When Nurses Say the Wrong Thing: 4 Ways to Improve

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.

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Story #1

"Oh, I work a couple of shifts per week. Just enough that I can get out of the house and feel like I'm contributing, but not so much that I'm letting someone else raise my children.” These words spoken to me in passing cut like a dagger to my worn-out-mama soul. Her innocent implication that I let someone else raise my children as a full-time working mother piled on to the thickly layered "mom-guilt" I already put on myself.

The cruel irony of this moment was that the words came from the mouth of my hospital nurse, as I was recovering from surgery, unable to be with, much less care for, my children in my current state. I was already in physical pain, and rather than alleviate my pain as her job should have been, she added emotional pain to my heart and mind.

I feel certain that the nurse did not intend to wound me with her words. She was just "making conversation.” But what she failed to remember was that just another day at work for her was a huge life-altering experience for me. A hospital is a workplace for many, but for those of us lying in the beds, it's often a scary and intimidating time.

I implore you, keep your words positive and uplifting, or don't say anything at all beyond the standard phrases of patient care. What you say can be just as much of the healing process as what you do.”

Story #2

"I was in a rehab facility recovering from surgery to repair a shattered leg. I was in a lot of pain and had the feeling I was being judged unfairly as a 'complainer.’ I just couldn't get comfortable and desperately needed to talk with a doctor who had the authority to make some changes.

During my discussion with the bedside nurse, she said, 'You'll see. Good will come out of this. Just think positive thoughts.’ Yikes. I know she meant well but that was NOT what I needed to hear. It may indeed be true eventually, but what I replied was also true, 'I don't need to hear that right now. I need words of comfort.’ Honestly, I don't know if she even registered what I said.”

Improving Communication

Our words matter, don't they? These simple comments, probably intended as attempts to connect, are received in a completely different way by the suffering patients. Sadly, the words linger long after the event and sometimes are repeated often as the patient struggles to make sense of a tough time.

How do we improve our practice so that we don't commit these types of gaffes? Researcher Brene Brown says, "Rarely can a response make something better. What makes something better is connection.” Making gentle connections without adding to our patient's pain is our challenge, isn't it? While this type of sensitivity may come more naturally to some than to others, all of us can learn and become better nurses in the process.

Keep it Professional

When we are in the patients' room, our conversation and concern should be about them. We are not center stage. If they ask personal questions, it is courteous to answer, but generally, they are just being polite and they don't really have the energy to know or care about our extended family or our troubles with our children or whatever our concern of the day might be. If the patient is argumentative or disgruntled or venting, we can begin to feel defensive and be tempted to offer them correction (or more!). Once a friend taught me the technique of saying, "Hmm. I had not looked at it quite that way…” and then let the sentence trail off without engaging. Another tool that can help us here is to answer their question as succinctly as possible and then turn it back to them with a question that helps us understand them better.

Be Empathetic

Our patients are sicker than ever before. Their family members are often super-stressed. As professional nurses, our job is to care for them to the best of our ability while recognizing the strain they are under and giving them extra grace in their time of need. Sometimes simply being present, prompt and professional is our best response—no particular words needed.

Repeat What They Said

Many of us nurses remember learning in nursing school about being good active listeners and reflecting back what the patient tells us by saying things like, "So you are saying…” In other words, finding ways to clarify what they say to make sure we are on the same page.

Be Genuine

When we are confident and comfortable in our own skin, we transmit that to others and help them feel comfortable as well. Being genuine does not mean that we tell people what we think, it simply means that we acknowledge their inherent dignity as persons and that we care for them with competence and professionalism, meeting their needs in the best way we can.

No One is Perfect

We are all going to be less than stellar nurses from time to time, but we must also keep trying to improve as we move forward in our careers.

Specializes in Surgical Specialty Clinic - Ambulatory Care.

The idea that the examples given show “chummy” conversation instead of therapeutic is a moot point to me.

If a patient asks you something personal about your life and your answer avoids the question and tries to redirect it back to them, then there is a decent chance your patient will find you rude. Being completely “professional” often denotes you as being non caring for a lot of people.

I am currently stuck with this issue for MANY of my patients because I do home care. I come to their home and “visit” them 1-3 times a week. If I did not have “chummy” conversation they would feel that I am only there “for the money”. I have had several of my patients complain about other staff who provide visits in my absence of being “cold” because they didn’t “talk with me.” It is a conundrum to say “keep the conversation therapeutic and professional.” Sharing pieces of your life in “chummy” conversation with patients is mostly how people end up seeing you as a person they can trust....trust is what is most therapeutic. Yes, one can “over share” but there is a build to it as well. In a once or twice patient interaction it is easy to keep the “Polite” conversation about something innocuous such as the weather.

