Patients' Perceptions of Nurses' Skill

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. Nurses Announcements Archive Article

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.

Every time my husband was hospitalized he was very impressed with the young, pretty RNs and allowed'm to get away with everything... They could've tried to kill him, and he'd still be happy just to see'm walking in/out of his room, trying so hard to have everything done right, and following every questions with "I'm not sure, but I promise I'll get back to you ASAP" lol

Anyway, last time we were in the hospital, I was very touched by an older nurse who nailed his diagnosis withing 15 minutes of reading his chart and talking to him for a while, she came in to help the young RN who was having trouble with his NG tube, and took the time to assess him, and talk to me (I was holding 2 little kids and he was sitting there for 7 days with heart problems and no explanations to what was wrong with him). When we left the hospital, the cardiologist still could not tell us what had triggered my husband's heart, or how it reversed itself into a proper rhythm. We chuckled, we wanted to have the RN come in and explain to him... But we just thanked him and left with our discharge papers... Followed nurse's orders and hubby has not had any heart problems since, that was 2.5 years ago!

Moral of the story: Every nurse has something to give!! Young or old, new or seasoned! :yeah:

Every time my husband was hospitalized he was very impressed with the young, pretty RNs and allowed'm to get away with everything... They could've tried to kill him, and he'd still be happy just to see'm walking in/out of his room, trying so hard to have everything done right, and following every questions with "I'm not sure, but I promise I'll get back to you ASAP" lol

Anyway, last time we were in the hospital, I was very touched by an older nurse who nailed his diagnosis withing 15 minutes of reading his chart and talking to him for a while, she came in to help the young RN who was having trouble with his NG tube, and took the time to assess him, and talk to me (I was holding 2 little kids and he was sitting there for 7 days with heart problems and no explanations to what was wrong with him). When we left the hospital, the cardiologist still could not tell us what had triggered my husband's heart, or how it reversed itself into a proper rhythm. We chuckled, we wanted to have the RN come in and explain to him... But we just thanked him and left with our discharge papers... Followed nurse's orders and hubby has not had any heart problems since, that was 2.5 years ago!

Moral of the story: Every nurse has something to give!! Young or old, new or seasoned! :yeah:

What was the trouble with your husband's heart? How sad that the doctor didn't figure it out and that the nurse, who did know, couldn't say anything. Nor could you, really. Egos and all that.

What was the trouble with your husband's heart? How sad that the doctor didn't figure it out and that the nurse, who did know, couldn't say anything. Nor could you, really. Egos and all that.

I took him in to the ER cuz his HR was incredibly high (can't remember exact rate), and would vary every minute, I was so scared!! He's had his share of heart troubles before, and no one could tell him what triggers those episodes... He had been sick with a stomach virus and done A LOT of vomiting in the days prior to being admitted. Nurse checks his labs and said "his Potassium is depleted, all electrolytes need to be brought back to normal levels... This poor man vomited too much..." Poor hubby was so messed up his GI system SHUT DOWN and his HR went off the charts going up n down like an inconsistent yo-yo! After days of medication and waiting around, Docs were ready to operate, 1st they suspected a blockage or hernia (there was no way such thing was true, there was nothing to support such suspicion!) next day, change of plans, docs wanted to open his chest... I really didn't want that to happen...

Nurse came in and looked at his new labs when doc wasn't around, she said to me "I have a feeling things will be normal soon", I refused to let the Docs open him up and asked that they waited another day, next day he was stable and we went home. He just needed to normalize his labs and give his body time to respond, he didn't need any invasive surgery!! He had a wife and 2 young children to care for! I did give her a big bear-hug before we left though!:heartbeat:nurse::heartbeat:nurse::nurse:

I took him in to the ER cuz his HR was incredibly high (can't remember exact rate), and would vary every minute, I was so scared!! He's had his share of heart troubles before, and no one could tell him what triggers those episodes... He had been sick with a stomach virus and done A LOT of vomiting in the days prior to being admitted. Nurse checks his labs and said "his Potassium is depleted, all electrolytes need to be brought back to normal levels... This poor man vomited too much..." Poor hubby was so messed up his GI system SHUT DOWN and his HR went off the charts going up n down like an inconsistent yo-yo! After days of medication and waiting around, Docs were ready to operate, 1st they suspected a blockage or hernia (there was no way such thing was true, there was nothing to support such suspicion!) next day, change of plans, docs wanted to open his chest... I really didn't want that to happen...

