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When Nurses Say the Wrong Thing: 4 Ways to Improve

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jeastridge is a BSN, RN and specializes in Faith Community Nurse (FCN).

5 Followers; 109 Articles; 150,275 Profile Views; 447 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.

When Nurses Say the Wrong Thing: 4 Ways to Improve

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.

Joy is a Faith Community Nurse with many years of experience in a variety of clinical settings.

5 Followers; 109 Articles; 150,275 Profile Views; 447 Posts

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Emergent has 25 years experience.

7 Followers; 2 Articles; 2,899 Posts; 66,410 Profile Views

Good article. Great advice!

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KalipsoRed21 is a BSN and specializes in Currently: Home Health.

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13 hours ago, jeastridge said:
When Nurses Say the Wrong Thing: 4 Ways to Improve

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.

I disagree with this. Being empathetic is always a nursing priority, but because someone is over thinking your kind words or polite conversation as their caregiver we need the be MORE thoughtful is just the wrong way to continue going. If we continue down this path where we censor EVERYTHING we say because THEY could take it the wrong way, no one will ever end up having the hard conversations about death, dying, end of life and quality of life that are ALREADY happening in such vague ways that patient’s don’t even realize what they are being told! 
 

I just had a fragile patient who had bad COPD, orthostatic hypotension, end stage kidney disease, and a history of cancer 3 years in remission. She would end up in the ER with RDS and the X-rays there would say her cancer was back and metastatic. She would follow up with her oncology MD and he would tell her, her nodules were stable and the doctors at the other facility didn’t know how to read a radiated down lungs. She would come home and sit around for 3-4 days at a time. I was very stern, as she was adamant that she was not ready for hospice, that she had to get her but up every day. I wouldn’t let her tell me she was to tired to do therapy, I’d make her try. This had been going on for 6 months. Most recent ER visit with follow up with new oncologist (the old one had moved to a new job) proved sad because the MD confirmed that the little hospital where she goes for ER care was right, her cancer has been back x several months. She and her daughter were mad at me for pushing her all these months. I am devastated for her too, but I sure as *** don’t feel bad for pushing her based on the reports and repeated conversations I had with her MD offices. I don’t feel like I missed something or that I was doing anything more than trying to help her get to her goals...which are to live. Also I’m pregnant and they were also upset that I didn’t invite them to my baby shower. Actually I’ve had several patients offended because I haven’t invited them to my baby shower or promised them that I would bring my baby to their house after it is born. But you think that we need to be more compassionate with our conversations?!

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Some people are very thoughtless or even cruel with their words.  And all of us occasionally put our foot in our mouth. However, NEITHER of the cases here are examples of that. The nurses made innocuous comments.

Especially in Case 1, the only thing the nurse was guilty of was not being able to mind-read.
 

Case 2: She used an unhelpful platitude.
 

But honestly, unless you want nurses to go about our business in total silence, it is totally unrealistic to expect us to never say anything that could be taken wrong. Particularly when a patient (as in case 1) is feeling highly-sensitized, vulnerable, and ready to find offense where none was given. 

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Leader25 has 35 years experience.

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I remember a Nurse Mgr telling a c-section patient  who was complaining of hunger :"you really need to lose weight".

Wow that poor woman went on afit of rage tossing stuff and screaming.Too bad she did not punch that mgr in the nose.

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Leader25 has 35 years experience.

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1 hour ago, KalipsoRed21 said:

Just think positive thoughts.’

wow someone saying things like this can kill you by not catching  what might be really wrong.The one time you didnt listen and it turns out to be a legitimate complaint.

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14 hours ago, jeastridge said:

“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.

 

She did not imply that. She said something about her own feelings as they related to her own life choices. It probably didn't need to be said--although it sure sounds like a response to the type of question that didn't need to be asked, either.

 

15 hours ago, jeastridge said:

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.”

 

Not entirely helpful for a lot of people, true. It isn't particularly heartless though. Hard to identify with the concern since I wouldn't be looking for comfort from strangers for the most part.

 

15 hours ago, jeastridge said:

Sometimes simply being present, prompt and professional is our best response—no particular words needed.

