Fired By My Patients

[Nurse Beth, MSN]

Dear Dismissed By Patients,

It must be very distressfully to frequently be dismissed by patients without knowing why.

It's puzzling, because no one would fire you for being soft-spoken, dutiful and rule-following.

The perception you have of yourself and the perception others have of you is different. This happens when you don't realize your impact on others,

and come across to others in an unintended manner.

The only clue you have given is to say you show an interest in your patients but then don't pry beyond that.

Is it possible that what you believe to be not prying is taken as lack of caring or interest?

Even if you are perceived as uncommunicative, it shouldn't rise to the level of you being dismissed.

I would ask my manager for insight and help. I would also talk to some trusted friends or family and ask for their feedback.

People who know you and care about you will want to help you discover whatever behavior it is that is holding you back.

[Anne413]

Nurse Beth said:

Dear Nurse Beth,

I am 58 and a new 2-Yr. RN, I am a soft spoken, rule following, dutiful person & RN. I always inquire about my patients stay in the hospital but tend not to pry beyond that. I most often get very good feedback from my Med/Surg patient base, however, I am frequently dismissed from patient care by patient request. I am struggling to stop this from happening. Can you give me any advice?

How very distressing for you. The biggest way change is made when related to patient care, whether individuals, units, hospitals or entire hospital systems, is feedback. I would hope that there was some written or verbal feedback when patients requested dismissal of a nurse from their care. Of course many don't want to bother and just want a new nurse, but hopefully they are asked, either by a written feedback form or speaking to a hospital representative why they feel this way. Talking to supervisors and coworkers might also be valuable, but no one can know what a patient is feeling when they decide they don't want someone caring for them, except them. This information is invaluable in helping a nurse make changes when encountering something like this. I wish you luck...

[Purple_roses]

I wonder if your being soft spoken comes across as closed off and rude? I don't think you're closed off and rude, but I used to be pretty shy when I first met new people, and those people would later tell me that they thought I was "a total *****" until they got to know me. I'm what you would call an extroverted introvert now. I can be fun and outgoing, but need my alone/quiet time later. I wonder if this might be what you're struggling with as well?

Hope it gets better for you!

[JBMmom, MSN, NP]

Clearly you are a very conscientious person and I'm sorry you're dealing with a difficult situation. I would recommend you meet with your manager and ask that in the future if someone asks that you be removed from their care team, your manager or charge nurse follows up with that patient to get more detailed information about the issue. Once you have specific feedback about whatever the issue might be, you will know what you can work on to make improvements. Try not to take it to heart too much, you obviously have had many happy patients as well. Good luck.

[babynurse4u]

I also wonder if your quietness is being interpreted incorrectly by your patients or their families. Maybe you di not seem confident? That is one of the first things I teach my students-always appear confident. If you need assistance, seek it out but do not let the patient see your indecision. Not being talkative could also be interpreted as being aloof or non-caring. I think the others are correct: approach your unit manager and ask for feedback-you need to know what the real issue is so you can begin working on a plan of correction. Good luck, and hang in there!

[Silver_Rik, ASN, RN]

Is it appropriate to ask feedback from the nurse who takes over on the patient? I think it's very likely that the patient will volunteer their reason(s) for wanting the change in communicating with the new nurse. If not the new nurse, they may vent to the UAPs (CNAs)

I agree with what others have said, it may just be that you are new. Your minimal communication style may enhance their sense of lack of experience and confidence. I get mistaken for an MD (50, silver hair) but if I hesitate or do a step out of order on a patient care procedure some patients can be merciless - and I'm dealing with patients who tend to not have much filter (psychiatric). Yours may be more discreet in expressing their concerns.

As far as being more open with your patients, you can show more empathy without prying.

[gettingbsn2msn, MSN, RN]

I think sometimes people who are quiet or soft spoken are intimidating. It shouldn't be that way but I work with someone who only answers questions but does not carry on conversations. I know him now and he's not this way but he sure intimidated me at first.

[cdsavannah59, CNA]

I'm a PCT, As I was taking a patient's blood pressure she asked me "Do you like my nurse". I was surprised by her question but knew I had to answer it professionally so I said yes I like her. The patient then replied " My nurse is very book smart and good at her job but she lackes empathy, she's cold as ice and I think she's in the wrong profession" After I left the patient's room I thought to myself that girl just hit the nail on the head with that comment. The nurse she was referring to was as cold acting to staff that weren't part of her circle of friends and although she is smart she has no social personality. It's hard to determine why your patient's feel the way they do, but it may be how you relate to them. Patient's just want know that you actually do care how about their health issues etc and not a act like a human machine just

doing her job.

