oh I see; maybe you haven’t but your fellow nurse might have. And so you wonder! As a nurse, what tips can I use to successfully handle a difficult patient?

But wait! Who are difficult patients?

Neil Chesanow of Medscape wrote about them in his 2015 article “The art of Handling difficult patients’:

“Patients who are angry, disrespectful, and rude. They demand specific drugs or tests, even when they are not indicated; and patients who growl at everybody, act suggestively to the nurse, or ask you to submit a fraudulent (false) bill so the insurer will cover the cost of treatment”.

And allow me to add that, sometimes, they want your care, attention, resources and time at the expense of your other patients’ care.

As you already know, I am a nurse and public health officer. In my years of experience, I have encountered many good and extraordinary patients but also terrible and difficult patients to deal with. Actually, on private wards, we don’t only take care of difficult patients but also political and tricky patients.

But then how do we manage them? I mean, how do I successfully handle a difficult patient?

Listen, while nurses, doctors, midwives, public health officers and all other health workers are called upon to take care of patients or their clients the best way they can, their daily goals and plans for patients can be thwarted or even be made unyielding if difficult patients are not handled well.

READ THIS: What Makes You a Good Nurse?

Why Nurses Get Affected More By Difficult Patients

While doctors and other health workers have specific and usually short time with patients, nurses and midwives spend their whole time at the hospital with patients. Actually, specific cares like bed-side nursing, ICU and other special care wards have a nurse with a patient for a longer time. This closeness between a nurse and the patient or client is good for a number of reasons. However, it can as well be a serious problem especially with difficult patients.

What am I saying? A nurse has long hours with patients or clients and thus more exposed to patients’ disappointments, anger, complaints, and bad behavior compared to other health workers like doctors, public health officers or even laboratory technicians.

Do you want to have another reason why nurses are more at risk than other health workers? Oh yes, this will be a little hurting; nurses are undermined, not only by their fellow health workers, health center managers (call them bosses) or even themselves, but also by patients

READ THIS: 90% of nurses and midwives have faced work-related abuse and violence

See this: I have encountered angry patients a hundred times and when I did my deep assessment and analysis, I found out that actually their doctors had mishandled them somehow in one way or the other. And all they could do was to wait for me, the nurse they weren’t scared of, and gush out all their anger on me!

What am I saying? I am saying that patients shall seriously keep all their disappointments and anger and shall empty such only on the poor nurse or midwife. Of course, it isn’t always this way, but it is possible and common.

Waoh, have we not talked a lot already?

Let us jump into the real issue here;

How do you successfully handle a difficult patient?

1. Calm down

Listen, to be calm is not to bow down or give up or show some kind of fear; it is to prepare well for your task. Studies have revealed that calm people take time to react and, when they do, they already have solutions.

For God’s sake, I don’t enjoy shouting nurses. Listen, the patient is quarrelsome, nagging and complaining, and the last thing that you should fail to accomplish is calmness. When you calm down, you pay attention to the patient’s complaints and issues objectively. Sometimes, these patients really have issues even though they could be presenting them in unacceptable manner.

On this same note, please, be empathetic and understanding.

Just like me and you when we are sick or have some disappointments, it is not easy to get along with everybody. In the same way, when patients are in pain, denial, stressed or depressed or have been mishandled at some point during admission, they lose patience and tolerance.

As a nurse, you need to be in their shoes. Some of their misbehavior can be ignored and we move on. And I have realized that such patients who are simply shifting their pain to you soon realize that you are the best thing to ever happen to them. This makes you special!

Do you get this?

Oh my God, my best nursing opportunities are when I am working on a patient that has been disappointed somewhere by others. I always take such moments as my opportunity to be and remain special. I give the care the patient deserves, answer questions well, and play friendship. Believe me, this is the best chance to make a great friend out of such a disappointed, hurting or angry patient.

2. Exercise Self-esteem, confidence, and set boundaries

This is a very important aspect for every nurse for effective services. And this aspect is not only useful to you, but to the patient you are taking care of. And yet most nurses and midwives lack this! But who can blame them?

Wait! Some patients may need to take advantage of your size, education level, knowledge, and level of confidence and insult you, send you for things that aren’t your concern as if you have become their slave or ‘servant’. They may say abusive words or behave in weird manners; listen, never allow this to happen.

