Improve the care I give.

  1. Please help! I am an RN of 2 years now and a frequent problem I am having is being dismissed by patients on my med/surg unit. More than 90% of my patients are very happy with the care I provide, however about 5% will dismiss me at some point. Things I have tried to prevent this from occurring are:
    Good eye contact
    Attentive listining
    Backing off when Pt is not ready to hear what I have to say/educ them on
    as well as safe nursing practice.
    Can anyone help me with any tips to prevent this from happening so often?
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  2. 13 Comments

  3. by   Rose_Queen
    Dismiss, as in request someone else? Trust me, that's not punishment, it's a reward. You cannot please everyone- that's just part of being human.
  4. by   puckrj
    Well in most cases I am pleased, however my manager wrote me up for being dismissed/replaced by a mothers request that I now longer take care of her daughter, 17 recovering from hip surg. My manager as spoken with me on previous occasions of dismissal and I very much take those to hart. I learn from each conversation we have had but this does keep happening and now its in my record and she is sending me to a class to improve communication.
    I am just at a loss on how to improve this situation. I do not want to lose my job.
  5. by   JKL33
    Can you tell us more detail about the complaints? What are patients/families saying about you?

    Examples: rude, dismissive, talked down to patient, "never saw the nurse", bossy, mean, unsympathetic, "doesn't seem to like her job", "seems unhappy", "doesn't know what she's talking about"....

    Sorry this is happening; we can try to help...
  6. by   puckrj
    There have been times patients that have their PCA pump DC'd that 2-3 hours later they are pissed that they cannot get more pain meds and I have had them just go off on me for not being able to give them the type or amount of meds they want and they fire me. In the last 2 years that type of situation has happened 3-5 times to me.

    Also one thing I have tried hard to be mindful of is that patients have said I am "all business" so I have made concerted effort to slow down, make eye contact and listen, on other occasions (that I have now corrected) I steadfast on teaching information when Pt wasn't ready. These are issues I have successfully addressed.

    This recent dismissal was from a 17 YO Pt that in report I was told that she was a real *****, so I have to say I was nervous. I was also told that she was arguing and bickering with her mother and "stay the night boyfriend" all night.

    We went into the Pt room for introduction, I asked if I could get anything for anyone ... all "no". An hour later I entered with morning meds one of which was lovenox shot for tummy, Pt started whimpering, they crying "no, no, no," I was ready to chart "Pt refused" and mom stood up came to bedside for daughter and said "you have to have it." Mom proceeded to to console Pt,
    I pulled up gown, warned about cold alcohol wipe, the warned about pinch, then warned "small stick." Pt continued to whimper and cry thru process as mother comforted.
    I asked as always if I could get them anything, mom said no. I left the room reminding them to use their call light if I can help.

    The next trip I made in the room was an hour later. Pt per doctor order was a Q2 turn. The PSA and I went in to log roll and pillow support the Pts hip, Pt began whimpering and crying no no no again. Mother questioned why this had to be done, I explained that the doctor want to prevent blood pooling, pressure sores etc. Mother agreed we rolled the Pt.

    An hour later my charge RN came and told me not to go back into the room that the mother said I wasn't caring enough and that they wanted a new nurse. This always devastates me. Because this impacts my coworkers, my charge RN, and messes with my head because I am constantly rethinking every move, word, and gesture I have made while caring for the Pt.

    This was all on Wednesday, by Friday I was called into my bosses office. She decided to formally write me up. She had spoke to the Pts mom and apparently when I gave the lovenox shot I wasn't caring enough and that's why they wanted a new RN. As I saw it mom was consoling the daughter, as I have also done as a mom. The RN would give the shot, I console, they leave.

    My boss also filed something with HR (I will ask more on next shift), and is now sending me to a care and compliance class. I asked what I could have done differently as I explained the lovenox procedure and she had no advise and added she may not have done any different.