[Kooky Korky, BSN, RN]

Sometimes quiet people are perceived as snobbish. Inside you are probably humble and courteous, but, depending on their own history, mindset, life experiences, they might see you as something completely different than what you really are.

Make 'em laugh, make 'em laugh, all the world loves a clown, make 'em laugh. From

"Singing In The Rain". Great movie - Doris Day, Gene Kelly, and Donald O'Connor. Great music and dancing, great philosophy. So try some humor, is the point.

Try being a little more talkative, ask about their hospital stay, remark on their kids, pets, whatever. If you see lovely plants or evidence of a hobby - collector of thimbles, a train set up, crochet in the works, whatever - strike up a conversation about that.

Take a couple of conversation pieces to the job. "Here's a picture of my baby" (your dog, your bird, your car or kids, whatever). "Do you like crossword puzzles"? "Do you feel like building this jigsaw puzzle"? (make it just a few pieces, not 500 or 1000).

And your supervisor really needs to be frank with you about the reasons for patients not taking to you much. She or he is probably hoping you will bring up this topic. So let the Sup know that you are puzzled and worried and want to get to the bottom of the matter, so ask her to please be upfront with you and help you learn how to make things better.

Best wishes.

[pmabraham, BSN, RN]

Good day, Dismissed By Patients:

I'm also a new RN with seven months' experience on a very busy cardiac telemetry unit. I've been dismissed twice by two separate patients. One was a pregnant black woman who stated she didn't want a white man caring for her. The other was based on a family member wanting another nurse; I later found out the family member involved dismissed multiple nurses.

Several more experience nurses shared they have been "fired' (aka dismissed) multiple times over the years, and they once had a patient on the unit who fired every nurse on the unit which meant having a supervisor share with them they must start over.

My recommendation is to not take such things personally. Do introspect (assess yourself) as to what you could do differently next time. Do talk with the nurse(s) who took over care when possible to find out if they could share with you what might have happened.

By the way, on our unit, like most good ones I imagine, we work together as a team and have a no pass zone for call lights et al. The afternoon I was fired by the family member, the family member was later yelling out for help and using the call bell. The patient was aspirating on food. I happened to be the first one on the scene, helped the patient recover, and alerted the new primary nurse. Then I left the room silently pondering again why I was dismissed in the first place (even though the charge nurse and several others shared the family member dismissed several nurses that week).

Just a few weeks ago, the patient was readmitted and I saw the family member in question walking the halls of our unit teary eyed. I asked how they were doing as well as the patient. The family member thanked me for asking, shared news about how the patient was doing, and then said something to the effect of thank you for saving their life. I replied, your welcome, but internally still wondered why I was dismissed; yet I was still thankful to have been recognized as having been helpful.

So while it makes sense to ponder and introspect, be careful not to weigh too heavily on certain situations. There's the old saying, you cannot please everyone.

[Pepsimx5]

Hi Nurse Beth,

First, I would like to say, there is not a nurse in practice who hasn't been "fired" once or twice. Don't stress too much over it, or take it too personally. Sometimes patient/nurse chemistry just doesn't mix, and EVERY patient isn't going to like you.

You say that "most often" you get positive feedback from your patient base, but then say you are "frequently dismissed from patient care by patient request." It seems to me that both of these things cannot be correct. So to you, how frequent is frequent? If this is happening once or twice a year, I wouldn't worry, but if it is happening on a weekly basis, there might be a problem on your end.

I think everyone has given you really good feedback. If you're close enough to a co-worker to ask what's up, I would. Or if this has already gone to the supervisor, look for feedback there.

I think both Kooky Korky (#10) and pmabraham, ADN, RN (#11) gave you great advice.

Patients want a personal touch, that's why nurses have not been replaced by machines, make a connection, make them feel they can trust you and that you can relate to them. Go a little out of your comfort zone, and beyond their hospital stay, let them know you want to know who they are, and not just a diagnosis in a bed.

The most important thing is that you care about this and as long as you strive to improve, you will do fine.

Good luck!

[Jeskoto]

I was thinking the same thing. Maybe it's your body language or tone of voice, or some other non verbal cues. For example, maybe the way you're acting is coming off as you are not comfortable or not competent, or not very approachable. Also, you have to act confident in everything you do, because if you're not, that might make the pt think that you don't really know what you're doing and make them nervous and dismiss you. P.S. also try to build a relationship with them and show them that you care. You said that you don't try to pry beyond the basics, but from my experience, most patients really enjoy talking about themselves.