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When Nurses Say the Wrong Thing: 4 Ways to Improve

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jeastridge has 36 years experience as a BSN, RN and specializes in Faith Community Nurse (FCN).

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What Communication Techniques Have You Used to Improve Your Nurse-Patient Relationship?

We all mess up from time to time and say the wrong thing. This article focuses on some specific things we can do that will help improve our practice. You are reading page 2 of When Nurses Say the Wrong Thing: 4 Ways to Improve. If you want to start from the beginning Go to First Page.

jeastridge has 36 years experience as a BSN, RN and specializes in Faith Community Nurse (FCN).

5 Followers; 110 Articles; 449 Posts; 150,530 Profile Views

1 hour ago, JKL33 said:

Of course.

And nursing in general is a profession in which one will have the opportunity to experience both personal and professional growth related to our interpersonal interactions and relationships with others.

It is good to think before we speak (in real time) and in general to think about the types of things we tend to say in order to learn better ways to respond therapeutically to patients.

In my original nursing program therapeutic communication techniques were taught as part of the psychiatric nursing curriculum. Although the techniques are useful for helping patients requiring care for psychiatric and mental health concerns, I always wondered why the information was presented as if those situations were its sole (or main) use. The specific techniques are applicable to many different situations including most nursing situations and even some other professional, collegial, and personal situations. 

Here's a scenario: A coworker had ongoing nausea and overall felt nasty during a pregnancy and didn't have much excitement for the situation (being what it was). When the pregnancy suddenly ended in a 2nd trimester fetal demise, another coworker tried to provide comfort by saying, "Well, you weren't really very happy about it anyway" as if to say the outcome was some kind of relief or blessing in disguise (maybe it was and maybe it wasn't, but that's for the person themselves to decide, not for someone else to suggest).

That's the kind of thing we should be thinking about.

We are wise to start with not assuming what others are feeling and go from there. Even if we start with that one little thing (acknowledging that people feel various ways about things and we can't assume how they feel), that will tend to lead us to make more careful choices with words.

Well said. Joy

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KalipsoRed21 has 12 years experience as a BSN and specializes in Currently: Home Health.

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Sorry, but I am at a point with healthcare that we really need to quit trying to do self improvement. Healthcare motto of the USA...and maybe the world, “Do more, with less.” 
We have reached a pinnacle of sorts. We are now so overwhelmed with just ridiculous patient and insurance expectations that it is taking me DAYS to get call backs on patients now...and that is me as the patient’s nurse it is taking DAYS for another nurse to call me back. How I, or anyone else, messes up in speech is so damn low on my totem pole of concerns for my patients, my license, and my future health should I actually need to access the healthcare system my self, that I just find it aggravating that it keeps getting brought up.

It is like a ship in the ocean with a gigantic hole in the hull but someone decided the most pressing concern is what music is playing for the passengers. 
 

In the past year I have had to take several CEUs about therapeutic conversation and one course was so FOS that it implicated that there is a way for me to make a deep and meaningful connection to my patients in 56 seconds. Such B.S. touted by companies/hospitals that need nurses/CNAs to take on more people in the name of the almighty dollar than one can do an actual good job at taking care of. I don’t want hospitals/companies to go out of business either, but medical persons are at the tipping point with administrative creep and unreasonable expectations for patient experiences. That is not where the corporations are going to maximize their profits...but it is the only thing they can do to maximize their profits because quality is regulated by the government and cost is regulated by the government and/or insurance providers. 
 

There are just to many truths that aren’t spoken already in fear or out of concern for saying it “wrong” for me to see this as a top patient care issue right now. I’d rather people started saying what needs to be said even if it comes out harsh than to continue to pussyfoot around in order not to offend.

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jeastridge has 36 years experience as a BSN, RN and specializes in Faith Community Nurse (FCN).