But what can you do if it happens?

How about addressing your client like this; Mr.x, I feel your pain and I understand or I am trying to understand your issue, and so I will kindly ask you to stop being abusive, vulgar or behaving this way so we can cooperate and make life easy for both of us.

What if he does not listen?

For some patients, a break or change of nurses shall do. Many of such patients leave me with no choice but to walk out of their rooms. But how do I do that?

I say something like this; Oh! It seems we are not getting along. I will walk out of the room and give you some time to think about it. Oh! by the way, how about someone else comes in for me? Of course, they usually keep quiet. And yes, I can continue with them until they reveal that actually they have not changed. Then, I apply my above 2 solutions; walk out of the room and send in someone else!

NB: Some cunning patients can take away your time, divert your attention even from more sick patients that need your time. We have had patients who want oxygen cylinders removed from some patients and be put onto them even when they are not indicated for supported breathing.

Setting your boundaries and making sure your patient knows about them helps.

For example, you may tell the patient that you will again check on them in 15 or 30 minutes time so they don’t bother you before then (of course unless there is an emergency).

Remember to keep such a promise; it builds more your confidence and tells them about your principles as professional nurse.

3. Provide information

Personally, I have realized that more than 50% of difficult patients (those behaving badly, abusive, nagging, complaining, and not appreciative) are due to inadequate information given to them.

What do you expect from a patient who just saw a guy-in-whites (nurse) throw himself into the room with a syringe, withdrew blood from the patient’s vein and flew away without saying a word or explaining where he was taking the blood? What else do you expect from a patient who has been told to buy albumin (a drug) at 350,000 Uganda shillings for five days and up to now he cannot answer the question; what does the drug help you in?

I mean, always give enough information and explain reasons for tests and procedures and drugs.

Patients are just pushed for investigations, told to lie up or down or bend, asked to buy drugs, stop some and continue others, and at times are greeted by an invoice that is exponentially beyond their expectations and no word of explanation is given! This is not good. And sadly, we expect them to cooperate; really?

READ THIS TOO: Male nurses not fit for nursing-Nightingale

Yes, if a patient is nagging, asking for unavailable services or offers, scaring you with this or that, at least the best you can do is to make sure he really has information about everything.

Like I said before, sometimes (actually most of the times), doctors are the ones to blame for not explaining the reasons for their demands on investigations, drugs, tests, or even about the diagnosis, and the poor patient shall wait to throw the tantrum onto the poor nurse.

What do you do then?
Here is what I do; I give the information that I as a nurse can and should and kindly advise them like this; Oh dear, I am sorry I have not told you enough but I would love you to know that it is your right to understand well what is going on with you, your care and health condition, and so please, make sure you ask the doctor more when he shows up; yeah, I am sure he will be happy to explain to you more about your treatment plan.

Listen, few days ago, an angry patient’s caretaker came to me with a bill-related complaint. He was bitter. He was not listening. He simply wanted to tear the invoice and leave. I tried to explain to him about each item and reasons for the charges and he was not satisfied.

What did I do?

Hear me; “Oh yes, I really understand your pain. You really deserve to understand the details before you can clear the money, and I personally would love it that way too. And since I have not been able to thoroughly help you (indeed I don’t understand some parts of our bills or accounts; we have hospital accountants and billing clerks who do that), let me give you the number of our billing clerk; she will surely help you”. And yes, I gave him the number and he was happy. I could as well could have called the billing clerk myself!

And do you know the surprise?

Concerning the bill, nothing changed; he just needed more information and so our billing clerk convinced him well with figures and explanations for everything! Problem solved.

NB: Reporting to your next supervisor about an abusive patient is very important. Your supervisor may need to forward the issue to the hospital manager or administrator so you get helped. Some physically dangerous patients may necessitate you to call the hospital’s security immediately. Never undermine the danger a patient can cause; be vigilant.

4. Avoid annoying behaviors when attending to your patients

Difficult patients will even get worse if you try to be so irritating. For God’s sake, I am 21st century guy; I love computers, phones, and enjoy social media, but the last thing I could ever do is to be on a phone while taking care of my clients.

