As an assistant nurse manager in an extremely busy pediatric emergency room, I dealt with difficult family members. Although I was an experienced nurse, it took many years before I felt comfortable and confident handling conflicts with family members.
Hospice nurses often deal with difficult patients due to the stress of a dying loved one. Penny Hawk worked as a hospice nurse for 11 years and encountered rude or difficult families all the time. But through trial and error, she’s learned some strategies to ease conflict, resulting in win-win situations.
As a nurse, you will deal with family members in addition to caring for patients. Many will be cooperative and pleasant. But there will be a few who are outright difficult.
Do you want to feel confident dealing with difficult families at your workplace? Review these five tips we’ve used throughout our nursing career. You can apply them to your nursing practice today.
1. Communicate With Open-Ended Questions
Communication is key when dealing with difficult family members. But learning how to communicate with a difficult person takes practice.
There are several reasons why someone would be difficult. The family may perceive their needs aren’t being met. They also may be dealing with additional factors including:
- Mental health conditions
- Unhealthy family dynamics
Unfortunately, they take it out on you, leaving you in difficult situations.
It is important to understand the family’s needs at the present moment of the conflict. Open-ended questions allow the family member to express their thoughts. It allows you as the nurse to offer solutions.
“Using open-ended questions often helps family members get to where they need to be,” Hawk says.
Open-ended questions are broad enough so the family member can answer in detail. Open questions usually start with “how” or “what.” Framing the questions this way can help you get to the bottom of what may be causing family members to be difficult.
Here are some examples of open-ended questions:
- “Tell me, how can I help you?”
- “What is the best way you think we can resolve this?”
- “What do you think is making you feel this way?”
- “How can I make you feel more comfortable?”
- “What do you think this means?”
Having a healthy line of communication between you and your difficult family members can eliminate any confusion or misinformation that might occur. Practicing effective communication is a necessary skill, especially if you are interested in becoming a nurse leader.
If open-ended questions aren’t working, it might be a good idea to invite a third person to help mediate a conflict. This can be your charge nurse, nurse manager, or security. It’s important to know right off the bat you are not alone.
If at any point you as a nurse feel threatened, excuse yourself, leave the room, and talk to the nurse in charge or call security.
2. Offer Comfort
Many times, dealing with difficult family members comes down to providing comfort. I found as an assistant nurse manager offering a food voucher or even a hot cup of tea helped ease tension. Comfort can come in many forms.
As your patient’s nurse, you can offer their family members:
- An extra chair or leave an extra chair in the room
- Leave extra pillows and blankets in their closet in case they are spending the night
- Fix the television in their room or put on their favorite show
- A hug when appropriate or a light touch on their shoulder or arm
- Offer a private room (when possible)
The family member may become upset when surrounded by the patient or other family members. Talking to them away from their loved ones in a private room is also a form of offering comfort.
It is also important to offer comfort to the patient as well. This way you might get a better understanding of their family dynamics. Hawk would speak to patients privately if the family members weren’t on the same page.
“[I] wanted to check in and see how the conflict is impacting them,” Hawk says.
As a nurse, you should offer comfort to all family members whether they are difficult or not. Providing comfort to family members who need extra attention can remove a layer of stress, leaving them less anxious, worried, or difficult.
Listening is a powerful skill; anyone can improve their listening skills. Most people want to be heard, especially when their loved one is in the hospital. It is important as a nurse to listen to the concerns, wants, and needs of your patient’s family members. This is a form of validating their feelings.
When listening effectively, you want to:
- Be present and not let distractions come in the way of the conversation.
- Stop what you are doing and make eye contact.
- Never give your back to the person you are conversing with.
- Pay attention to nonverbal cues.
- Be conscious of your body language.
- Do not interrupt.
- Listen without judgment.
Not all family members have the same needs. Some family members may just want a call when the status of their loved one changes. Others may just want to vent their frustrations. Whatever the case, listening to a difficult family member can help de-escalate certain situations.
4. Integrate Cultural Beliefs Into Your Care
I’ve seen nurses completely dismiss patients’ wishes rooted in their cultures or beliefs. This can also offend family members, causing conflict.
As a healthcare provider, it is imperative to provide culturally competent care in nursing. You should be aware of your patient’s and family’s cultures, beliefs, and rituals. Hawk advises never to assume anything about spiritual, religious, or cultural beliefs.
“It’s important to always let patients and their families take the lead on any rituals,” Hawk says.
Certain beliefs or rituals may go against the provider’s orders. Regarding safety, Hawk believes that as a nurse you are responsible for educating patients and their family members about specific health risks.
You may follow another set of protocols if you are a hospice nurse. Because the patient is dying, although rituals may cause a health risk, it is even more important to allow the patient and their family members to incorporate their beliefs into their loved one’s care.
“There are some cultural practices that are unsafe such as feeding a person soup while they’re dying when they can no longer swallow,” Hawk says.
She doesn’t necessarily agree, but in the past, because it is part of their belief, Hawk allowed family members to do what they needed to practice their culture. But it is important to educate the family members about the risk of aspiration, for example, so they can make the most informed decision for their loved one.
At the end of the day, if you don’t feel good or fill your cup, you won’t have the patience to deal with difficult family members. Self-care for nurses has become widespread and necessary, especially with the stain of the COVID-19 pandemic. It is very important for nurses’ mental health.
When I worked at the bedside, I took self-care seriously. It was important to me to get adequate rest, exercise, and socialize with friends and family.
Here are some other self-care tips:
Leaning Into Your Team
As a form of self-care, Hawk remembers leaning on the team’s social workers to debrief. She also believes having very good emotional boundaries is key.
“[I tried] my best to leave work at work,” she says.
Taking Advantage of Employee Assistance Programs
Most hospitals and facilities have employee assistant programs. These programs assist employees with personal problems that are impacting their day-to-day life. Using your hospital’s program is a great way to practice self-care.
Hawk found gardening as a form of self-care. For her, it is a great outlet. Before moving to another home, Hawk had many plants from patients’ families.
“It was cathartic to walk around and admire the blooms and remember my patients,” Hawk says.
Hawk warns that unhealthy family dynamics or difficult family members may not change even when someone is sick or dying. It may get worse.
“As I gained more experience, I learned that our experiences with our family and patients are just a fraction of a window of time in their lives,” Hawk says.
So in these moments, approach them with open-ended questions and empathy. Lastly, take care of yourself. You want to have a smooth shift and happy families.
Meet Our Contributor
Penny Hawk is a certified hospice nurse with 17 years of hospice experience within inpatient care, home hospice case management, and quality and education. She found social media during the pandemic and has gathered over 430,000 followers on TikTok and 60,000 on Instagram. She educates on hospice and normalizing death and dying.