Do patients know a "good nurse"?

roser13, ASN, RN · May 11, 2015

In short, no they don't. Unless they are a part of the medical system (nurse, physician, etc) patients will judge their nursing care as they judge hotel staff: friendliness, availability, response time, etc.

Libby1987 · May 11, 2015

The feedback I get from patients relates to skill, follow through, reliability, communication, advocacy, or lack thereof.

Lev, MSN, RN, NP · May 12, 2015

Some do and some don't. Some focus far too much on being served and "taken care of" emotionally - tucked into bed with an extra pillow and tea and chicken soup and pain meds on board vs being provided quality care that is not always comfortable but is for their benefit and welfare - medications, ambulation, remaining NPO, having an IV, getting vital signs taken etc. Of course both are possible, but if you have to choose because of time constraints...good care tops every nurse's list.

Anonymous865 · May 12, 2015

Just like in everything else, there will be a portion of the population who will recognize a good or bad nurse and there will be a portion who will not.

I'm not part of the medical establishment.

Here's an example when I thought the nurse WAS good:

My mother was in the hospital. The nurse came in and told us that someone would be coming to take my mother for a chest X-ray. I asked why they were doing a chest X-ray. The nurse said that when she was listening to my mother's lungs earlier, she thought she heard a rattle. She called the Dr and got an order for a chest X-ray to see if mom was developing pneumonia. A short time later the nurse came in and told us, that the chest X-ray did show some pneumonia and what the Dr had ordered for it.

Here's the conversation I had with a nurse that made me think she was NOT a good nurse.

Nurse: "Here. Take this." while handing me a pill.

Me: "Okay. What is it."

Nurse: "It's one of your home meds."

Me: "Okay, but what is it" while looking at it and not recognizing it. I only take 2 home meds and neither are generic, so I ought to recognize it.

Nurse: "It's Darvon."

Me: "I don't take Darvon at home."

Nurse: "Oh. It's Diovan" reading from the computer.

Me: "I don't take Diovan at home. I do take Benicar at home. They are the same class of anti-hypertensive."

Nurse: "Oh the pharmacy must have substituted the Diovan for your home Benicar."

Me: "My Dr tried me on Diovan initially, and it didn't work for me. She then tried me on Benicar which was effective."

Nurse: "Are you refusing to take the drug."

Me: "Well I don't think the benefits of a drug we know doesn't work outweigh any risks."

Nurse: "I'll just chart you refused the drug."

As a patient I expect anyone who is giving me medications to know what they are giving me, why they are giving it to me, and what potential side effects are. I'm that careful when I take meds at home. I don't think that's too much to ask of a professional.

Regarding your comment about liking nurses who have a gift of gab, I do think that makes someone a better nurse if other things are equal. For example, there are two nurses who are equally skilled at doing a procedure. One goes in and focuses on what she is doing and does it without talking. The other goes in and chats to distract the patient while doing the unpleasant procedure. I'm going to say the one who distracted me while doing the unpleasant procedure is the better nurse.

These are the kinds of things my friends and family care about also.

I'm sure there are people who care about the stupid stuff, but there are also patients who care about the important stuff.

NursesRmofun, ASN, RN · May 12, 2015

....................
Regarding your comment about liking nurses who have a gift of gab, I do think that makes someone a better nurse if other things are equal. For example, there are two nurses who are equally skilled at doing a procedure. One goes in and focuses on what she is doing and does it without talking. The other goes in and chats to distract the patient while doing the unpleasant procedure. I'm going to say the one who distracted me while doing the unpleasant procedure is the better nurse.
These are the kinds of things my friends and family care about also.
I'm sure there are people who care about the stupid stuff, but there are also patients who care about the important stuff.

If all things were equal, having someone with the gift of gab would be nice. From my experience, at least in the hospital,....if a nurse does all she/he is supposed to do, there really is seldom the time to have the gift of gab on the scale that my co-worker did, honestly. There were other things she should have been doing when she was gabbing.

I will also just reiterate, the nurse I spoke of knew some of these people from the town she lived in for most of her life...or knew someone they knew. I didn't have all that much in common with some of the patients, but she did. I never felt bad about it. I sought to be the best nurse I could be....and still do. That is what makes me tick.

I appreciate your feedback.

Caffeine_IV · May 12, 2015

Some do and some don't. It may depend on the patient population you are caring for.

The last written compliment I received was from a gyn surgical patient and largely in part to me bringing them coffee at 530am.