5 Followers; 110 Articles; 449 Posts; 150,530 Profile Views

19 minutes ago, KalipsoRed21 said:

Sorry, but I am at a point with healthcare that we really need to quit trying to do self improvement. Healthcare motto of the USA...and maybe the world, “Do more, with less.” 
We have reached a pinnacle of sorts. We are now so overwhelmed with just ridiculous patient and insurance expectations that it is taking me DAYS to get call backs on patients now...and that is me as the patient’s nurse it is taking DAYS for another nurse to call me back. How I, or anyone else, messes up in speech is so damn low on my totem pole of concerns for my patients, my license, and my future health should I actually need to access the healthcare system my self, that I just find it aggravating that it keeps getting brought up.

It is like a ship in the ocean with a gigantic hole in the hull but someone decided the most pressing concern is what music is playing for the passengers. 
 

In the past year I have had to take several CEUs about therapeutic conversation and one course was so FOS that it implicated that there is a way for me to make a deep and meaningful connection to my patients in 56 seconds. Such B.S. touted by companies/hospitals that need nurses/CNAs to take on more people in the name of the almighty dollar than one can do an actual good job at taking care of. I don’t want hospitals/companies to go out of business either, but medical persons are at the tipping point with administrative creep and unreasonable expectations for patient experiences. That is not where the corporations are going to maximize their profits...but it is the only thing they can do to maximize their profits because quality is regulated by the government and cost is regulated by the government and/or insurance providers. 
 

There are just to many truths that aren’t spoken already in fear or out of concern for saying it “wrong” for me to see this as a top patient care issue right now. I’d rather people started saying what needs to be said even if it comes out harsh than to continue to pussyfoot around in order not to offend.

I hear you. Thanks for sharing. We do live in a tough time, for sure. Joy

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I agree KalipsoRed. I am so tired of this “you need to make a connection” attitude. Why? Why is this my job? I am there to medicate a patient. Clean them up. Assess them and catch if things are going bad. Advocate for them. Encourage them to do what they need to get better. Why am I *also* required to do all this emotional labor on top of it? It is already hard enough to keep upbeat when you answer the patient’s 12th call light for a ridiculous request. 
 

I am always polite and listen to patients but I shouldn’t have to try and connect with them. I know being in a hospital is rough and I give people tons of leeway on their behavior for that but I think it is crazy to expect us to also carry their emotional burdens. We don’t ask that of anyone else in the hospital.

The examples were of people being upset that nurses didn’t cater to their emotional requirements. Maybe the first nurse didn’t even know you had kids. Or that you worked. Or anything else. 

Attitude does have a lot to with how you handle pain. Maybe saying “good will come of this” wasn’t the best thought but nothing wrong with encouraging a patient to do their best to stay positive and try to reframe the issue. You said you need words of comfort and she thought that was what she was doing. 

Maybe nurses wouldn’t misstep if patients weren’t trying to keep using us as their support blanket. There is a difference between needing some reassurance from a nurse that things are okay and taking advantage of someone who can’t easily extricate themselves from the conversation. 
 

I don’t get complaints from patients and many give their sincere thanks. But I do my best to limit the non-care related conversations. And that is how it should be, IMO. 

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Emergent has 25 years experience.

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6 minutes ago, Elaken said:

 

I don’t get complaints from patients and many give their sincere thanks. But I do my best to limit the non-care related conversations. And that is how it should be, IMO. 

In the first scenario, That's exactly what the nurse was doing. She was having a chummy conversation with the patient. She was talking about more personal things, like her schedule and how it affected her children.

I think we as nurses need to tread carefully when bringing personal stuff into conversations. It should be a rarity. I agree, we should focus on giving the patient details about their plan of care, informing them about their meds, and listening to their concerns.

 

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jeastridge has 36 years experience as a BSN, RN and specializes in Faith Community Nurse (FCN).

5 Followers; 110 Articles; 449 Posts; 150,530 Profile Views

48 minutes ago, Elaken said:

I agree KalipsoRed. I am so tired of this “you need to make a connection” attitude. Why? Why is this my job? I am there to medicate a patient. Clean them up. Assess them and catch if things are going bad. Advocate for them. Encourage them to do what they need to get better. Why am I *also* required to do all this emotional labor on top of it? It is already hard enough to keep upbeat when you answer the patient’s 12th call light for a ridiculous request. 
 

