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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).

5 Followers; 110 Articles; 150,579 Profile Views; 449 Posts

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 3 of When Nurses Say the Wrong Thing: 4 Ways to Improve. If you want to start from the beginning Go to First Page.

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

247 Posts; 4,842 Profile Views

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. 

 

 

 

Edited by KalipsoRed21

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

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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; 150,579 Profile Views

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

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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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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.  

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