Advice for Handling Pt. Criticism Please

  1. Hi everyone,

    I am in my first year of nursing and after 10 months of employment on a mother/baby unit and great feedback from my patients and my co-workers, I finally received my first complaint, and I would like some feedback as to how I should take it.

    Last week a Labor and Delivery nurse took me aside and told me that she had received a gift basket from a patient that included a letter to the nurses thanking them for being so wonderful to her during her labor. However, she also included some negative feedback in the letter about me personally and another nurse on our postpartum floor. The labor and delivery nurse thought it would be in my best interest to know about it because the patient also sent this letter to my boss, as well as the head of nursing department for my company and she wanted to give me a "heads up" in case I got in trouble.

    Apparently the patient was displeased with my nursing care. Actually to quote her I was "completely incompetent". I have to admit I was a little shocked. I remembered this particular patient and she had been nothing but pleasant to me. I never received any indication that she was unhappy with me. I couldn't think of anything I could have done to her.

    After reading the letter this nurse showed me, I was very heartbroken. The patient thought I was incompetent because she had to wait 15 minutes for pain medication. She was annoyed that I asked her which type of pain medication she wanted, instead of just bringing her something.

    I remember that she needed to urinate but was unable to. Before she had come up to my floor she had urinated after delivery so I was hoping she would void normally and that I could spare her an in and out cath. However, her husband (a former EMT) suggested that I in and out cath her moments before I was going to suggest it. I didn't realize she had also drank 2000ml of water right after arriving to my unit! I then asked her directly if she wanted me to do the cath (to get consent of course) and she agreed. As I had never performed this procedure before I asked an experience nurse to help me.

    In her letter to the entire labor and delivery and postpartum floor, she described word for word our conversation as she remembered it. I was "totally incompetent" for asking her if she wanted the in and out cath, for asking her what type of pain medication she wanted, for not in and out cathing her sooner, and for making her wait 15 minutes to receive pain medication.

    Now, I am sure she did not realize that I also had 7 other patients I was attending to and that I didn't know she had called out for pain meds until I had returned to the nursing desk and got the message, which explained the delay. She didn't know that I had a diabetic mother I needed to give insulin to but had to clarify a conflicting order so that I wouldn't give her too much insulin. She probably didn't realize that when you are unfamiliar with a procedure you don't just try to do it and hope for the best, but you ask for help.

    My boss told me that the letter was bogus, and that she never would have mentioned it to me. She said it was inappropriate for that patient to send that letter to everyone on the unit, and not just to my boss. I felt better after that. I was worried that all my co-workers and my boss would think that I was a "bad nurse".

    It still leaves a bad taste in my mouth. Any feedback? I don't think that I am the "best nurse ever" and that I never need any improvement, however I don't believe that I am "totally incompetent" either.

    Thank you.
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  2. 13 Comments

  3. by   muffie
    your care sounds ok to me

    nice that your nm backed you up

    can't please everybody

    let it roll off your back

    sleep well tonight
  4. by   CHATSDALE
    these things happen to all nurses
    when you get a complaint whether in writing/verbal take a moment to see if there is an validity to it...if you determine that you have nothing to learn from it then write down you recollection so that if you are called on later to explain your actions..believe me at some point all pts can blend together and some people questioning you will take advantage of it
  5. by   Mulan
    She sounds like a real ***** with a problem, and it isn't you.

    Don't take it personally. In my opinion, you did nothing to be criticized for.

    As far as waiting 15 minutes, I highly doubt that she got everything else she asked for immediately either from anyone else. You are one person with one pair of hands and you can only do one thing at a time. Sometimes they have to wait.

    Sounds like she singled you out as a scapegoat for some reason.

    Again, it's her problem, not yours.

    You have your boss's support and that's what counts.

    Try not to let it bother you. In the overall scheme of things it really doesn't matter.

    See if there is anything you need to learn from this and then move on.

    Good luck.
  6. by   norseman
    Wow. I have read plenty of letters from patients and relatives thanking the staff for good care, but I've never heard of a letter where people have been named like that in such a negative way. Had I been the target of such a letter I would have been furious! So, just like your boss said, I think it was totally inappropriate for the patient to "oust" you in such a negative way.

    That being said, I am fresh out of nursing school. The teachers have always pointed out to us how important it is to listen to the patient, make a connection, and so forth. But I have noticed while working extra as an LPN and during clinical studies in nursing school, that the nurses who are considered the most professional and liked by the patients, are those who don't make alot of fuss over procedures (i don't mean one way communication, but efficiancy). It think it comes with experience but also with self confidence. I have a friend who up to recently was a medical intern at our hospital. I asked her if she thought it was difficult. She said yes, but her best asset was her ability to act confident even though she was facing a new situation. That's what they're told from day one: "you're a doctor. you decide. act."

