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Rookie Wit & Wisdom
Responding to Rude Patients

I have been a nurse for nine months and work in a busy ER outside of Washington DC. I often find myself dealing with "Frequent Flyers" and people who misuse the emergency system (i.e., I'm fairly certain the rash you've had for six months did not just today become an emergency).

I am really struggling with how to deal with some of these difficult patients. I just cannot understand the nerve of some people! Just last night, I was discharging a patient and the curtain wasn't completely closed. The wife of a patient from the room next door peeked in and told me she was going home for the night.

As she began talking and asking for help, I interrupted her and said, "Excuse me, ma'am, but I'm with another patient right now. Please ask one of the other nurses for assistance."

I have even had patients' families actually come into other patients' rooms while there is a code situation- or while I am doing CPR-and repeatedly ask me for pillows, test results, food trays, etc. How do people not understand that we're in the middle of something?

I have struggled with trying to be polite, but I think in a way that only will encourage this behavior. I just don't know how to be assertive without getting so upset at patients and their families.

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20 Responses to “Responding to Rude Patients”

  1. Kim Says:

    In addition to being assertive – use HIPAA to your advantage for once – patients can’t just roam around into other patients rooms! It’s absurd! Redirect them to remain in their own room and use the call system for assistance. It is completely inappropriate for another patient to enter someone else’s room – besides being rude, it invades that other patient’s privacy and HIPAA rights as well! I would be furious if I was a patient and some other patient wandered into my room trying to pull my nurse away from me! Sometimes I do wonder about people these days:)

  2. Brent Says:

    No one says you have to be a punching bag as a demonstration of your compassion.

    Always acknowledge them, eg “I understand or know that you are distressed/sick/malingering right now but Mr X needs my care more urgently than you.”

    Although some never learn, subtle education might work. “Would you prefer that I leave this patient pulselss whilst I fluff your husbands pillows?”

  3. Bonnie Says:

    Very good advice Kim! Most patients are fine, but every once in awhile there are those “difficult” ones that think the world revolves around them.

  4. C.V. Compton Shaw, R.N. Says:

    In regard to an appropriate response to these varied situations, the legal standard of behavior, to avoid liability for negligence, for a nurse in this and other situations is “what a reasonable RN, using ordinairy prudence, would do under the same or similar circumstances.”
    To be more specific, legally speaking, negligence involves 1. Duty 2. Breach of duty 3. Causation (and proximate cause and 4. Damages. The standard of care for a general RN is delineated in the first sentence. However, the standard of care for RN’s with more specialized training and/or in more specialized areas of care may be higher.
    I am an R.N. with an Associates of Applied Science Legal Assistance-Paralegal.
    Of course, we all deserve to be treated in a respectful manner. There is too much disrespectful treatment of nurses! That is not the specific topic of the original post. As a result, I will not go into great depth in addressing that issue.

  5. andrea Says:

    When all is lost, humour seems to work. It’s really difficult when there are’needy’ patients who try our patience, but even in stressful situations, a bit of humour will often lighten the situation and allow you to move on. I’ve tried silence and a blank stare too. That works in some situations. The patient re-thinks what they’ve demanded and back off.

  6. bryn hagan Says:

    I give it to them like it really is. I politely and camly say what needs to be said. Don’t swear yourself or get excited.
    For example “I’m sorry, but your foul language is not appreciated, and if you don’t stop I will have security remove you” (good one for the reliatives)
    As for rude patients, well, I know a patient who was foul mouthed and ended up in court. The patient ended having to pay the court fees as well as $100 for the nurse.
    Oh, and when you know a complaint is coming in, it really pisses them off if you ask them make sure they get the spelling of your name right.

  7. Paula Says:

    25 years of experience have taught me there will always be rude patients out there and your best guide is to “kill them with kindness” The ruder they become the kinder you become. It will eventually really piss them off

  8. Amy Says:

    I’ve had this same experience in my ER. People just don’t understand.

    I’ve probably said some things that I shouldn’t have but they got the point through better than anything else. One patient was waiting in the waiting room for an hour (gasp!) and were very upset, the triage nurse turned the monitor so that you can see all the beds in the ER, and it shows they are all full. She asked the patient, “which patient would you like me to kick out of bed so you can have a room? the one they are currently doing CPR on or the kid who was hit by a car? I’ll just tell them that you’re six month old abdominal nausea can’t wait any longer.”

    I’ve also told patients, “I understand that you’re frustrated at this time, but this is an EMERGENCY ROOM and at this time another patient is in the middle of a life-threating even and they are more of an EMERGENCY at this time, if you can wait in your room I will be here as soon as I can.” Really emphasize the EMERGENCY word 🙂

  9. Muhamed.B.Sedibeh Says:

    my 14 years of expereience as a nurse midwife i came across a patient who is very aggressive but i never knew so she came to my clinic for the first time and was asked to join the que. she refused then started insulting and was asked by one nurse to stop insulting then stabbed that nurse with a knife.this is why nurse’s life is always at risk.

