"You are an angel!"

Altra, BSN, RN · Aug 13, 2011

Clinically astute physicians are usually recognized as such by their patients, even when they exude a brusque manner or have suboptimal communication and/or interpersonal skills. But it is often the case that a nurse that "fails" to meet needs up at the top of the Maslow iceberg is deemed "uncaring" or "just doing the tasks".

I was encouraged by this recent article noting the disconnect between patient perceptions and actual medical outcomes: https://allnurses.com/nursing-news/medicare-data-can-601841.html

" ... Patients fill Maimonides Medical Center in Brooklyn every day, but that doesn't mean they like it.

One in five complain that their rooms are "sometimes" or "never" clean, that help may be late in coming and that the nightly commotion makes it hard to sleep. Fewer than half give Maimonides high scores for patient satisfaction. Just over half say they would recommend it to others, lower than the 67% average for hospitals nationwide.

Yet, by measures that arguably matter more — what percentage of patients survive killer conditions, such as heart attacks, heart failure and pneumonia — Maimonides ranks among the best hospitals in the USA….

… Hospital officials say they can't help but be upset by the patient dissatisfaction numbers.

"We wouldn't be human if we weren't disheartened by them," says Sheila Namm, Maimonides' senior vice president of professional affairs.

There's a flip side to the perception gap, as well. A USA TODAY analysis of the Medicare data found that more than 120 hospitals well-liked by patients have death rates for heart attacks, heart failure or pneumonia that are signficantly worse than the national average. In each case, the hospitals were recommended by two-thirds of their patients or received patient satisfaction scores of 9 or 10 on a 10-point scale.

Yale cardiologist Harlan Krumholz, who helped fine-tune Medicare's approach so that the hospitals are rated fairly, says

personal experience can only tell so much about the quality of medical care

... "

(the bolding is my own emphasis)

I once went into a patient's room where an additional family member had just arrived. The new family member had questions about the patient's condition and treatment, which I answered at length after introducing myself. The family member said, "thank you so much for your time, Doctor." (my ID badge was prominently displayed, and was not flipped backwards) I gently reminded the family member that I was Altra, the patient's nurse. There was confusion on her face as she said, "Oh. But you have a stethoscope ..."

She was not overbearing or otherwise difficult, our conversation ended pleasantly, and I did not feel resentment toward her. But it was telling that she, a youngish, professional-looking woman with a vocabulary that indicated advanced education had no clue that a nurse would have a need for a stethoscope, or have knowledge of and participation in medical treatment.

The underlying attitude or perception that nurses simply comfort ... but are not involved in actual clinical outcomes ... I resent that very much.

Anna Flaxis, BSN, RN · Aug 13, 2011

Funny, I actually found the article discouraging, albeit interesting! Thanks for posting it.

talaxandra · Oct 30, 2011

I'm very good at my job - I time manage well, I can teach effectively (students on placement, less experienced staff, patients and families), I've got great assessment skills, and I'm better than anyone on my ward at getting recalcitrant doctors to respond to pagers or review patients.

I also have an excellent eye for recognising an uncomfortable patient, and am adept at pillow readjustment. I get more thanks from patients about that than anything else. I think this is an important part of my care - a comfortable patient has less pain, is less anxious, sleeps better, and is better equipped for recovery.

And when they thank me I say "You're welcome. It doesn't take as long or need as much expertise as the other things we do to help you recover, but it's easier to see. A lot of what nurses do looks easy - like adjusting your pillows, it's really the result of education, skill, experience and aptitude. Sleep well."

My patients know I do more than fluff their pillows :)

MinnieMomRN · Oct 30, 2011

I don't think patients truly understand what's going on when they are in the hospital -- what's going on with them, or what we are doing to help. Yes, we teach, we provide anticipatory guidance, we are clinically astute in seeing small changes in their condition which because we acted upon prevented the REALLY bad sh*t from occurring, but they focus on "just make me feel better". And so that's what we get the thanks for.

The part I wish we would change is the 'Angel' perception. No there are no wings on my back -- not even rusty old ones. And no, your MD is not a 'God' who can solve/fix anything. Your MD and your nurse partner together to give you the best care possible. That's a view I hope that we nurses can deliver, because until nurses truly believe that we are important in the realm of healthcare and (this is the important part) are willing to be vocal about it, society's perception of us will continue to be that of the angel delivering care sent down from the God in his white coat on high, or perhaps worse, that of "just a nurse".

rita359 · Oct 30, 2011

It is a matter of priorities. Pt got themselves to hosp for symtoms of afib. Didn't eat. Now your priority is to treat their afib but they are hungry and the feeling just won't go away. You know how it is if you have not had something to eat in a long time. Nobody in er got them anything to eat. Now many hours later they STILL haven't had anything to eat and its been hours. So, yes they are grateful that someone knows how to treat their afib but just now they are SO grateful for the little thing to you like something to eat.

nightengalegoddess · Oct 30, 2011

Awsome Brandy! If we actually gave them the play by play during our walking rounds...they might grow to understand what it is we do. Oprah needs to do a show on what RNs REALLY do for their patients. If no one tells them......how can they possibly know? Most think the techs are the RNs anyway!!!!!! Even MY MOTHER......who talks to me weekly about what I DO........was in for knee surgery!!!!!Her star RNs "who did everything a nurse should do"..........were the ones who fluffed and tucked........and she ought to know much better!!!!!! As one frequent poster here says......"they don't care how much you know until they know how much you care"...........blessings to all!!!!!!!

