difficult patients refuses to look at nurse at bedside

The Difficult Patient Tool Kit, Part 1: Proactive Ways to Defuse the Difficult Patient

Difficult patients are not all the same. Some people are simply unpleasant and end up becoming our patients, and there may be little we can do to change their behavior. But some patients can become demanding, hostile and even abusive or otherwise “difficult” as a reaction to a perceived threat in the environment. These patients may feel fear, frustration, intimidation, manipulation, and/or a sense of loss of control.

To the extent that you as the nurse can relieve these threats, you can prevent some distressing situations with proactive approaches.

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12 Ways to Deal with Difficult Patients

Try these 12 approaches to keep patients from feeling threatened, improve communication and lower your risk of difficult patient encounters:

  1. Strive for clear, mutually-understood, nurse–patient communication, remembering that one size does not fit all. Be sensitive to cultural, generational, and age-related communication implications, such as comfort with eye contact and physical touch. When in doubt, ask!
  2. If you are aware that you speak with an accent or at a fast or slow pace, acknowledge that with the patient and ask him to let you know if you need to speak more slowly, loudly, or otherwise alter your speech to facilitate understanding. Inability to understand can lead to anger and frustration.
  3. Don’t assume that your messages are always received and understood. As a patient, even the most intelligent person may process information more slowly, misinterpret, or simply fail to hear what is said to him.
  4. Use the teach-back approach to be sure the patient understands what you have said. For example, say, “I want to be sure you understood what I meant. Please tell me what I suggested about how to get out of bed.”
  5. Reflect back what the patient has said: “I understood you to say that the doctor gave you bad news. Can you tell me more about that?”
  6. Use open-ended questions that require more than a “Yes” or “No” answer. For example, instead of, “Do you have any pain?” ask, “How is your pain right now?” With this approach, you are communicating concern, not just collecting a number on the pain scale.
  7. Be alert for signs of anxiety, frustration, fear or anger. Tell the patient what you observe: “You seem nervous this morning, how are you feeling?” Noticing and expressing concern may de-escalate a potentially difficult patient.
  8. Patients may become anxious when their usual routines are disrupted and they feel loss of control. Ask the patient about routines and habits to determine which ones may be maintained in the hospital environment.
  9. Begin every shift on a positive, proactive note. Say things like “What’s important to you today?” and “I’ll be looking in on you approximately every hour to see how you’re doing and what you need.”
  10. Use the white board to communicate the names and titles of those involved in the patient’s care and to record activities during the shift. Keep the board up to date. Yesterday’s information can communicate negligence.
  11. Environment alone can provoke anxiety. Maintain a clean, neat, and quiet environment with a comfortable temperature and protected privacy to promote a calm atmosphere.
  12. Develop reciprocal relationships with peers before you need help. Your peers can validate your observations and interpretations. They can also suggest approaches from their own experience.


When a patient knows that you respect him and his concerns and that you value mutual understanding, he is less likely to become a “difficult patient.”

Learn more about how to handle difficult patients and improve communication with the RN.com courses, Managing Assaultive Behavior for Healthcare Professionals and Professional Communication: Speak Up, Speak Well.

The Difficult Patient Tool Kit Series

Part 1 focuses on preventing difficult patient situations; Part 2 explores ways to manage demanding patients and families, and Part 3 identifies assertive actions and teamwork approaches to resolve difficult situations. Look for Parts 1 & 2 of the series in upcoming issues of the RN.com Bulletin newsletter.

© 2014. AMN Healthcare, Inc. All Rights Reserved.

Bette Case Di Leonardi has worked in nursing, education and healthcare administration for more than 40 years and was among the first group of nurses certified in Nursing Professional Development. Today, Di Leonardi is an independent consultant who publishes and presents on a variety of professional and educational topics.