How to get people to LISTEN TO ME!--Vent

RainDreamer, BSN, RN · Jan 11, 2008

UGH, what an incredibly frustrating situation for you! I know it's frustrating and it'd be easy to get nasty so people will listen, but that'll just make things worse.

The charge isn't listening to you, so you need to go above her head. Go talk with the nurse manager. You're right that this is unacceptable and something needs to be done about it, for your and your patients' sakes.

Good luck!

november17, ASN, RN · Jan 11, 2008

In the words of the greatest CNA I have ever worked with, "You gotta be firm yet sweet"

She would have the biggest smile on her face and say, "SIR YOU NEED TO GET BACK IN BED" (or whatever) and patients would go wide eyed and do exactly what she said. One time we had a very difficult confused patient trying to fight us while were dressing him and she said, "Knock it off!!" And all the sudden he was like a puppy. She would get the perfect tone of voice for it, like a grandma scolding their grandkid. I mean, if she had ever told me to do something/not do something in that tone of voice I probably would have done it. I can't explain it. Maybe she just had a knack. It wasn't harsh or abrasive, it was just authoritative like the word of God just came down from heaven or something.

love-d-OR · Jan 11, 2008

Discuss it with the patients physician or your manager. If this patient is capable of hitting you and pulling his lines, he is probably capable of getting out of bed and falling. No physician or manager would want that to happen to their patients. So if you put it in the context of patient safety and hospital liability, they might listen to you.

My hospial uses sitters on a regular basis, so this is rarely an issue. As for your charge nurse, she needs to brush up on her 'nurse support skills.'

As for your age, you cant change that. So, be assertive, show confidence and carry your self in a professional manner (Im not insinuating that you dont). Also, if you have a mentor (your primary preceptor during orientation) you could speak to them about the matter. They could give you some advice or help you convince the charge that you need help with this patient.

Scrubby · Jan 11, 2008

[in the words of the greatest CNA I have ever worked with, "You gotta be firm yet sweet"

She would have the biggest smile on her face and say, "SIR YOU NEED TO GET BACK IN BED" (or whatever) and patients would go wide eyed and do exactly what she said. One time we had a very difficult confused patient trying to fight us while were dressing him and she said, "Knock it off!!" And all the sudden he was like a puppy. She would get the perfect tone of voice for it, like a grandma scolding their grandkid. I mean, if she had ever told me to do something/not do something in that tone of voice I probably would have done it. I can't explain it. Maybe she just had a knack. It wasn't harsh or abrasive, it was just authoritative like the word of God just came down from heaven or something]

I disagree with this advice. I have tried this with some patients and believe me some people really don't care. They may have a mental illness, ETOH, delirous or they are just not very nice people and this type of bravado attitude simply makes them worse. There are times when all the communication skills in the world fail. As an RN it is important to understand when a situation simply cannot be handled by you alone. This is in the interest of the patient and yourself. Also there may be an underlying health issue that may not have been picked up previously, i.e alcohol withdrawal.

PiPhi2004-If I seriously believe that a patient is going to potentially harm me i will not go near them without a team to help. I'm not going to risk my health by being a matryr. I will request a restraint whether it's chemical or physical. You say that you do not know what to do, people aren't listening and this keeps happening. Have you documented the violence you have experienced, written an incident report? You need to do this to be taken seriously. I have had situations like this before and i WILL go to someone higher if the docs and everyone else refuse to listen. If they are pulling out lines, etc swinging at staff and a potential risk to themselves or someone else i would call a met (medical emergency team). This means that a team of docs, specialised nurses will arrive, and assess the situation, prescribe drugs, restraints whatever needs to be done immediately. I've done this before and believe me it works because other professionals become involved in the situation and something HAS to be done about it. It may make me unpopular with the docs BUT at least i know that i'm advocating for my patient and for my fellow staff. Also I will document everything and provide a rationale for calling a met. We have a protocol at my HCF that for any patient you are 'seriously worried' about you can call a met.

november17, ASN, RN · Jan 11, 2008

I disagree with this advice. I have tried this with some patients and believe me some people really don't care. They may have a mental illness, ETOH, delirous or they are just not very nice people and this type of bravado attitude simply makes them worse.

You're right, but for some reason it ALWAYS worked for her.

nursemike, ASN, RN · Jan 11, 2008

At my facility, we have standing ICU/Stepdown protocols for restraints to protect invasive tubes and lines. I've never worked ICU, but in stepdown we have 3 patients, and it's almost impossible to get a sitter at that level of staffing. Sometimes it is possible to care for two other patients and watch a problem patient closely enough to avoid restraints, but I recall a shift not long ago when we had no "floor" patients in restraints, and all nine stepdown patients were restrained.

In my state, a nurse can initiate restraints on a patient, but they then have to be assessed by a physician and an order written within one hour. Of course, you would need to check your own Nurse Practice Act and your facility's policies. Personally, I hate restraints, and I'll bust my tail to avoid or d/c them, but sometimes they're unavoidable.

