A few questions about bedside manner.

[0.adamantite]

I am a nurse of about a year on a medical-surgical ward. Many of my co-workers are also new nurses. They are great nurses and often get many compliments from our patients. Our manager will print the compliments and had them in the break room.

I never get compliments or remembered by my patients. I have not heard anything bad about my clinical practice, which my manager says is at or above her expectations. My manager says I'm a calming presence for my patients. I think what I'm lacking though is a good bedside manner. I believe that I may be on the autism or Aspergers spectrum, as I have always had difficulty with social skills and have been described as awkward or "weird" more times then I can count. My speech patterns are often weird, too.

I am friendly, introduce myself to patients and families, make sure they are comfortable, fill their water pitcher, round on them, and update them with any changes to their care. I manage pain and nausea. I am wondering what you as nurses do to go the extra mile for your patients and make them feel truly cared for?

For example, I had a patient who got tearful while we were discussing his plan of care. I sit in the chair next to him and ask him if he's having a hard time now right. He tells me he's afraid of what his test results will show. I tell him that he's in the right place, I'm glad he's here, and the doctors will do their best to figure out what is going on with him. I offer him a warm blanket or to go for a walk with me. I also offer our chaplain service. He declines, and remains tearful. I sit for a few more minutes and then my phone rings and I have to excuse myself. When I return, he is not so tearful, and says he doesn't need anything more.

I am left feeling that I didn't do enough to comfort him. I have trouble finding the right things to say, as well as I don't feel comfortable touching people or offering hugs. What else can I do?

[LadyFree28, BSN, LPN, RN]

Compassion is overrated. It is not a prerequisite for excellent nursing.

Hmmm...being compassionate is not as overrated as I think....It's nice...

HOWEVER, I believe in the three E's of excellent nursing: empowerment (advocacy), empathy, and efficiency (flexible and ability get the job done within REASON)...oh and a dash of energy in order to keep sane in this business. These qualities can be tailored to ANY personality. :)

Personally, people think that I am warm and fuzzy, although I'm aloof, like to be very goal oriented (it's a good quality in centering confused patients) and sometimes my quirkiness can come off as funny...I like to be laid back and can be very assertive...I'm not one of those people who kiss rings or what have you...I can be warm and fuzzy, but I regulate that to my personal side and close circle and my family...not for business.

[jadelpn, LPN, EMT-B]

Oh, and I want to add that nothing I described would necessarily indicate being "on the spectrum". Do you really think someone being reserved or maintaining a distance equates with them having Aspergers or something?

The OP described themselves as being on the spectrum.

i think that one can have a reserved personality. On the other end is someone who is reserved because they are attempting to figure out how to be appropriate. People who are dealing with autistic disorders have a hard time processing-- which makes it even more difficult when communicating with patients.

There's a huge difference when one is reserved because it is their nature, and when one is reserved because of a condition.

[AZ_LPN_8_26_13]

To the OP - Sounds like you are doing just fine and nothing to worry about. I am this way myself - sort of on the quiet side - one of my supervisors once told me that I have a "calming effect" on our nursing pod. I am not a "bubbly" person and could never be if I tried. I will always be me. And I've never had any real complaints either. TheCommuter and other posters are correct - the nurses and aides that the patients tend to remember are the more "bubbly" and extroverted ones, and most of these so called surveys tend to lift up or gravitate toward people who are that way, but people who quietly and calmly do their jobs with little fanfare have their place too. I wouldn't want to be any other way myself.

[BrandonLPN, LPN]

The OP described themselves as being on the spectrum.

i think that one can have a reserved personality. On the other end is someone who is reserved because they are attempting to figure out how to be appropriate. People who are dealing with autistic disorders have a hard time processing-- which makes it even more difficult when communicating with patients.

There's a huge difference when one is reserved because it is their nature, and when one is reserved because of a condition.

Yeah, I was under the impression that the "spectrum" comment was directed toward me as a snark. My bad.

Somewhat off topic, but I think Aspergers is one of those conditions that gets overdiagnosed. Kind of like how some kids who happen to be hyper are labeled with ADD too quickly. The OP said she thinks she may be on the spectrum, but it sounded to me like she shes very empathetic, just introverted.

But I'm no expert, just my opinion.

[jadelpn, LPN, EMT-B]

I do not disagree, could be that the OP is just shy and or introverted.

A number of young adults were just shy of the "autism explosion" --so many went undiagnosed for a number of years--formative for appropriate social nuances, understanding non-verbal cues, or understanding verbal tone. So although they are perhaps socially intregrated, they still struggle at times with appropriate response.

I think we all have those people in our lives that we sometimes think "are they kidding" as they are so dry that sometimes it is hard to tell. (like me at times LOL) Especially when talking about someone who's not a friend, but a patient. Just hard to read. Times 1000 for someone who struggles with social nuances--Autistic or not. And add to the fact that one is adult enough to know that "something" may or may not be right with communication, and there's a lot of perseveration.

Autism may or may not be over-diagnosed, but at one time it was sorely un-diagnosed. One of the kids has Aspergers and is one of the most empathetic people I know. Effects are learning based, and socially--it is awkward for him at best. But brilliant. (if I do say so myself). Lots of processing issues.

In any event, hoping that the OP continues to strive for effective communication--and sounds as if she is on the right track.

[x19amanda]

you sound like you are doing a great job. You are being formal, polite, and very professional. You cannot spend all your time with one patient and you are going back to your nursing school roots it seems and doing the right thing. Some people are just better talkers! it doesn't mean that you did not do your job. Sometimes it's better to not be in the spotlight, good or bad. I too am a new nurse and sometimes feel SO AWKARD if I am stressed and doing a new task, diff shift etc. Sometimes I feel as though ppl are juding me so I stutter or sound stupid but I know I'm not. You aren't the only one! Nobody has complained about me but sometimes I just laugh at myself and think wow I seemed nervous etc. Ya just gotta laugh:-)