My patient thinks I'm incompetent. Should I care?

[RNpatterson]

The short story is I gave my patient an insulin injection that apparently hurt and resulted in a bruise. He reported this to a nurse on the next shift, and added that it seemed like I didn't know what I was doing and that I used the wrong needle (which is kind of impossible to do with insulin syringes since the needle is attached). This resulted in an email to my clinical instructor who then had to talk to me about it. I didn't actually do anything wrong so it was easy to clarify and explain what happened.... not a big deal.

The part that is bothering me is that I can't explain to my patient that he was wrong and why he was wrong. Half of me is trying to let it go knowing I'm dealing with very sick patients who are experiencing all kinds of crazy confused emotions and it really doesn't matter but the other half of me is really upset because I don't want my patients to think I'm incompetent. It's very frustrating when you know you can't "clear the air" when there's a misunderstanding. To make matters worse, this was my first patient EVER! Am I silly to let this bother me?

[TheCommuter, BSN, RN]

I would move on from this incident and not allow this patient to continue to rent space inside your head. Obviously, this patient has gotten to your head because you're bothered enough about it to post here.

There will be plenty of patients over the years who are wrong, but firmly believe that they are correct. However, healthcare facilities and managers view patients as "customers" and clients. And, you very well know the old customer service adage: "The customer is always right."

Even though a patient is blatantly wrong, they are always right in today's healthcare climate (unfortunately). Let this one roll off your back and move forward. This is a battle that you likely will not win.

[rn/writer, RN]

Were you able to clear the air with your instructor?

Do you think you were incompetent?

If you answered "yes" and "no" respectively, no one else gets a vote.

Sometimes people who are dealing with health issues let off steam by focusing on one tiny piece of their care as a place to "make a stand." Hold their complaint at arm's length. Take anything out of it that would help you to improve your practice. Then take a deep breath and let the rest of it go. This is a really important skill for you to learn in every day life as well as in nursing.

I wish you the best.

[Mike R, ADN, BSN, RN]

The way I see it, I gotta agree with RN/Writer. As long as your instructor and you feel you followed the proper procedures, I wouldn't worry. You can't make every one happy but all you can do is your best. You'll soon find that there are those who will find the smallest detail to fixate on just because they can.

If the next few sub cu injections end up in complaints, that's when I'd start worrying.

[nursel56]

Just a couple of thoughts. It sounds like you were on your own in the room with him- but if not I apologize. First, some people feel a little unsure with students and it has nothing to do with you. I hope he had it explained to him and he was fine with having a student taking care of him.

It just seems to me almost a matter of percentage that some people will tell you that you gave a horrible and painful shot, but your technique is the same and you did everything right-- I've just learned to realize that it happens from time to time and let it roll off. Trying to explain it may not even be helpful if you did have the chance. Such is the way people perceive things. If they say "ouch!" I do say I'm sorry (about the pain) but not that I gave a "bad shot" because I know I didn't. Does s*ck that it was your first patient- but now you have that out of the way at least! Best wishes.

[RNpatterson]

Thanks everyone. I'm even feeling better this morning after a decent night's sleep; when you're tired everything seems worse that it really is. I did easily clear the air with my instructor and I do feel competent.

nursel56 - No, I was in the room with my assigned nurse (another reason this took my by surprise when I heard he complained).

I know things like this happen but I guess it really caught me off guard by happening so soon - I'll chalk it up to early clinical jitters and grow from it. :)

[llg, PhD, RN]

I think we all go into nursing with the hopes that our patients will appreciate what we do. They will be grateful for the effort we made on their behalf, etc. While a part of us knows that "not all patients are nice," we spend more time fantasizing about the nice ones who think we are terrific than the ones who are nasty to us, hit us, bite us, kick us, swear at us, judge us harshly, etc.

In short ... we envision being recognized as "angels of mercy" more than we envision ourselves in the more negative positions that nurses often find themselves in. That's part of what "reality shock" is all about -- finding out that our fantasies were just that -- fantasies. In real life, we have to deal with the not-so-nice aspects of being a nurse, too. One of those not-so-nice aspects of nursing is that some of the patients don't like us and/or view us in a positive light.

Learning to "do your best and then move on" is hard sometimes ... but that's the best you can do in this situation. I'm glad to read you are feeling a little better about it this morning.

It's good that you care -- but you proabably can't do anything more with this particular patient. You're probably going to have to just move on and let it go.

[RNpatterson]

I am happy to say that I can look back on this post and laugh. I did nothing wrong so nothing more ever came of this, except an aversion to shots. But there's a humorous story to go along with it:

My nurse and I discharged a patient who was in need of her insulin shot before a long ride home. I prepped the injection and was chatting with the patient while waiting for my nurse to meet me in the room so I could give the shot. During this time, I confided in this patient that I was terrified of giving shots and was determined to give as many as possible until I overcame my silly fear. (this is about the time my nurse walked in). She said she'd been a diabetic for over 20 years and that I was welcome to poke all I needed.

I went to the computer to pull up the patient's information and I heard her chuckle about something with my nurse. I didn't hear what was said so I blew it off. The patient asked me to give her shot in her arm and as I did, she let out a blood-curdling scream that made me jump and I instantly got a familiar sinking feeling in the pit of my stomach. I thought "oh great. I can't even give a damned insulin shot to an experienced diabetic without hurting them. I HATE THIS!" As I was completing this thought feeling myself go pale, the patient and the nurse started cracking up!

I was then informed that this patient had a cyst removed years ago and no longer has feeling in the back of that arm. I went from pale to red instantly. I felt like a schmuck but happily laughed along with them. With subsequent injections I realized that this patient successfully scared my aversion away. I think of her every time I give a shot and I smile inside.

[nursel56]

musician's wife -- thanks for returning to update the story! I wish more people would do that, and the lady who set up the "scream" episode sounds like a gem. When I have encounters like that - I never forget that little extra bit of kindness they showed. It helps on those days when "everything seems to go wrong". Thanks again. :)

[llg, PhD, RN]

I agree. Thanks for the up-date. It's a great story ... and it's always nice to read about a happy ending.

[DolceVita, ADN, BSN, RN]

In my limited experience how we present ourselves to our patients seems to make a huge difference. If we are calm and professional it seems to instill greater ease with them. So, even if I was petrified of something I would not share it with a patient. Also, I think it more important to understand the patient's fears/concerns than for them to know about mine.

I had a real nurse pull that screaming thing on me once. We did an employee flu shot clinic for a local hospital. One woman asked if I would be doing my clinicals there and I said yes. She shared that she was a nurse on the unit I would be working on. When I went to poke her she screamed like a banshee. I nearly pulled the needle out! Then she started laughing so hard she had tears in her eyes. She was doing a little bit of hazing prior to my working on her floor. I don't think my instructor thought it funny but I did.

I don't know that I really approve of doing things like that. I wouldn't do it to someone else because it would be getting a laugh at someone else's expense.

[RNpatterson]

Dolce - I would have to disagree to some extent. You're right in that how we portray ourselves to our patients makes a difference but otherwise your words seem to paint a rather black and white picture. I think a little poking fun and humor is completely warranted and fun if the situation is right. The same goes for sharing a fear with a patient; sometimes, such as in my case, it was very appropriate for the situation. It worked in everyone's favor. Every nurse is different, every patient is different, every situation is different.

Kudos to your nurse for having a great sense of humor (and you too) - much needed in our line of work!