Difficult Patient? How to Work with All Shapes & Sizes

I’ll be honest right up front. I do not even like the title of this blog post. The term ‘difficult’ carries negative baggage. Yet, as nurses we all have that one patient we will never forget.

You know the one. Presenting to us with all sorts of co-morbidities. Not adhering to the treatment plan. Bouncing in and out of the healthcare system for all sorts of reasons.

While we, as the nurse, must care for this person- is it always as easy as pushing our own feelings aside and putting on a professional face?

NP blog August postReflecting back on my own nursing career, there were a handful of very difficult patients. As a psychiatric nurse, our ‘difficult’ may be different than those types of med-surg patients presenting with multiple medical concerns.

Is it the delirious elderly woman who screamed at night for months on end? Or the personality disordered criminal male that wanted to beat everybody up on the unit? It’s a tough choice… but I would say my most ‘difficult’ patient was one that challenged me on several levels.

Working in a large city, on a general adult unit that primarily served the surrounding community, we typically received patients with substance abuse issues who were homeless and did not have much family involvement. For the most part, they lacked possessions, higher education, and support systems.

So my most difficult patient was actually not someone from the local area. It was a successful lawyer in her mid-50’s that looked, well… like my Mom. Now, I am not saying that she resembled my mother in physicality- but she was successful. She had a family, an established career, and a put-together life. “How could this person have bipolar illness?” I often wondered.

I struggled with the fact that we were forcing her to take medications to treat her symptoms. She must have sensed it, because on multiple occasions, she completely berated me in the hallway- screaming and shouting at the top of her lungs. One day she was so angry, I thought that her eye balls were going to pop right out of her head. As I walked away, I realized… I myself was a shaking mess!

Patients come in all shapes and sizes. Think about it- many of them do not even want to be there. They are in crisis. Sick. Scared. Worrying about the worst. As nurses, we must take care of them all.

So how can we handle the diverse patient experience? How can we cope with the challenging situations? What do we do when we know that this patient is going to present us with hardship?

Here Are 3 Tips for Working with Patients of All Shapes & Sizes

  • Observe Yourself. Right off the bat, when we deem them to be ‘difficult’ we are setting ourselves up for heartache. We are labeling the patient and, when someone receives a label, they subconsciously begin to fit the mold. We need to be mindful of our language. Be present to our thoughts and feelings. Notice how we act and, if we find we are judging a patient in any way, stop and shift course.
  •  Change Directions. So, you may notice that you are thinking about or calling a patient ‘difficult’. It is OK. We all have done it. Rather than beat yourself up, take action to change this pattern. Bring it up to your nursing colleagues. Have an open, honest, and objective discussion about your feelings. If you are having these thoughts about the patient, it is likely that another nurse is too. The best way to change a negative thought or feeling is to bring it to the surface. Now, it might be tempting to have an all out gossip/vent session about this. Be careful! Talking about the feelings is not to go down the road of negative complaints. It is about coming up with a strategic solution and letting these labels go.
  • Put Yourself in Their Shoes. Remember- most of the time the patient does not even want to be in our care. They would much rather be happy, healthy, and out in the world doing something that they enjoy. So think about it- what if that was your mom in the bed? What if your son was labeled the ‘difficult’ patient? How would you feel if you yourself was in a patient gown and overheard staff speaking about you in that way? To get to the root cause of why the patient is having a hard time, you may have to do a little bit of extra work. Ask them about things other than the reason they presented to you. Get to the root cause of the issue. You might find that the things that are stressing them out have nothing to do with their health at all! See if you can come from a place of empathy and understanding as you treat each and every patient with respect.

Do you have any patients that you’ll never forget? What have you done to cope with a challenging patient experience? Be sure to tweet me @ElizabethScala on Twitter to tell me about your difficult patient memories!

Elizabeth Scala

Keynote speaker and bestselling author, Elizabeth Scala MSN/MBA, RN, partners with hospitals, nursing schools, and nurse associations to transform the field of nursing from the inside out. As the host of the Nurse’s Week ‘Art of Nursing’ program, Elizabeth guides nurses and nursing students to a change in perspective, helping them make the inner shift needed to better maneuver the sometimes challenging realities of being a caregiver.Elizabeth received her dual master’s degree from Johns Hopkins University. She is also a certified coach and Reiki Master Teacher. Elizabeth lives in Maryland with her supportive husband and a playful pit bull.