Patients' perception of your demeanor.

[dudette10, MSN, RN]

I saw this in the horrific write up thread, and it got me to thinking.

yes hospital politics is craaazzzzy, the patient is always right it seems, i sure would like for them to back the employee once in a while. my horrific write up was unbelievable. I was working on a medical floor with 3 nurses and a tech, one of the other nurses' patients expired. it was at 0600 and we were about to change shifts so we were all running and doing our morning stuff. i went home after my shift that morning. i found out a few days later by a meeting with my nuse manager that i was written up for showing no compassion to that family. someone from the family complained that the hospital staff showed no compassion that morning. this was not even my patient; i was taking care of my own as well as helping the nurse finalize things with the death then gave report and went home. i was written up for "detrimental patient care" and patient neglect. it beats all i've ever seen. the nurse who was responsible for the patient got fired. the other nurse on the floor didn't get written up, i just didn't understand it.

Here's my story. No write-up or any complaint about it, but the poster's story that I quoted reminded me of it.

I was doing my assessments, and I knew an admit was coming in. A wife of a patient was having a very hard time with her husband's diagnosis, so I spent a few minutes with her. My admit came in, and he was a very funny guy. I went back to the nurse's station to do some charting, and I whispered in my charge's ear something funny that the admit said. We both giggled. I turned around, and the wife of my first patient was standing there. She was going to leave for the night, and I said, "Thanks for letting me know you're leaving. Get some rest." She thanked me and left.

I felt weird about that incident. I was truly concerned about her and her husband, but not 45 minutes earlier, she had seen me with a completely different demeanor.

When you are dealing with patients of various acuties and families in various stages of grief, do you ever wonder if they look at you at the nurses station and think, "SHE DOESN'T CARE!" We can't let all our patients get to us--we would burn out so quickly--but do you ever feel as if you need to be an actor on a stage? I think we all went into this profession because we do care (although that's probably not the only reason), but do you ever wonder if your demeanor outside of direct interaction with a patient is misconstrued? Do you have a "work face" that is deliberately designed to project something to patient's and families to avoid any misperception?

[Altra, BSN, RN]

This is definitely true.

Patients' & families' perceptions about the same nurse's demeanor will range from glowing to appalled -- clearly, beauty is in the eye of the beholder, no?

My own demeanor is pretty low key - I am warm but not naturally "bubbly". Many, many patients have commented on this over the years, mostly expressing appreciation. A phrase I've heard more than once is, "you look organized and like you know what you're doing." But every once in a while, that demeanor clearly "doesn't work" for a particular family member, who feels the need to tell me, "you don't seem like you're taking this seriously." (note: I am taking it seriously - the patient's symptoms, that is, but YOUR need for drama ... not so much)

When I am charge and need to speak with a patient or family who has an issue and I ask, "what can we do to make this better?" ... 7 times out of 10 they have no answer other than to name things that are completely out of anyone's control. I make sure the physician and nurse for that patient reiterate what the plan of care is, and I advise the patient/family of what the process is to get those things accomplished. This reinforces what the priorities of the patient's clinicians are, including the nurses. Other unrelated things - parking, etc. ... I direct them to the appropriate person.

Is everyone thrilled and satisfied like they've just spent a week at Disney World? Nope. But honestly I think they do better having had some limits set and reinforced from multiple levels ... than to simply have their unresolved anger/anxiety fester and be fully directed at those who spend the most time with the patient -- the nurse.

[TheCommuter, BSN, RN]

I am fairly quiet, serious, struggle with small talk, have a restricted affect, and I don't have the biggest sense of humor. People are generally disturbed or turned off by my ultra-introverted personality, so I must put on an acting game during every shift if I wish to avoid complaints. While in the presence of patients and visitors, I pretend to be more smiley, friendly, sociable, and relaxed than I truly am.

In addition, I try to appear somewhat physically busy around visitors because most people in society have a 'factory-worker' mentality which tells them that the nurse is lazy and shiftless if (s)he is on the telephone, sitting behind the computer, charting, discussing something with a colleague, reviewing a H&P, or doing any number of things that are not physically laborious. Over the years my supervisors and managers have gotten complaints from doctors and families that "those nurses were just sitting there and not working," so I try to avoid the perception of laziness.

Nursing is one of the few jobs where we spend our days in a highly-visible fishbowl for everyone to see.

[sharpeimom]

by nature, i tend to be a smart aleck, but not with patients or their families because it can backfire too easily.

i have had a young psych pt.'s mom accuse me of "trying to take undue advantage" of her son "because

my hair smelled so good." (from baby shampoo??)

an ortho pt.'s husband reported me to my nm because he felt i didn't understand the gravity of his wife's condition..." (she had had her ankle repaired surgically following a fall off a curb.) turns out he

felt i was "too young to have any nursing common sense." i wasn't assigned to her again.

i have never claimed to know everything or to have all the answers, but what i have said to patients and their families is, "i don't know the answer to that but i'll be very glad to look it up (or check) and get right back to you." and that was acceptable to most patients and their families. usually. once in a while, someone would say, "a good nurse would just know that." my dad used to say that knowing where to look something up quickly was as useful as knowing an obscure or seldom used fact, and he was right. i wish more people realized that!

i discovered years ago that if i offered to get coffee or tea for family members or just brought it when they were really upset, that they were much less demanding and critical. i realize i am not a server and was to busy to do it sometimes, but i did not and do not feel the act itself is, in and of itself,

demeaning. instead, it comforts and calms. that accomplishes quite a bit.

as to jokes and laughing at the nurses' station, i say to be careful. take it to the lounge and/or the meds room when possible. nurses' humor is its own brand. too many people remind me of a new yorker

cartoon i had on my fridge front for years, until it fell apart: a middle-aged man is on the phone. "no, my wife isn't home. she's out taking umbrage."

