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Dealing with Difficult Patients: Behaviors that drive you bananas


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By Joan Monchak Lorenz, MSN, RN, PMHCNS-BC

Does a certain group of patients simply drive you bananas? Sometimes you can’t put your finger on it. Something just doesn’t fit for you. Then, someone points it out to you by saying, “Don’t you see how he or she is manipulating you?” Oh, that’s it! He or she is a manipulator and the problem is solved. Or is it? What is manipulation? How does it get in the way? Can it ever be a good thing?

Persuasion, influence, and manipulation: What’s the difference?
Persuasion and influence are often seen as positive traits. We look at people who seem to be able to encourage others to get things done and wish we could be more like them. Indeed, very popular books have been written that teach others how to persuade or influence others. For example, there is a famous book by Dr. Jerome Frank—now updated by his daughter Julia—called Persuasion and Healing. It elucidates the positive influence of therapeutic relationships and other psychological healing  techniques. In addition to this classic for healthcare providers, numerous pop books on the market give lots of hints on how to stop arguments by persuasion, get projects completed by influence and persuasion, and further your career by using your influence and persuasion.

Bothersome behaviors
Rather than using the label “manipulation,” let’s refine the definition and talk about the specific behaviors that drive us bananas. Then, let’s look at ways to handle these behaviors in our work situations.

Whether we see them in patients or our peers, the following are some behaviors that cause distress in the workplace.

First, we have the overt types of behavior that come across as verbal violence. These are often easier to handle because they are so overt. It is hard to miss them. They include:

Making demands: “I must have this weekend off to attend my cousin’s graduation,” or “I can’t go to x-ray until after I have my shower and shave.”

Violating rules and routines: A staff member consistently comes back from break or lunch late. A patient’s family member brings in food from home, even after being told that the patient is presently on a very restricted diet.

Making threats:
“I’ll throw this food tray at you if you come any closer.”

Then, we have the more passive types of behavior that are meant to persuade you to do what the person wants. These might be harder to spot. If you grew up with adults who used these, you may even think they are healthy behaviors. Once pointed out to you, however, they may become more obvious.

Eliciting pity:
The staff member who says, “You just don’t understand how hard it is for me to take care of that patient . . . ,” but says this often about all kinds of patients. Or the person who is abusing drugs: “If you had my horrible upbringing you would take drugs to numb your pain, too. Can’t you see how tough my life has been?”

Ingratiating and flattering:
The person who is always commenting on your clothes, your jewelry, and how good you look. Or the patient who says, “You are the best nurse on this floor. I don’t know what I would do if you took a day off.”

Evoking guilt feelings: When people say, “If you had called me over the weekend like you said you were going to, this would never have happened,” or “If you had made your rounds earlier like you usually do, I wouldn’t be in this mess.”

Abusing compassion: When patients say, “You acted like you were a caring person and said that you would have a hard time on a restricted diet, so why are you making such a fuss over my wife bringing me food from home?”

Attempting to exchange roles: When someone says, “I see that you have a problem with your weight. I am a fitness trainer and can help you with a personal plan to get you in shape. When you get a chance, come back and we’ll start on it.”

Pitting people against each other: When a peer says, “That night shift is something else. I don’t see them making rounds or doing any of the things I know they should be doing at night. You guys and gals on the day shift are top-notch.” Or when a patient says, “Who is that young doctor who came in here yesterday anyway? I bet you know a heck of a lot more about my condition than he does.”

Questioning competence or authority: When a patient says, “Now, honey, you just go take care of your other patients, and send in the charge nurse. I need a real nurse in here to answer my questions.”
Being overly dependent: People who allow others to do for them, do not accept self-responsibility, and then skirt responsibility if things go wrong. They say things such as “I am sure you know best. Just take care of that for me. I rely on all you nurses to make sure I get better.”

Using avoidance: People who change the subject when it comes up, avoid being around people they dislike, or are silent rather than open with their opinions. When they do speak, it is in order to avoid: “I can’t be on the same team as Susan. We don’t work well together.”

Joan Monchak Lorenz, MSN, RN, PMHCNS-BC is an HCPro author and contributed to the book Stressed Out About Difficult Patients.