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Fired By My Patients

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Nurse Beth Nurse Beth, MSN (Columnist) Educator Columnist Innovator Expert Nurse

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

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?


Dear Dismissed By Patients,

It must be very distressful 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.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

nurse-beth-purple-logo.jpg

Edited by Brian S.

middleagednurse

Specializes in nurseline,med surg, PD. Has 50+ years experience.

Be alert to non verbal cues. If you say something and mom gets a weird look on her face, communicate. Speaking of communication, that is very important. Make sure you interact verbally with client and famiy members.Dont be TOO quiet. Observe social graces, say hello good bye thank you please etc.Ask permission to use the bathroom or refrigerator or microwave. Be positive and encouraging.

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...

I wonder if your being soft spoken comes across as closed off and rude? I don't think you're closed of 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

Specializes in Long term care; med-surg; critical care. Has 6 years experience.

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.

I liked the post! I don't think the new rn should take it too hard. Her patients may just recognize she is new, and be nervous about having a new nurse take care of them. This can be conveyed by "thinking" while doing tasks/communicating (I have trouble with this right now so I can relate). We'll get quicker one day!

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

Specializes in Perioperative / OR Nurse Intern. Has 1 years experience.

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

Specializes in medical surgical. Has 5 years experience.

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.

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.

Edited by cdsavannah59
Missing letters

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

Specializes in Hospice, Palliative Care. Has 3 years experience.

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.

smartnurse1982

Has 7 years experience.

It sounds like the OP works Private duty through an agency.

I could be wrong though.

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!

Maybe you can ask a fellow nurse to stand outside the door out of sight of the patient and then give you feedback.

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.

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.

I agree that some nurses come off snobbish. And if they don't care that they do, it's a serious problem. I truly believe you cannot be a nurse and not make empathy a priority. Because if you only do the tasks and provide care, even if you are the best critical thinker, you are only helping one aspect of health. The physical. The other aspects of health, like emotional needs, greatly suffer from an unempathetic approach.

However, I believe wanting to learn empathy means something. No one is skilled with empathy equally, and some cannot be empathetic in certain situations as others. This is congruent with the statement regarding life experience that you mentioned. Empathy can be developed with practice and education.

NurseAlhara, MSN

Specializes in Neurotrauma, PCU, Family practice. Has 13 years experience.

Dismissed,

I am not a frequent poster. In fact, I don't know that I have ever responded to a thread up til now, even though I read a lot here. But something in your message struck a chord with me. (I read it, and the comments, went on to do something else, and kept thinking about it afterward.)

There was one part of your letter that no one addressed. What does "rule following" mean, exactly, and why is it a relevant point?

I agree with everything the other posters have said in terms of not over-worrying about it, checking with others for useful insights, and perhaps looking at how you are coming across to the patients. However, the way that one can be "rule following" can come across as uncaring about the patient's needs and/or wishes. I will give you some examples.

An NPO patient that has a surgery scheduled (but you don't know what time it is going to be, or, worse yet, you know it's not going to be before noon) and has IV fluids, but complains of being thirsty. IV fluids keep a person hydrated, but they do not relieve the sensation of thirst. Critical thinking is necessary here. Why do we keep patients NPO for procedures requiring anesthesia? We do it to prevent aspiration. We need the stomach empty so that when they are anesthetized, the stomach contents do not come up and then get into the lungs. Ice chips are useful (up to about 2 hours prior to the procedure) to relieve thirst because the small amount of water is absorbed almost immediately. But telling a patient an unequivocal "no" will only make the patient think that you do not care about his issue.

In the same vein, I have had several situations when post-op patients are NPO because the doctor is afraid of nausea or vomiting. When, by post-op day 1, the patient is still NPO, I often question the doctor and am told they can have water, but no meals. In other words, they do not always realize that we keep the patient completely NPO until they tell us otherwise.

In other situations, such as pain medications, it is usually useful to explain *why* an order is the way it is. A patient who came in with altered mental status is not going to be given narcotics for their chronic pain because the doctors do not want to have neuro symptoms masked by medications. They need to know what is causing the drowsiness and confusion. But I always offer to ask the doctor about getting an additional pain med order. This lets the patient know that I am still advocating for them, even if I tell them that there is not much hope of them getting what they want.

Little things like that, which sometimes means more work for me, can make a big difference when needing to tell the patient they cannot have what they want. I can think of many more examples, but I think you get the picture.

If I am barking up the wrong tree, then I apologize, but it might be the missing link you are looking for.

I hope this helps.