Over a 12 hour shift when you are seeing a patient 6 or more times a day this becomes more challenging. Patients start asking personal questions and if you are to vague with your answers then you seem “cold”, if you remind the patient that you are here to concentrate on them and try to redirect the conversation you are “cold”.....there is no winning this argument. If you spend 45 minutes at time with a person several times a week and actively avoid questions about yourself that doesn’t build trust with the patient....and makes them feel like you are uncaring. Yet even trying to share a minimal amount of information with your self with the patient to gain trust and have them feel cared for, one can end up in very inappropriate situations.

I am currently pregnant. I have had 3 of my patients ask to be invited to my baby shower and 2 of them have also made it very clear that they expect me to bring the baby BY THEIR HOUSE after she is born. I have one patient who BOUGHT me a GIFT for my baby. So I have made up an excuse that my baby shower is very far out of town....but I couldn’t do anything about the whole gift giving issue and the idea that I am going to bring my kid to WORK except to kindly as I could disappoint these people. Now they are upset because they “thought I was their friend.”

So tell me; what should I have said when my patients started asking me about my growing belly? “It looks like you got a little something going on dear?” “Oh Mrs. Sonso, yes I am pregnant, how are your blood sugars?” “They’re fine. I forgot to take them this morning. When are you due?” “Mrs. Sonso we discussed you were going to set an alarm so you would remember?” “Oh I forgot. Are you going to find out the sex?.” And on and on and on. And my pregnancy is just an obvious example of how INVASIVE patients are about our lives, about how emotionally needy people are. But there is some sort of consensus that there is a way to avoid these conflicts and it is SOLELY up to the nurse to do so? Not buying it.

Look, the patient can have a less trusting, less genuine, more professional connection with their medical clinicians and thus have little to no disappointing conversation OR the patient can have a relationship with their medical clinicians but that will mean communication issues will arise and that PATIENTS will have to bear SOME responsibility for an occasional miscommunication or “bad experience”.
The patients who wanted me to bring my baby to their house, who wanted to be invited to my baby shower, who bought me gifts, had a “bad” experience because THEY expected more out of our relationship than professional contact. That isn’t on me. I can only avoid sharing so much with repeated bombardment without seeming rude or cold.

Now if you watch politicians you can see demonstration after demonstration of how to communicate professionally and answer questions with an evasive non answer....but how many people do you know who trust a politician?

Nursing is a damned if you do, damned if you don’t situation.

I deflect responsibility if need be. Something like ‘I am not allowed to discuss my personal situation.’

Specializes in Faith Community Nurse (FCN).
1 hour ago, KalipsoRed21 said:

The idea that the examples given show “chummy” conversation instead of therapeutic is a moot point to me.

If a patient asks you something personal about your life and your answer avoids the question and tries to redirect it back to them, then there is a decent chance your patient will find you rude. Being completely “professional” often denotes you as being non caring for a lot of people.

I am currently stuck with this issue for MANY of my patients because I do home care. I come to their home and “visit” them 1-3 times a week. If I did not have “chummy” conversation they would feel that I am only there “for the money”. I have had several of my patients complain about other staff who provide visits in my absence of being “cold” because they didn’t “talk with me.” It is a conundrum to say “keep the conversation therapeutic and professional.” Sharing pieces of your life in “chummy” conversation with patients is mostly how people end up seeing you as a person they can trust....trust is what is most therapeutic. Yes, one can “over share” but there is a build to it as well. In a once or twice patient interaction it is easy to keep the “Polite” conversation about something innocuous such as the weather.

Over a 12 hour shift when you are seeing a patient 6 or more times a day this becomes more challenging. Patients start asking personal questions and if you are to vague with your answers then you seem “cold”, if you remind the patient that you are here to concentrate on them and try to redirect the conversation you are “cold”.....there is no winning this argument. If you spend 45 minutes at time with a person several times a week and actively avoid questions about yourself that doesn’t build trust with the patient....and makes them feel like you are uncaring. Yet even trying to share a minimal amount of information with your self with the patient to gain trust and have them feel cared for, one can end up in very inappropriate situations.

I am currently pregnant. I have had 3 of my patients ask to be invited to my baby shower and 2 of them have also made it very clear that they expect me to bring the baby BY THEIR HOUSE after she is born. I have one patient who BOUGHT me a GIFT for my baby. So I have made up an excuse that my baby shower is very far out of town....but I couldn’t do anything about the whole gift giving issue and the idea that I am going to bring my kid to WORK except to kindly as I could disappoint these people. Now they are upset because they “thought I was their friend.”

So tell me; what should I have said when my patients started asking me about my growing belly? “It looks like you got a little something going on dear?” “Oh Mrs. Sonso, yes I am pregnant, how are your blood sugars?” “They’re fine. I forgot to take them this morning. When are you due?” “Mrs. Sonso we discussed you were going to set an alarm so you would remember?” “Oh I forgot. Are you going to find out the sex?.” And on and on and on. And my pregnancy is just an obvious example of how INVASIVE patients are about our lives, about how emotionally needy people are. But there is some sort of consensus that there is a way to avoid these conflicts and it is SOLELY up to the nurse to do so? Not buying it.

