When the Conflict Is with a Patient
Sydney Johannson, a 67-year-old man, was admitted to the medical/surgical unit 3 days ago for unresolved nausea, vomiting, and jaundice. A tumor was discovered in his bile duct, and he is scheduled for surgery tomorrow. His probable diagnosis is cancer.
You have been the primary RN caregiver for Mr. Johannson the past 3 days. He is short tempered and verbally abusive to you. He barks orders at you, ridicules almost everything you say, and is never satisfied with the care you give him. You realize that he is sick and frightened, but his behavior is frustrating and obnoxious. You find yourself avoiding going into his room just to avoid his verbal backlash. Today, when you enter his room to adjust his IV and give him his routinely scheduled medications, he makes several derogatory comments about your ethnicity and taunts you about looking like “an overstuffed pillow” and moving “slower than a snail.”
Instructions:
Read the Scenario above, and then answer the questions below:
What is the source of this conflict?
Answer the following questions concerning the scenario: Decide how you will respond. Is conflict avoidance justified since the patient is sick? Are other conflict resolution strategies more appropriate? Is bullying by a patient any more acceptable than bullying by coworkers? Role play with your peers how you might respond to this patient and what if any limits, you might set in terms of his behavior. How much control do you have over the patient’s behavior?
What is your bottom line in terms of behavior you will accept from this patient?
How will you respond?
My immediate response must prioritize de-escalation, professional boundaries, and patient safety, even in the face of provocation.
Response Strategy: Assertive Boundary Setting
Immediate Pause and Direct Statement: I would stop the task (adjusting IV/giving meds), make direct eye contact, and use a firm, calm, and professional tone.
Acknowledge Distress, Address Behavior: I would use a clear "I" statement to set a boundary while acknowledging his underlying illness:
"Mr. Johannson, I know you are very ill and feel frustrated, and I want to provide you with the best care. However, the comments you just made about my appearance and ethnicity are abusive and unacceptable. I will not continue this interaction if you use abusive language toward me."
State the Consequence/Choice: I would clearly present the choice for him to regain cooperation:
"I am here now to safely give you your medication and adjust your IV. If you can speak to me respectfully, I will complete your care. If the abuse continues, I will have to leave the room and notify the charge nurse and physician, but this will delay your necessary care."
Complete the Task Professionally: Regardless of his response, I would focus only on the necessary task (IV and medication administration) quickly and efficiently, maintaining professional neutrality.
Documentation and Follow-Up: I would immediately document the incident precisely, using direct quotes, and notify the charge nurse/nursing supervisor. This documentation is crucial for formal support and establishing a behavioral care plan.
3. Is conflict avoidance justified since the patient is sick?
No, conflict avoidance is generally not justified, especially when the conflict involves abuse and harassment.
Impact on Care Quality: While avoiding the patient reduces the nurse's immediate stress, it leads to missed care, delays in vital tasks, and compromised vigilance, ultimately harming the patient (the opposite of the nursing mandate). The feeling of avoidance already signals that the quality of care is suffering.
Professional Integrity: Avoidance reinforces the patient's unacceptable behavior, teaching him that verbal abuse is an effective tool to manipulate the environment. This undermines the nurse's professional integrity and safety.
Safety Issue: Since the behavior escalated to ethnic slurs, it is a workplace violence issue, not a personal preference issue. Nurses have a right to a safe work environment.
4. Are other conflict resolution strategies more appropriate?
Yes, Assertive Boundary Setting and Collaboration/Team Strategy are far more appropriate than avoidance.
Assertive Boundary Setting (Used in Response): This is the immediate, necessary step. It separates the person (the sick, fearful patient) from the behavior (the abuse) and establishes professional limits.
Collaborative Team Strategy: Since the behavior is ongoing, the nurse must collaborate with the Charge Nurse, Physician, and Social Worker/Ethics Consult to develop a unified Behavioral Care Plan. This plan should:
Validate the patient’s distress.
State clear, documented behavioral limits.
Stipulate consequences for crossing those limits (e.g., restricted visitation, requiring the nurse to be accompanied).
Ensure care continuity with a rotation of caregivers if necessary, distributing the emotional burden.
5. Is bullying by a patient any more acceptable than bullying by coworkers?
No, bullying by a patient is not any more acceptable than bullying by coworkers.
While the source and motive may differ (patient bullying is often rooted in fear/illness; coworker bullying is often rooted in power/jealousy), the impact on the nurse is the same: emotional distress, reduced job satisfaction, potential burnout, and a hostile work environment.
A patient's illness may explain their poor behavior, but it does not excuse the abuse, especially when it targets immutable characteristics like ethnicity. Healthcare organizations must uphold a Zero-Tolerance Policy for Workplace Violence for all sources, including patients and visitors.
Sample Answer
Conflict Analysis and Professional Response
The scenario presents a classic ethical and interpersonal conflict arising in healthcare, centered on patient behavior, nurse well-being, and professional obligation.
1. What is the source of this conflict?
The conflict has dual sources:
Situational/Internal Source (Patient): Mr. Johannson is facing a life-threatening illness (probable cancer) and major surgery, leading to intense fear, anxiety, and loss of control. His physical symptoms (nausea, vomiting, jaundice) also contribute to discomfort, irritability, and stress. His aggressive, abusive behavior is likely a defensive coping mechanism to displace his internal distress and reassert control in an environment where he feels vulnerable.
Interpersonal/External Source (Behavior): The conflict escalates from general rudeness to explicit verbal abuse and harassment (derogatory comments about ethnicity and body shaming). This introduces an element of discriminatory and personally targeted offense, making the conflict not just about care dynamics, but about workplace hostility and dignity.