Dealing with Difficult Patients


By University Alliance

Nursing is one of the most rewarding and satisfying professions, but at the same time, it is one of the most challenging and demanding. Verbal and physical abuse from patients is unfortunately a reality in today’s hospitals and facilities. Knowing how to prevent, avoid, handle and document these situations is something all nurses need to know.

Reasons for Abusive or Difficult Behavior

  • Patients under the influence of drugs and alcohol, or those experiencing psychiatric trauma, can be unpredictable and lash out verbally and physically at those trying to help them.
  • The shortage of ER nurses, increasingly crowded waiting rooms, and long waiting times can cause tempers to flare and people’s patience to wear quite thin.  Many nurses experience emotional and verbal abuse due to individuals feeling as if their needs are not being met, or they are not taken seriously once they enter the hospital.
  • In many cases, patients are miserable and afraid when admitted into the hospital. Their insecurities, anxieties and fears may surface in the form of verbal or physical abuse. 

How to Handle Abusive Behavior

  • Above all, become familiar with your hospitals’ policy on protecting nurses from abusive behavior.  Your department should have a plan in place that includes easily available security personnel, alarm buttons within easy reach and a security committee dedicated to creating a safe working environment.
  • Don’t take anything personally, no matter how personal the attacks may feel.  Remember that your patients’ actions reflect their own feelings and experiences, and that outside issues, not you, are at the root of their behavior.
  • Acknowledge their feelings without necessarily agreeing with what they are saying.  At the same time, set firm boundaries and insist that you be treated with respect, just as you are treating them with respect.
  • Whenever possible, try to allow the patient to tell you why they are acting as they are, giving them a chance for their fears and frustrations to be heard.  Analyze and assess the reasons for their anger and use calm, reassuring logic to help them overcome their anxieties and address unanswered questions.
  • To avoid being tongue-tied during a confrontation, practice strong and clear phrases such as, “I will not tolerate this behavior,” “I deserve to be treated with respect,” and “Help me understand exactly what is wrong.”
  • Establish communication between you and your co-workers and share what has worked for each of you in past situations.  Enlist the support of your colleagues and supervisors so everyone is on the same page when it comes to handling abusive patients.
  • Make sure to note any witnesses during an abusive incident.  You may need their help later if the situation is serious enough to go to a higher level. Additionally, you should document the incident immediately after it occurs so that no pieces of the confrontation are forgotten or omitted. Detailed documentation can be very helpful later, after emotions have settled.

Despite the many rewards of nursing, difficult patients will always be part of the package, so knowing how to deal with abusive situations is a necessary part of the job.  You will find that some techniques work well in certain situations but not well in others, and this is to be expected.  Empathy, respect and good listening skills go a long way.  Fill your professional toolbox with strategies and ideas that include a positive attitude, ambivalence and even humor, so when that difficult patient finds you, you are prepared to handle the situation liked a seasoned professional.

Category: Nursing