Look, the patient can have a less trusting, less genuine, more professional connection with their medical clinicians and thus have little to no disappointing conversation OR the patient can have a relationship with their medical clinicians but that will mean communication issues will arise and that PATIENTS will have to bear SOME responsibility for an occasional miscommunication or “bad experience”.
The patients who wanted me to bring my baby to their house, who wanted to be invited to my baby shower, who bought me gifts, had a “bad” experience because THEY expected more out of our relationship than professional contact. That isn’t on me. I can only avoid sharing so much with repeated bombardment without seeming rude or cold.

Now if you watch politicians you can see demonstration after demonstration of how to communicate professionally and answer questions with an evasive non answer....but how many people do you know who trust a politician?

Nursing is a damned if you do, damned if you don’t situation.

You make many good points. Nursing is not an easy job and home care poses even more challenges in terms of boundaries. Thank you for sharing your experiences and perspective. Joy

Specializes in Med Surg, Tele, Geriatrics, home infusion.
6 hours ago, KalipsoRed21 said:

The idea that the examples given show “chummy” conversation instead of therapeutic is a moot point to me.

If a patient asks you something personal about your life and your answer avoids the question and tries to redirect it back to them, then there is a decent chance your patient will find you rude. Being completely “professional” often denotes you as being non caring for a lot of people.

I am currently stuck with this issue for MANY of my patients because I do home care. I come to their home and “visit” them 1-3 times a week. If I did not have “chummy” conversation they would feel that I am only there “for the money”. I have had several of my patients complain about other staff who provide visits in my absence of being “cold” because they didn’t “talk with me.” It is a conundrum to say “keep the conversation therapeutic and professional.” Sharing pieces of your life in “chummy” conversation with patients is mostly how people end up seeing you as a person they can trust....trust is what is most therapeutic. Yes, one can “over share” but there is a build to it as well. In a once or twice patient interaction it is easy to keep the “Polite” conversation about something innocuous such as the weather.

Over a 12 hour shift when you are seeing a patient 6 or more times a day this becomes more challenging. Patients start asking personal questions and if you are to vague with your answers then you seem “cold”, if you remind the patient that you are here to concentrate on them and try to redirect the conversation you are “cold”.....there is no winning this argument. If you spend 45 minutes at time with a person several times a week and actively avoid questions about yourself that doesn’t build trust with the patient....and makes them feel like you are uncaring. Yet even trying to share a minimal amount of information with your self with the patient to gain trust and have them feel cared for, one can end up in very inappropriate situations.

I am currently pregnant. I have had 3 of my patients ask to be invited to my baby shower and 2 of them have also made it very clear that they expect me to bring the baby BY THEIR HOUSE after she is born. I have one patient who BOUGHT me a GIFT for my baby. So I have made up an excuse that my baby shower is very far out of town....but I couldn’t do anything about the whole gift giving issue and the idea that I am going to bring my kid to WORK except to kindly as I could disappoint these people. Now they are upset because they “thought I was their friend.”

So tell me; what should I have said when my patients started asking me about my growing belly? “It looks like you got a little something going on dear?” “Oh Mrs. Sonso, yes I am pregnant, how are your blood sugars?” “They’re fine. I forgot to take them this morning. When are you due?” “Mrs. Sonso we discussed you were going to set an alarm so you would remember?” “Oh I forgot. Are you going to find out the sex?.” And on and on and on. And my pregnancy is just an obvious example of how INVASIVE patients are about our lives, about how emotionally needy people are. But there is some sort of consensus that there is a way to avoid these conflicts and it is SOLELY up to the nurse to do so? Not buying it.

Look, the patient can have a less trusting, less genuine, more professional connection with their medical clinicians and thus have little to no disappointing conversation OR the patient can have a relationship with their medical clinicians but that will mean communication issues will arise and that PATIENTS will have to bear SOME responsibility for an occasional miscommunication or “bad experience”.
The patients who wanted me to bring my baby to their house, who wanted to be invited to my baby shower, who bought me gifts, had a “bad” experience because THEY expected more out of our relationship than professional contact. That isn’t on me. I can only avoid sharing so much with repeated bombardment without seeming rude or cold.

Now if you watch politicians you can see demonstration after demonstration of how to communicate professionally and answer questions with an evasive non answer....but how many people do you know who trust a politician?

Nursing is a damned if you do, damned if you don’t situation.

Home care makes maintaining barriers much tougher than inpatient where you have them for a shift or two rather than seeing them weekly for months. If one of my home infusion clients tries to get too involved in my personal life I usually use some variation of the following line. My company has a very strict policy on my behavior with clients such as we cannot exchange contact information, and we can't engage in social interaction unrelated to the care I'm here to provide. Now you know I enjoy being your nurse Mrs. XYZ so I can't do anything that would jepordize that. That line handles 75% of my clients, for the remaining 25% that are especially persistent, I add on the tale of woe, of my good friend "Susan" who did not take this policy seriously and was let go.