I am always polite and listen to patients but I shouldn’t have to try and connect with them. I know being in a hospital is rough and I give people tons of leeway on their behavior for that but I think it is crazy to expect us to also carry their emotional burdens. We don’t ask that of anyone else in the hospital.

The examples were of people being upset that nurses didn’t cater to their emotional requirements. Maybe the first nurse didn’t even know you had kids. Or that you worked. Or anything else. 

Attitude does have a lot to with how you handle pain. Maybe saying “good will come of this” wasn’t the best thought but nothing wrong with encouraging a patient to do their best to stay positive and try to reframe the issue. You said you need words of comfort and she thought that was what she was doing. 

Maybe nurses wouldn’t misstep if patients weren’t trying to keep using us as their support blanket. There is a difference between needing some reassurance from a nurse that things are okay and taking advantage of someone who can’t easily extricate themselves from the conversation. 
 

I don’t get complaints from patients and many give their sincere thanks. But I do my best to limit the non-care related conversations. And that is how it should be, IMO. 

Thanks for your comment. As nurses, we certainly have our hands full. As you point out, neither of the examples cited was particularly egregious. We have all certainly seen worse! But I used those because they were little things but in both cases the patients brought those up with me much later. Yes, they are subtle but I thought they might effectively highlight how even small comments carry heavy weight coming from the nurse. Joy

39 minutes ago, Emergent said:

In the first scenario, That's exactly what the nurse was doing. She was having a chummy conversation with the patient. She was talking about more personal things, like her schedule and how it affected her children.

I think we as nurses need to tread carefully when bringing personal stuff into conversations. It should be a rarity. I agree, we should focus on giving the patient details about their plan of care, informing them about their meds, and listening to their concerns.

 

Well said. "It should be a rarity." It happens, but being on guard and being careful about what we say is a beginning. Thank you for your comment! Joy

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Orion81RN has 7 years experience.

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On 2/14/2020 at 6:10 AM, jeastridge said:

I hope these examples serve as simple reminders that even innocuous comments can be misconstrued. You are right, we would have to go around in complete silence if we were to never mess up, but we can all find an occasion, from time to time, to be more careful about our conversation. Thank you for your comment. Jo

Perhaps better examples then? Bc I would 100% not feel too bad for these 2 examples. Not to the extent where I would feel the need to completely rethink how I talk to patients, anyway.

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jeastridge has 36 years experience as a BSN, RN and specializes in Faith Community Nurse (FCN).

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15 hours ago, Orion81RN said:

Perhaps better examples then? Bc I would 100% not feel too bad for these 2 examples. Not to the extent where I would feel the need to completely rethink how I talk to patients, anyway.

You are right. There are probably better examples out there. Readers? 

Joy

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Last weekend I was in the emergency room with my dad. This was the second time this month he needed to go to the emergency room and be admitted. My dad expressed he did not want to stay overnight, but I told him it is what the medical staff highly recommended. Either way, he took it like a champ. My dad is a very positive person and friendly to medical staff. One nurse came in (I don't remember what for), but she had been the nurse to take down my dad's information when we entered the ER. My dad asked her how she was doing. She responded, "Better than you!!" and laughed. My dad chuckled. I was so confused as to why she would say that. She left and I asked my dad if he had worked with her before. I thought that maybe they had built some kind of rapport where they joked with each other like that. He said no, this was the first time he had interacted with her and that it's just her personality. He did not seemed too bothered by it, I think I was more bothered by it than my dad. I thought it was insensitive and inappropriate for anyone to say to a patient. Thoughts?

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scribblz has 13 years experience as a BSN, CNA, LPN and specializes in Med Surg, Tele, Geriatrics, home infusion.