Nurse came in and looked at his new labs when doc wasn't around, she said to me "I have a feeling things will be normal soon", I refused to let the Docs open him up and asked that they waited another day, next day he was stable and we went home. He just needed to normalize his labs and give his body time to respond, he didn't need any invasive surgery!! He had a wife and 2 young children to care for! I did give her a big bear-hug before we left though!:heartbeat:nurse::heartbeat:nurse::nurse:

Wow, that is wonderful that he is doing so well, that you had the courage to wait things out, that she had the guts to advise you to wait. Still makes me mad that the doctors didn't note K+ depletion or other 'lytes off or consider the vomiting. It is so frustrating that a nurse must tiptoe around these things.

I hope he's been fine since then.

When my mom was sick, I suggested a CXR to a surgeon who had failed to order one for her. Pneumonia was found. I later heard him tell the rest of the family and a couple of awe-struck surgical residents how he had heard her lungs amiss and ordered a CXR. I was glad my Mom got the right treatment but upset that he took credit. He failed to credit me, even privately. I just wish we could all be more self-confident (I think he lacked self-confidence, evinced by him taking credit for my thunder) and I wish we could all just speak plainly.

Should I need or want credit where credit was due? Well, heck yeah, why not? Everyone else wants it, why not KK? :uhoh3: See, that's what Nursing does to us. It forces us to be schizophrenic - glad the CXR was done, heeded, and helped Mom get better and be more comfortable. Also wanting to be treated right myself.

I think this is what is done to women a lot by society in general, certainly in cultures that seriously repress women. And it's not all that long ago that American women have had the extensive freedom that they have today.

The wife of a minister I know told me that marriage could be peaceful if the wife didn't care who got the credit for the wife's good ideas, the ideas that a helpmate who is meet (fit for, suited to) for her husband has and shares with him. This minister is always praising her publicly, telling how thrilled he is with her. Well, he thanked her for many years of devotion and loyalty and beautiful children and a lovely job of homemaking (as far as I know she was never anything but loyal and devoted) by having an affair and various dalliances with women. Well, what can we think about that! :eek:

Oh! I was not brave, I had never been so scared in my life! I beat myself up for every steak I grilled him, and every cake I baked him... I felt his heart trouble was my fault, so I had to take a stand, I could not bear to see him under the knife, I could not even be in the room for the NG tube... I held my children and prayed so hard...

That nurse was an angel, had not been for her I don't know if his body would've even handled the surgery...

I mentioned to the doc the K+, and electrolytes, the vomiting, but he dismissed any idea that didn't come from him (I never mentioned the nurse though, not for the credit, but cuz I didn't want the Doc to get mad at her). Funny that you mention the minister story, Doc was of my background (Brazilian), and the nurse was a good old white lady. Coming from Brazil and being the daughter of a very authoritarian macho Brazilian MDA, I have experienced all that first hand. I made a point to move out of the country and told myself I'd never, ever, marry into my own culture. (touchy subject here lol). So I was very sensitive not to let the doc know I was going with what the nurse told me. Our Doc had a lot to say, and at the end of every conversation left me with nothing, or a complete different scenario (?!):nono:... But the nurse had a lot of knowledge, with little words...

I have to disclaim my mention of the cultural stereotype though: it can be a tricky thing at times. Many moons ago, I married a clean-cut white boy when I was barely old enough to buy myself a beer. He turned out to be a horrible man! I divorced him and 5 years later married a middle-eastern man who thinks I'm the queen of the world, and would give his life to make me happy! lol Life goes round n round... When we think we know something God sprinkles new knowledge my way...