When The Patient Fires You

If you are a Nurse long enough, you might find yourself in the awkward position of getting fired by your patient. It usually has more to do with personality conflicts rather than nursing competence. As an ICU charge Nurse I had to delicately deliver the news to my friend and coworker that the patient requested a different Nurse. I’ve also been the Nurse to take over those assignments and recently I was the Nurse that was fired. How does one stay “balanced” when they are fired from a patient? Well I will share my story in hopes that if you are in the situation, you know you are not alone and there is no reason to add additional guilt or shame to the situation.

My nineteen-year old patient in early labor, broke her bag of water six weeks early and it was time to induce her to deliver. Her boyfriend and parents were her primary support roles, with a team of ten additional cheerleaders of friends and family. She was in early labor, managing her pain well, so I rolled with the flow and actually enjoyed the large number of visitors.  Five hours later when the pain kicked in and she wanted an epidural, I asked one person to stay (per hospital policy). The boyfriend stayed. Both the anesthesiologist and I told him more than once to remain seated. Any seasoned obstetric nurse has seen at least one dad pass out – and quite honestly, we are not looking to recruit new patients.

A short while later I ask the family to step out again to give the patient privacy for the Foley catheter placement to drain her urine. At this time I complement the patient for getting to 5 centimeters of dilation without any pain relief and explain the road to 10 cm is long, followed by pushing, which sometimes can take a few hours. I suggest this is a good time to take a nap and you might want to consider just having one or two visitors stay with you so you can rest.

The family stepped out, the catheter went in and the next thing you know I was reassigned. Apparently the patient’s mother didn’t like the suggestion of a nap if it involved some family leaving the room.

How do we react when we receive negative feedback? Most of us get defensive and try to justify our actions. Even in situations when we think we are right, there is usual a little morsel of a learning opportunity.

Could I have been more delicate in my delivery of that information? Probably. If I was working with better staffing ratios and was 1:1, would that have given me more space and time to communicate more effectively? Probably. Was it negotiable? Absolutely but the patient or mother never shared their concerns with me. Was my intention to upset the family? No. Was my intention to act as a patient advocate? Of course.

Anytime I offend someone, regardless of the circumstances, it is cause for reflection. It was incredibly short staffed, I was busy and I probably was more succinct than I needed to be. This was something to remember for next time.

My intention was pure, to act as a patient advocate. What I did next was just as important. I told the other Nurses and now I am telling all of you. Instead of hiding the information, feeding the guilt and shame, I dissipated it by sharing it with coworkers. That in itself can be very healing. The situation loses power and my colleagues reminded me that they would’ve done exactly the same thing. There isn’t any of us that hasn’t made a mistake. It is part of the human experience. Save yourself the added burden of shame and guilt by talking it out with supportive coworkers.

Are you a good communicator?

Have you ever found yourself regretting the words that have just been uttered from your mouth? Moments after we say something, we can see the impact on others. Our communication, both verbal and non-verbal has the ability to heal or harm, to create connection or divide.

 

In our fast paced world, it seems nearly impossible to be aware of every word that comes out of our mouth. It is challenging, but let’s see what happens if we sprinkle a little bit of mindfulness into our world of communication. When we are stressed out or met with a difficult conversation, our natural reaction is to want things to be different.

Take a look at your work or home life. Are there challenging conversations that you are putting off, complaining about, using sarcasm or arguing with others about? You don’t need to be an Aikido master to communicate effectively but we can learn from their principles. The Japanese martial art of Aikido translates as the way of unifying with life energy. It is an art that defends the practitioner while also protecting their attacker from harm.

Mindfulness allows us to sense our own body sensations, thoughts and emotions prior to reacting from a place of defense or stress. Here is an example: Your anxious patient has been ringing the call light all day. You just left her room and the light goes off again. You have a choice to react on autopilot or respond from a place of awareness.

Depending on the circumstances and the inner and outer resources, you may have the opportunity to notice frustration arising as an increase in heart rate, heat, flushing or tension. You can then name your thoughts or emotions, such as frustration or anger. This awareness gives you the choice of a different approach.

Before you put your foot in your mouth, reflect on whether what you have to say passes the Buddha test.

Is it true?

Is it helpful for this person to know this?

Are you saying it from a compassionate heart with empathy?

Is now the right time to share it?

I dare you to do nothing but listen when your friend is in pain.

Your friend is recently diagnosed with a chronic illness.  Your response to this person is:

A.   You are so strong; you will be fine.

B.    Well at least its chronic and it’s not going to kill you; for now.

C.    I get migraines every month and they are worse than anyone else’s.

D.   I’m so sorry.  I can’t even imagine what you are going through.  What can I do to help?

You probably picked D because you are so smart and we are playing make believe.  I know of plenty of real situations that I didn’t chose “D” because I was coming from a place of defense.  Perhaps you can relate.

I received all sorts of comments when greeted in my plaster body cast from my neck to my pelvis, while healing my broken back. I had so much support but I was also aware of how unskillful some people were in offering their version of support.  More than once, I heard: “Do you know how lucky you are?”

At twenty-five I cared less about my own honest emotions and more about accommodating others.  I just nodded, feeling guilty.  “Yup, really lucky.”  I could barely go to the bathroom by myself and I really wanted to say was “Shut the **** up!”   I didn’t need any reminding of my good fortune. The moment I could wiggle my legs with my body stretched out on the street, as I gazed at the truck that hit me, I figured out how lucky I was, all by myself.

There was no fast-forward button, as is the case with many life circumstances.  We need to learn to “be” with them.  As supporters, sometimes that means we need to let others “be” with difficulty and serve as witnesses without action.  Sometimes we can’t bear to see someone suffering and we want to make it better by going into “fix it” mode, feeling productive as if we are helping. If “fix it” mode doesn’t work we flip the channel to “cheerleader mode”.

If the idea of doing nothing except listening and supporting sounds foreign, it is probably due to a lifetime of patterns of fixing suffering.  That is understandable, as nurses, we do it all day long.  That magic 5th vital sign, on a scale of 0 to 10, pain is what the patient says it is.  What do we do about it?  We get rid of it with pharmaceuticals.  We are paid professional suffering busters!

However, when you can’t simply “be” with another’s suffering, you are rejecting their experience in a very subtle way.  We are turning our back on their pain because WE are uncomfortable.  By denying their experience, we are actually creating more suffering for them even though our intention is to remedy their pain.

If we can find a way to quiet the mind and open our heart, there can be so much healing in just listening.  Check in with your own emotions and see what comes up.  Leave the advice giving until later when they actually ask for it.  You may find yourself biting your tongue.  Be patient with yourself as it may be challenging to change habitual patterns but as with everything, we get better with practice.

Here is a 3 minute video of Brene Brown explaining the difference between empathy and sympathy.  Not only does it have a lot of wisdom, it will also make you laugh.