Patients making me feel dumb

ktwlpn, LPN · Aug 19, 2006

I just never know what to say to defend myself in these situations with patients, so i end up feeling dumb or like i'm not doing my job over things that aren't my fault.

"there are no victims-only volunteers" Don't let the ignorance of some people get you down..Does your name tag clearly state your title? Nothing wrong with a fast description of your duties and a reminder to the pt that they should always speak to the doctor regarding their concerns....In the first instance you could have very professionally reminded the patient that SHE is responsible for knowing her meds -generic names,too ...In the second instance you could have reminded the patient that it is appropriate for her to address her questions to the doctor prior to the procedure and explained that you are not a nurse.I'm inlined to cut her more of a break-she probably heard the word "biopsy" and then went partially deaf with fright.Still no excuse for rudeness....

nursingisworkRN · Aug 19, 2006

As a nurse, I always default to the "what did the Dr. say?" response. If they are unsure, then I will follow up with the Dr. or I will instruct them to ask the Dr. before the procedure. If they are dissatisfied with that and start to push me, I simply state it is outside of my scope of practice and that my knowledge of _____ procedure is very limited to that of the Dr., and that the Dr. is most qualified to discuss it with them. If I know the answer and am comfortable discussing the plan of care, then I will. Otherwise, it is better to be safe than sorry. Don't ever feel dumb. It is always better to admit not knowing something than to proceed in error because you were worried what others thought. It also helps to set limits with your patients. Smile, do your job the best you can, and realize that often all they want is reassurance. I have at least one pt attempt to put me down everyday. It used to get under my skin. But the reality is often they are in denial and lack knowledge about their own medical condition. Consider the source. You know what is and isn't in your job description. JMHO :)

catlady, BSN, RN · Aug 19, 2006

It sounds like you handled the rude patient well. It's ok to admit that something is outside your area of expertise, and then offer to find the right person to answer the patient's questions. Even we nurses sometimes have to give that response and go find the doctor or whoever can really address the concern. You know you're doing your job, so you have no need to defend yourself.

I do wonder if some of the confusion comes up in ambulatory care/doctor's offices because the patients tend to think (or sometimes even be told) that the person attending them is a "nurse," even if they're not.

TazziRN, RN · Aug 19, 2006

The biopsy pt: "I'm sorry ma'am, but it really isn't my job. I can ask the doctor for you, though."

The med pt: "Ma'am, I am not a licensed staff member and medications are outside of my scope of practice. That really is something you need to discuss with the doctor."

SaraO'Hara · Aug 19, 2006

There is one resident at my work who never fails to make me feel rather awkward, usually over changing a disposable brief. Essentially..

"Ma'am, I need to change your brief."

"What?"

"*holds up new brief* Your brief might be wet. I need to change it."

"I don't understand what you're talking about."

"Er... you might need clean underwear?"

"*fishy stare* I don't want it."

Generally, I end up feeling like a bit of a pervert for having to ask so many times. Yesterday, I asked the charge nurse to accompany me, and she was able to put a bit of RN muscle into convincing the resident that brief changes are, in fact, a good thing. Sigh.

TheCommuter, BSN, RN · Aug 19, 2006

What would you have said to a patient like this, patients who expect you to know things beyond your scope of practice and get mad when you don't.

Simply state, "That's not within my scope of practice since I am unlicensed. Please ask a licensed staff member such as a physician or nurse in order to obtain an answer."

Many patients of clinics are fully unaware or unconcerned that the majority of the staff is unlicensed; therefore, they expect you to know everything. Plenty of 'old-school' patients come from another era when medical assistants did not exist and only an RN or LPN assisted the doctor.

MIA-RN1, RN · Aug 19, 2006

I might say something even simpler and just say "I am sorry, I am not a nurse. You will need to speak with a nurse or a doctor about your medication. Let me get him/her for you." Talking about licensed/unlicensed won't mean a thing to a patient who is not familiar w/ the insides of the medical field.

ERNurse752, RN · Aug 19, 2006

I also agree with telling them that you aren't a nurse, therefore can't answer their question....I think they may think you are, and that's why they're so irritated when you don't know things. And then offering to get the MD/RN, or putting a note on the chart or something that the patient has questions about a procedure/meds/etc.

SharonH, RN · Aug 19, 2006

A very simple and matter of fact "I don't know, I will ask your physician" or "I will let him/her know of your concerns" should suffice. You are under no obligation to cater to rude behavior . In the case of what is or isn't your job, you can enlighten them with "no, as a matter of fact it isn't" with a cold smile. You absolutely should not apologize.

And remember, there is nothing wrong with not knowing. There have been times I didn't know and I just say so, simply and without embarassment and I certainly don't offer any apologies. I have also seen physicians say "I don't know". That's just the way it is, there is not always an answer for the 1001 questions some of these people have.

