Dealing with negative patients is never easy. They can monopolize your time, make you angry, and frustrate everyone they come into contact with. What can you do?
According to a number of experts, quite a lot.
“I approach patient interactions using the nursing process of assessment, planning, intervention, and evaluation. These steps are taken with patience and understanding,” says Cynthia Rochon, MBA, BSN, RN, Director of Nursing, Behavioral Health Services, Largo Medical Center. “In order to assist with a problem, you first have to understand the root cause. Never make assumptions because that can lead to more negativity. After gaining a clear understanding of the problem or patient care need, you provide an explanation of how the nurse can assist to remedy the problem or facilitate access to the resource who can provide further assistance. The last step is evaluation—validate that the patient has a clear understanding of how to follow up on directions that have been provided. Patient education is an important component of nursing care. When communicating with empathy, the patient experience will usually change from a negative experience into a positive interaction.”
Oftentimes, patients become negative because they are scared, says Jodi De Luca, a licensed clinical psychologist working in the Emergency Department at Boulder Community Hospital in Colorado. “Firm empathy and compassion are an example of setting structure and limitations. Be kind, respectful, and validate the patient’s feelings, but remain professional and clarify unacceptable behavior and/or unrealistic patient expectations.”
“Although it’s true we deal with these patients in the same manner we would other patients, it does take a lot of listening on our end to determine where the negativity is coming from,” says Debra Moore, RN, Director of Nursing of the BrightStar Care Edmond/Oklahoma City as well as the Midwest Region Nurse of the Year for 2017. “They could feel mad because they’re sick, missing a spouse from a recent death, or they may have just heard some bad news or had a frustrating experience in some other area of their lives. After we determine the cause, we talk with the patients and reassure them that we are going to care for them as much as they will let us. These patients may also need a lot of education on their diagnosis and what we can do to help. While it may take time for them to trust us, they will see that we are there for them and that they still have free rein over their lives. We honor them. It will take them sitting back and observing exactly what great care we can provide them. This will, in turn, help them relax and trust us in the end.”
Kristin Baird, RN, BSN, MHA, president and CEO of the Baird Group, is a consultant who coaches and trains nurses and nurse leaders. She shares two of her training points:
1. Suspend judgement and assume a neutral position.
By doing this, you position yourself for great empathy. Empathy is portrayed more through non-verbal behaviors than verbal, but both matter. When a patient feels you are showing empathy, they will have greater trust.
2. Use empathy statements and body language that will diffuse anger.
Try sitting by the patient, touching his/her arm or hand, and saying something like, “You sound upset.” By validating them with your words and showing compassion with touch, you are demonstrating that you care.
Nurses do so much more during one day than the average person may think. We know that they do more than take vitals, change bedpans, and give shots, but others may not. In fact, we know that nurses often make amazing differences in the lives of their patients. And they love doing it.
Here are a couple stories from nurses who have done just that.
Shortly before his 60th birthday, life had become exceptionally difficult for one of Huda Scheidelman’s patients. Scheidelman, RN, and a home care nurse with the Visiting Nurse Service of New York, saw these terrible changes. Once a man who loved to explore the city, she saw his health going downhill. He was severely depressed after a recent divorce, he wasn’t following the meal plan from his dietitian, his blood sugars were out of control, and he quit his job as his diabetes made walking painful. Scheidelman decided to mix compassion, facts, and some tough love to get her patient back to his former health. It took some time, but he slowly changed his ways—he quit smoking, got back on insulin, and began following his diet. “Thank you,” he said on a recent visit. “I don’t know what I would have done without you.”
The Social One
Patricia O’Berg, PCCN, RN, BSN, a clinical instructor at the State College of Florida as well as an ICU nurse at Englewood Community Hospital in Englewood, Florida, had a passion for nursing that began at an early age. She didn’t pursue nursing, though, until later in life. After she had a career in public relations and raised a family, O’Berg decided that her passion for being a nurse was “alive and well.”
While earning her bachelor’s degree in nursing, O’Berg decided to participate in a study abroad program in Nicaragua. She immediately realized that missionary nursing touched a special place in her heart, allowing her to care for many underprivileged residents of small villages. By contributing her nursing talent and compassionate care with a small team, O’Berg helped to treat more than 1,000 patients with a variety of health conditions over the course of only five days.
Since then, O’Berg commits to annual visits to the villages of Nicaragua as a clinical instructor to help save patients who wouldn’t otherwise receive care. That’s how she garnered the nickname The Social One—because she has such a passion for people and loves to heal.
In honor of Transplant Nurses Day—April 19—we decided to ask a transplant nurse what it’s like to work in this part of the nursing field. Austin Timmons, BSN, RN, CNOR, an Operating Room Registered Nurse at Largo Medical Center in Largo, Florida. Took times to answers some questions for us. What follows is an edited version of our interview.
As a transplant nurse, what does your job entail? What do you do on a daily basis?
A transplant nurse’s job entails many criteria including patient education, clinical care, and patient safety as well as a wide array of interdisciplinary coordination within the hospital. Transplant nurses work closely with transplant physicians, pharmacists, the lab, anesthesia, Organ Procurement Organizations (OPOs), perfusionists, surgical scrub technicians, and other specialists to coordinate the best care possible for our patients.
