How to Give Good Phone

by jparadisi

painting by jparadisi 2013

Nurses spend lots of time on the telephone. So much, that I believe How to Give Good Phone should be taught in nursing school as a subtopic of therapeutic communication. For the rest of us, here’s a crash course developed over the years.

We all remember that communication has three components: sender, receiver, and a message:

Sender. Nurses call other departments for a variety of reasons. We call material supplies requesting special bio-occlusive dressings for patients with adhesive allergies. We call the pharmacist with questions about unfamiliar medications. We call physicians requesting new orders when a patient isn’t doing so well.

Receiver. Nurses also receive phone calls. Physicians call to admit patients. The lab calls, announcing we didn’t send the blood tests in the right colored tubes, and they need to be redrawn.

Someone we don’t know calls, asking if his mother, who we also don’t know because she is not one of our patients, is done with her appointment. When we ask him for more information to find her, the caller misconstrued this to mean we’ve misplaced his mother, which brings me to…

Message. Clarity begins with the sender. Intuitively, message should be the simplest part of the communication process, but in fact it is often the most difficult, especially over the phone, where visual information is lost to the sender, the receiver, or both. This loss of visual information is what makes reading back a telephone order by a nurse to a physician a critical component of that type of communication.

Here’s another example: you’re calling in a hemoglobin value to the physician. If the lab value indicates borderline for anemia, but you strongly feel the patient would benefit from a transfusion, you would want to include the subjective symptoms you see at the patient’s bedside: headache, shortness of breath on exertion, and increased fatigue. Knowing that you are going to suggest a transfusion for this patient based his clinical assessment before pushing the phone number keeps the message on track and focused on the patient.

I’ve been the sender of a message to a receiver (not a physician), who appeared confused about our roles. She did all the talking.  This obstructed my message. Perhaps anxiety caused her to blurt out lengthy commentary irrelevant to the subject of the call, I don’t know. I let her talk until she needed to take a breath, then interjected, “May I give you more information?” each time this occurred, until finally my message was delivered, and we got to work on the real problem.

Why would I devote so much time to this phone call? Because I needed the services of the receiver on the other end of the phone. Interrupting her abruptly to tell her how busy I am, using a smug tone of voice, or getting angry would simply slow down progress, and patient care. Giving good phone requires a purpose, an intended outcome, and patience.

What is your biggest peeve about telephones at work? How does your unit help patients seeking information by telephone?

A version of this post was previously published on TheONC.org.

The Adventures of Nurse Niki Chapter 6: Sometimes The Job is a Diversion from Life

The Adventures of Nurse Niki
The Adventures of Nurse Niki

The Adventures of Nurse Niki Chapter 6 is posted. It’s not a happy chapter. Niki feels disappointed by marriage. Sometimes the best plans and intentions just don’t work out, and spouses shut down.

You can interact with Nurse Niki on her Facebook page, and don’t forget to “Like” it. Show Niki some love!

Many thanks to the readers following The Adventures of Nurse Niki blog, the retweets of  @NurseNikiAdven, and those who not only Like Nurse Niki’s Facebook Fan Page. The support is very much appreciated!

Nurses & Doctors: Make Appreciation Reciprocal

artist: jparadisi

artist: jparadisi

Few life-threatening or terminal diseases present themselves in otherwise healthy, alert, and charming hosts the way cancer does.

From the get-go, oncologists are not only captain of the ship; they hoist life preservers in the form of treatment to patients drowning in waves of shock after a cancer diagnosis.

In my opinion, oncologists’ hearts closely resemble those of nurses. This is attributed to the fact that although oncologists do not spend the same quantity of time with patients as nurses do, the quality of the time they spend is intense. They often form relationships with patients over years. It’s common for an oncologist to know close members of their patient’s family, also like nurses.

During my last episode of possible (it wasn’t) recurrence, I experienced this truth.

My oncologist and I share a professional relationship. One of the reasons he’s my oncologist is because I know he’s good at what he does. My husband likes him, too. They share an easy communication, which is another reason for my choice. If/when cancer recurs, I know they will cooperate on my care, freeing me to be the patient, not the nurse. This arrangement brings me peace of mind.

Anyway, I had suspicious symptoms, which landed me face down in an MRI. My appointment to receive the MRI results was scheduled at end of a workday for my oncologist.

David accompanied me. Dr. My Choice entered the exam room holding the films, clipping them to the light box.

“I haven’t looked at these yet,” he explained. “I thought we could see them at the same time.”

It hit me in a flash: Dr. My Choice likes us too. He is about to find out if he will tell a nurse he enjoys working with, and her husband, whether or not her cancer has recurred.

Snap! What have I done to him?

Fortunately, the films revealed I am still cancer free. The look of relief on Dr. My Choice’s face nearly equaled David’s.

Oncologists, (doctors) have feelings, too. This knowledge affects the professional relationships of nursing practice in the following ways:

  • When questioning an order, assume the doctor has good intentions toward his or her patient, same as you.
  • Avoid framing questions to a doctor with your personal inferences, such as opinions of whether or not the physician is “good” or “bad.”
  • Consider that doctors suffer from work overload, and burn out, as do nurses.
  • Remember: Being part of a team is catching one another when we fall. No one is on top of his or her game every time.
  • Protect the Rock Star Doctor (every unit has one) by double-checking their orders the same as you do for any other physician. Don’t let them fall to earth because you were not diligent in providing a safety net for their patients.