 

Best/safest choice. ^

 

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jeastridge is a BSN, RN and specializes in Faith Community Nurse (FCN).

5 Followers; 109 Articles; 447 Posts; 150,275 Profile Views

9 hours ago, KalipsoRed21 said:

I disagree with this. Being empathetic is always a nursing priority, but because someone is over thinking your kind words or polite conversation as their caregiver we need the be MORE thoughtful is just the wrong way to continue going. If we continue down this path where we censor EVERYTHING we say because THEY could take it the wrong way, no one will ever end up having the hard conversations about death, dying, end of life and quality of life that are ALREADY happening in such vague ways that patient’s don’t even realize what they are being told! 
 

I just had a fragile patient who had bad COPD, orthostatic hypotension, end stage kidney disease, and a history of cancer 3 years in remission. She would end up in the ER with RDS and the X-rays there would say her cancer was back and metastatic. She would follow up with her oncology MD and he would tell her, her nodules were stable and the doctors at the other facility didn’t know how to read a radiated down lungs. She would come home and sit around for 3-4 days at a time. I was very stern, as she was adamant that she was not ready for hospice, that she had to get her but up every day. I wouldn’t let her tell me she was to tired to do therapy, I’d make her try. This had been going on for 6 months. Most recent ER visit with follow up with new oncologist (the old one had moved to a new job) proved sad because the MD confirmed that the little hospital where she goes for ER care was right, her cancer has been back x several months. She and her daughter were mad at me for pushing her all these months. I am devastated for her too, but I sure as *** don’t feel bad for pushing her based on the reports and repeated conversations I had with her MD offices. I don’t feel like I missed something or that I was doing anything more than trying to help her get to her goals...which are to live. Also I’m pregnant and they were also upset that I didn’t invite them to my baby shower. Actually I’ve had several patients offended because I haven’t invited them to my baby shower or promised them that I would bring my baby to their house after it is born. But you think that we need to be more compassionate with our conversations?!

You are clearly a compassionate and involved nurse. This article is meant to encourage us all to do better where we can, not to be critical of the good things we are already doing. You will probably agree, that most of us have some room for improvement at some point. Joy

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jeastridge is a BSN, RN and specializes in Faith Community Nurse (FCN).

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8 hours ago, CommunityRNBSN said:

Some people are very thoughtless or even cruel with their words.  And all of us occasionally put our foot in our mouth. However, NEITHER of the cases here are examples of that. The nurses made innocuous comments.

Especially in Case 1, the only thing the nurse was guilty of was not being able to mind-read.
 

Case 2: She used an unhelpful platitude.
 

But honestly, unless you want nurses to go about our business in total silence, it is totally unrealistic to expect us to never say anything that could be taken wrong. Particularly when a patient (as in case 1) is feeling highly-sensitized, vulnerable, and ready to find offense where none was given. 

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

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Emergent has 25 years experience.

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It's ironic to see someone come to this post and get defensive, and then complain that the patient took something the wrong way. 

I think the takeaway from this article is just be professional. It's not a social interaction, it's about the patient. Avoid falling into the pitfall of letting your guard down and getting too familiar. That's what the nurse in scenario 1 did. Scenario 2 was just empty platitudes that are not helpful. Avoid them.

Like the OP said, we all can improve.

 

 

 

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jeastridge is a BSN, RN and specializes in Faith Community Nurse (FCN).

5 Followers; 109 Articles; 447 Posts; 150,275 Profile Views

36 minutes ago, Emergent said:

It's ironic to see someone come to this post and get defensive, and then complain that the patient took something the wrong way. 

I think the takeaway from this article is just be professional. It's not a social interaction, it's about the patient. Avoid falling into the pitfall of letting your guard down and getting too familiar. That's what the nurse in scenario 1 did. Scenario 2 was just empty platitudes that are not helpful. Avoid them.

Like the OP said, we all can improve.

 

 

 

We can always learn more, do better, and grow professionally. Thank you for your comment. Joy

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3 hours ago, jeastridge said:

You will probably agree, that most of us have some room for improvement at some point.

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.

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