KatieMI, BSN, MSN, RN · May 12, 2015

Anonimous865,

I am sorry that you have a negative experience with one of your nurses, but just to let you know:

- hospital pharmacies routinely substitute one drug for another, and one brand of the same drug for another. While doing so, they in 99.99% of times consider only two things: dose/pharm class and cost. In case of Benicar, which is, BTW, not exactly the same class as Diovan (Diovan is a pure angiotensin II receptor antagonist while Benicar also contains hydrochlorothiazide, a diuretic which increases the effect of the first component but has its own side effects and so there are cases when Benicar is contraindicated while Diovan is still OK to take), pharmacy can substitute generic angiotensin II receptor antagonist and a diuretic just because it is cheaper, because patient can take only one of the components, or because doctor wants another diuretic or the same but in another dose. Doctors usually do not tell nurses why they think the dose of a med needs to be changed, and may become quite obnoxious if we ask. Nurses have no control whatsoever on the process of substituting meds by pharmacy. So, every single of your "home pills" may or may not look exactly like the pill you take home, and nurse cannot do anything with it even if she wants.

- if you want to take exactly your home meds, feel free to bring all the bottles in hospital with original labels still on. They will be checked by pharmacist and given to you. But if your doctor thinks you need to take something else, you will be given what is available in pharmacy. If you still have questions about why you are given this and not that pill, ask your doctor, not nurse.

I am sorry again, but the nurse you characterized as "NOT good" did precisely what she was trained for, not more and not less, maybe in a bit curt way. She might be uncomfortable to say that she could not have a slightlest idea why one drug was substituted for another and almost no way to figure it out, that she was afraid to call doctor right away and be yelled for doing that, or just too busy (how many other patients she was caring for?) In any case, if the situation looked like you described it, then it was indeed too much to ask from a professional nurse.

Here.I.Stand, BSN, RN · May 12, 2015

While I agree that a bedside RN might not automatically know which formulary drugs were substituted for non-formulary home meds... It would concern me too if a nurse said "Darvon...oops, I guess it's Diovan" (after the pt stated she wasn't on Darvon).

I'd also be concerned that she was so singularly focused on the pt taking the drug and how she said "I'll just chart you refused it," rather than try to ascertain why the pt was concerned about Diovan vs. Benicar. A better way to approach it is if she was insanely busy, to advise the pt that it will be a while before she is able to call the physician, but that she trusts the pt's report of what has worked for her. She will follow up, but in the meantime would Anon 1.) like to take the Diovan (as it's probably better than nothing) or 2.) wait, with the understanding that it may be a few hours before it's available? If nothing else, if it's Benicar HCT that she takes at home, the pharmacy could dispense their formulary angiotensin II receptor agonist plus a separate tab of HCTZ (like you suggested in your reply)

I'd also wonder why she was ID'ing the med by looking at the computer rather than at the packaging. If she'd brought it into the room opened, she should have known what it was since she should have done all of her "Rights" already. If she's planned on checking "Rights" at the bedside, it should have still been in its packaging.

I get that floor nursing is stressful--I've done it. I also get that pharmacies will often sub drugs without consulting the pt. However I really don't think this RN handled it well.

Anonimous865,
I am sorry that you have a negative experience with one of your nurses, but just to let you know:
- hospital pharmacies routinely substitute one drug for another, and one brand of the same drug for another. While doing so, they in 99.99% of times consider only two things: dose/pharm class and cost. In case of Benicar, which is, BTW, not exactly the same class as Diovan (Diovan is a pure angiotensin II receptor antagonist while Benicar also contains hydrochlorothiazide, a diuretic which increases the effect of the first component but has its own side effects and so there are cases when Benicar is contraindicated while Diovan is still OK to take), pharmacy can substitute generic angiotensin II receptor antagonist and a diuretic just because it is cheaper, because patient can take only one of the components, or because doctor wants another diuretic or the same but in another dose. Doctors usually do not tell nurses why they think the dose of a med needs to be changed, and may become quite obnoxious if we ask. Nurses have no control whatsoever on the process of substituting meds by pharmacy. So, every single of your "home pills" may or may not look exactly like the pill you take home, and nurse cannot do anything with it even if she wants.
- if you want to take exactly your home meds, feel free to bring all the bottles in hospital with original labels still on. They will be checked by pharmacist and given to you. But if your doctor thinks you need to take something else, you will be given what is available in pharmacy. If you still have questions about why you are given this and not that pill, ask your doctor, not nurse.
I am sorry again, but the nurse you characterized as "NOT good" did precisely what she was trained for, not more and not less, maybe in a bit curt way. She might be uncomfortable to say that she could not have a slightlest idea why one drug was substituted for another and almost no way to figure it out, that she was afraid to call doctor right away and be yelled for doing that, or just too busy (how many other patients she was caring for?) In any case, if the situation looked like you described it, then it was indeed too much to ask from a professional nurse.