    So, what did I want to say with all this? Perhaps you should have acted more confidently and just presented the patient with your solution to her problems, after speaking with the patient ofcourse.

    I know this will be a tough one for myself when I start out on my first job. I have a tendency to ask one extra time "just to be sure" which is something the other staff like (an over-confident 'know-it-all' new nurse they dont like) but there's a fine line to be toed, i think. ask too much, they will question you. Ask the patients too much, and they will too.

    "A selfconfident manner hides oceans of insecurity."

    I hope you're able to forget the letter. Think of all the grateful patients you've met so far, they know how good you are, right!!
    Last edit by norseman on Mar 7, '07
  7. by   Tweety
    It stings to get complaints, especially the unwarrented ones. I recently received a complaint "he needs an attitude adjustment and he wasn't even my nurse", and a second complaint a few weeks later complaining how lazy I was, I couldn't get the PCA from working right and I didn't give him a bath (the PCA was working well and my ratio was 7:1, those who needed a bath got it, those that asked for a bath got it, there was nothing wrong with his hands, he could have washed himself, he didn't complain until his family came in a 6pm).

    I try to understand that the complaints are few and far between and are usually not warranted, or there's a lack of understanding, or that they might have a legit complaint but given the current staffing ratios people are just going to get short changed and complain.

    Try not to let the one complaint get to you. Patients and families are now complaining more than ever. I hate when they complain later behind your back. You think things are o.k. then you get a letter or Press Gainey comment.

    You can't please all the people all the time.
  8. by   fakebee
    :spin: While nobody likes criticism, if this is your first patient complaint in 10 months, you are obviously doing a great job and have a bright and rewarding career in an area you enjoy and are good at so please take a deep breath and pat yourself on the back! You've earned it. We as nurses are so perfection driven that we fail to see we work in the most flawed work environment possible, the arena of sick and unhealthy people. That we accomplish all the positive things we do on a daily basis is truly amazing. That's why I get so upset when a manager or administrator takes us to task for that one out of 10,000patients who complains. Anywhere else that 99.99 percent satisfaction rating would get you a huge bonus and promotion. Praise and criticism in nursing reminds me of my favorite Army saying- One aw s*it wipes out a hundred attaboys. Forget this clown and enjoy your self!We all love you here.
  9. by   NotReady4PrimeTime
    Ditto. Ditto. Ditto. Ditto.

    Wonder how she'd feel if you sued her for libel? It's too bad that the letter was distributed to everyone, because as your manager said, she saw it for what it was and wouldn't even have mentioned it to you.