  10. Major Says:

    Most Nurses and Patients get along just fine. However I wonder why there are so many nurses blaming the patient for all the conflict. I have seen heart patients being yelled at by a nurse, Nurses yelling at patients in ER that “they are the nurse and if it gets done they will do it” Nurses pushing the “it the rules, you cant request a different nurse”, “Male nurses dont know anything and cant do anything”, and the one that tops them all “What makes you (the patient) think you have a right to want a different nurse”. We all like to talk about how the patient and their family intrude on the nurse and their duties, but no nurse wishes to admit they bring a lot of the abuse on themselves with bad attitudes, practices,and demeanor. Alot of situations can be averted simply by working with the patient, and their feelings. When no life threating condition is present the patient has the right to request a different nurse, doctor, techinician, for their comfort and peace of mind. The average patient can not get up and walk around the ER to talk to their Doctor, they would be risking restraint. I would like to see ever medical person have to be admitted to the ER or Hospital and given the same treatment that the average patient has to endure, the embarrassing exposure, the treatment of the staff when they complain, the rough treatment when being preped for surgery the cold unfeeling treatment of a shy child, the crying of a senior citizen when malhandled. WHEN DID THE MEDICAL PROFESSION LOOSE ITS COMPASSION? We have become a group of paper pushers and not caregivers. Let us think of the patient first.

  11. Emily Says:

    How about the male patient who says, “you don’t know what you’re doing. You’re incompetent.” Then when his family walks in, “this is the sweetest nurse!” What about the patient that you see once a month who wants that “d stuff, you know that dilauda. It’s the only thing that works” They mean dilaudid. Or the patient that is addicted to morphine, so they’re allergic to lortab, percocet, tylenol, fentanyl, dilaudid… everything but what they want. Or the family who wants information, and throws a fit when they can’t get it. The family member who is unstable and threatens to shoot everyone in the hospital, and so they’re kicked out, a description given to everyone, including security, and you get off the elevator and they’re standing at the desk asking for the nurse. Really? We’re so safe.. How about when you ask, “is there anything else I can get for you, and they say a drink. You get the drink, and they say, can I have crackers. You get the crackers and they say, can I have a warm blanket. And in the mean time, the family member of the patient next door is out in the hall looking in and trying to get your attention so they can ask you when the doctor is coming, which you never know the answer to. Or, you’re in a patient’s room and a visitor walks in the room and asks you for directions to the elevator. How about when you have someone incontinent and you are wiping their butt and the whole time they’re telling you you’re doing it wrong. The ones who go smoke or smoke in their rooms, or move their families in and expect them to be fed and cared for. If you’re a nurse, then you know I could go on, but I’ll stop. We get little respect, and we went to college for this….

  12. gomezaddams Says:

    There is no solution. If you don’t treat the patient like royalty, you get into trouble. The hospitals see these frequent flyers as customers (paying customers), not true. These frequent flyers are a burden on society, healthcare, our workloads. They think that they are the only patients there. I am sick and tired of being told to be nice, courteous, kind and caring when most of these patients abuse us.

  13. tired Says:

    Major Says:
    September 21st, 2010 at 2:59 pm

    to answer Majors question, “…when did the medical profession loose compassion?…” that is easy one. This happened gradually with the empowerment of greedy opportunistic lawyers, professional liars, out of touch , dissassociated government entities, shirikning reimbursement, blood sucking HMO’s, and jackass whiners who have an outof bound sense of entitlement started to plague the health care system. I could go on and on, but before bullshitting yourself into a hollier than though statement of disbelief, remember that usually the problem is not out there…

  14. Amy Says:

    I had a patient today who was too lazy to get out of bed, so he pooped and peed in it repeatedly. He was 42 yrs old. I had another end stage dementia patient’s son scream and come jusr shy of decking me b/c he thought 75 degrees was too warm for his mother’s room. Mind you, he wants us to do everything to keep he alive despite her poor quality of life. The CEO, DON and nurse mgr couldn’t kiss this guy’s ass enough. Then his wife gets mad b/c I told her I couldn’t take three calls per shift from multiple family members on each of my patients. I asked her to designate a spokesperson for the family. How dare I? Have you seen me running around like a chicken with it’s head cut off all day? Why are you more important than my other patients. How dare I be in another room pushing meds on a guy with a 50% venti with a sat of 79%?! Thank God I’ve talked my daughter out of becoming a nurse. All the time and money we spend on keeping people alive when they should be dead disgusts me. And treating people with easily preventable conditions caused by lifestyle choices. And the sense of entitlement people have to my paycheck simply because they forgot to go to college and/or use birth control. This is how I spend 90% of my workday. And don’t get me started on the documentation.

  15. kitnog Says:

    Emily, That was soooo funny!!!! This is so
    accurate. Every day, all day long. I’m seriously thinking of writing a book. No one could understand unless they have walked in our shoes. Sometimes when I’m on my way home at night, I ask myself, “are they serious”. OMG!!!