Anonymous865 · May 12, 2015

Anonimous865,
I am sorry that you have a negative experience with one of your nurses, but just to let you know:
- hospital pharmacies routinely substitute one drug for another, and one brand of the same drug for another. While doing so, they in 99.99% of times consider only two things: dose/pharm class and cost. In case of Benicar, which is, BTW, not exactly the same class as Diovan (Diovan is a pure angiotensin II receptor antagonist while Benicar also contains hydrochlorothiazide, a diuretic which increases the effect of the first component but has its own side effects and so there are cases when Benicar is contraindicated while Diovan is still OK to take), pharmacy can substitute generic angiotensin II receptor antagonist and a diuretic just because it is cheaper, because patient can take only one of the components, or because doctor wants another diuretic or the same but in another dose. Doctors usually do not tell nurses why they think the dose of a med needs to be changed, and may become quite obnoxious if we ask. Nurses have no control whatsoever on the process of substituting meds by pharmacy. So, every single of your "home pills" may or may not look exactly like the pill you take home, and nurse cannot do anything with it even if she wants.
- if you want to take exactly your home meds, feel free to bring all the bottles in hospital with original labels still on. They will be checked by pharmacist and given to you. But if your doctor thinks you need to take something else, you will be given what is available in pharmacy. If you still have questions about why you are given this and not that pill, ask your doctor, not nurse.
I am sorry again, but the nurse you characterized as "NOT good" did precisely what she was trained for, not more and not less, maybe in a bit curt way. She might be uncomfortable to say that she could not have a slightlest idea why one drug was substituted for another and almost no way to figure it out, that she was afraid to call doctor right away and be yelled for doing that, or just too busy (how many other patients she was caring for?) In any case, if the situation looked like you described it, then it was indeed too much to ask from a professional nurse.

I was saying the nurse was a bad nurse because she told me she was giving me Darvon initially. Darvon is a narcotic pain reliever not an anti-hypertensive.

When I questioned the Darvon she had to look on the computer and then tell me it was Diovan. Clearly she did not know what drug she was giving me or what it was for.

FYI - Benicar is only an angiotension II inhibitor. (This is what I took.)

Benicar HCT is a combination angiotension II inhibitor and thiazide diuretic. I did not take that.

Libby1987 · May 12, 2015

I sure hope this was years ago and before Darvon was taken off the market.

Here.I.Stand, BSN, RN · May 12, 2015

To answer the OP's question, I think some pts know good nurses, and yes a lot of them place more importance on being a kind, soothing angel of mercy. Like a PP said, all other things being equal I can see a patient wanting a nurse with a good bedside manner; it doesn't have to be either-or. Holistically minded care plus clinical knowledge is much of what separates nurses from task-oriented technicians.

For what it's worth, most of my "good nurse" compliments come from people who I make sure are kept in the loop (very important in critical care when most families don't understand all what's going on) and from people who were in difficult places but felt that I heard them.

Quick example of the latter: when I worked in a SNF rehab unit, we had a patient whose legs were covered w/ venous stasis ulcers. We were using this waist-to-toe apparatus that worked like SCDs, and to my knowledge none of us nurses had seen it before. This patient was also what you'd call "difficult." He was angry at the world, sick of being sick, and would take it out on anyone in his path. I ended up being the one that he had confidence in--even complimented me to our NP--because I'd try to find out specifically how to help him at the moment, and seeking his input on his care. Even for simple things like asking if he felt the pump sleeves were placed correctly.

Or I'll make a pain control plan with the pt, e.g. for someone who's requested PRNs on a very regular basis, asking if they would like to be awoken for them or to be left to sleep.

That kind of thing has earned me a fair amount of appreciation, even from pts who don't fully understand nursing.

And then there are some who do think that a sweet nurse is a good nurse, no matter how little benefit sweetness has on getting them better and out of the hospital. What can you do? Be nice and provide the best nursing care you can whether the pt "gets it" or not.

Do patients know a "good nurse"?

Do patients know a good nurse?