    I have gone from deeply sad (diff not to cry for rest of shift, cried all the way home) to angry! Why write me up when I actually did nothing
    WRONG vs should have done ... whatever. If on edgecant give a corrective measure should it be written up. I get that this is happening too much for me, that I need/want more insight to handle this stuff better . . . but write it up? Confused? Making me physically sick, and on edge as I approach my next shift.

    Please help!
    Last edit by dianah on Jul 16 : Reason: formatting
  7. by   KatieMI
    Although none of us was there to see it, I would dare to suggest that it could be worthy idea for you to bring your NM your 2-week note ASAP and try to find a place where nurses are not treated as maids with additional function of distributing drugs, and patients are not entirely coddled into idea that they are on 5 stars all-inclusive resurt and spa with drugs included w/o limits.
  8. by   JKL33
    I'm so sorry. Based on the fact that you displayed an appropriate level of concern by writing your OP, I was almost sure that your next reply would contain something like this. Absolutely ridiculous.

    I have never faced this, but let's see what our colleagues here have to say about this suggestion: I think the very first thing you should do is visit HR and take advantage of your right to make notations in your file w/ regard to this incident. I would keep it short and factual: "Mother consented to pt's ordered SQ injection after medication rationale explained. Mother consoled pt while writer administered the ordered injection. When discussing mother's complaint with writer, supervisor/director states she has no suggestions for better handling such a situation, and states 'I probably wouldn't have done anything differently'."

    I don't think this is a situation where we can critique you too much. We are all facing the same sort of threats these days, and the ones who don't find themselves in your situation are likely dealing with managers who are more reasonable and don't feel the need to punish situations where it's anyone's best guess what upset someone.

    Here are a few thoughts, sorry for the length:

    1) If you are internally frustrated by these types of situations (pt demanding something, pt with poor behaviors, etc), it is likely that you are conveying your frustration one way or another, whether you realize it or not. That's just natural. So if I were to suggest anything, it would be that you work to decrease your own internalization of frustrating situations. You must get it in your brain that someone else's frustration is situational...you end up being the object of it ONLY because you are standing there, NOT because it's about "you". Hope that makes sense.

    -When you no longer internalize their problem thus making it "about you", then you are able to seriously decrease the amount of non-verbals you may be giving off without realizing you're giving them off. Your tone of voice will change, your posture will change, your facial expression will change. Everything will basically relax, because it's not about you.

    2) When patients complain about something I have no control over (both the examples you gave involve physician's orders) I speak pleasantly out of compassion for their situation [be careful that your "pleasant" voice doesn't come off as condescension] - and kindly give them the specific rationale, and then offer to contact the physician to see if there is another option.

    Same thing with the patients upset about their pain meds. I offer to contact the physician. If s/he doesn't think it's prudent to give different or additional orders, I go back to the patient and let them know that I followed through and that the physician feels that we need to try to work with the options we already have, and then review those. I let them know I'd like for the both of us to come up with something that would improve their comfort (ordered meds, repositioning, ice pack, warm blankets, pillow supports, whatever...)

    Lastly - and I say lastly because first you must make every effort to do what YOU can do to mitigate this issue - Lastly, it may be time to take mental inventory of the unit's culture and your manager's philosophies. If there are other signs that Nursing isn't supported, you should keep your eyes open for an opportunity to get off that unit.

    ((hugs))
  9. by   LovingLife123
    Just maybe a little help on what you could do. Lovenox injections do hurt. Trust me. When I give lovenox I always explain the med, why it is being given, and explain it could possibly sting for a second. I judge their reaction and state, Im so sorry, I know that wasn't comfortable, if they seem to be in pain. Then I reiterate the benefits of giving the med.

    As far as the pain meds go, if the pca pump was dcd, are these patients getting pain meds PO? Of course the effects have worn off after 2-3 hours. They should have something on board to transition them. If they don't, are you calling the doctor? I always say, let me call the physician and see what they say you can have to control your pain. Deflect responsibility from yourself to them. You can't just say no, and walk away. That may be where you are getting tripped up.

    Nursing is half a psychological game with people. You need to let them know what exactly you are doing to help. Parents get very overprotective if kids. It's their child that is in the hospital requiring care. This is why I don't work peds. Love kids, hate parents.