[Ruby Vee, BSN]

someone wrote on here once (and i wish i'd cut it and pasted it to my journal then because i cannot find it again) that people who are cool, calm and organized are often seen by families as being cold and lacking in compassion. they're happier with the "rainbows and cuddly bunnies" nurse who is clueless and disorganized because they see her as having more compassion and therefore being the better nurse.

people say they want the truth, that they want a nurse who can be honest, direct and straightforward. they don't really want that at all; they can't handle it. they want someone to be nice and make them feel better.

there was more, and it was more eloquently stated. if you wrote that post or if you know who did and can point me in that direction, please do. i read that post exactly when i needed to read that, and i've regretted ever since that i didn't tell that poster thank you.

[dudette10, MSN, RN]

ruby, i'm not sure who wrote that. now i wish i could find it to see it for myself.

for what it's worth, as the family member of patients, i've been more comfortable with the serious nurses. frankly, i didn't know them well enough to judge their competence, but i perceived them to be more competent.

as to jokes and laughing at the nurses' station, i say to be careful.

good advice. thank you.

[TheCommuter, BSN, RN]

people say they want the truth, that they want a nurse who can be honest, direct and straightforward. they don't really want that at all; they can't handle it. they want someone to be nice and make them feel better.

i fully agree. society prefers niceness over bluntness virtually every single time, and this preference trickles down into our patient populations. when people are faced with a genuine person who is honest (but blunt and terse) and a phony person who offers false reassurances (but is sweet), they'll gravitate toward the sweet person. people claim to want the truth, but they cannot handle the truth. they prefer to surround themselves with 'yes'-people and false reassurances that everything is going to be alright.

this is why certain nurses are not received well by some patients and families, although they might be highly skilled, very competent, chock full of expertise, and the person most likely to save one's life. many people really want a bubbly cheerleader to tell them what they want to hear, and if (s)he is incompetent, then so be it.

[SuesquatchRN, BSN, RN]

I am extremely extroverted, talkative, irreverent and with a pretty dry sense of humor. Also direct. I do well in some environments, not so well in a hospital.

[dudette10, MSN, RN]

When people are faced with a genuine person who is honest (but blunt and terse) and a phony person who offers false reassurances (but is sweet), they'll gravitate toward the sweet person. People claim to want the truth, but they cannot handle the truth. They prefer to surround themselves with 'yes'-people and false reassurances that everything is going to be alright.

This is why certain nurses are not received well by some patients and families, although they might be highly skilled, very competent, chock full of expertise, and the person most likely to save one's life. Many people really want a bubbly cheerleader to tell them what they want to hear, and if (s)he is incompetent, then so be it.

Can't one project both niceness and honesty at the same time in nursing? There seem to be so many either/or scenarios presented on this forum. It happens in the BSN vs. ADN debate; it happens in the management vs. floor nurses debates; it happens in the lazy PCTs vs. lazy nurses threads.

Particular wording you chose strikes me: Being honest, imo, doesn't automatically mean blunt and terse. Terseness often borders on rudeness.

I guess the fact that we're having this conversation provides more evidence that, indeed, nurses are actors on a stage. We are almost required in the current environment to be what our patients and families want us to be. If we have five patients, we might have five characters to play.

As a new nurse, I'll accept it for what it is, but it is also very difficult to do.

[Bortaz, MSN, RN]

Someone has a sig line on this forum that I think is pretty accurate. Something like "People don't care how much you know, until they know how much you care." or something.

I've found that to be true in my short nursing career. Especially in the NICU. If a nurse is tender with their baby, the parents love them (and don't question their ability).

I'm an old guy with a background in military, law enforcement and corrections (death row) that now works in a level 3 NICU. I am often the one that is called when a set of parents need an attitude adjustment. The parents take it from me better than they do from any of my peers (all women). One family that comes immediately to mind was out of control, and i sat them down and squared them away for about an hour one night. They now bring their baby back to the unit all the time to see me. I got an invitation to dad's bday party the other day.

On the other hand, I'm also the nurse that gets the gifts from parents, have parents hunt me down on the unit even when I dont have their baby assigned to me just to say hello and goodbye, get asked "I know you don't have her, but can you keep an eye on Angel for us? We wish you were her nurse every day".

So, I guess my point is: It depends. I think you can be both structured/professional/competent-appearing AND friendly/caring/sweet-appearing.

For every parent that has lauded my work, maybe there have been 3 that complained about me. But from what Ive experienced, both types of presentation have worked for me.

[SuesquatchRN, BSN, RN]

I guess the fact that we're having this conversation provides more evidence that, indeed, nurses are actors on a stage. We are almost required in the current environment to be what our patients and families want us to be. If we have five patients, we might have five characters to play.

As a new nurse, I'll accept it for what it is, but it is also very difficult to do.

So true.

[sistasoul]

I have a problem with this. I know of two nurses who were fired due to "customer" complaints. My unit manager calls back patient's once they have been d/cd and asks them about their stays. The manager has to do this and it is not her choice. One nurse who had been fired had been a nurse for over 15 years and the other had over 20 years under her belt. It is all patient's perception. One patient may think I was the greatest and on that same shift another may think I was a horrible nurse. I swear I live in fear of offending someone or giving off the wrong vibe. It is crazy. You cannot tell how someone is going to perceive you. Half the time the patient is under the influence of pain meds and they may not be seeing the situation accurately. No one is happy to be in the hospital in the first place. This customer service mentality is getting to be too much.