We’ve all had them. The patient whose room we would avoid all shift if it were possible. The patient who, when receiving report from the off-going shift, made us groan. What I have found, however, is that frequently it takes a change in nursing staff to elicit a different response or different interaction than the previous nurse experienced. I would need both hands and feet to count the number of times that my experience with a patient was amicable, workable and downright fun when the previous nurse labeled them as “a piece of work that will have you in their room the whole shift.”
Why have I had such a different experience? Maybe because, after having been alerted of the possibility of avarice, I am determined that I will not have the same relationship with the patient. Maybe because I’m more patient, given my years. Or maybe because the previous nurse and the patient simply had a clash of personalities. Not every one is going to get along with every one else.
One of the greatest tools I have found to be of use with the difficult patient is listening. Many of the most difficult patients simply feel they have not been heard. Most people are reasonable and will respond well when told that the nurse has 5 or 6 other patients, many of whom are sicker and have more complicated issues than theirs. Many will enter into a verbal contract, if you will, when they know that the nurse will return to their room in an hour to attend to them again. The nurse, then, needs to keep their end of the contract as well and if unable to do so, send an aide in to update the patient on their return. Patients may need to vent about the previous shifts’ care of them, and the nurse can respond with empathy while not placing blame on their co-workers. In most cases, the patient feels validated and can then move on with a clean slate with the current nursing staff. I have found charting at the point of care, gives me a few extra minutes to get to know the patient, and the patient feels that I have been in their room longer than the previous nurse.
I have found that even the most difficult patient has something to teach me, if I am simply willing to listen.