Patients' Perceptions of Nurses' Skill

by AmyCardsNP

8,250 Views | 16 Comments
  1. 11
    I subscribe to several nursing journals, one of which is "Critical Care Nurse" - published through the AACN (American Association of Critical Care Nurses) and I really do try my best to read all of the articles in each one, but honestly, only get time to skim through the magazine and read the articles that pertain directly to my career or articles where the title catches my eye.

    Every once in awhile an article comes along that I love. Heck, I've even been known to rip out an article and put it in the nurses' lounge at the hospital a time or two. In September 2009, they published an article titled "Patients' Perceptions of Nurses' Skill" which I read and loved. The article discusses the factors that our patients use to assess our skill level. How do the factors that they use differ from the factors you use to look at your own nursing skill, or the skill of your coworkers?

    Nursing practice has three domains that make up skill: interpersonal, critical thinking, and technical. Which of these can our patients most easily pick up on? Interpersonal, of course. Our patients have very little insight into our critical thinking skills. As they lay in bed trying to breathe post-extubation with stridor, they don't know that you're the one calling the doctor for racemic epi, IV steroids, and heliox because you know the cause of the stridor. The same is true with our technical skills. Sure, they see us removing their central line, but they don't know correct steps to tell if you're performing the procedure in conjunction with best practice standards. All that our patients can see is our attitude about these things. When you call the physician on your patient with respiratory stridor, they see that you are doing this quickly and with confidence. You are in the room reassuring them that things will be okay and educating them on what is happening. When you are pulling the central line, you are explaining each step to the patient to reduce their stress level about the procedure and possibly chatting about another topic to get their mind off of it and show interest in them as a person.

    I highly suggest reading the article (I've attached the PDF below), but the big take-aways for me were:

    • Patients describe the attributes of skilled nurses as: friendly, caring, compassionate, kind, good listener, confident, enjoyed his/her job, well-organized, and followed through with tasks he/she said they would do
    • Patients describe the attributes of a non-skilled nurse as: Lack of confidence, timidity, rudeness, abrupt answers to questions, indecisiveness, frustration, and a negative attitude

    So, I look at these terms that our patients use to decipher our nursing skill and I can see the affect on our unit. There are a certain group of nurses who often get thank you cards or small tokens of appreciation from patients and family members and they display off of the attributes of skilled nurses - seems that this article is telling the truth

    This article helps me remind myself when my day is going horribly, to take a breath. You're getting paid to be at work and these patients/families are going through a hard time right now. Relax and do your job, they don't need to know that you just got chewed out by a jerk physician or that the patient next door is confused, crawling out of bed, and on your last nerve. When you go in the room to do something, do it with a smile and take the extra time to try and make a connection with each one of your patients. You will stand out as they remember their hospital stay and you will personally feel better for having a relaxed attitude.


    Patients' Perceptions of Nurses' Skill - Critical Care Nurse (pdf)
    Last edit by Joe V on Mar 17, '10 : Reason: spacing issue
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    AmyCardsNP joined Oct '06 - from 'Arizona'. Posts: 49 Likes: 27; Learn more about AmyCardsNP by visiting their allnursesPage


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    16 Comments so far...

