How to Handle Difficult Patients as a Nurse: A Comprehensive Guide

According to the U.S. Bureau of Labor Statistics, healthcare and social service workers, including nurses, are 5x more likely to encounter a workplace violence injury than workers overall, with 1 in 4 nurses reported being physically assaulted, according to a 2019 ANA survey.

The statistics are shocking, however, the unfortunate reality is violence is becoming an unavoidable issue in the healthcare industry. The World Health Organization (WHO) estimates that between 8 to 38% of all health workers will suffer physical violence during their career, with many more experiencing difficult patients.

All healthcare professionals, from doctors in New York to students in online accelerated BSN programs in Texas, will likely deal with difficult patients at various points in their careers. It’s important to learn how to spot early warning signs for difficult patients and how to respond.

It’s scary how common difficult patients and violent behavior are becoming in the healthcare field. Studies have found that violence against healthcare workers is only rising, and it has been getting worse since the COVID-19 pandemic.

In this article, we’ll be covering how to handle difficult patients as a nurse, spot early warning signs, and defuse situations for safety. When dealing with difficult and potentially violent patients, there are various strategies you can employ.

What is a ‘difficult’ patient?

A difficult patient isn’t defined as one with bad veins, or having a bad memory day and forgetting their list of medication. The term ‘difficult patient’ is defined as a group of patients with whom a healthcare worker is having trouble forming a normal therapeutic relationship.

Difficult patients in one way or another present challenges in a healthcare setting. This could be because they’re being noncompliant—refusing to follow medical advice, exhibiting negative attitudes and behaviors, emotionally unstable, distrusting, or aggressive and hostile.

It’s important for every healthcare worker, from nurses to doctors, to learn how to properly care for and treat a difficult patient. Effective communication, patience, and empathy are key when managing situations with difficult situations.

Worst case scenario

Before delving into strategies for managing difficult patients, it’s important to understand the worst-case scenario. If a difficult patient is dealt with effectively, it could lead to:

• Verbal or physical abuse from the patient.

• Security incidents requiring intervention from law enforcement or security personnel.

• Reduced morale for the healthcare worker.

• Difficult patients can also contribute to burnout due to emotional exhaustion and compassion fatigue.

• If care is compromised due to patient-provider conflict, it can lead to ethical and legal risks.

• Persistent negative interactions with a difficult patient can lead to a loss of trust in a therapeutic relationship.

• Damage to the reputation of the individual or organization.While it’s rare for a situation to escalate to a worst-case scenario, it’s always a possibility. It’s critical for healthcare staff to always be prepared and follow the safety protocols as laid out by their organization when dealing with difficult patients. 

Examples of difficult behavior

Difficult patient behavior can manifest in a number of ways, ranging from mild to severe. Common examples include:

• Noncompliance with treatment, ranging from ignoring professional medical advice and refusing to take prescribed medication.

• Aggression or hostility (yelling, shouting, threats, intimidating behavior, and physical violence).

• Frequent complaints, like complaining about wait times, or facilities in an unreasonable manner.

• Unreasonable expectations, like expecting immediate care or round-the-clock access to care providers.

• Disrespecting boundaries and policies, for instance, refusing to wear masks during an infectious disease outbreak.

• Passive-aggressive behavior—including sarcastic or backhanded comments, showing up late to appointments, and using dismissive tones.

Handling a difficult patient

Understanding how to handle a difficult patient is an extremely useful tool when working in healthcare. Effectively being able to manage a patient can also be the difference between a situation escalating to physical violence or not.

Below, we’ve listed out common strategies for managing difficult patients. Along with the strategies, it’s critical to always report any aggressive patient incidents to a manager or supervisor and follow your organization’s protocol.

Following organization protocol is important for maintaining your safety, maintaining professionalism, and a paper trail if documentation is required, e.g.: in the case of the patient filing a complaint. 

Identify the problem

When handling a difficult patient, the first step is to always try to empathize and understand their feelings. If you can, try to identify what is causing the problem, and if you can—remedy it for them if possible.

If you can understand and address the issue, you can follow up by assessing the risk and notifying any other staff to help. It’s important to remember, however, that depending on the cause for difficulty, like mental health, patients may not be able to identify the root cause.

Managing the situation

While there is no golden standard for dealing with difficult or aggressive patients, The Joint Commission has a fantastic list of de-escalation techniques for healthcare workers. The list includes:

• Utilize verbal communication techniques that are calm and clear. Staff should always be non-confrontational with verbiage.

• Use non-threatening body language if you are approaching the patient.

• Approach the patient with an empathetic attitude, being supportive of their issue or problem.

• Respond to the patient’s expressed concern or condition. This can also help with building rapport and trust with the patient.

• Set clear limits and boundaries for the patient to follow.

What to avoid

There is no one correct way to respond when you’re dealing with a difficult and potentially violent patient. However, in most cases, for your safety and reputation, there are two things you always want to avoid.

1. Avoid responding defensively. It’s a natural response, especially if you feel like the patient’s anger or frustration is misdirected, but try to avoid responding defensively as it may escalate the patient’s feelings.

2. Avoid getting angry. When interacting with a difficult and agitated or angry patient, it’s important to stay level-headed and mindful. Try to keep control of your emotions and remain professional in all interactions.