How to not be rude AKA how to quiet a patient

[msygrnbw]

As a new nurse on orientation the one thing I have really ever enjoyed is getting to connect with my patients. With a 5+ patient load, I realize that this cannot always happen, but I am wondering how you all are tactful about it?

When your patient starts rambling I tend to fall into the "Ok" pattern (discussed in an earlier recent thread as being not so effective/therapeutic). I try to back out of the room gently. I try to let them know I am listening, but the truth is, no matter how interested I am in what they have to say, I'm still trying to stay above water as a new grad just with meds and dressing changes and orders. So how do you experienced nurses seem to always make it out of the room so quick? (Or is this just an illusion that I seem to see when you've finished all the meds/assessments on your patients about 5 times faster than me?)

What tips do you have for backing out of a room gracefully? How do you politely tell someone that you just are trying to get their admission information so you can at least get pain medication orders to start the night off instead of their whole life story? As a new nurse and someone who is VERY awkward to begin with I find myself falling into the ramble/I don't wanna be rude telling you that we need to move on zone.

[SoldierNurse22, BSN, RN]

Some of this comes with time. I also used to struggle with this a lot as I hated being perceived as rude. But the truth is, you're not there to listen to them all day. You have other patients. It's your responsibility as the nurse to carefully budget your time between patients.

With that said, here's my favorite trick. I'll catch the offending rambler on the end of that reflexive "OK" and add, "OK, that sounds good. Now, I need to go do X, Y and Z, but I'll be back in XX minutes. Is there anything I can get you before I head out?"

Of course, you really do have to go back and check on them, but that usually does the trick. It politely tells the patient that I'm busy, but I'm going to be back.

If you have a patient who's more difficult to disengage, I've learned how to interrupt in that natural pause between sentences and untangle myself from the monologue. "Mr. Talksalot, I hate to interrupt you, but I really need to check on something at the desk/another patient/get you your 1000 medication. Is there anything I can do for you before I go?" Sometimes you really do have to just jump on in there and start talking, nearly cutting off the patient. It can seem awkward and strange and perhaps a bit blunt at first, but if you don't get into the habit of doing this, you can waste hours at a time with one person.

Another fun trick is to tell your coworker that you're going onto Chatty McChatterson's room and ask if they'll come along in 15 minutes and rescue you. Keep in mind that this is a beginner's trick and shouldn't be your main method of backing out of a conversation. It also doesn't establish boundaries with your patient as the patient may think the only reason you left is because someone asked you to go, not because you yourself needed to go.

[Esme12, ASN, BSN, RN]

It is a skill like everything else. It comes in time. Keep the patient focused during admission. When they ramble refocus them to...I just need a list right now of what your meds are we can get details later. Or...Acknowledge what they are saying but follow with...we can get the details later. If they are chatty I will again acknowledge them but that I have to get other patients meds on time and I will be back and give specific time range that they will see me again...and if they need anything to call me as I place the bell in their reach.

Let them know you hear them but you have to move on. It does get easier.

[Lev, MSN, RN, NP]

I'm not so experienced (1.5 years only), but I've gotten this mostly down pat. When I was establishing my routine, I just made a point to minimize communication with patients in the first 4 hours of the shift. I wasn't rude, I just wasn't ultra friendly. Patients know you are busy and they will understand. Once I figured my routine out, I was able to go in there and talk a little. If I'm short on time, I look at the clock and tell myself "You have 20 minutes...go" (Assessment, meds, document pain assessment, health assessment, education form, and activity form and bronchial hygiene (I work surgery) form. That's how I pace myself when I'm short on time.

Another thing I've noticed, people like talking about their bodies. As you assess your patient, you are having a conversation. You can have a conversation about their pain and get your whole pain assessment. To them it feels like you really care about them (and hopefully you do), but it's really the assessment of their pain that you're after. Same as for appetite, GI complaints etc.

To get out of a long conversation...basically let them talk and don't ask questions if you are looking to exit a conversation. Sometimes you ask questions to be polite and show that you are interested in the conversation, but if you need to leave, stop asking questions and giving long answers. If they are still talking after 5 minutes and you need to leave, find a good place to break, and say "I'd like to hear more, but I need to give medications to my patient next door, but Ill be back to check on you later." Or if they asked for something you can quickly say "Let me get that pain medicine for you..I'll be right back." Hopefully they'll lose their train of thought and you can make a quick exit. Try to stay at the doorway while you're waiting for them to take the med if po. I know this sounds bad, like you don't want to spend time with your patients. But nursing is about prioritization. When you have 5 med passes to do and your patient wants to talk...it's a clear choice. Round on your patients when you're done with the meds and assessments and hear them out then.

Another tip I've heard is to sit in your patient's room at the beginning of each shift for 5 minutes and let them talk to their hearts content. After a couple minutes, just say you are going to round on your other patients.