  5. 1
    Patients (and people) want to know that you care before they care what you know.
    This article is an excellent example of this.
    lamazeteacher likes this.
  6. 14
    I may have to work 15 minutes longer. I am "slow" as the fast nurses say, that within 45 minutes of beginning our shift, assessments are done, meds are passed. They are the ones that sit around the Hucs station and talk about men, love....each other..worse MEE!! But, nursing is my job, is what I do. My job is to put those patients who lie in that bed, who haven't been in a hospital bed in 24 years, minds at ease. I ask about their family, their lives at home, their pets. I tell them everything that I am doing in the room. This is your antibiotic that I am hanging..we want to kill any germs that may have snuck in while we weren't looking. I walk them to the bathroom. I clean up their bed, if they wet and I think they may be embarrassed, I tell them everyone does it or I tell them I'll clean them right up. I bring them any requests, water, peanut butter etc...within minutes, knowing it may put me behind a little. They don't know we have 6 other patients and its not their job to know. They need to get well. I tell them to make themselves at home..ya can't break the bed! I am sure I say outloud as I am leaving "can you reach your things, what cha going to do to call me for any little thing? So many many times I hear "if all the others were like you...it'd be so good" or "I tried to tell other nurses that my husband isn't taking this pill....would you check on it (it'd be a fluid pill! or some heart pill that got left off their med list by someone's mistake). I am a new RN, over 50 years old, breaks are not my priority (they aren't long enough!! lol) I work nights and barely have time to eat. But I know this, some folks you just can't please, they are mad at the world, as the movie Tombstone says "sorry for ever being born". But, there are so many more that are scared of the new white coat environment who tell me "those other nurses act like robots, they come in, they do their job...which is ok...but scary to me...they don't say much", but you make us feel like - well, you care. THAT! MY FELLOW WORKERS...is worth any breaks missed, your gossipping at the huc's desk is mean and puts everyone in a foul mood within earshot of your flapping beak - you may think your Queen LaNursa but deep down everyone doesn't like your negative mouth, its unbelievable your so mean, those that listen to you...are weak and just don't want you to talk about them... and then...they - the weak, infected with your limelight, in turn talk about you as you leave the huc. Monkey see, Monkey do..every single time. Its a big waste of time.

    Our hospital, because of the cell phones, Super Large drinks...has banned everything..even coffee at the desk..because a patient who was being ignored by their nurse was too busy playing at the HUC's station. So many were texting their boyfriends or hubbys at home. Guys were playing cards on the phones. Well, bad apples that spoil it for everyone..cell phones are banned, they are cracking down on smoking breaks, magazine reading, crossword puzzles. You just can't ignore the patients. Patients who aren't happy aren't going to be liable for any services according to Medi....and you may be good at skills and saving lives but if your heart ain't in it...your floor manager will say "well, she, may be good in a code...BUT SHE is NOT a good nurse, patients can't stand her Better than Thou attitude!"....I have heard it myself on on of my favorite hateful coworkers.

    Take a moment, put yourself in that bed, tell that patient what your doing...or something as simple as "hey, I got your labwork back..you know when they drew your blood this am...?? well, I just want you to know, I'm happy that your bloodwork is super duper", or as you leave a patient's room.."I'll be making rounds again but it may be an hour or I might get stuck...you sure you don't need something before then..I'm trying to take good care of you". Yeah, I may be a little slower, but I know at the end of the day, when I think of the hug I got from a patient, I feel good about my sacrifices.
    Kim, HHRN, Artistyc1, AllSmiles225, and 11 others like this.
  7. 2
    @camoflower...thank you for writing all that.

    I'm a nursing student whose only hospital experience has been with myself and my family in the hospital. I'm trying to keep in mind what I felt when I was in the hospital as I go through clinicals. I know that right now, I won't be as adept at anything as the experienced nurses, but I do know that I can be human. I've got lots of experience at that. (And, also trying to remember to not let patients necessarily side-track me...a balancing act that you seem to have down pat. )

    When I was pg with my second child, I was going to be induced. My first decided to come on his own. I went with my husband to the hospital at the appointed time, and the nurse was running around getting everything read, and she told me to do this and do that. I was scared about being induced, but I didn't know it until I got to the hospital. I remember going to the bathroom in my room, and I started crying. My husband heard me, and he came in, asking, "What's wrong? What's wrong?" I said, "I don't know. I think I'm scared about being induced, but the nurse is just running around getting all these scary things ready and telling me what to do, and she isn't talking to me at all!"

    My husband went out and talked to her. When I came out of the bathroom in my gown, she gave me a smile and said, "I'm sorry. This is your second baby, and I didn't think you'd be scared. It's ok. Do you want to ask me anything?"

    I just smiled and said, "Are you doing all these things because you know something is wrong?"