    We all have that difficult patient and may get fired from them. But 3-5 times tells me there is an issue. And I don't think it's because you don't want to give the best care, I think you most certainly do. It may just be your delivery.
  10. by   FolksBtrippin
    My advice to you is to relax, keep an open mind and just take the class you were assigned.

    Be open to learning.

    Try not to take this too hard. It sounds like your manager has sympathy for you and it doesn't sound to me like you are in trouble.

    Don't let this hurt your self esteem. A good nurse is one who is always willing to learn and self reflect. Let the class be time to do that.

    You will get through this and come out better for having been through it.
  11. by   martymoose
    Id look for another job. Clearly your manager doesnt give a fat rat's .... about the employees, only the customer is always right mentality

    Too bad for them.

    Good luck.
  12. by   NuGuyNurse2b
    Quote from martymoose
    Id look for another job. Clearly your manager doesnt give a fat rat's .... about the employees, only the customer is always right mentality

    Too bad for them.

    Good luck.
    Sadly, the HCAP or whatever type of surveys that hospitals now employ in order to receive money from the gov is widespread. OP won't escape this type of mentality at any other hospital, they are driven by these patient scores. And when OP is getting more than a few dismissals it's tellig management that she's the problem, not the patients. We all know patients aren't always right, but the surveys are the bottom line nowadays and hospitals have to be smart about it.

    And while I do sympathize with OP's predicament, Lovinglife123's post pretty much nailed it on the head. While the pt was clearly difficult, I see some gaps in OP's care of the pt that could've used some improvements that Lovinglife123 noted. So it's telling me that, at least in this case, it's not completely the pt that is the problem.
  13. by   Katillac
    Welcome to nursing in the new age, where providing customer service nobody complains about is the management expectation, and the feelings of entitlement of patients and families are off the charts. The first time I saw a billboard for my hospital with the slogan "Amazing technology, graceful care," I knew we were in trouble. Marketing encourages the public to look at nurses as combination maid, waitress, hostess and personal assistant with no consideration for the professional life-saving roles they play. From your OP and comments, this is what is resulting in your being dismissed from cases, not a deficiency on your part.

    On the other hand, regardless of what you ask to be put in your HR file, if you are in a right to work state you can be fired for anything. And if you are taking complaints personally, it's likely that you'll continue to display defensive non-verbals in response to difficult "customers", and that will appear that you in fact don't care enough to please these folks.
    I say that only because of personal experience - when I get endlessly complained about and straight up lied about by a family and my org responds to this family by throwing staff under the bus, I don't have it in me to walk in with a genuine smile on my face for the family. I continue to give compassionate and competent care to the patient, but the family gets polite and factual responses. How can it be otherwise when anything I say gets twisted and used against me? I feel sorry for these families, because their demands make it so that no staff extend themselves, but instead stick to the care plan and the facts.

    But back to you. If I were you, I would look at the cases and see if there was something you could have done differently while still maintaining your personal integrity. Look at the subtle cues people throw and see if you can meet their wants and needs while retaining your sanity and meeting your responsibility to your other patients. Sometimes a simple, "I can see how hard this is for everyone. We will all keep working to keep your person safe and comfortable," can TOTALLY reverse a difficult situation. Try shifting your perception to seeing a potential misfit between what your role and environment offers and what these customers expect, and not about you personally. And understand that a health care culture that doesn't set limits is an unhealthy one.

    Best of luck to you.
  14. by   Zyprexa
    Most patients are whiny and entitled, they take no responsibility for their own health and expect to be treated like honored guests in a 5 star hotel, and if they don't get their way...well then we have HCAHPS and reimbursement to worry about. Why don't we just give everyone PCA pumps with their choice of narcotic, benzos in a little bowl mixed in with M&Ms, and let patients smoke and drink alcohol in their rooms? After all, "the patient is always right!"

    Can you tell I'm a little bitter?
    Last edit by Zyprexa on Jul 17

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