Tips for Dealing with Difficult Patients

Keith Carlson, RN, BSN, NC-BC - 05/31/19

When you work with patients as a nurse clinician, those individuals come to you with a wide variety of personalities, vulnerabilities, traumas, and coping skills. As your relationship with a patient begins, many factors must be considered for the creation of healthy boundaries and a solid relationship. But what happens when you have to deal with a particularly difficult patient who challenges your skills of communication, empathy, and compassion? 

Two Ears, One Mouth

Over several decades of nursing, I’ve encountered lovely, heartfelt, and self-directed patients, as well as those who prefer to blame, project, and impose their pain on those around them. Whatever the situation, listening is where it all begins.

There’s a saying that we have two ears and one mouth so that we’ll listen twice as much as we talk; this isn’t easy for most humans, but for nurses it’s an essential skill.

When a patient lashes out, refuses to cooperate, or pushes back, your utmost compassion demonstrated through active listening. This doesn’t mean simply sitting there passively; rather, it means that your posture embodies openness and receptivity, and that your eye contact, head nods, and verbal responses let the patient know that you’re present and accounted for.

Compassionate Reflection

When you listen actively, you’re able to paraphrase and reflect back to the patient what’s been said; being understood is a basic human drive, and when the nurse can give the patient this gift, much good results.

Active listening means using intuition and perception to hear the meaning behind the words. Not everything is communicated clearly; thus you may need to make leaps of compassionate logic to get to the bottom of what’s truly troubling this individual.

Psychic pain can be born from not feeling heard, seen, and understood. When a patient is testing your patience, try to discern the emotional, psychological, or spiritual subtext. Your compassion and empathy can go a long way towards disarming a disturbed soul.  

The White Flag of Surrender

As human beings, we nurses obviously have buttons that can get triggered like anyone else; and if we’re stressed or overwhelmed, it takes even less to push us over the edge. We can experience our own brand of projection or counter-transference, and some patients clearly know how to test us.

If a patient pushes your buttons and your efforts at bridging the gaps fall short, there’s no need to be embarrassed about requesting the patient be assigned to someone else, if possible. After all, we each have limits based on our personal history and inner resources.  

Most human beings have trauma that they bring to the table, and if another person – colleague or patient – somehow embodies an aspect of your personal trauma, it may be veritably impossible to make the relationship work. Raising the white flag of surrender isn’t something to be ashamed of; in fact, it can be a sign of self-knowledge and ego strength to speak your truth and make your needs known.

Know Yourself

In being ready to deal with difficult patients, one of the most powerful things you can do as a healthcare provider is knowing yourself as deeply as possible. Self-knowledge is key to healthy relationships at work and at home, especially since such knowledge helps you know when you’re triggered, what previous trauma makes you most vulnerable, and when to walk away.

In a society where being a tough badass and never saying “quit” are held up as norms we most admire, there is even more power in being vulnerable and admitting limitations. If a taxing patient reminds you of the uncle who made your childhood miserable, maybe you just need to demand that that patient be reassigned. And if a particular patient’s situation hits too close to home and you can’t be objective when objectivity is absolutely crucial, that’s another moment to speak up in deference to your own needs.

Knowing yourself is central to understanding your own boundaries. I’ve personally been in situations where I allowed a patient or their family to violate my boundaries, and there’s always a price to pay in this regard. Whether achieved through psychotherapy, counseling, your faith, or other forms of personal exploration, self-knowledge will strengthen your ability to know where you stand and how to conduct yourself in challenging nurse-patient relationships. 

Difficult patients can reflect back to you the inner struggles inhabiting your heart; they can also cause you to doubt yourself and question your choice of being a nurse in the first place. Dig deep, learn who you are, study communication skills, become emotionally and relationally intelligent, and you’ll be able to master the art of navigating even the thorniest nurse-patient interactions.