No! It is NOT OK.

As a student you learn that the nurse-patient relationship is critical for effective, humane, holistic patient care. You also learn that the communication necessary for a nurse-patient relationship is a two-way street. There is what we say... and there is what the patient hears. Both of these must be precise for optimal nurse-patient interactions to occur. Unfortunately, we all have deeply ingrained linguistic habits that too often garble our communication efforts... and we should NOT be OK with that! Nurses Announcements Archive Article

No! It is NOT OK.

I have noticed over the years that student-patient interactions are loaded with relationship killing words and phrases. The students are not being unkind. Rather they are speaking without thought or purpose.

Though I don't want students to feel stilted and confined and "fake" when they converse with patients I do want them leave linguistic tics and mannerisms at home. These are fine in "everyday life" but they impede the development of a therapeutic nurse-patient relationship in professional interactions.

The most common example of conversational "tics" is the way we (Americans, at least) punctuate much of what we say with "OK". "OK" is a multi-use tool in common speech. For example:

* We use it to end a conversation. ("OK, OK. I get it. OK?")

* Sometimes we use it to take the sting out of what we've just said. ("Honey, slacks with horizontal stripes are not a good look for you... OK?")

* We use it to determine if our listener is still with us. (Remember teaching lowest-common-denominator to your 5th grader? Having pointed out that 4 goes into 12 as does 3 you look at your child and say "OK?" And of course, their eyes are glazed over!)

But this tic is hugely counter-productive at the bedside. The most common way students use "OK?" seems to reflect some distorted sense of courtesy. For example I often hear students say something like:

"No, Mr. Andrews, those chips your visitor brought you don't go with your cardiac diet. OK?"

Think about what the student did in that interaction. Initially he/she was speaking as a nurse, conveying important information. Then instantly became a petitioner asking the patient if he would be "OK" with refraining from potato chips. The student turned a therapeutic relationship into one that was ambiguous. The patient, hearing this "OK?", is entitled to imagine the student is making a suggestion instead of giving him important information about living with congestive heart failure. This was a "teachable moment" and it was wasted. How much better if the student had said...

"Mr. Andrews... those chips have a lot of salt in them. You'll have to avoid salty foods at home and let me explain why... etc."

The habit of saying "OK?" is also insincere. Students commonly say things like

"Mr. Watson, we have to turn you to your other side now... OK?"

Well, no. In Mr. Watson's mind it is not "OK" because turning hurts. He knows it. The student knows it. And Mr. Watson also knows it's futile to tell the student "no". In this interaction, the student was not honestly asking Mr. Watson's opinion about turning. But... the student could have used this simple nursing task to give the patient some much needed autonomy. The student could have said

"Mr. Watson. It's time to turn. Would you rather face the door or the window?"

Note two things. First, this is a sincere question. As a result, the nurse-patient relationship is strengthened. And second, a previously helpless patient is invited to participate in his care. He is being treated like an adult.

There are times a patient may be going on at some length about a concern (Not uncommonly, this is a "problem patient". Often one the nurses prefer to avoid) For most students the impulse to nod and say... "OK." "Uh huh." "OK" is irresistible . Unfortunately, doing so adds nothing to the conversation and the patient eventually realizes the student nurse is trying to hurry her to the end of her soliloquy.

A much more therapeutic approach is to make eye contact with this patient and listen for recurring themes. (Things that she is telling you multiple times in different words.) These can then be reflected back at appropriate times. In this manner, the student is engaged and the patient knows it. This patient who was previously acting out (because no one would pay attention to her if she didn't)... now feels she has an advocate she can talk to, someone who understands. The nurse-patient relationship is strengthened.

In real life, all of these nursing measures don't work all of the time. But sometimes they actually do. On the other hand... without hesitation or equivocation... I can tell you that just reflexively saying "OK" when speaking to patients adds nothing to your plan of care and may actually impede it.

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Episteme

About Episteme

RN. 43 year(s) of experience in Education, research, neuro

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I mostly agree.

I think though that I use "okay?" to ask the person to verbally confirm that they are with me. "Let's stand up, okay?" "Take these pills and then you can go back to sleep, okay?" To me it's like a shorter version of "do you understand."