  16. Coool Says:

    in response to Amy #14.. i am literally flabergasted at your comment… That is borderline ABUSE on your part…. Your comment such as “All the time and money we spend on keeping people alive when they should be dead”.. and treating people with preventable conditions caused by lifestyle choices … You are unbelievable to make those comments… I have been in nursing for 18 years and i understnad the abuse we have to deal with on a daily basis… I understand that.. But I CHOOSE my career… to be professional, understanding … and i have been spit on, slapped, and called bad names and chased down the hallway …. I report it to my manager and let them deal with it.. But would never turn around and make those comments… I think you need to retire !

  17. Fed Up Says:

    Let’s face it…it’s a culture of I want it all and I want it yesterday. Yes, most chose this profession of nursing. We DID NOT, however, chose the constant abuse from patients, family, administration and coworkers. In no other profession have I seen such disrespect and degredation as nursing. I have my degree. I didn’t pay for an education to have rude, ignorant, ungrateful people try to tell me how to do my job when they know no better. Tired of people placing themselves in poor health situations and expecting and demanding a quick fix from monumental years of neglect and their own personal INTENTIONAL physical abuse of their own body (news flash, NOT MY FAULT AND I DIDN’T DO IT TO YOU). A hospital is NOT a hotel nor is it a Buger King where you can have it your own way. The people taking care of you ARE trained professionals and it so happens that I am the one that is going to save your life in a CODE situation. It won’t be the residents who have no clue, it won’t be your DOCTORS who are never around, it will be me. So show some gratitude and appreciation for what nurses can do for you and your family member. As for visitors and family. Ask questions politely. If you want to know something ask the damn doctor who gets paid to do not much of anything and stay OUT OF THE NURSES WAY and stop being a nuisance and distraction. Know your limits and boundaries. Is THANK YOU so hard for people to say anymore? Does anyone have to wonder WHY nurses are leaving the profession. Soon there won’t be any nurses……and who will care ? Also, sick of hearing I make “good money”….FYI: NOT WORTH the aggrevation and stress and constant fear of losing your license over dumb asses and an administration that doesn’t have your back and only cares about their reimbursement levels. Give me the doctors salary and mine and maybe it will be being that I end up doing 95% of their work for them. So much more to say here……disgusted after 17 years of nursing….(the wholier than thou nurses zip it) I KNOW what nursing is about, I took my oath but I am also about reality. Give respect you get it. Nursing doesn’t equate to doormat or punching bag.

  18. ciarra Says:

    I had a family member of another patient approach me to get things for several other patients in the middle of a huge MED PASS in a nursing home. She had alcohol on her breath and proceeded to tell me she was a teacher and she knew how difficult people are because the people in her area (parents) were a pain and rude and you know how awful parents in Westerville can be. I SAID I’M FROM WESTERVILLE. She was worried I would call Westerville schools so she called my boss and said I was mean to her and my patients. She smelled like alcohol, she was disruptive and complained openly about the people that pay her salary. She was interfering with my work, sticking her nose in when I was so obviously busy. Called my boss made me apologize and lectured me over the phone berating me the whole time and when I left I squirmed. Then she actually told my boss after all this, “she won’t stalk me or call Westerville schools about me will she?” Oh my gosh! so I have no union like she does. I would never announce I’m a school teacher with booze on my breath and berate someone obviously over whelmed with 40 -50 patients and lecture them how to do THEIR job. Then call the people in my school district names who pay my salary. So now I know how a poor teenager feels when a school teacher lectures them, berates them and calls the families a bunch of pains taking it out on a student. Oh I heard how hard she worked and how the tax payers were trying to cut back in that scrappy Westerville district. Hmmm I wonder why?

  19. rondodondo Says:

    I was once pulled outside the hosp. to a parking lot next door where an elderly woman was on the ground in Cardiac arrest. The daughter had come into the hosp screaming for a nurse and unfortunately I just happened to be going to lunch at the time (one of my rare lunches). I immediately started CPR including rescue breathing (yuck) until the squad got there. During compression the one daughter started screaming at me that I wasn’t doing it right. At that point I stopped and asked if she wanted to take over. She looked at me and said “no I don’t know how”.I then told her to shut up and let me do my job. The woman went on to make a full recovery but not one person in her family, which I saw every day during her stay even said thank you for saving their mom’s life. Nuf said

  20. Something should be done Says:

    I have been a nurse for 13 years and I’m running out of patience for these people who demand better than everyone else. Usually there is a lawyer or celebrity in the family and the management will do everything they can to appease them. Yesterday, they asked a nice woman if they could have her chair so that they could give it to this patient with the lawyer daughter, who couldn’t possibly sit in the same chair as everyone else on the unit. The nurse for the woman advocated and said no..The porter came back when the patient was in bed resting and took this chair for my patient. Really????? We have universal health care here. I don’t care if he’s donated money or not. Universal means we are all the same… After the slamming things around, yelling, verbal abuse to staff…they got a nicer chair from a nice patient. Something is wrong here!!!!

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