You’re Going to be Alright

Years ago, following an art reception, my husband and I were enjoying dinner at a restaurant. As the server set our food on the table, we watched through a window as a car hit a bicyclist who had run a red light.

Go Team Oncology by jparadisi

Go Team Oncology by jparadisi

Immediately, we left our table and went to the woman’s aid. She wasn’t wearing a helmet, and her face was bleeding. She was unconscious, but breathing. Besides a possible neck injury, my concern was that she would stop breathing before the paramedics arrived. Despite my fears, I told her over and over, “You’re going to be alright. Help is on the way.” I don’t know if this mantra helped the woman, but it calmed me.

Nurses tell patients, “You’re going to be alright” all the time, whether or not the situation is as dire as the scenario above.

We tell them they will be alright while we are learning a new EHR documentation system at the same time we are administering their treatment. We tell them they will be alright while we struggle to enter lab orders correctly in the new EHR. Fortunately, EHR experts are readily available to answer questions and help us through this transition. They show us the step we missed, which is the reason the order did not go through.

I slap myself on the forehead, and the EHR specialist kindly reassures me, “You’re going to be alright.”

I think this is one of the most special qualities of nurses: Despite our fears and misgivings about a patient’s condition, or our ability to handle a situation, we tell our patients, “You’re going to be alright.” For the most part they believe us, probably because what other choice do they have? What choice do we have? It is what it is. We must move forward, together.

In Human Resource department lingo, focusing either a patient’s or coworker’s attention on the positive is called “managing up.” For instance, instead of telling a patient you are precepting a nurse who’s giving chemotherapy for the first time, you might introduce yourself by telling them they won the jackpot today — two nurses caring for them instead of one! — and that you are helping Nurse B, who is new to the unit. By doing so, you tell both the patient and Nurse B, “You’re going to be alright.”

In what ways do you manage up at work? What techniques have you adopted to promote a patient’s or coworker’s sense of security during a change of condition or a work-related transition?

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.

Who’s a Jethro? Thoughts on an Aging Nurse Population

Study Detail/artist: JParadisi (2009)

     My patient was watching The Beverly Hillbillies on TV while I set up the supplies needed to start her IV. I stopped what I was doing when she said, “What is this show? Is it a movie? What’s the name of this show?”  

     “How young are you?”, I asked, gesturing towards the TV.  “That’s The Beverly Hillbillies. You know how people say, What a Jethro? Well, that’s Jethro. He’s always coming up with good ideas that don’t actually work.”  

     I’m not all that old myself. The Beverly Hillbillies was already in syndicated reruns when I was in elementary school. However, I meet the over 40 criteria which the Age Discrimination and Employment Act uses to identify “older” employees.  

      I read an article on Medscape,  Retaining an Aging Nurse Workforce: Perception of Human Resources Practices, written by Mary Val Palumbo, Barbara McIntosh, Betty Rambur, and Shelly Naud. The paper explains that a majority of employed nurses are over 45, and Human Resources departments worldwide are looking for ways to increase retention of nurses into their 60’s.  

     According to studies, nurses want three things from the organizations they work for:  

  • Recognition and Respect
  • Having a Voice
  • Receiving Feedback

     Really? That’s what nurses in studies say they want? Really?  

      Listening to my colleagues discuss what they want, increased healthcare benefits, increased reimbursement for educational conferences, pay increases for career related achievements such as advanced degrees and certifications, are examples of what nurses want. I think this falls under Recognition.   

     Nurses universally complain about missing scheduled breaks because of too heavy patient assignments, and uninterrupted lunch breaks are considered a luxury by most of us.  Some department managers even post important notices such as changes in policy on the staff bathroom walls, to read during our “bathroom breaks”. Fortunately, the walls of the staff bathroom where I work are free of required reading. This probably falls under the Respect category.  

     Coincidentally, I attended a Human Resources customer service presentation. A Power Point slide projected a scripted phrase to ask the patient (customer): Is there is anything else I can do for you? I have the time.”  The HR representative emphasized that studies show the phrase “I have the time” is a crucial part of the customer service interaction, and we were urged to say it.  I raised my hand: “I’m playing devil’s advocate here: if the phrase is of such importance, then shouldn’t staff be provided with the necessary resources ( i.e. time = staffing)  to say it truthfully?”  

  • Recognition and Respect
  • Having a Voice
  • Receiving Feedback

will never be achieved unless nurses of all ages find the voice to clearly define what these terms mean to us.