    I encourage patients who have a legitimate problem with specific nurse(s) to take their concerns directly to a manager. And that includes issues with me. If I've done or said something that wasn't appropriate and has bothered a patient or family member (it happens... no one's perfect!) I want to know. I'd prefer it if it's discussed face-to-face with me first, and if it's still a concern then I'll identify the manager for the patient and offer to arrange a meeting for them. I've only had to do that once so far, touch wood.
  10. by   NicoleRN07
    Look at it this way. You CAN NOT please everybody. It sounds to me like you did a great job, and have obviously been doing a great job taking care of your patients if this was your only complaint in 10 months. When you do get complaints, don't look at them as so, look at it as constructive criticism, and a way to improve the care that you give. No one likes criticism or complaints, but the fact of the matter is.....we can't make everyone happy, and we can't be in more than one place at a time. So, when there is a delay in your patients care, simply apologize that you took so long, but explain that you were dealing with another situation. Most times, they understand, and if they don't, then....OH WELL!!
  11. by   CRNI-ICU20
    OH Honey,
    Chalk this one up to a woman who just had a hormone surge from hell...
    First, look at the 'delivery' of her criticism....this was CLASSIC STAFF SPLITTING! This is the practice where a patient will complain either in writing or verbally to the rest of the staff about another staff person....
    (in the sixth grade, this was called bullying and gossiping)
    I am glad your nurse manager backed you up.....but .....
    It's always good to keep some notes tucked away on the situation...
    Here's why....
    Sometimes, eventhough the nurse manager may back you....the fact that this whacky noodle complained to the administration and others up the ladder from your manager, THEY may not back you.
    Especially if someone else comes along with a string of whiney complaints. My dictum: the higher up on the corporate ladder you go, the thinner the oxygen level to the brain!
    I cannot tell you the many times in 22 years of nursing where someone on that ladder was hauling my behind into the hot seat so they could feel like they had done their job.....the only problem was, they jumped into the situation with their proverbial blinders on....singing the corporate fight song, (rah rah raaaah), and had no intention of even beginning to hear the TRUTH......what this can do is set you up to look 'less than' some other employee who may never had a complaint....yet that other employee could be a real schlump!
    What has always served me well is a gifted memory of the situation, which I sense you have, and the ability to speak professionally about it to your boss...
    I commend your colleague for drawing you aside and giving you a head's up....that was quite noble....there are some who would have used that for break room fodder....so she deserves a good kudo for upholding a code of honor amongst you....
    Keep a little journal....I have named mine "You GET TO ***** ONLY ON MONDAYS".....
    This is taken from an idea that my second son gave me. He ran two govenor's campaigns at the ripe old age of 20....(he graduated magna cum laude with a triple major in Pol. Sci, Psych, Intrnl. Rel,....) When members of the staff would get to ******** about something er other....he gave them one hour on Mondays to get all the angst and bellyachin' out of their system....when the hour was up....he walked out of the room....
    People soon learned that quite a bit of their whining was timewasting and fruitless....and some of their whining did hold merit...and soon enough, problems were dealt with as they needed to be....
    So, my journal is named for his method....I only allow myself to ***** about what ever happened or didn't happen on Mondays in my journal....
    it is there that I log what happened....who said what....date it...time it....and even name names....so if I ever have had to defend my position, judgement, care delivery, or any other thing, I have it down...it's also a good place to 'unload' the emotions of whatever happened....because carrying that around isn't healthy....and it gives you a outlet that doesn't involve another person...that way, you won't drive your spouse nuts, if you have one...and your friends won't abandon you during coctail hour!
    I have taken my journal in....and once the ladder crawlers and clip board carriers see the REALITY, they are a little less carnivorous. There's nothing wrong with sticking up for yourself....and as long as they understand that you do this both for your own mental health and to learn from your experiences, they are less offended by it....some might raise their hackles if they believe that you are taking a litigious stance...(ie plan on suing them for slanderous remarks or harrassment in the work place)....so this has to be relayed to them gingerly....ladder crawlers are typically very suspicious individuals by nature....
    I also take the time to document "family" issues, or patient care issues that seem to be a little edgy in the progress notes....
    Here is an example:
    I had a patient who had been intubated...multiple times, 80 years old...severe respiratory distress and failure....her kidneys were shutting down....she required no sedation....and was fully in capacity to make decisions for herself....I walked into her room.....she grabbed my hand....she didn't even require wrist restraints, as she was sooo tired she didn't even reach for her et tube...she requested a writing board....and she begged me to tell her daughter that she no longer wanted to live....that she was tired of being intubated and extubated...only to end up back on the vent again and again....so...her daughter was at the bedside at that moment....and I showed her not only the paper that her mother had stated this on....but took her aside and shared with her the idea of honoring her mother's wishes and hoped to help her daughter come to the same place as her mother now was...
    This daughter at the time THANKED ME.....
    She then proceeded to call the Dr., my boss, and every other person who came in the room and told them that I was like Dr. Kevorkian, and I was telling her mother that it was okay to do EUTHENASIA!!
    Sadly, despite how ludicrous this sounds even to a lay person's ears, my boss did not back me, and hauled me into the office to begin her rant...
    I held up my hand and said, "Can you allow me to get the chart???"
    She said, "okay."
    So, I went to get the chart....I showed her not only the note that the patient had written...but also the entry I had charted under nursing notes and interventions regarding this situation.
    Once she saw that the PATIENT had initiated this conversation, not me, and saw with her own eyes that the patient had clearly said, "please, take me off!" "please, I don't want this", she backed down...
    It did however, leave a bad taste in my mouth, like you...but, that taste goes away real quick with a something chocolate and a sweet hug...
    Don't let the clip board carriers kick you in the guts....
    You are doing wonderful, sacred, needed work....and no one can fill those nursing shoes but you....
    Hugs to you....and keep up your good work...
    ICU20
  12. by   VTBabyNurse
    Wow, you guys are amazing!

    Thank you so much for your words of encouragment, advice, and support!

    You've helped me to see that this isn't worth dwelling on!
  13. by   PANurseRN1
    VTBabyNurse: Take the advice from the people here who are experienced nurses; try to let it roll off your back. Most likely it had nothing to do with you.
  14. by   Batman24
    As your NM said it was bogus and paid it no attention I would do the same. Clearly your work ethic and performance are more than up to standards for this woman to have received absolutely no attention.

    The patient should be ashamed of themselves. If they were going to send a gift basket and complain about you it should have been handled separately. There was no need to compliment one group while ripping apart another. Your NM was right about that. Her actions were deliberate and despicable. What goes around comes around. Don't give this another thought. She's not worth it.

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