Nurse Personality

[Davey Do]

Unwillingly or not, we bring our personalities into our duties. We often provide care in a manner in accordance to who we are and what we believe.

We learn in nursing school to objectively provide quality care and document accordingly, no matter what are our own personal beliefs or feelings toward the patient or their situation. However, we all possess our own personalities and subjective belief systems and separation from these traits is not always easy.

If a patient is treatment compliant and shows appreciation for services rendered, then our duties can be performed relatively easily and can be the icing on the cake of our paychecks.

However, if a patient, as many are, treatment noncompliant, demanding, and responds negatively in other ways in our attempts to provide quality care, then our duties are quite the chore to perform.

Our personalities and belief systems can be an adjunct or hinderance in performing our duties in difficult situations. If we become, like the difficult patient, forward and demanding, chances areall will not bode well. All patients are victims and we can easily be interpreted by them as being the perpetrator.

We are all actors in this thing we call life. Every patient playing the victim needs a perpetrator, because it always makes us feel better if we have someone to blame for our poor station or lot in life. With some patients, and a lot of people in general, we are always going to be battling or hitting a brick wall, no matter in which manner we play the part.

What is the rationale for this aberrant behavior and how is it best approached?

Well, I've got my ideas, and wish not to give a dissertation but begin a discussion.

Do you have any ideas for the rationale for which difficult patients act?

Have you used your personality and/or belief system to therapeutically achieve a desired goal of quality care?

What has worked, and if you dare, what has not?

 

[VivaLasViejas, ASN, RN]

One of the most helpful things I did when I was nursing was invest quality time in the “difficult” patient at the very beginning of the shift. I’d ask them what their pain level was, what they needed, and what their goals were for the shift. Most of them appreciated the attention and went pretty easy on me for the rest of the workday. Of course, there were notable exceptions, such as the LOL who “saw” mice in her room and spent most of the shift standing up on her bed screaming at me to kill them. But it was still worth doing, even for the nasty patients or the ones with helicopter families.

[speedynurse, ADN, BSN, RN, EMT-P]

The biggest thing that I have come to understand is the need for awareness of our strengths and faults of our own personalities.

It’s very easy to claim being the “victim” even as a nurse....claiming someone is “grumpy” because they are quiet, or someone is “annoying” because they are talkative, or someone is “slow” when they are grieving or don’t feel well. 

It’s very easy to pass blame and much harder to try to balance that instead and put things in perspective. Maybe what someone says is offensive only by perception or by certain personalities.....it’s very easy to put someone down as being uncooperative or  difficult instead of realizing that maybe you are feeling threatened by that nurse...by understanding that *maybe* that nurse is more skilled at a certain job aspect. I have seen this last happen between charge nurses or even nurses and managers.

In other words, there are always two sides to everything and it’s very important to be aware of ourselves.....same with patients.

It’s extremely easy to judge......much harder to have a sense of awareness. 

As for patients, I think some of the same issues may run hand in hand. I do think there are unreasonable patients. I think there are also misunderstood patients. There are patients that are angry at life and at healthcare and have no support and take that out on us. I do think personality can play a role in nurse patient interactions as well. As an example, a quieter nurse may be really comforting and soothing to a patient in pain - often loud noises, bright lights, etc are very overwhelming to someone already under a lot of physical stress. On the other hand, a patient with a more manipulative personality may prey on that and may need a nurse with a louder personality. 

Hopefully some of this makes sense...it’s been a long shift ?

[Davey Do]

39 minutes ago, VivaLasViejas said:

One of the most helpful things I did when I was nursing was invest quality time in the “difficult” patient at the very beginning of the shift. 

EXCELLENT maneuver, Marla!

Investing time with difficult patients from the get go is akin to an ounce of prevention that will later cost us a pound of cure!

We need to follow the philosophy of world wide wrestling and give them what they want!

For the delusional patients, we need not to feed into their delusion, but instead, support their perspective on reality.

Like the delusional patient who, in dismay, informed me that she had "to go to Hell tonight with Satan".

I told her that I get her one of these cards:

 

[Davey Do]

38 minutes ago, speedynurse said:

The biggest thing that I have come to understand is the need for awareness of our strengths and faults of our own personalities.

It’s very easy to pass blame and much harder to try to balance that instead and put things in perspective. 
 

In other words, there are always two sides to everything and it’s very important to be aware of ourselves.....same with patients.

It’s extremely easy to judge......much harder to have a sense of awareness. 

Hopefully some of this makes sense...it’s been a long shift

Your entire post, once again, Speedy, was a great read. I made a shortened version of it to shine the gems of wisdom. So your post not only makes sense, it is one of a higher consciousness which I truly enjoyed reading.

 

 

As I was waiting for responses to this thread, I was thinking about methods to calm an irate patient. The hilarious scene from the movie Airplane! popped into my head, where the upset passenger is lucrudiously attempting to be calmed by the flight attendant, doctor, and others waiting in line.

Have you ever experienced such a situation?

 

 

[JBMmom, MSN, NP]

I figure to some extent anyone that has to see me at work is having an awful day. I don't give a pass for all manners and civility, but I have much lower expectations for rationality and congeniality in critical care patients than I do for the general population.

I try to use humor for the most part to break the ice, throw in some education, and maybe even give some serious advice or information in between smiles. SO many people in our unit are there for noncompliance issues, alcoholism, drug overdoses, COPD patients that continue to smoke, noncompliant dialysis patients in hypertensive crisis, diabetic patients that flout dietary restrictions, you name it. But preaching in their current state is ineffective and inappropriate.