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Specializes in Education, research, neuro.

Chism, thanks for your reply. I would bet 95% of nurses speak to their patients just like you with the same good intention. But here's the thing, you know what you mean when you say "OK?". But there is no reason to believe your patient always understands it that way.

For example, I think at our biggest facility 10% of our patients speak only rudimentary English. They may honestly think you're asking for their permission to get them up. And if they are afraid to get up, (big incision, significant pain) you're going to get the big wave-off and the answer "NO".

Additionally, (I'm serious... I'm not lying) I've had young nurses come to me and say... "The guy in 175-B won't get out of bed." I go in and say to him... "Mr. Smith... it's time for you to walk. But if you like, we can do it after your pain med in an hour. Which would you prefer? We'll do it however you want" I'm able to get the patient's cooperation. The young nurse was not because of the way she communicated with the patient.

I don't know chism if you are female. But when females (especially young females) say "OK?" at the end of a statement, they diminish (literally "feminize") their position of strength relative to the other person. No female business executive speaks that way. Nor do female attorneys.

As you can see from the patient care example above, I was the professional in the room. I was in charge, but in no way was I rude or bossy. We are professionals. We should relate to our patients as professionals. They want to believe we know what we're doing.

PS: I do say "OK?" as a precedent to the action... "OK. Here we go. 1-2-THREE" and we're out of the chair.

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I feel the use of "okay" can be construed as uncertainty, a lack of confidence. If you are giving meds or turning a person, that's not for your benefit, but for theirs. To ask their opinion of it is condescending. To give them their autonomy, do not treat them as children, even if you're doing it out of kindness. It grates on me the same way it does when I hear nurses calling patients "honey, baby, sweetie," etc. Speak kindly and firmly and if the patient has questions he or she will certainly ask them of you since you will have demonstrated confidence.

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Specializes in Pediatrics, Emergency, Trauma.

I use OK in "OK...here we go" when turning or transferring a pt. I used to use OK as a tech, because I knew I could "only do so much", at least in my opinion; I didn't use much once I became a nurse because I knew And felt that I had the tools to engage with the pt more effectively.

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Specializes in Intermediate Care.

Fantastic points, episteme!! I am a new graduate nurse and did not realize I was saying a lot of the things you mentioned.. I also did not realize what my communication could actually be saying to the patient (i.e. Lack of confidence). When I start work next month, I will be more mindful of my use of "OK."

Thank you for the post!

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I'm a pre-nursing student (hopefully will be enrolling next semester, since I'm still waiting on my letter), but this information was very helpful to me! I will definitely be paying more attention to how I address patients when I'm doing clinicals. I'm one of those people who loves reading new articles, and I read somewhere that giving people an option, like how you said "Which would you prefer?" makes them much more willing to cooperate. I think the article was mainly aimed towards raising children, but I think it is definitely applicable in these situations as well.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I don't say Ok. I had a high school English teacher that used to make us pay for OK and Yeah but. I usually will say alright. Alright...on three stand..one two three. I don't end my sentences with a question unless I require an answer.

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Specializes in Non-Nursing Management Experience.

I will definitely take this advice with me to my first semester in clinical. Thanks for your post :)!

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Specializes in ICU, LTACH, Internal Medicine.

At last someone wrote it.

It's nice to know that I'm not the only person around who feels that these pervasive "Okaaaaay"s sound as insulting toward the helpless human beings they're addressed to and who may have no means to express their refusals or preferences. I was told so many times that it was "the second language problem"...no, yet another time it isn't problem with me.

BTW, I do politely say "no, it's not OK" outside of medical field when I need it ("is it OK if I put you on hold for just a few seconds?" "Is it OK if we move your oil change appointment for just a few days?") The usual reaction is shock and awe, typically followed by immediate, dramatic and lasting improvement of the quality of service.

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You have a really good point. I tend to get a bad case of the "ok"s when I'm new to an environment and am not very confident. Similar to when I get the "um"s at times with projects involving speaking in front of a crowd. I find that the more confidence I have the less I use the word. I'll try to be more conscious of it when interacting with patients.

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I might do some of these things and I might not. I'm going to think your suggestions over, okay?

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