Of course, during your breaks in your duty or resting rooms, you can do anything you want, but don’t be on Facebook or WhatsApp when the patient is trying to talk to you or is complaining. Some postures like holding yourself with your two hands in your groins and so much more show some form of disrespect. Of course, this is never easy, but it helps. Also, avoid such behaviors that show impatience (for example having your eyes on and off your watch as if you have somewhere or someone more important to attend to).

5. Make sure you are right

I once received a patient who later threatened to report us (I mean report me) to the director for moving around the ward with his file and thus exposing his medical information to other people (he was lying, but was partially right).

What had happened?

Usually, files are kept under lock and we can easily tell the patient’s treatment using what we call treatment sheets. However, for some reasons (I won’t disclose these ones), this specific patient had no treatment sheet. When time for drug administration came up, all we had to do was to retrieve his file and find out the medication he was on.

And so I safely handled the case; got his file, personally went and entered his room and followed the confidentiality protocol even in his room. I explained what was going on and why I had to use his file. At the moment, he looked understanding and easy, but he had changed the whole story the next day.

What did he do?

He threatened to report me to the hospital director!

While he was still in the threatening mode, I personally had already reported his case to the director and explained everything and obtained permission to use his file. By the time he reported me (on his discharge day), the director already knew about it and bluffed it off.

That is how I managed. And as you can sense in my writings, there was no big issue here, but the patient (being elite and understanding what confidentiality really means) had enlarged the issue to that scary level.

But I was informed; yes, I made sure I was right by following steps and obtaining the permission at the right time.

Yes, I repeat this; make sure you are right. For drugs and diseases, I even hide in the duty room and first do some ‘googling’ if I am not sure of anything.

Like I highlighted in my introductions, some patients are not only sick but are thieves, gamblers, killers, opportunistic and very political. And so they will utilize every gap to open up a case against you or your institution. You need to make sure you did your part and then strongly and rightfully demand the patient to meet his.

NB:
Most of the times, these patients just need your genuine apology, acknowledging that something is really missing in their care package or simply a promise that you are going to do your best to rectify the problem. Yes, always make sure you are right.

6. Don’t take it personal (shake it off).

Ashley Brooks (2015) cites the important advice from Julianne Haydel, a nurse consultant at Haydel Consulting Services; “it’s easy to think that a difficult patient is upset with you personally, but that’s almost never the case. Just knowing that the nastiness is not about you is a good start”

Yes, when we realize that it is actually not about us, we become less defensive and start listening with attention to the patient’s complaints. Yes, it is important to recognize that the patient has issues like bills, pain due to disease, missing family, or has just been mishandled at some point and therefore be in position to be patient, open, and caring despite the difficulties involved. And when it is all over, never think it was about you. Don’t go home with it.

My wife, Amulen Winfred (a professional midwife and counselor) is even better at this than me. Comparably, my ward is a little better and easy than hers. Actually, she experiences difficult, disappointed, angry, and nagging mothers, dads and patients almost every day of her work.  And you know what! Winnie rarely gets haunted by such patients!

What does it mean?

It means that what happens at work remains there and when she gets out, she is herself again in her usual life issues. Of course, I am not saying that work-related issues don’t influence life at home; I am talking about managing such issues.

Now listen; this is very important

If a nurse gets affected beyond the encounter and is always stressed and angry at such patients, then it means this will have effect on her physical and emotional health. Uncontrolled work-related stress, anger and disappointments can make your other social life hard, disturb your sleep and energy, worsen your work productivity and shorten your life.

So as you drive or walk home after work, it is important to know that it was not about you or anybody in particular; the patient was simply unhappy, you dealt with it and it is done. It is time to enjoy your life as always and prepare for more tantrums the next day. Remember, abuse isn’t part of your job description; report any form of abuse.

Recap or summary

Difficult patients cannot be avoided, at least not on the side of nurses. Understanding this puts a nurse or any other health worker in the best position to successfully handle difficult patients. Suggested steps include; staying calm, empathetic and understanding, setting boundaries and exercising self esteem and confidence, providing enough information, making sure you are right, avoiding irritating behaviors or actions during care, and shaking it off.

The above may not be all, but can generally help.