    She answered, "Oh, no, no. We just do these things because you're being induced. Nope. Nothing is wrong."

    I felt so much better.

    I'm forever grateful to her...and to all the nurses like her. I want to be like her. But maybe proactively.
    lamazeteacher and 4chun_cookie like this.
  8. 0
    I read that article too. Seems as though *how* you deliver the treatment really really matters. Sometimes that is really easy to forget. Thanks for your thoughts. Ivanna
  9. 1
    This shows that honey attracts more flies than vinegar. In other words, patients gravitate toward the nurses who display confidence and warm bedside manners. They do not like the nurses who are abrupt or lacking in social skills.

    The delivery of the care is sometimes more remarkable than the care itself.
    ♪♫ in my ♥ likes this.
  10. 1
    Every patient should feel as if they are your only patient.
    franciscan gypsy likes this.
  11. 0
    Quote from TheCommuter
    The delivery of the care is sometimes more remarkable than the care itself.
    It's the delivery of care that people remember. The very few things that I remember about being hospitalized for several weeks 25 years ago are my (positive) interactions with a couple of nurses.
  12. 0
    [quote=camoflower;4169873]I may have to work 15 minutes longer. I am "slow" as the fast nurses say, that within 45 minutes of beginning our shift, assessments are done, meds are passed. They are the ones that sit around the Hucs station and talk about men, love....each other..worse MEE!! But, nursing is my job, is what I do. My job is to put those patients who lie in that bed, who haven't been in a hospital bed in 24 years, minds at ease. I ask about their family, their lives at home, their pets. I tell them everything that I am doing in the room. This is your antibiotic that I am hanging..we want to kill any germs that may have snuck in while we weren't looking. I walk them to the bathroom. I clean up their bed, if they wet and I think they may be embarrassed, I tell them everyone does it or I tell them I'll clean them right up. I bring them any requests, water, peanut butter etc...within minutes, knowing it may put me behind a little. They don't know we have 6 other patients and its not their job to know. They need to get well. I tell them to make themselves at home..ya can't break the bed! I am sure I say outloud as I am leaving "can you reach your things, what cha going to do to call me for any little thing? So many many times I hear "if all the others were like you...it'd be so good" or "I tried to tell other nurses that my husband isn't taking this pill....would you check on it (it'd be a fluid pill! or some heart pill that got left off their med list by someone's mistake). I am a new RN, over 50 years old, breaks are not my priority (they aren't long enough!! lol) I work nights and barely have time to eat. But I know this, some folks you just can't please, they are mad at the world, as the movie Tombstone says "sorry for ever being born". But, there are so many more that are scared of the new white coat environment who tell me "those other nurses act like robots, they come in, they do their job...which is ok...but scary to me...they don't say much", but you make us feel like - well, you care. THAT! [quote]


    Way to go camoflower! I'm new and slow too, but my patients know I care. I may not be able to start every IV but I can always find someone who can for me (Fortunately I do work at a good hospital where we don't place the patient in undue stress). Interacting with the patients is what it is about I want my patients to know that I actually CARE. Who cares if it does take more time, they are worth it and they are the reason we have a job in the first place(Job security).

    I may feel SO rushed with all I have to do but I don't ever let the patient know that.
    Last edit by Kim, HHRN on Mar 26, '10 : Reason: forgot to add something
  13. 1
    Quote from Ruth1417
    Patients (and people) want to know that you care before they care what you know.
    This article is an excellent example of this.
    With doctors, it is the reverse. A doctor can behave like a pig's butt and people will accept that, even if he is a walking disaster clinically. That bedside manner can be cr*p in a doctor and he can be a total klutz. But the MD after his name grants him immunity from having to be nice or even be competent - at least, for a long time, with a lot of people.

    Let a nurse have a scowl or even just be busy and she will be judged most harshly. Especially if the nurse has no male sex organs. Sorry, but it's true.
    Last edit by Kooky Korky on Mar 28, '10
    wooh likes this.


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