Perception is reality (Long)

[abbaking]

I just had my Ah Ha! Moment. Bear with me as i try to explain my idea.

Having read the posts on here and attended numerous staff meetings, I can now safely say that hospital nursing is all about perception. And for patients and visitors, their perception equals reality.

Take for example the post discharge survey. A list of vauge and misworded questions all at the aim of constant preformance improvement. "Was your pain needs addressed in a timely manner?"

Now here is the big problem. If a patient is in pain (and I have been one) but they are not due for another dose of pain meds, then we get burnt for not providing good customer service. What people (patients, contract people {press-Gayney}, and some upper managers) often fail to realize is the medical implications and the desperate attempts the nurse has made to make the patient more comfotable. The patient thinks we are being mean and withholding meds.....they dont see us paging the resident, paging anesthesia, paging pain management, arguing with the doctor, looking up vitals, doing assessments, fighting with the pharmacy, and so on. So, in the patients eye of course we are bad because we didnt give them the shot in a timely manner.

Someone said something on here to the likes of walking around and staying physically busy. Many people seem to think that nurses just come into to work, sit on the computer, or read, or gossip and check the patient a few times and give pills.

Those of us who work know its a different story. Sitting at the desk charting is not a pleasure cruise....I HATE charting. But then comes the patients percetion. "Well your just sitting there not DOING anything"

There is no easy solution to this one. If i am constantly running around (as i usually am the first 4 hours), then i am perceived as being either manic or diligent, but if i sit i am being lazy.

Now is my biggest peeve. Attitude and smiling. We all have been told the same line of crap - smile and the patient feels less X, Y, and Z. Your attitude is a direct reflection of the hospital and you must show a positive attitude all the time. I am in agreement that we as healthcare professionals should make a good first impression and be nice, have geneuine empathy and have compassion BUT management and the public takes this to a whole other level. Many people expect us to burst into a patients room with boudless energy, smile, dance and save the world. People also seem to think that if we don't always have a smile or a good "energy" that we must be the worst of the worst. I am not sure where these idea come from but I am sure that I am not going to go room to room with a Miss America phony smile, sing songs and be all sunshine and rainbows. I work in Oncology - the pits of fear, terror and depression. But for some reason, the powers that be (weather patients or management) seems to think that if a nurse does not smile then they are unprofessional. "He was mad at me. he was rude to me beacuse he didnt smile when he woke me up at 4am to give me my meds".

In closing, Perception Is Reality. Just when you think it cant get any worse, it always does. Many times it feels like a double edged sword. Thankfully, my hospital management realizes that I am a nurse. I am NOT an angel of God. As long as i get my job done and people are nice to me, its all fine.

[Thujone]

I feel ya, I am not the smiling type either. People always tell me to smile, but I would rather not because I don't feeling like walking around looking like a jackass with a fake smile on his face.

[imintrouble, BSN, RN]

If perception is reality, and I think it is, then the reality is we promote the idea that NOTHING is more important than the needs and wants of the pt.

They only have to ask and it will be done. And they won't have to wait.

Nurses are provided to serve.....with a smile.

If that is not the case, then surveys are conveniently provided to allow the pt to vent. And make someone pay.

When it comes to angry pts, most of the time it's because they have been made to believe a reality that doesn't exist.

[Tait, MSN, RN]

I really do not understand the constant fuss and blunder over customer service. I have never felt burdened by treating my patients as I would want to be treated.

Overall most people want to feel someone is looking out for them, cares that they exist, and understand that they are scared. Most people are not out to get you on Press Ganey surveys or letters to your manager.

As far as patients not "seeing" us page docs/PA's etc TELL THEM. I always try to keep my patients abreast of my actions. I come back on my rounds a few minutes after I put out a page and let them know that I have paged for the 12th time, or that I have an order for another dose of Dilaudid and I am waiting for Pharmacy to put it in. Popping my head in the door takes 30 seconds as I walk by and gains me hours of patient patience. I never let my patients think I am not holding up my end of the bargain. I let them know where the kink in the system is and how long I think it is going to take me to fix it.

The first rule of nursing shouldn't be "keep a smile on" it should be "put yourself in their shoes".

[Ruby Vee, BSN]

you're singing my song there, abbaking.

tait -- you may be one of those people with a naturally perky personality. you don't get the customer service fuss and bother because you're one of those people that the patients want you to be. if you're not naturally perky or warm and fuzzy; if you're one of those people who is cool and calm rather than sweetness and light, you're going to get dinged on customer service even if you put yourself in the customer's shoes and treat them exactly as you'd want to be treated. because they don't want to be treated calmly and professionally by someone who is cool and calm and competent; they want warm and fuzzy and (if they really get it) competent.

yes, patients want someone who they feel is looking out for them and is aware that they are scared, thirsty, in pain, whatever. but they want someone who expresses those things in the way that they want them expressed. and most of them, no matter what they might say they want or even believe they want, want someone who is perky or warm and fuzzy. more than that, they want real perky because most people can spot fakiness a mile away. if you're not really perky or not naturally of the brow stroking persuasion, patients will claim that you're mean to them, that you don't like them or that you're a horrible nurse no matter what your knowledge base, skill level or degree of politeness and professionalism.

the first rule of nursing seems to be "big, happy smile" because anything short of that isn't enough for some folks. "put yourself in their shoes" only works if you express feelings the way they're happy with. and no matter how much some of us might wish it otherwise, perky smiles and warm fuzzies trump cool, calm and competent most of the time.