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43 minutes ago, wanderlust said:

Last weekend I was in the emergency room with my dad. This was the second time this month he needed to go to the emergency room and be admitted. My dad expressed he did not want to stay overnight, but I told him it is what the medical staff highly recommended. Either way, he took it like a champ. My dad is a very positive person and friendly to medical staff. One nurse came in (I don't remember what for), but she had been the nurse to take down my dad's information when we entered the ER. My dad asked her how she was doing. She responded, "Better than you!!" and laughed. My dad chuckled. I was so confused as to why she would say that. She left and I asked my dad if he had worked with her before. I thought that maybe they had built some kind of rapport where they joked with each other like that. He said no, this was the first time he had interacted with her and that it's just her personality. He did not seemed too bothered by it, I think I was more bothered by it than my dad. I thought it was insensitive and inappropriate for anyone to say to a patient. Thoughts?

Definitely inappropriate and insensitive... But not intentionally so would be my guess. Like your dad said "it's just her personality" , sometimes nurses develop "gallows humor" or dark humor as a coping mechanism for the things they see everyday. Not intended to offend, but understandable that you as a concerned family member would be put off by it.

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scribblz has 13 years experience as a BSN, CNA, LPN and specializes in Med Surg, Tele, Geriatrics, home infusion.

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I personally take my cues from the energy of the family/ patient on what "tone" they need from me. Some people are reassured by a formal, serious bullet list approach. IE good evening Mr Stevens I understand that you are here with XYZ. This is what has been done so far, and this is the plan for tonight and tomorrow. Assess and answer questions then leave them be. An elderly person might need a completely different approach where they don't want too many details, just to know the reason they feel like crap is they have PNA and that you are giving them medicine for it and will keep them comfortable. I rarely discuss my personal life with patients, but if it's a lonely elderly person I may mention my kids and a funny anecdote about them because it opens the door for them to share about their kids and grandkids which gives me insight into their needs and makes them feel connected/ safe with me. Which if they sundown later in the night I use those insights to remind them of who they are and what matters to them.

Nursing is an art as well as a science. We're all just only human with unique skill sets. Some of us better listeners, some of us more comforting, some more clinical. There's no one way to be because nursing is too broad for that. 

At the end of the day I say be practical and kind. If they are manipulative, be firm/ set limits. If they are anxious address their concerns/ if the concerns are unreasonable/ be kind but firm in trying to readjust expectations. If they talk forever... arrange for a co-worker rescue you. 

If a communication goes badly learn from it, forgive yourself and move on. This expectation that nurses are expected to be all things is a harmful one. We should communicate in a way that takes into account the patient and their needs because that is therapeutic. We should not attempt to fill some void in their life... that's insane 🤷‍♀️

 

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jeastridge has 36 years experience as a BSN, RN and specializes in Faith Community Nurse (FCN).

5 Followers; 110 Articles; 449 Posts; 150,530 Profile Views

4 hours ago, scribblz said:

I personally take my cues from the energy of the family/ patient on what "tone" they need from me. Some people are reassured by a formal, serious bullet list approach. IE good evening Mr Stevens I understand that you are here with XYZ. This is what has been done so far, and this is the plan for tonight and tomorrow. Assess and answer questions then leave them be. An elderly person might need a completely different approach where they don't want too many details, just to know the reason they feel like crap is they have PNA and that you are giving them medicine for it and will keep them comfortable. I rarely discuss my personal life with patients, but if it's a lonely elderly person I may mention my kids and a funny anecdote about them because it opens the door for them to share about their kids and grandkids which gives me insight into their needs and makes them feel connected/ safe with me. Which if they sundown later in the night I use those insights to remind them of who they are and what matters to them.

Nursing is an art as well as a science. We're all just only human with unique skill sets. Some of us better listeners, some of us more comforting, some more clinical. There's no one way to be because nursing is too broad for that. 

At the end of the day I say be practical and kind. If they are manipulative, be firm/ set limits. If they are anxious address their concerns/ if the concerns are unreasonable/ be kind but firm in trying to readjust expectations. If they talk forever... arrange for a co-worker rescue you. 

If a communication goes badly learn from it, forgive yourself and move on. This expectation that nurses are expected to be all things is a harmful one. We should communicate in a way that takes into account the patient and their needs because that is therapeutic. We should not attempt to fill some void in their life... that's insane 🤷‍♀️

 

You sound like an amazing nurse. I loved reading your comment. Thank you for sharing! Joy

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