Fired By My Patients - page 2

Dear Nurse Beth, I am 58 and a new 2-Yr. RN, I am a soft spoken, rule following, dutiful person & RN. I always inquire about my patients stay in the hospital but tend not to pry beyond that. I... Read More

  1. by   Pepsimx5
    Hi Nurse Beth,

    First, I would like to say, there is not a nurse in practice who hasn't been "fired" once or twice. Don't stress too much over it, or take it too personally. Sometimes patient/nurse chemistry just doesn't mix, and EVERY patient isn't going to like you.
    You say that "most often" you get positive feedback from your patient base, but then say you are "frequently dismissed from patient care by patient request." It seems to me that both of these things cannot be correct. So to you, how frequent is frequent? If this is happening once or twice a year, I wouldn't worry, but if it is happening on a weekly basis, there might be a problem on your end.
    I think everyone has given you really good feedback. If you're close enough to a co-worker to ask what's up, I would. Or if this has already gone to the supervisor, look for feedback there.
    I think both Kooky Korky (#10) and pmabraham, ADN, RN (#11) gave you great advice.
    Patients want a personal touch, that's why nurses have not been replaced by machines, make a connection, make them feel they can trust you and that you can relate to them. Go a little out of your comfort zone, and beyond their hospital stay, let them know you want to know who they are, and not just a diagnosis in a bed.
    The most important thing is that you care about this and as long as you strive to improve, you will do fine.
    Good luck!
  2. by   psychenurse
    Maybe you can ask a fellow nurse to stand outside the door out of sight of the patient and then give you feedback.
  3. by   Jeskoto
    I was thinking the same thing. Maybe it's your body language or tone of voice, or some other non verbal cues. For example, maybe the way you're acting is coming off as you are not comfortable or not competent, or not very approachable. Also, you have to act confident in everything you do, because if you're not, that might make the pt think that you don't really know what you're doing and make them nervous and dismiss you. P.S. also try to build a relationship with them and show them that you care. You said that you don't try to pry beyond the basics, but from my experience, most patients really enjoy talking about themselves.
  4. by   operations
    Quote from Kooky Korky
    Sometimes quiet people are perceived as snobbish. Inside you are probably humble and courteous, but, depending on their own history, mindset, life experiences, they might see you as something completely different than what you really are.

    Make 'em laugh, make 'em laugh, all the world loves a clown, make 'em laugh. From
    "Singing In The Rain". Great movie - Doris Day, Gene Kelly, and Donald O'Connor. Great music and dancing, great philosophy. So try some humor, is the point.

    Try being a little more talkative, ask about their hospital stay, remark on their kids, pets, whatever. If you see lovely plants or evidence of a hobby - collector of thimbles, a train set up, crochet in the works, whatever - strike up a conversation about that.

    Take a couple of conversation pieces to the job. "Here's a picture of my baby" (your dog, your bird, your car or kids, whatever). "Do you like crossword puzzles"? "Do you feel like building this jigsaw puzzle"? (make it just a few pieces, not 500 or 1000).

    And your supervisor really needs to be frank with you about the reasons for patients not taking to you much. She or he is probably hoping you will bring up this topic. So let the Sup know that you are puzzled and worried and want to get to the bottom of the matter, so ask her to please be upfront with you and help you learn how to make things better.

    Best wishes.
    I agree that some nurses come off snobbish. And if they don't care that they do, it's a serious problem. I truly believe you cannot be a nurse and not make empathy a priority. Because if you only do the tasks and provide care, even if you are the best critical thinker, you are only helping one aspect of health. The physical. The other aspects of health, like emotional needs, greatly suffer from an unempathetic approach.

    However, I believe wanting to learn empathy means something. No one is skilled with empathy equally, and some cannot be empathetic in certain situations as others. This is congruent with the statement regarding life experience that you mentioned. Empathy can be developed with practice and education.
  5. by   NurseAlhara

    I am not a frequent poster. In fact, I don't know that I have ever responded to a thread up til now, even though I read a lot here. But something in your message struck a chord with me. (I read it, and the comments, went on to do something else, and kept thinking about it afterward.)

    There was one part of your letter that no one addressed. What does "rule following" mean, exactly, and why is it a relevant point?

    I agree with everything the other posters have said in terms of not over-worrying about it, checking with others for useful insights, and perhaps looking at how you are coming across to the patients. However, the way that one can be "rule following" can come across as uncaring about the patient's needs and/or wishes. I will give you some examples.

    An NPO patient that has a surgery scheduled (but you don't know what time it is going to be, or, worse yet, you know it's not going to be before noon) and has IV fluids, but complains of being thirsty. IV fluids keep a person hydrated, but they do not relieve the sensation of thirst. Critical thinking is necessary here. Why do we keep patients NPO for procedures requiring anesthesia? We do it to prevent aspiration. We need the stomach empty so that when they are anesthetized, the stomach contents do not come up and then get into the lungs. Ice chips are useful (up to about 2 hours prior to the procedure) to relieve thirst because the small amount of water is absorbed almost immediately. But telling a patient an unequivocal "no" will only make the patient think that you do not care about his issue.