SuesquatchRN, BSN, RN · Oct 30, 2011

Look at all the angel user names here and tell me. We perpetuate it.

AgentBeast, BSN, RN · Oct 30, 2011

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**NickiLaughs, ADN, BSN, RN** · Oct 31, 2011

I think most people when they feel like crap and are scared, they want to feel normal. They focus on the little things that are within their realm. The sandwich, pillows, etc. They don't understand the meds, they don't understand what's wrong, and most don't really want to know, because it brings their mortality to life. Just a thought. :)

But yeah, it is hilarious when they focus on something small, I had a guy who came in, early sepsis, and all because his son noticed his neuro changes. After some boluses, icing down for a temp over 105, etc. The guy just wanted some of his special water. He got it, but I did make a point to tell him that he should give his son some recognition, because he probably saved his life.

CompleteUnknown · Oct 31, 2011

I don't know, when I go to the doctor I don't really think about the fact that he or she is drawing on their knowledge and experience to figure out what's wrong with me, and decide on the best approach to whatever problem I'm having. I sort of expect that. However I do like it when they're pleasant, seem interested, go out of their way if necessary to get me what I need. Given two doctors with the same skill, experience and ability, I'll choose the 'nice' one over the brusque or 'cold' one every time. That's just human nature.

Nice isn't everything, but it sure goes a long way.

nurseprnRN, BSN, RN · Oct 31, 2011

i was once as sick as a dog and had to be admitted to a hospital, leaving my 3-year-old and my breastfeeding 9-month-old with their father, who i was in the process of divorcing because he was an abusive sob. the most fun was the blinding headache and my stretcher slamming into the doorframe on the way to radiology at the same time the tech is asking, "what's the diagnosis?" and the resident hollers out, "rule out subarachnoid hemorrhage!"

well, it turned out that i (only) had meningitis, but it was a damn miserable coupla days. and what do i remember about my nurses the most? the night supervisor came in, no doubt to make a courtesy call on the nurse in the bed, found me weeping, and brought me a chocolate milkshake. that was the best damn milkshake i ever had in my life, and i will always him for it.

another time i had what was supposed to be an epidural for childbirth that (oopsie!) turned out to be a high spinal, and i could not feel or move my legs for about 18 hours after they hauled her outta there with the big spoons. i was filthy and tired and gross in the morning, still immobile, and this nurse came in with a student and asked if i wanted a bath. i nearly wept with relief. she said, "would you mind if we both did it together?" and i said, hell, no, and they proceeded to give me an amazingly thorough bath, one on one side, one on the other, and changed my sheets, and brushed my hair. and told me what a beautiful baby i had. i told them they made me proud to be a nurse.

now, i suppose that a sympathetic ear and a chocolate milkshake, a good roaring bath and clean sheets (and a few kind words about the darling product of my labor) weren't high-tech nursing, and god knows i can recognize and appreciate high-tech nursing and the expertise that goes into it. i loathe house's and other tv/movie misrepresentation of nursing and support sandy summers' truthaboutnursing.com and i completely agree with the tag line, "if caring were enough, anyone could be a nurse." but by heavens, thank goodness we are more than that. if i get a kind word for being an angel, i'll take it. i may add, gently, that it was a little more than the sandwich, but i'll take it. it's what they remember. the education can come another time.

CompleteUnknown · Oct 31, 2011

i was once as sick as a dog and had to be admitted to a hospital, leaving my 3-year-old and my breastfeeding 9-month-old with their father, who i was in the process of divorcing because he was an abusive sob. the most fun was the blinding headache and my stretcher slamming into the doorframe on the way to radiology at the same time the tech is asking, "what's the diagnosis?" and the resident hollers out, "rule out subarachnoid hemorrhage!"
well, it turned out that i (only) had meningitis, but it was a damn miserable coupla days. and what do i remember about my nurses the most? the night supervisor came in, no doubt to make a courtesy call on the nurse in the bed, found me weeping, and brought me a chocolate milkshake. that was the best damn milkshake i ever had in my life, and i will always him for it.
another time i had what was supposed to be an epidural for childbirth that (oopsie!) turned out to be a high spinal, and i could not feel or move my legs for about 18 hours after they hauled her outta there with the big spoons. i was filthy and tired and gross in the morning, still immobile, and this nurse came in with a student and asked if i wanted a bath. i nearly wept with relief. she said, "would you mind if we both did it together?" and i said, hell, no, and they proceeded to give me an amazingly thorough bath, one on one side, one on the other, and changed my sheets, and brushed my hair. and told me what a beautiful baby i had. i told them they made me proud to be a nurse.
now, i suppose that a sympathetic ear and a chocolate milkshake, a good roaring bath and clean sheets (and a few kind words about the darling product of my labor) weren't high-tech nursing, and god knows i can recognize and appreciate high-tech nursing and the expertise that goes into it. i loathe house's and other tv/movie misrepresentation of nursing and support sandy summers' truthaboutnursing.com and i completely agree with the tag line, "if caring were enough, anyone could be a nurse." but by heavens, thank goodness we are more than that. if i get a kind word for being an angel, i'll take it. i may add, gently, that it was a little more than the sandwich, but i'll take it. it's what they remember. the education can come another time.

love this post grntea, i think it says it all.

keeping the patients alive and safe will always be first on the list, but what i find sad is that i'm seeing increasing numbers of nurses who think a ''good roaring bath and clean sheets' are not a part of nursing at all.