[Thujone]

Preach it, Ruby

[Tait, MSN, RN]

you're singing my song there, abbaking.

tait -- you may be one of those people with a naturally perky personality. you don't get the customer service fuss and bother because you're one of those people that the patients want you to be. if you're not naturally perky or warm and fuzzy; if you're one of those people who is cool and calm rather than sweetness and light, you're going to get dinged on customer service even if you put yourself in the customer's shoes and treat them exactly as you'd want to be treated. because they don't want to be treated calmly and professionally by someone who is cool and calm and competent; they want warm and fuzzy and (if they really get it) competent.

yes, patients want someone who they feel is looking out for them and is aware that they are scared, thirsty, in pain, whatever. but they want someone who expresses those things in the way that they want them expressed. and most of them, no matter what they might say they want or even believe they want, want someone who is perky or warm and fuzzy. more than that, they want real perky because most people can spot fakiness a mile away. if you're not really perky or not naturally of the brow stroking persuasion, patients will claim that you're mean to them, that you don't like them or that you're a horrible nurse no matter what your knowledge base, skill level or degree of politeness and professionalism.

the first rule of nursing seems to be "big, happy smile" because anything short of that isn't enough for some folks. "put yourself in their shoes" only works if you express feelings the way they're happy with. and no matter how much some of us might wish it otherwise, perky smiles and warm fuzzies trump cool, calm and competent most of the time.

i have never once in my life been described as "perky" lol. per my customer comment cards i am:

professional-3/4/2011

always on the spot-5/6/2011

prompt-3/7/2011

dedicated-1/7/2011

efficient-9/14/2010

humanitarian-9/15/2010

empathetic-3/3/2010

competent-3/20/2009

supportive-7/31/2008

patient oriented-1/24/2008

diligent-11/24/2007

in my last four and a half years of nursing i have never been told i was perky, sweet, smiley, or sunny (to name a few of the apparently taboo ways to be in nursing). i have a very dry sense of humor and matter of fact personality. i tell it like it is, but i do it respectfully. so i guess i am an anomaly in the "cool and calm" category which personally i am fine with.

[martymoose, BSN, RN]

hmm, i dont see customer service oriented on any of those cards.or good pillow fluffer. or good chair go- getter. or good waitress attending to the needs of the 8 family members crammed so far into the room that I cant even touch the patient.

This is coming. It's the pay for service. key word- service.not competence, not knowledge, not foresight into a pt heading towards a crash. As some else quoted, we won't be mentioned on the surveys for saving their life, we'll be remembered for bringing chairs to the family members and providing beverages and blankets promptly.

[Tait, MSN, RN]

hmm, i dont see customer service oriented on any of those cards.or good pillow fluffer. or good chair go- getter. or good waitress attending to the needs of the 8 family members crammed so far into the room that I cant even touch the patient.

This is coming. It's the pay for service. key word- service.not competence, not knowledge, not foresight into a pt heading towards a crash. As some else quoted, we won't be mentioned on the surveys for saving their life, we'll be remembered for bringing chairs to the family members and providing beverages and blankets promptly.

On a side note I was a pretty fantastic waitress in my day.

[canesdukegirl, BSN, RN]

C'mon y'all! This is the era of McMedicine! Drive thru style!

[Tait, MSN, RN]

C'mon y'all! This is the era of McMedicine! Drive thru style!

Mmmmm McDilaudid with a side of McPhenergan and a tall frosty McGICocktail!

[dudette10, MSN, RN]

I really do not understand the constant fuss and blunder over customer service. I have never felt burdened by treating my patients as I would want to be treated.

Overall most people want to feel someone is looking out for them, cares that they exist, and understand that they are scared. Most people are not out to get you on Press Ganey surveys or letters to your manager.

I think you're right about most people. Unfortunately, all it takes is one person to tarnish your reputation, if you've even been there long enough to create a reputation.

I wrote a thread here not too long ago about a patient that turned on me. Didn't see it coming at all. What I didn't mention in that thread was that I got called out on it by my manager.

Since that time, I have been asked by my co-workers to deal with three particular patients who were very difficult and driving the other nurses crazy. I'm actually good at it. The patients calmed down, became more compliant with cares, laid off the call bells a little. I even had an experienced nurse say to me, "You have a lot more patience than I do!" I didn't get a pat on my back from the manager for that because he does not know and will never know about it.

I, too, believe in treating patients the way you want to be treated. In fact, I'm not too upset by the idea of customer service in healthcare. I actually enjoy making my patients comfortable, spending time with them when I can, keeping them abreast of what's going on with their plan of care, providing them the little comforts that can make a big difference in their perception of care. Interacting with patients is the reason I wanted to become a nurse!

However, getting called out isn't fun, especially when you know that the patient's perception was just a wee bit off. I think that's what this thread is about--what they feel becomes real, even if it's not.

I hate sounding jaded only four months into my career, but being called out so early on when other events have shown that I can effectively deal with difficult patients is...disturbing.

ETA: Just for clarification. The complaints are handled with a serious meeting in a closed-door office. The kudos and the cards from patients thanking us for the work we do...stuck on the dirty old bulletin board in the corner of the nurse's station right next to the notice to get our flu vaccinations and reminders of hand washing from infection control. Without a word spoken. Maybe that's my issue.