The Nurse Practitioner's Guide to Handling Upset Patients

Security! Working as a nurse practitioner in the emergency department, I've encountered my fair share of upset patients. Sometimes, these interactions escalate and require intervention from hospital security staff or are unfounded and based on psychiatric illness or substance abuse to name a few. Most often, however, frustrated patients have a legitimate concerns that deserve acknowledgement. 

Occasionally, patients get angry or agitated when I refuse to prescribe opioid pain medications - usually after a query into my state's controlled substance databank. Other times, patients are frustrated about their insurance plan or lack of resources for care and take this out on myself and other staff members. Long wait times are a common complaint among patients in the emergency department. We've all been there as nurse practitioners - faced with a patient that's not happy. So, how do you approach a patient who's upset and reach the best possible outcome?

Whether a patient is upset about wait times, or simply angry as a result of feeling ill, it's inevitable that as a nurse practitioner you'll need to manage these issues. Regardless of the reason for the confrontation, taking the following steps will maximize the chances of reaching a positive resolution. 

1. Seek first to understand

Before you dive into an explanation about why things are the way they are, dismiss a patient's concern, jump to conclusions, or even apologize, get more information about the problem. Allow the patient to vent, if needed. Listening to them express their concerns will not only cool hot tempers, but also help you take stock of the situation. You can't solve the problem if you don't understand it.

Maintain an even-keeled approach as you learn more about the issue. A calm disposition prevents the situation from escalating. And, never discuss a patient's concerns over a messaging platform. This leaves too much room for misinterpretation. Talking on the phone or in-person is best. 

2. Take and concerns seriously

Listen to the patient express their concerns without interrupting. This let's them know you take their concerns seriously. Reflecting the problem back to the patient also shows that you've heard and understand their position and ensures there hasn't been a miscommunication. Repeat back the message you've received from the conversation to make sure you are on the same page about the cause of the issue. This further validates concerns and thaws icy interactions. A little empathy goes a long way in setting the stage for you then to explain your own point of view. 

3. Share your perspective 

Once you've given the patient a platform to share their grievances, add your perspective to the problem. If you're in the wrong or your practice is at fault, this should come in the form of an apology. If you messed something up, say you're sorry. If the frustration is a result of something you can't fix or comply with, such as a request for controlled substances, share your reasoning. In the case of an insistent patient, try the broken record technique. Continue calmly citing the reason you can't comply with the patient's demands. Avoid diving into multiple explanations as this will more likely lead to a heated discussion. 

4. Reach a mutually agreeable solution

Assure the patient that you want to help resolve the issue however you can. Explain how things will be different moving forward, or what actions you plan to take to make things right. Give a timeline for doing so. If it remains unclear what can be done to remedy the problem, ask the patient what you or your practice can do differently to make his or her experience better in the future.

5. Learn from the interaction

It's likely that other patients have experienced similar frustrations with your practice but not expressed them in the past. Interactions with upset patients let you know what issues must be addressed to improve customer service in your practice. Recognize signs of frustration early to avoid a confrontation or losing a patient as a customer. Ask for regular feedback from your patients to keep tabs on how your practice is perceived. 

There are times when you are in the right, or patients are upset for reasons outside of your control as a nurse practitioner. Regardless, taking the time to understand the issue in an empathetic manner will go far when it comes to patient satisfaction

How have you handled upset patients in your practice?

 

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Comments

I just wanted to ask some advice about how to speed up the process of getting California to verify my RN license for endorsement to another state. I was originally licensed as an RN in California, then moved to Georgia and have been licensed in Georgia as an RN since 1989, and licensed as an FNP since 2006. I let my California license expire, and since they don't participate in Nurseys, they say it will probably take 4 months for the verification.
I have read where one RN went in person to the California Board office and was able to walk her paperwork through and get her endorsement to another state within 2 weeks. But she did have an active Calif. license at that time. If it would speed up the process I would gladly fly to California and walk it through in person. Any thoughts or advice on this would be greatly appreciated.
Thank you
Leslie Jarrett

Leslie Jarrett

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