DaFreak71 · Aug 19, 2006

From a patient perspective:

I use to go to a NP for my health care needs and she was assisted by a LPN. The woman in charge of the paperwork and sometimes helping gathering supplies was frequently in and out of the exam room while I was trying to discuss personal issues or being examined. I did not like this at all. She was not a health care worker and therefore should not have been privy to my conversations. Even if she handled the paperwork and knew about my concerns after the fact, I still didn't think she should be allowed to witness my exams or hear my first hand accounts of my problems.

If I had been a patient getting a gyn exam and the office worker walked in, I would have thrown a hissy fit. I think what is happening is that the patients assume that you are a licensed health care worker otherwise you would not be in the room during these times. (specifically with the gyn exam). Is this really an unrealistic assumption on the part of the patient?

I now go to another NP who is more professional. When I am in the exam room either being examined or talking to him, he is the only one in the room with me unless my husband accompanies me. To think that a clerical worker could just pop in whenever (even if the NP or MD) doesn't mind, I mind and I would imagine that most patients would too.

What happens if a nurse or doctor violates HIIPA? They could lose their license. What happens if a clerical worker violates HIIPA? They could lose their job, but not their profession. This, in addition to the personal privacy issues, are why I do not think it is appropriate for a non licensed health care worker to be present when certain exams are being done or when priveleged conversations are taking place.

Of course I do not mean to insinuate that the OP would violate HIIPA or that the OP has ever done anything wrong, I am just speaking from a patient perspective and expressing my preferences in my health care experiences. I believe that the patients in the OP's office assume that he/she is a licensed health care worker otherwise they would not be that intimately involved in the patients visit/face time with the doctor. And considering that this is the patients assumption, they would be rightly surprised to learn that you weren't familiar with medications, etc.

I'll bet if the OP started telling the patients that he/she was not a licensed health care worker that the patients will be very uncomfortable the next time the OP shows up during a gyn exam.

Basically I'm just saying that it sounds like in the case of the particular office where the OP works, the lines between clerical workers and LPN's, CNA's, RN's are obviously blurred if the patients don't know the OP's job function.

kmokay · Aug 20, 2006

From a patient perspective:
I use to go to a NP for my health care needs and she was assisted by a LPN. The woman in charge of the paperwork and sometimes helping gathering supplies was frequently in and out of the exam room while I was trying to discuss personal issues or being examined. I did not like this at all. She was not a health care worker and therefore should not have been privy to my conversations. Even if she handled the paperwork and knew about my concerns after the fact, I still didn't think she should be allowed to witness my exams or hear my first hand accounts of my problems.
If I had been a patient getting a gyn exam and the office worker walked in, I would have thrown a hissy fit. I think what is happening is that the patients assume that you are a licensed health care worker otherwise you would not be in the room during these times. (specifically with the gyn exam). Is this really an unrealistic assumption on the part of the patient?
I now go to another NP who is more professional. When I am in the exam room either being examined or talking to him, he is the only one in the room with me unless my husband accompanies me. To think that a clerical worker could just pop in whenever (even if the NP or MD) doesn't mind, I mind and I would imagine that most patients would too.
What happens if a nurse or doctor violates HIIPA? They could lose their license. What happens if a clerical worker violates HIIPA? They could lose their job, but not their profession. This, in addition to the personal privacy issues, are why I do not think it is appropriate for a non licensed health care worker to be present when certain exams are being done or when priveleged conversations are taking place.
Of course I do not mean to insinuate that the OP would violate HIIPA or that the OP has ever done anything wrong, I am just speaking from a patient perspective and expressing my preferences in my health care experiences. I believe that the patients in the OP's office assume that he/she is a licensed health care worker otherwise they would not be that intimately involved in the patients visit/face time with the doctor. And considering that this is the patients assumption, they would be rightly surprised to learn that you weren't familiar with medications, etc.
I'll bet if the OP started telling the patients that he/she was not a licensed health care worker that the patients will be very uncomfortable the next time the OP shows up during a gyn exam.
Basically I'm just saying that it sounds like in the case of the particular office where the OP works, the lines between clerical workers and LPN's, CNA's, RN's are obviously blurred if the patients don't know the OP's job function.

well no, we're not licensed, but we are patient care providers. My job is to assist in procedures, there are only a handful of nurses in the entire clinic that sees 700-800 patients daily. Without us, I don't see how the docs would be able to get very much done. So do have the right to be in the room. yes I do clerical work, but there is also direct patient care involved. And in the case that there is direct patient care is involved, I don't think there is any violation of hippa. but then again the rules of hippa are abundant. really i think that most of it comes from the fact that I look 15, I don't see my co-workers being spoken to this way. atleast not that i'm aware of, but then again i could just be oblivious.