As far as "talking down" an agitated patient, I find it to be something of a Taoist exercise. Confront them head on, and they just get more agitated. I seem to do best with a sort of verbal deflection and reminders that they are in the hospital and that they are safe. It's hard to explain and largely intuitive, but a big part of it consists of not letting myself get agitated. Also, to avoid over-stimulation, I try to have only one person speaking to the patient at a time. If it's my patient, that's usually me, but if I'm not getting through, someone else may be able to. But everyone talking at once is no good.

As for getting co-workers to listen, I'm afraid I don't have much help to offer. If you're new, maybe it will improve as they get to know you and learn to trust your judgement. In the meantime, maybe you can find allies among your peers who do have the attention of doctors, charge nurses, etc.

suanna · Jan 11, 2008

To some extent you can thank our Uncle Sam and his ugly sister JCAHO. The documentation for restraints and justification for thier use is overwhelming,- not to mention the liability if a patient becomes injured while restrained. Chemical sedation is almost as troublesome since nasty side effects pose new risks for the patient that a jury could see as unnesessary if things go awry. No doc is going to take that risk as long as it's just nurses getting knocked around. If you loose an a-line or swan they still have a nurse to blame for not watching the patient close enough. Not thier fault!-no liability. They really should have told us in school that all our patients are going to be confused, combative and/or noncompliant the first day of class. At least we'd have had fair warning.

Pediatric Critical Care Columnist · Jan 12, 2008

Document, document, document. Write everything you observe, using objective terminology, in the chart. Chart what steps you've taken to try and head off the situation. Identify by name and professional designation in the chart whomever you spoken to about the issue and document their response. When the inevitable happens, report it to the required personnel and document that. Fill out the appropriate incident reports referring to your chart documentation. Risk management doesn't like it when there's a paper trail that implies culpability, but those resopnsible for accreditation love it when they have specific issues that need to be addressed which are also well-documented. Your charting is your best defence.

Oh, and be sure when you've reported the issue to the poroper person that you ask for the correct spelling of hteir last name so that you can chart accurately. That tactic sometimes is very effective.

nursemike, ASN, RN · Jan 12, 2008

At my facility, I was taught repeatedly not to refer to an incident report in my nurse's notes (which would be the reverse of janfrn's suggestion to refer to the documentation in the incident report, so I don't think that would be a problem.) As I understand the rationale, if a patient's attorney is reviewing your chart, there's no need to remind them to look for incident reports, as well.

I find it sad to think that way, but it probably is prudent, and the stated purpose of the incident report isn't to document what occured (that's done in the note) but to alert the appropriate authorities to a problem so that it can be avoided in the future.

Pediatric Critical Care Columnist · Jan 12, 2008

Nursemike, how right you are about never charting that there's been an incident report filled out. Every facility will tell you that; a competent atorney would know to look for one when seeing a note on the chart describing a patient pulling out a line, self-extubating, falling out of bed or assaulting someone else. But it is important for the nurse's protection to document that s/he's reported to someone with authority that the patient's behavior might result in some disastrous event, that this person was fully aware of the nurse's concerns and did nothing to solve the problem. Indeed, incident reports are the facility's method of tracking events and identifying underlying reasons for them. When a pattern is identified and no action is taken, then the facility has to take responsibility for subsequent similar events.

This advice applies to all sorts of situations wherein a nurse might find his/her career and reputation on the line. When I've repeatedly told a physician that my post-op cardiac patient is losing large volumes of blood from the chest tube and I get the old, "Well, it's really not THAT bad... keep an eye on it and let me know if it continues" kind of line, I'm darned well going to be making a note about it on the chart so that when the child's hemoglobin reaches 6 and they're in trouble, I can prove that I made all the appropriate notifications. I worked in a unit that had been involved in a series of pediatric deaths following cardiac surgery that resulted in a very long medical inquest; the nurses were the canaries in the coal mine, telling the other physicians, management and administration about the concerns they had with the condition the kids were in on admission and surgeon's attitudes and behavior when things went badly. The inquest found no complaint with the documentation of the nurses on the unit; in fact the judge determined that the nursing documentation on each child's chart provided him with the best picture of what exactly happened in each case and with insight into the origins of the problems. I took that lesson to heart and make sure that every time I report something to someone it's documented.

In another sense, documenting such things can help protect your license another way. If there were ever an investigation into a nurse's fitness to practice over a high incidence of patient falls for example, and that nurse has charted every single time s/he'd reported the potential for this to happen without the facility making changes in staffing or policy, the nurse would be at least partially vindicated.

nursemike, ASN, RN · Jan 12, 2008

janfrn,

I totally agree, and your examples illustrate that the OP's frustrations are about a lot more than a bruised ego (not that I read the OP that way). A nurse, however young, is a trained, licensed professional who is well acquainted with her/his patients, with opinions that matter.

I find it extraordinarily unfortunate that the OP's CN isn't more of a resource at such times. Mine want to be kept informed of patients' issues--no doubt in part because their licenses are also on the line (but more because they care about the patients).