Education is the tool of our trade. It is our demeanor, which makes us professionals.

Not All Days are Magically Delicious

Wound Vac ink & pastel on paper 2010 by JParadisi

        When I was a pediatric critical care nurse working in busy trauma centers, my duties included wound care. I have salved and wrapped burns, and limbs ravaged by meningococcemia. I’ve dressed the fingers of a child whose surgeon successfully used leeches to regain their circulation.  As an adult oncology nurse, I occasionally float to the wound care area and change dressings. 

       A few weeks ago, I changed a wound vac dressing. A wound vac is a small mechanical device in a fanny bag, worn by the patient 24/7.  Black sponge is packed into the wound and covered with an adhesive, transparent film. A suction tube connects the dressing to a canister attached to the wound vac. When the wound vac is turned on, it sucks all the air out, compressing the sponge tightly into the wound. There is barely any sound as the machine “vacuums” the wound’s drainage into the canister. The suction stimulates healthy tissue, often reducing healing time dramatically. If an air leak is present, there is a loud sucking noise when the machine powers on, and the sponge will not compress. This means it needs more transparent covering to seal it. If that fails, the entire dressing comes off and redone, which is not very comfortable for the patient. 

     The patient I was seeing dreaded the dressing changes. I sat on a rolly stool, listening to him express his feelings about the progress he was making. I used my best communication skills. We connected, and he trusted me with the dressing change. 

     His wound was shaped like one of the marshmallows in a box of Lucky Charms cereal. Its complex shape made cutting the bulky, black sponge to fit difficult. Nope, there wasn’t a template from the previous dressing changes, but that would have been nice. The wound’s location made keeping the sponge in place challenging. Using tricks, I managed to get everything in place. The patient tolerated the procedure well. I turned on the wound vac. 

     The machine made a loud sucking noise and the sponge did not compress. I looked at my patient and the disappointment in his eyes matched my own. I was unable to make an airtight seal by reinforcing suspicious areas with more transparent film. My patient said, “You’re not going to redo the dressing, are you?” It sounded more like a statement than a question. I knew he had reached his limit of tolerance, and I felt terrible.  “Let me try one more thing first,” I said. I stepped into the hallway and looked for help. Fortuitously, one of my WCON friends was out there, holding her lunch sack.  Also a nurse, she has advanced certification in wound and ostomy care.  “I need help, I can’t get a seal on a wound vac,” I pleaded. She put away her lunch and in five minutes she found the leak, fixed it, and the wound vac powered on in silence. The black sponge fully compressed. My patient went home. 

     I was not the hero I wanted to be that day. Someone else stepped in for me. That’s why I like being part of a team, because not all days are magically delicious.

The Woman from Human Resources is Right About This

An Unexpected Discovery photo: JParadisi 2009

     A friend of mine told me about his experience a few weeks ago at a dental appointment. He arrived on time for a scheduled cleaning with his hygienist. After waiting five minutes, the hygienist came to the door of the waiting room. My friend stood up to follow her, but the hygienist called the name of a woman sitting across the room instead. My friend sat back down. Puzzled, he assumed the hygienist would return for him shortly.  My friend works in health care. The doctor’s office he works for sometimes runs late, and patients wait. He figured it was Karma.  After staring mindlessly at the pages of a six month old tabloid magazine, he checked his cellphone for messages and noticed  half an hour had passed. He requested a day off from work for this weekday appointment. Anticipating it to last an hour he scheduled other appointments and mundane errands after the routine dental cleaning. He wasn’t going to finish his errands that day.     

     Finally, a dental technician called his name. Once he was in the exam chair, the technician told him the appointment changed. He was rescheduled for an exam with the dentist instead of the hygienist. The technician readied to take a full mouth of x-rays.  My friend asked about the cleaning  he  scheduled the appointment for, and the tech told him not to worry about it.  He told the tech that  he only had time for a teeth cleaning, and this was his priority for the appointment. Could he reschedule the exam with the dentist for a later date? Annoyance reverberated throughout the dental office like an earthquake measuring 8.8 on the Richter scale. Eventually his teeth were cleaned. The appointment lasted two hours. My friend left puzzled by the entire scenario. Weeks before this appointment, the office called him twice with reminders that he needed to call within 24 hours to avoid an office charge if he wasn’t there.  Why was his appointment changed without his permission, my friend asked?  Why wasn’t he at least informed a change was necessary with one of those phone calls?     

     There are lessons to extrapolate from my friend’s story into my nursing practice.  Occasionally my patients wait beyond their scheduled appointment times too.  Events occur or sometimes patients are late, causing unexpected delays. More intriguing is the chasm between the expectations of my friend and his dentist, leading to an unhappy encounter for each. I imagine that the dentist and my friend both felt disrespected.     

     How many times do patients say, “I didn’t realize this was going to take so long”? Immediately, we have different expectations for the appointment. I don’t remember any patient expecting a different treatment than the one I expected to administer though.     

     The story reminds me of how important communication is when managing expectations for both the patient and the care provider.  Unexpected changes without explanation during a medical (or dental) appointment are rarely appreciated.  The Human Resources woman is right about this:  managing expectations is an important factor in customer service and satisfaction.