Managing conflicts with patients: Strategies for FNPs

It is not uncommon for providers, such as physicians and family nurse practitioners (FNPs), to become involved in conflicts with patients. Such incidents are usually a consequence of unreasonable behavior by the patient, although health care providers sometimes can be at fault. Marika Davies spoke to the prevalence of such encounters in an article published by the British Medical Journal, reporting that a notable minority of doctor-patient interactions — some 15 percent — are perceived as being challenged by the physicians surveyed.

Why does patient-provider conflict sometimes occur?

As detailed by Davies, difficult interactions between patients and providers can be a corollary of any number of things, although in a health care setting some factors are more likely than others. Davies offers the following examples:

• A health care provider’s actions may be the problem. For example, the provider may be rude or dismissive to the patient or late for an appointment and so on. Such issues also can be exacerbated by miscommunication and varying interpretations. A patient may feel offended by a provider’s tone and attitude, for example, while the provider may not understand or be aware that is the way he or she is being perceived.
• A patient may become frustrated with his or her provider due to factors such as the stress of his or her illness. He or she also may be difficult to deal with because of unreasonable demands concerning receiving certain medications and expecting particular outcomes. He or she also may display unwarranted rudeness, anger or aggression. Given that health care providers are trained in effective patient communication, dissatisfaction from the patient’s perspective is a primary cause of conflict.
• External factors, such as short appointment times, delayed wait times and a lack of effective resources also can create stress that may engender conflict.

Strategies for a peaceful resolution

Should a conflict become heated to the extent that violence is a possibility, providers should seek assistance from other staff members, security and/or law enforcement, if necessary, Dr. Karen Broquet and Dr. Sharon K. Hull explained in an article for Family Practice Management. For general conflicts wherein providers feel safe enough to resolve disputes independently, the following approaches can be helpful:

1. Active listening

Providers should take the time to listen carefully to patients’ concerns, even if they do not agree with what is being stated, journalist Stephanie Staples wrote in an article for Nurse Together. Practicing active listening can help diffuse tensions, as patients are able to see that their providers are hearing their concerns and taking them on board. This approach is most effective when providers repeat back patients’ queries, emphasizing that they have heard and understood what has been articulated.

2. Clear communication of information

In an article published by Medical Economics, Dr. David A. Fleming, president of the American College of Physicians, explained that providers should communicate information as clearly as possible to help manage conflict with patients. As Fleming made clear, conflict can arise when patients become frustrated or confused about what they are being told. Effective communication involves asking patients questions to gauge their level of understanding; speaking slowly, clearly and calmly; and employing language that can be considered universal instead of using medical jargon.

Fleming elaborated on the importance of clear communication as an approach to resolving conflict: “Information can be powerful. Often, conflict arises because there is a lack of communication about the information that has been provided, either from the patient giving information to the physician or the physician conveying information back to the patient.”

3. Avoiding an emotional response

When patients become angry and upset, providers easily can get emotionally involved in the situation, becoming frustrated or taking offense. However, as detailed in an article published by the American Society of Registered Nurses, an emotional response can exacerbate any tension present, so providers should work to maintain a level head throughout the conflict, taking an objective look at the situation as opposed to an emotional one. To achieve this frame of mind, providers should try identifying with patients, considering their point of view and understanding that their emotional responses may be due to external factors beyond anyone’s control. If providers remain calm and measured, the chance of a successful resolution increases considerably.

Consider Bradley University

Effective communication skills and best practices for patient communication are important components of the education one receives when enrolled in Bradley University's online Master of Science in Nursing – Family Nurse Practitioner program. Designed with flexibility in mind for working professionals, the online course is an efficient way to gain the education you need, while still working professionally as a nurse. To learn more, click here.

Sources

http://medicaleconomics.modernmedicine.com/medical-economics/news/managing-conflict-patients?page=full
http://www.nursetogether.com/10-ways-handle-difficult-patients-or-co-workers-your-nursing-job
http://www.asrn.org/journal-nursing-today/356-dealing-with-the-difficult-patient.html
http://careers.bmj.com/careers/advice/view-article.html?id=20013822
http://www.aafp.org/fpm/2007/0600/p30.html