As you pointed out, coming in the room with a "you will", "you have to" etc., attitude, is just setting everyone up for a shift full of conflict and no therapeutic relationship. I try to give choices when possible, with the caveat that there are some things that just need to be done. (I AM going to brush your teeth at midnight and 4 am, especially if on a ventilator)

I try my best to remain respectful and forthright with my patients. I go through every shift as if someone is always watching our interactions, because someone probably is. 

[Davey Do]

4 minutes ago, JBMmom said:

As you pointed out, coming in the room with a "you will", "you have to" etc., attitude, is just setting everyone up for a shift full of conflict and no therapeutic relationship.

YES, JBMmom!

Certain words can come across as aggressive orders! Instead of "should", we can use "need to". Or something as simple as "you" can be interpreted as a lone direction when "let's" implies to do something together.

 

9 minutes ago, JBMmom said:

I go through every shift as if someone is always watching our interactions, because someone probably is. 

As my brother in arms Rooty Payne says...

 

[mmc51264, BSN, MSN, RN]

I treat adult patients so I don't speak to them as if they are children. Most pts I can create some rapport with. I pick and choose my battles with pts. (refusing a laxative versus refusing Lovenox). I do not tolerate aggressive behavior. 

As a parent of 2 type 1 diabetic kids, I am a string advocate for compliance with diabetic patients (I myself and a well controlled T2). 

I am very sympathetic to our geriatric population as they have few visitors (thank you Covid). I have a harder time with co-workers than I do with patients as I feel many of them do not see people. ?

 

[Hannahbanana, BSN, MSN]

I am concerned with how nursing and medicine persist in using the word “compliance,” as if the patients are at the bottom of some chain of command and must comply with orders. 

1) We are not in the army (well, OK, some of us are, but ... ) The military model in force when nursing got more formalized during the Crimea and the US Civil War is well-past its freshness date. Physicians are not superior officers; patients are not enlisted men; nurses are not part of a military structure of caregiving. We do not “take / follow orders,” we are now coequal colleagues in care with different strengths and legal obligations. 
2) We now recognize our patients as autonomous agents, partners in their own healthcare. We also now recognize their legal authority to refuse any part of a nursing plan of care, medical plan of care, therapy plan of care, or any other action. 

Therefore the growing movement to eliminate the word “orders” from all aspects of care. We have prescribers, not superior officers. We have plans of care from many disciplines, some (but not all) parts of which nurses are legally obligated to implement, some implemented by other professionals, and all are offered to the center of our care world, the patient. 

The patient doesn’t have to take orders or comply with them. They always have the right to choose. We would be doing them a service if we sought to explore why a patient doesn’t adhere to a treatment plan. Not because he’s being defiant in refusing to comply, but because he made that choice not to follow recommendations, or perhaps could not. Asking why might disclose something we could help assist with. 

Words matter. They can change perceptions. Think on that. 

[Davey Do]

13 hours ago, mmc51264 said:

I treat adult patients so I don't speak to them as if they are children.

This line caused me to recall a situation when I was a patient back in '76, mmc.

I was a 19 year old involved in an MVA, suffering from multiple fractures, internal injuries, assorted other injuries, including a closed head injury. I regained consciousness after three weeks, got my trach out and was transferred from ICU to ortho.

Soon after, early one morning, this pretty little nurse came beebooping into my room, and as if speaking to a child, asked....

 

[UrbanHealthRN, BSN, RN]

41 minutes ago, Davey Do said:

This line caused me to recall a situation when I was a patient back in '76, mmc.

I was a 19 year old involved in an MVA, suffering from multiple fractures, internal injuries, assorted other injuries, including a closed head injury. I regained consciousness after three weeks, got my trach out and was transferred from ICU to ortho.

Soon after, early one morning, this pretty little nurse came beebooping into my room, and as if speaking to a child, asked....

 

Sounds like that nurse didn't do a good job of, ahem, reading the room. 

Some days it's easy- my personality just clicks with the patient in front of me, and we work on treatment goals like we're planning what to bring to a potluck. Other days, the patient I'm meeting with is on a very different page, heck maybe even book. And that's when I've really got to be mindful of how I'm presenting myself so that the patient can get the best care from me. Nursing has brought out sides of my personality that I never knew were there, and it's really helped me to grow as a person because of it!

[Davey Do]

8 minutes ago, UrbanHealthRN said:

Sounds like that nurse didn't do a good job of, ahem, reading the room.

UrbanHealthRN, this is my response upon reading the opening line to your post:

 

10 minutes ago, UrbanHealthRN said:

Some days it's easy- my personality just clicks with the patient in front of me, and we work on treatment goals like we're planning what to bring to a potluck. Other days, the patient I'm meeting with is on a very different page, heck maybe even book. And that's when I've really got to be mindful of how I'm presenting myself so that the patient can get the best care from me. Nursing has brought out sides of my personality that I never knew were there, and it's really helped me to grow as a person because of it!

Your entire post was a calming joy to read! You, UrbanHealthRN, not only have a clue to therapeutically use your personality in your profession, you have won the game!

You are Col. Mustard in the library with the candlestick!

"Nursing has brought out sides of my personality that I never knew were there, and it's really helped me to grow as a person because of it" is quite a statement! It says to me that you have not only learned to talk the talk, walk the walk, but also gracefully dance with your patient partners!

Let's boogie!