Difficult behavior patients have a range of behaviors: needy, rude, demanding, mean, aggressive, or violent. They monopolize more of the nurse’s time than warranted for their illness and prevent nurses from being with patients who are more critical. Patients that are confused or have mental illness can act out, but it is easier to have compassion on them than a difficult patient who is fully oriented. When a fully oriented patient behaves inappropriately it makes our job more difficult than it needs to be. Some will continually push our boundaries and see if they can wear you down to get what they want.
How can Nurses establish boundaries with difficult patients?
1. Establish a Timeline
Nurses must address patient needs but not allow them to overtake them. When you leave the room set a timeframe for when you will return and honor it. Inform the patient that when you are not with them, you are with other patients because they need you too.
It builds trust and helps relieve anxiety if they are needy and build respect depending if rude. The patient may claim you forgot about them, but you can counter that you came within the time frame you promised them.
2. Clump Tasks
Nurses do this anyway as a time management trick, but it is particularly helpful when dealing with difficult patients. They tend to unnecessarily take up nurse’s time with nit-picking, complaints, numerous demands, or long-winded stories. Just going into the room is a bigger commitment. Take the time to be in the room longer to do more tasks, but the benefit is that you will limit the number of trips.
3. Draw Firm Line
Needy and demanding patients need to have their expectations of staff redefined. The nurse cannot be there every 10 min, they are not the only patient, and many patients are more critical than them. It does not mean they are not a priority, we just have to prioritize our priorities.
Rude and aggressive patients need their responsibilities as a patient redefined. Being in the hospital is not a free pass to be a horrible human being. When someone is verbally or physically abusive, demeaning, or derogatory, stand your ground and say “That is not allowed here” with authority.
4. Get Backup
We are stronger together. Ask a co-worker to turn off the needy patient’s call light because you just left and need to be away from them for 5 minutes. Or have a co-worker call you when you are in the room too long for an excuse to leave.
Always error on the side of caution and bring backup. If a rude patient won’t respect your firm line, bring in your charge nurse or someone with authority to reinforce the behavioral standards. When an aggressive patient won’t listen to you call security to have a conversation with them. Even if the patient remains unruly, security can act as a witness and protector when you have to do a procedure on a patient with a history of aggression. In some cases security can escort them off the property if they meet certain criteria.
As a nurse you have every right to place firm boundaries on patients. That does not make you mean or lacking compassion. It keeps you sane and your other patients safe. You cannot do your job when someone monopolizes your time and emotions for unnecessary reasons.
There are only 3 outcomes when you set boundaries: they immediately comply, argue and try to get you to break until they stop because it is futile, or they “fire” you hoping their next nurse will let them have their way. All 3 outcomes are a great improvement from letting them exhaust you physically and emotionally.
