By Carol Mulvihill, R.N.,C., Editor
Although my experience in dealing with most students who seek our services is positive and cooperative, every now and then a very challenging student comes through our doors. I'll tell you candidly how I handle these situations at the University of Pittsburgh at Bradford's Student Health Center. I don't pretend to have all the answers, nor am I proposing that my approaches are exemplary or useful for everyone. I am simply offering food for thought and honest discussion. At the end of this article, I will ask for your input in the form of strategies, anecdotes, and examples from your own experiences and observations.
First, I will attempt to define what I mean by "the difficult patient." I was going to title the article, "Dealing with the Rude Patient," but someone suggested I use the term "challenging" instead. I think "difficult" is more descriptive, as I am talking about negative behavior here. Some of the other terms my co-workers came up with in describing such behavior include: inappropriate, demanding, cocky, bossy, and angry. Those are the words I can print.
Here is what I do:
Our Director of Residential Life and Housing, Rhett Kennedy, is a very even-tempered guy, who does a remarkable job of staying professional at all times, regardless of what is being hurled at him. Rhett is very good at using the "Kill 'em with kindness" approach.
By encouraging a student to control the volume and tone of his/her voice during a conversation, as well as reminding him/her to listen, we are encouraging the development of positive communication skills which can reap life-long benefits. This fits with our philosophy of student development.
Jane Boudin, our part-time nurse, reminded me of a more tactful, therapeutic which we have used in the past with angry students. Say to the student, "Your reaction to this situation seems out of proportion to the problem. Is there something else going on with you that you would like to talk with me or a counselor about?
Last week I had to deal with a student who was raising his voice at me. He seemed to turn down his voice volume somewhat as I made it a point to speak softly in response to him. But he still reverted back to speaking in a demanding, critical manner before the visit was finished. I really would have liked to have kicked his butt. (Of course, none of you have ever felt that way ; ) Monday morning quarterbacking, I thought I should have said to him immediately, "Your behavior is inappropriate. If you want to do business here, you will speak in a courteous, civil manner, or come back when you can do so." Maybe if I rehearse that line, I'll remember to use it next time. Of course, hind-sight is always 20/20.
Also, my boss, Jim Evans, Vice President and Dean of Student Affairs is particularly supportive of our staff. He and I have problem-solved many crisis situations together. In a small college situation, where you are the lone nurse or have few support staff, involvement of your boss is essential in resolving student crises and difficult situations. Working alone doesn't mean you are expected to resolve everything yourself.
I also realized that professional comradery, a sense of humor, and sharing the problem do much to heal the wounds of a negative experience.
Of course, posting a statement of student rights and responsibilities would be a more appropriate reminder, and I will do this now that I have so many wonderful examples after which to model our own statement. In the meantime, the fine for rudeness sign stays up because, at least for the time being, it seems to be working!
Your Opportunity for Input
Readers, here is your opportunity for input. Click on my email address below to send me a message containing your own strategies, anecdotes and examples from your own experiences and observations in dealing with difficult students. Please indicate if I can print your comments in CQ. Also, please tell me if I can print your name along with your input, or if you wish to remain anonymous. Of course, all submissions are subject to the editor's review and discretion.
Thanks in advance to those who contribute helpful and practical solutions for the benefit of all. : )
Go to the list of articles in the Winter 1996 Issue of CQ.