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.