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.

The Frustrated Float Nurse

Here’s the deal…

As a traveler in labor and delivery, I can be floated within women’s services, which includes antepartum and postpartum (PP) units even though I have no PP experience. When you are a traveler, you go where they tell you, unless safety is compromised. During the phone interview, the manager reassured me the likelihood of floating to PP was low. Last week revealed a different reality as I floated 5 times in 4 shifts.

Most of my nursing career, I have worked in specialty units (ICU and L&D) in which I managed one or two high acuity patients. Even though PP acuity is low, managing eight patients (4 moms and 4 babies) requires a different set of skills and organization.

Four hours after I assessed, medicated and tuned up my patients, I was sent to a different unit, antepartum. My assignment included a postop GYN patient who was being ruled out for a pulmonary embolism, a stable antepartum patient and a new admission. The new admission had ruptured her bag of water and was losing her twin pregnancy of 21 weeks.

This was a busy assignment especially after settling in all my patients the previous 4 hours but I was much more in my comfort zone and that made all the difference. Shortly before I went off shift my patient moved into active labor, requiring an epidural. When the next shift came in, they felt terrible that I floated twice and had a challenging assignment. Of course venting felt therapeutic but I went home annoyed and I woke up annoyed. Then I was annoyed by my bad mood!

I had a choice, I could remain cranky for the next five weeks anytime I floated or I could change my attitude. Sylvia Boorstein, author of It’s Easier Than You Think has a saying that comes in handy for situations like this.

“It’s not what I wanted, but it’s what I’ve got”.

We can have a physical pain or a negative circumstance but how we relate to it impacts whether we add more stress to it or neutralize it. I decided I needed an attitude adjustment or I was going to make myself miserable for the remainder of the assignment. There is no part of floating that I want to embrace but I adjusted my expectations to be prepared to float and when I went in that night, I indeed was sent to post partum for four hours. I was met with a lot of empathy from the staff and they adjusted the assignments to give me higher acuity moms without the babies.

The following shift, the other traveler floated and I had the comfort zone of an active labor patient who delivered on my shift.

It’s really easy to be happy and mindful when things are going our way. The true test is how we handle ourselves when we are challenged. It may not always happen in the moment but if we can create the space to reflect on how to approach a situation with less resistance, we often find we encounter a lot less stress.

Nurse's Journey From Poverty to Transforming South Africa's AIDS Care

Squished in the middle seat on my flight to New York this week, I caught up on my reading. Empty Hands by Sister Abegail Ntleko was recommended to me last month when I was in Nepal. I am a sucker for non-fiction books and biographies. They inspire me while giving a little nudge about reality and history. Just as I was inspired by The Boys in The Boat by Daniel James Brown, I found myself moved by Sister Abe and her journey to save children orphaned by AIDS in South Africa.

I am hoping to meet Sister Abe next weekend in San Francisco during her book tour. We are both Nurses and that is probably where our commonalities end. Sr. Abe was raised in a rural village in a hut that she and her family built with cow dung and sticks. Even during the worst storms, I never questioned the shelter of my home. Her mother died in childbirth when Abe was three and a half years. I have been fortunate to be swaddled in my mother’s love well into adulthood. Access to education was the norm for me while Abe fought obstacle after obstacle to be educated. One thing we had in common was that we both had fathers that were very proud that we were Nurses.

Ubuntu is a Zulu understanding that you are here to help others and others are here to help you. Sister Abe has taken that philosophy to heart and transformed the care provided to people of South Africa. She faced challenges to overcome poverty, racism, sexism and even ageism to save children orphaned and infected with AIDS. She has personally adopted children with AIDS in addition to creating a home for over eighty children.

She received the Unsung Hero Award of His Holiness the Dalai Lama in 2009. While we have made tremendous improvements to the ethical and medical treatment of patients with AIDS, Sub Saharan Africa trails behind after years of governmental ignorance. I’m looking forward to getting inspired by this incredible humanitarian nurse. If you are in the San Francisco Bay Area, come join one of these events.

Bay Area Events with Sister Abegail Ntleko.
North Atlantic Books https://t.co/ezRbD8ZwFe
Empty Hands Available at Each Event.

February 24, 7:00 pm
In conversation with Meg Styles, founder of The Gretta Foundation
The Lafayette Library and Learning Center
3491 Mt Diablo Blvd., Lafayette, CA 94549
This is a free event, but guests are encouraged to RSVP.

February 28, 7:00 pm
In conversation with Eugene Cash at San Francisco Insight Mediation Community
San Francisco Unitarian Universalist Church
1187 Franklin Street, San Francisco, CA 94109
This is a free event.

February 29, 7:00 pm
In conversation with Andrew Harvey at Spirit Rock Meditation Center
5000 Sir Francis Drake Blvd., West Marin, CA 94973
This is a free event.

March 4, 7:00 pm
In conversation with Matthew Fox at Book Passage, Corte Madera
51 Tamal Vista Blvd., Corte Madera, CA 94925
This is a free event.

If you are not local, you can get her book on Amazon.


The Vulnerability of The Healing Relationship

This week I offer a short read from an inspiring teacher, Saki Santorelli. I highly recommend his book Heal Thyself which this excerpt is taken from.

"What happens in that alive, open space called the patient-practitioner relationship demands such close attention. It is an embodiment, a direct expression of interconnectedness and interdependence. Beyond a doubt we work on ourselves as a means of helping others, and simultaneously, working with others is a way of working on ourselves.

The simple truth of this is hard to open up to because it changes the entire nature of the healing relationship from one of fixing and rescuing, or authority and domination, to one of service, collaborative creativity, and inquiry. This alone is a cracking open of our imagined sense of self and position. For our work and our privilege is to assist and accompany others into the discovery of their own intrinsic wholeness existing behind illness, even when death is close at hand or when one faces living with chronic illness."