Difficult Patients

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Who You’ll Hear

Kati Kleber, MSN RN– Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Elizabeth Mills, BSN RN CCRN – highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center.

What You’ll Learn:

• Remember
• Talking Points
• Two Steps
• Mean and Demeaning
• Confused and Mean
• When to Call Security

This episode discusses practical tips and tricks and personal experience dealing with frustrating, demeaning, demanding or difficult patients and/or families.

It is important to remember

• It’s tough to figure out how to deal with people being rude to you while you’re trying to do your job in a way that maintains your trusting nurse-patient relationship.
• You are not alone. Most of us have had patients be rude or abusive towards us.
• Even though someone is ill or going through something really tough, it does not give them an excuse to be rude, demeaning, demanding, or inappropriate to you. You deserve respect. And sometimes when people are being rude as an unhealthy way of dealing with their situation, you need to command respect from them. There is absolutely no excuse or reason to treat you poorly. You do NOT deserve it.

Key talking points

Sometimes when people are going through something tough they lash out at those that are helping them. It can be a natural way for them to deal with something that’s totally out control. While that may be how they’re instinctively dealing with something, it does not make it okay. They may just need a little firm, but respectful, reminder that there are better ways to deal with difficult situations.

• “That is inappropriate.”
• “You will not speak to me in that manner.”
• “Do not curse at me.”
• “I am here to help you as your nurse, not to be disrespected.”

Two steps

Step one = tell them to stop
Step two = still provide great care and don’t change the quality of your care the rest of the shift

You drop the “you must respect me” bomb, but then you still take really good care of them. (This also applies to the patient’s loved ones/support system AND coworkers, people!)

You’re basically saying to the patient that’s taking their situation out on you,

“Hey – don’t treat me like that. It’s cool if you were frustrated with everything and taking it out on me.. that’s okay if that was your instinct, but you need to know that it’s not okay to talk to me like that and we’ve gotta change how you’re dealing with this. I’m still going to take really good care of you, even though we had this little bump in the road. Being sick sucks. I get it. And if you want to talk about it, I’m here.”

Mean and demeaning

• Short and sweet interactions
• Say what you need to and nothing more
• Educate matter of factly, document thoroughly
• Involve your chain of command, if necessary (charge nurse, shift supervisor, assistant manager, manager)
• Patient satisfaction is important, but not so important that you get disrespected

Confused and mean

• ICU delirium is a powerful thing
• Maintain an extremely strong (strong, not mean!) presence.
• Be respectful, yet firm in every single word you say
• Re-direct behaviors, identify and correct abusive language, and provide good care.
• Provide structure, try to joke with them if you can, and know when to just exit the situation and try again later

When to call security

• Know your boundaries and know when to call security. If a patient is seriously being abusive (cursing, threatening) – call security. Seriously, don’t play around.
• You drop a “treat me with respect” bomb and they come back hostile or cursing, immediately involve security
• This person may just need a firm reminder about the expected behavior of a human being in this facility by someone in a uniform.
• Know their phone number, spend some time getting to know the men and women in security and build rapport

More resources

• Working with “Difficult” Patients – FreshRN Blog
• Dealing with Difficult Families – FreshRN Blog
• How to Deal with Verbally Abusive Patients – FreshRN Blog