Andrew Wettengel / Friday, August 9, 2019 / Categories: Work World


As a medical professional of any sort, some of your greatest challenges on the job are bound to involve patients who are argumentative, disrespectful and/or disruptive.

That may be doubly true when you’re a travel nurse tasked with treating unfamiliar patients under all sorts of conditions.

While the definition of a difficult patient is highly subjective, NCBI research indicates as many as 15% of all ambulatory patients seen or treated in the U.S. are perceived by medical personnel as difficult. Further research places the ratio of difficult patients at a public hospital at 20%.

Further, problematic patients do more than simply annoy their doctors and nurses. At least one study suggests difficult patients can affect the quality of their own treatment through such behaviors. 

"Patients who behave disruptively by displaying disrespect or aggressiveness may induce their doctors to make diagnostic mistakes," advises study participant Dr. Silvia Mamede, estimating 15% of patients treated in doctors' offices are aggressive, disrespectful, overly demanding or distrustful. 

So, it’s a given that your travel nursing job will involve patients who tax your patience and make your job more stressful. What can you do to cope, and to keep from getting burned out by such experiences? 

  • Participate in any training offered by your employer(s) in how to react to such patients — and how to keep from internalizing such experiences.
  • Remind yourself the problematic behavior is not about you; it often stems from pain and/or fear and may even be related to the patient’s medications, says Charlene Berube, chair of the undergraduate nursing program at Simmons School of Nursing and Health Sciences in Boston. “My belief for many people is that either their best or worst self presents itself at that time of a health concern,” advises nursing instructor Charlene Berube on Nurse.org.
  • Give difficult patients a chance to vent; make eye contact, actively listen, then calmly repeat back your understanding of what their issues are. Often, people calm down once they know they’re being heard.
  • Calling patients by name may reassure them you’re not just seeing them as another case file.
  • Consider whether acknowledging the tension will help. Try moving the conversation forward by saying something like, “I feel like we’re getting off on the wrong foot,” or “I can understand why this is very upsetting for you.”
  • Modulate your voice even if a patient is shouting. Once he sees you’re not escalating the argument, he’ll likely be calmer.
  • Face the patient while talking to him and avoid defensive body language such as crossed arms or legs.
  • Set boundaries. Because you have a finite amount of time and energy and a roster of other patients, you must gauge when a patient is willfully wasting your time and (politely) end the confrontation. “All nurses need a healthy sense of what’s important and what won’t diminish quality of care if it never gets done,” notes nurse anesthetist Nick Angelis on Rasmussen.edu. “Never neglect a patient in need because you feel pressured into helping a difficult patient who doesn’t require immediate care.”
  • Plan recovery time into your day. Depending on your level of sensitivity, you may need to build in frequent “self-care” breaks during which you briefly exercise, meditate, pray, nap, laugh with co-workers or otherwise shake off negative energy.
  • Refuse to tolerate abusive behavior. If it continues following one warning, remove yourself from the situation and alert your supervisor. If you feel you’re in danger, contact security. Part of what motivates difficult people is that they can wear people down and get what they want,” notes charge nurse Jackie Jacobs on Americannursetoday.com. "By learning to disengage effectively, you can avoid getting hooked into the difficult-behavior cycle.”
  • Take care of your physical, mental and emotional health outside of work by exercising, eating right, participating in activities you enjoy and otherwise protecting your own well being. 


Finally, remember to focus on the big picture. No matter how discouraging some patients can be, you’re still part of an important team that works to help people — which is likely why you went into nursing in the first place. 

“Patients come to nurses with mental health issues, mood disorders, depressions, anxiety and a host of other complications,” notes Lee Nelson in the Nurse.org article. “They have lives or lifestyles you may not understand or even agree with. But none of that matters. Each patient deserves the best nursing care you can give them.” 

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