Patients' perception of your demeanor.

Nurses General Nursing

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I saw this in the horrific write up thread, and it got me to thinking.

yes hospital politics is craaazzzzy, the patient is always right it seems, i sure would like for them to back the employee once in a while. my horrific write up was unbelievable. I was working on a medical floor with 3 nurses and a tech, one of the other nurses' patients expired. it was at 0600 and we were about to change shifts so we were all running and doing our morning stuff. i went home after my shift that morning. i found out a few days later by a meeting with my nuse manager that i was written up for showing no compassion to that family. someone from the family complained that the hospital staff showed no compassion that morning. this was not even my patient; i was taking care of my own as well as helping the nurse finalize things with the death then gave report and went home. i was written up for "detrimental patient care" and patient neglect. it beats all i've ever seen. the nurse who was responsible for the patient got fired. the other nurse on the floor didn't get written up, i just didn't understand it.

Here's my story. No write-up or any complaint about it, but the poster's story that I quoted reminded me of it.

I was doing my assessments, and I knew an admit was coming in. A wife of a patient was having a very hard time with her husband's diagnosis, so I spent a few minutes with her. My admit came in, and he was a very funny guy. I went back to the nurse's station to do some charting, and I whispered in my charge's ear something funny that the admit said. We both giggled. I turned around, and the wife of my first patient was standing there. She was going to leave for the night, and I said, "Thanks for letting me know you're leaving. Get some rest." She thanked me and left.

I felt weird about that incident. I was truly concerned about her and her husband, but not 45 minutes earlier, she had seen me with a completely different demeanor.

When you are dealing with patients of various acuties and families in various stages of grief, do you ever wonder if they look at you at the nurses station and think, "SHE DOESN'T CARE!" We can't let all our patients get to us--we would burn out so quickly--but do you ever feel as if you need to be an actor on a stage? I think we all went into this profession because we do care (although that's probably not the only reason), but do you ever wonder if your demeanor outside of direct interaction with a patient is misconstrued? Do you have a "work face" that is deliberately designed to project something to patient's and families to avoid any misperception?

Specializes in ER.

Thank you, you get it.

PG might be a passing fad, but we have young nurses growing up in this environment. What is their priority, the extra chairs, or the extra vitals? It's a balancing act, and if they reprimanded for not providing for the visitors' every need the patient will quickly take second place. I think this is a marketing scheme, to make more money and avoid lawsuits. The patient, once they are sick enough to be in hospital, becomes less of a priority. They are too sick- service goes to those that are concious.

I'd like emphasis from the hospital on caring about doing the job as a whole, instead of putting on the caring act. Hourly rounding- maybe, mandatory smiles and homemade cookies- jeepers.

OMG yes, i feel like an actress. I put on a show everytime i go to work. I always have. In every job I pretend I am on stage, whether the job was at a night club or on a med surg floor.

Some people want someone who is constantly smiling. If you smile too much around others they will think you aren't taking their illness seriously. it is all a guessing game as to what the patient and family wants.

Look, I'm going to be blunt.

"Patients don't care that you know until they know that you care."

Guess what...I DON'T care. Not about each individual the way their families do. I don't have time to talk the way I need to to get there, and still do the tasks. I don't have the emotional reserve to get attached to each individual patient and then probably never see them again. Even worse for me is the patients that die, or go home to less than ideal conditions. I do what I can, and I move on to the next shift. Even then, I've spent days with a headache because we had a string of horrible deaths. I don't care like family, but it still hurts. Are they asking me to invest more, feel more, worry more, until I lose my own identity? No way.

I DO care deeply about doing a good job. So you will get all the tasks done, and done correctly and on time. I'll be watching your vitals, and dogging the lab if we need the results ASAP. You will get the little things that should be done, but are often neglected in the ER (bath, toothbrush and toothpaste anyone?). I will also spend my down time updating your family about the never ending wait. I'll look for a way to make them more comfortable, if I have a second I'll make a tea/coffee run to the kitchen. If someone dies, if someone makes a stupid mistake, they are treated with respect. If I can "teach" some you of the coping skills I've learned in horrible situations I'll pass them on. If the family can't even think I will call in backup for them, or care for them too until they are able to manage.

