L.E.A.D. a Difficult Patient Towards Respect

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We know that nurses experience bad behaviors from co-workers. But what do we do when the insults, unreasonable demands and bad behaviors come from patients? Patient and visitor bullying and violence is on the rise!! However, with the emphasis on improving patient satisfaction scores, dealing with difficult patients can be even more challenging BUT not impossible.

How to L.E.A.D. a Difficult Patient Towards Respect

The next time you care for a difficult patient, follow this simple acronym to LEAD your patient toward respectful behavior.


As nurses, we see the horrific myriad of ways pain and fear can grab hold of patients resulting in bizarre behaviors we don’t always understand. Pain, stress or fear aren’t excuses to treat others with disrespect, but they can cause people to act out of character. In some instances, you can diffuse an unpleasant situation by leading a patient back to a more grounded, calm space with active listening:

  • Check in with the patient frequently. Just a simple, “Just checking in to see how you are doing,” as you walk by their room can really help the patient feel that you care.
  • Use neutral body language with arms open, and observe the patient’s body language. They may be screaming but their eyes may be showing fear. How they look and act can often tell you more than their words.
  • Make eye contact. This helps to bring your patient back to the “now,” face-to-face which can often help diffuse the behaviors.
  • Acknowledge that you hear them, and reflect their concerns back, with “I” statements so they feel assured you know what the trouble is, and that you’ve got a good grasp of what they need.

Many times fearful, frustrated patients simply want to be heard. Taking this step might soothe your patient and solve your dilemma.


Some patients bark out demands because they need something, and others do it because they can. Neither reason justifies bad behavior. To communicate you expect better, maintain your boundaries:

  • Assertively communicate what you can and cannot, or will and will not do. I use scripts such as, “I am willing to help you as long as you are willing to be respectful.”
  • Respectfully stand your ground. If you tell your patient what you will and will not do based on his/her behavior and then give in, you’ve just taught your patient how to treat you.
  • Stay calm. If you feel yourself losing your cool, actively seek assistance, or coping strategies where you can. Breathe. Take a moment to ground and center yourself.

By assertively communicating your boundaries, you establish what is acceptable and unacceptable in the nurse-to-patient environment.


When patients feel they’ve lost control, they will seek to re-establish that control in other ways. If a patient is trying to push your buttons, pay attention to those triggers, and make them off-limits:

  • Respond instead of react. When you respond, you address a situation in a controlled, positive manner. When you react, you internalize the situation and reflect back by outwardly expressing emotion in an uncontrolled way.
  • If you’re prone to reacting in response to stress, avoid internalizing the moment and focus on your priorities, to avoid letting your feelings overtake you.
  • Create a list of coping strategies beforehand that you can quickly use when you’re in the moment.
  • Be honest with yourself. If you’re having trouble handling a situation professionally, seek assistance before making the situation worse.

Often a tough patient will back down when they see they can’t rattle you, and keeping calm and focused may lead the patient to becoming more calm and focused too.


As trained professionals nurses are no strangers to extreme stress. However, our expertise doesn’t mean we tolerate abusive behavior in response to patient stress. When enough is enough, make the call and seek support. Many organizations have certain codes that nurses can call when a patient is getting out of control. Call it!!

We owe it to ourselves, and all of our patients to stop bad behaviors in their tracks. When we LEAD difficult patients toward more respectful behavior, we create working conditions we deserve that helps us give the best care, and to make sure ALL patients – not just the difficult ones – receive the level of care EVERYONE deserves.

Renee ThompsonTake care and stay connected.

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Dr. Renee Thompson works with healthcare organizations that want to overcome the leadership and clinical challenges their people face every day. If you’d like to find out more about her programs, please visit her website

Contact Renee today at to bring her to your organization to talk about ending the cycle of nurse bullying.

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