    In the same vein, I have had several situations when post-op patients are NPO because the doctor is afraid of nausea or vomiting. When, by post-op day 1, the patient is still NPO, I often question the doctor and am told they can have water, but no meals. In other words, they do not always realize that we keep the patient completely NPO until they tell us otherwise.

    In other situations, such as pain medications, it is usually useful to explain *why* an order is the way it is. A patient who came in with altered mental status is not going to be given narcotics for their chronic pain because the doctors do not want to have neuro symptoms masked by medications. They need to know what is causing the drowsiness and confusion. But I always offer to ask the doctor about getting an additional pain med order. This lets the patient know that I am still advocating for them, even if I tell them that there is not much hope of them getting what they want.

    Little things like that, which sometimes means more work for me, can make a big difference when needing to tell the patient they cannot have what they want. I can think of many more examples, but I think you get the picture.

    If I am barking up the wrong tree, then I apologize, but it might be the missing link you are looking for.

    I hope this helps.
  6. by   smartnurse1982
    I hate to say this,but maybe you do not smile enough?

    I think nowadays anything less than a smile is perceived as "mean" or "sad"

    Many patients expect nurses to be cheerful and happy all the time,even though that is unrealistic.
  7. by   Daisy4RN
    Not sure what you mean by "frequent". Maybe what you think is frequent is just the normal amount of patients firing their nurse. Either way, I would consider what some of the others have posted and look at the way you are being perceived by your patients. But just remember that this happens to all nurses, as par for the course, and these days with the push toward customer service people (patients) will try to get away with what ever they can so they want the nurse that will give them exactly what they want.
  8. by   canyonforest
    Congratulations on achieving your RN, that is a real milestone I think
    In reading your post it can hurt to be dismissed by a patient; one thought came to my mind and I do not know if this applies to your situation or not..."people don't care how much you know, they just want to know that you care"

    In my personal situations, i have found that sharing some aspects of myself seems to break the ice. I once took care of a lady and things were going rough until I showed her a picture of my cat (he was a kitten at the time) Mikey...from there it was smooth sailing

    Good Luck to you as i am sure you are a wonderful nurse, otherwise you would not be a nurse!!!
  9. by   canyonforest
    I think smiles are important, and when nurses are under stress its not easy to smile, but it can make a huge difference, I have found...a smile conveys that the other person is important and worthy, and these are traits that many can appreciate....
  10. by   Natesmom98
    Hello everyone! I don't post much here either but I do agree with NurseAlhara. Sometimes " rule following " keeps a person so hyper focused on those things that the critical thinking part gets missed. It might come off as cold although we know that is not your intent. I work with someone like that. She is a wonderful person and dedicated nurse but she gets so caught up in following rules that she forgets about the patient as a whole. People do not always remember what you do for them..they remember how you make them feel. Best thing I ever learned from one of my nursing instructors was about building rapport with the patient and family. It really makes a difference. You obviously care and want to learn from this. Take these things into with your peers and manager...being aware is the first step!
  11. by   jaderook01
    A lot of people have sussed out multiple potential reasons for why you're being fired by patients- even though many give you good feedback. I especially think the advice that you may not realize how standoffish you come across may be a contributing factor. However, I also think some folks come off as outright timid and scared, which can alarm patients and their families. They may think you are very new and don't know what you're doing. If you don't seem confident it will show.
  12. by   Elaken
    I have had a few moments were I am pretty sure I would have ended up fired if I hadn't said I didn't want a patient back because we just weren't working well together. But so far in my little over 2 years I have yet to be fired.

    And to be honest I don't really care about people. I don't have interest in their lives. I am empathetic with their situation and know how sucky being in a hospital is for them. But, literally, if I never had to talk to my patients outside of explaining meds/procedures/plan of care I would be thrilled. And yet I am one of the most frequently complimented people in float pool.

    I smile. A lot (I have a resting pissed off expression so this helps balance that). I communicate a TON. I will tell a patient hey, I paged the doctor I will let you know what I hear. I will then go back 20 minutes later to say "I haven't heard back so I paged again." Any snippet of info I know I pass on even if just a small thing. I think that is huge for people. I might not care about their lives but if they say something I almost always ask a follow up question.
  13. by   PeacenJoy
    Let me give you some advice that has worked for me: overwhelm them with your knowledge.

    When a patient looks uncomfortable with me due to something or other, I overwhelm them with knowledge. When they ask a simple question, I answer in such detail they tune me out. When I watch their eyes glaze over, I know my work is done. From then on, they know that I know what I'm doing and they relax.

    For example, I'm giving you Metoprolol because it's a beta blocker that reduces the workload of your heart. Because of your congestive heart failure, we want minimize the impact on your heart. So it also decreases your blood pressure and slows down your heart rate so that we can prevent arrhythmias. It increases the ejection fraction of the left ventricle so that we can maintain cardiac output so it can pump blood to the rest of your body.

    I'm drawing your blood because we want to test for troponin, an enzyme released into the blood when some of the heart muscle dies. It dies when it's not getting enough blood flow, usually caused by accumulation of plaque in the arteries. We can sometimes treat it by opening up the arteries and restoring blood flow through catheterization.

    Do you have any more questions?

    Believe me, they never do.

    The bad part is that you will have to memorize this on every medication and procedure you do. However, the patients will relax and understand that they are in great hands.

    Good luck.