I can tell you that all those extras look easy (it was just a cup of coffee) but to do it day after day, and keep up quality technical care takes practice and determination. I don't think our employers "get" this, and their emphasis on care over quality is only going to worsen survival rates. It's much easier to give the warm fuzzies if you let all the extra vital signs/lab checks slide. Warm blankets are nicer for me to give than forcing an extra IV line or 12 lead. If patients wanted warm fuzzies they could get them at home. I am working as an RN in a hospital...I provide lifesaving. If that's not what you signed in for, then move on.

Wow I love this post! a billion kudos!

The drain of caring about 1 person let alone 6 of them a shift is too overwhelming for them to even imagine. I care in that I go to work and do the best job that I can with what I have been given everyday.

Specializes in CVICU, Obs/Gyn, Derm, NICU.

I have learned to manipulate difficult, demanding p'ts and families a little

Some of the things I find help:

- I use 'we' a lot

eg 'We' are all concerned about the the p'ts comfort

- I use 'Mom', 'Dad', 'Grandpa' just enough .... not too much ...be careful with this one

- I use the word 'feel' frequently

eg I really want you to 'feel' better soon

You will 'feel' better when we get rid of that nausea

How are you 'feeling' on the special mattress that we got you?

Ok let's get your treatment started so 'we' can get you 'feeling' better as soon as 'we' can

Also, make sure you show empathy and establish rapport right away

eg 'I know it's a really big day for you today - let's take this one step at a time'

Make difficult family members as comfortable as you can as soon as they arrive

eg Chairs and coffee

If the p't has a single room - I can get really sucky if needed

eg ' Now this is your room - it's for you to get comfortable in - eat/drink/rest/chat blah blah blah

It's not silly getting sucky to the difficult ones

Do it right and they start getting their own chairs and drinks and being really nice to you thereafter

'Stitch in time saves nine' is a good motto re handling difficult p'ts and families

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
PG might be a passing fad, but we have young nurses growing up in this environment. What is their priority, the extra chairs, or the extra vitals? It's a balancing act, and if they reprimanded for not providing for the visitors' every need the patient will quickly take second place. I think this is a marketing scheme, to make more money and avoid lawsuits.

Unfortunately, the results of Press Gainey surveys are going to determine the amount of reimbursement that each facility receives starting next year. Therefore, under the new healthcare reform law, poor customer service scores will result in less money for hospitals.

Hospitals are in existence to provide nursing care, not sodas, chairs, and flat-screen televisions. This extreme focus on customer service scores is going to lead to more poor outcomes and patient demise. I guarantee it.

Specializes in pcu/stepdown/telemetry.

it's hard but you do have to be able to read certain people's personalities and how to adjust to them to see what they can handle. I try to be as compassionate and honest as possible. Many have unrealistic expectations about hospitalization and don't understand the RN job so I educate them.Here are some examples:

You hate that incentive spirometer, fine, but I think you'll hate pneumonia and the longer hospital stay even more. And you'll be stuck with me :)

They ask me something that the MD already discussed with them and the family. MD has no diagnosis yet. So they ask me a million times b/c they think the MD is hiding the answer. I kindly remind them that the MD has already addressed that issue. When I have 5 different family members call for updates. I put them on hold and walk into the pt room and tell them that I am not able to speak to all of your loved ones, if I did that with every pt I would never get off the phone and I can't verify who they are so if you'd like you can designate 1 person. I then transfer the call to the pt. When they touch equipment such as iv pumps or bp machines. I ask them what are you doing?? usually the answer is I was putting it on hold cause that's what it says to do. I then educate them on the danger of touching things that they don't know how to operate and how only the rn can touch that and they could extremely harm their mom if they change the rate on her iv pump. That is why you don't touch anything when you come into a hospital and you don't shut the doors to the rooms, this is not home, I need to know what is going on and the doors have to be open no matter how loud it is in the hallway. They have even complained about the noise during codes and that they didn't get ice when they asked cause everyone was paying attention to that guy. I remind them that the current priority is life and not ice. All said politely but with the ability to get my point across. Sometimes they appreciate it and sometimes they don't. As long as you do what is right then you can live with yourself. I don't say it disrespectfully, just honestly

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