As an Operating Room nurse specifically, I focus–along with other members of the OR team–on providing the most current standards of care to our patients in a safe and respectful manner. We handle setting up supplies for a transplant procedure, providing education for our patients, keeping the patients safe under anesthesia, handling donor organs, and eventually taking our patients safely to a recovery unit to begin their journey with their new organ.
Why did you choose this field of nursing?
I personally chose this field of nursing to help expand the transplant services within our community and to assist in offering the best care possible for the patients that we receive. We all work closely together and have our own roles to make the procedure come together as a whole. We have a growing presence in our community, and, as a healthcare team, we are proud to be a part of the transplant program.
What are the biggest challenges of your job?
One of the biggest challenges of my job includes seeing the patient immediately before surgery. This is always an emotional time for them, and as nurses, we are able to comfort and sympathize with them at the bedside before the procedure begins. We are constantly in close contact with family members during the procedure to keep them involved and are available for their support as well.
What are the greatest rewards?
On the other side of the coin, the greatest reward as a transplant nurse in the operating room is seeing the patients after the procedure is complete–witnessing their joy and appreciation for this gift of life. For example, after one of our kidney transplant recipients had been brought to the Intensive Care Unit and woke up, the patient began to cry out of joy when they saw they were making their own urine for the first time in over a year. Knowing that our team has played an integral part in such a big milestone for their health is a great feeling.
What would you say to someone considering this type of nursing work?
To someone considering this type of work I would say, “Go for it!” It is a rewarding experience and allows you to work with many different departments and specialties, all of which have one common goal in mind. I believe compassion, attention to detail, organization, highly developed communication skills, and transplant-specific education are needed for this type of nursing work.
Is there anything I haven’t asked you about being a transplant nurse that is important for people to know?
One other thing that I would add is the involvement with our local population. The Transplant Institute of Florida at Largo Medical Center works with Life Link and other organizations to support community-centered events and education regarding donation and transplantation. These events help to strengthen our presence and help reach out to people in need.
Working as a nurse can really take a toll on your body. While many nurses work either all day work or all night work, there are others who work both day and night shifts, and that can be really tough.
We asked some experts for tips on how to make the switch and keep yourself healthy while working swing shifts.
Carrie Silvers, RN, MSN, a professor of nursing at the University of Arizona gave these tips:
On switching days to nights: Stay up later the night before you switch, and sleep in as late as possible. I used to find it hard to nap during the day, anticipating my shift. Schedule early family dinners and bath times for the kids on work nights.
On switching nights to days: A couple of ways I switched included not going to bed right away when I got home in the morning. I was able to see my kids, and make them breakfast. I’d sleep a shorter period of time so that I could go to bed that night and get a good night’s sleep. This also allowed me to be awake when they got home from school, help with homework, dinner, sports, and bedtime stories.
On eating healthy: Eat a balanced and healthy diet full of fresh fruit and vegetables with an increase in lean protein intake. Increasing protein will help with stamina and staying awake. Pack healthy snacks and a meal to take to work. Avoid high fat and fried foods while at work. Limit caffeine intake to early in your shift, and to only a couple of servings. Working during the day I would avoid caffeinated beverages after noon, and on night shift after midnight.
On exercise: I used to exercise before work because it helped me to wake up and get my blood circulating. Even a walk or 30-minute exercise videos work.
On staying hydrated: Drink a lot of water. At least 8 glasses/shift. You’ll feel hydrated, less tired, and your body will thank you.
Nicole Thomas, RN, MSN, CCM, founder of Nicole Thomas, Inc and Going Beyond the Chart, has been a nurse for more than 11 years and worked many swing shifts. Here are some of her tips for working swing shifts:
Get a calendar and get organized. By working swing shifts, it is very easy to forget other obligations including medical appointments, family functions, meetings, etc. for yourself and your family. You must get organized, and you can do that by getting a planner that you can write in or simply use google calendar which is free and has a mobile app which is amazing.
Do things you enjoy doing. While it’s important to rest, you have to have fun and enjoy life. Working shift work oftentimes limits you being able to enjoy events, family functions, etc. so you must make time to do the things you like. If you don’t, you can feel like you are missing out on living a fulfilling life. Have a balance.
Ever wonder why you might think about earning a certification? In honor of Certified Nurses Day, we asked Karen S. Kesten, DNP, RN, APRN, CCRN-K, CCNS, CNE, associate professor at George Washington University School of Nursing in Washington, DC, as well as the chair of the American Association of Critical-Care Nurses Certification Corporation board of directors her opinion on the matter.
What follows is an edited version of our Q&A.
How long have you been in the nursing field and what certifications do you hold?
I have been a nurse since 1974. My first certification was in 1980 as a CCRN. Now I hold these certifications:
- CCNS (Acute/Critical Care Clinical Nurse Specialist, Adult) – 2004 to present
- CCRN-K (Acute/Critical Care Knowledge Professional, Adult) – 2015 to present
- CNE (Certified Nurse Educator) – 2012 to 2017
Why do you think it’s important for nurses to get certifications? What does it do for them? For the field?
It is so important that nurses become certified because it demonstrates that they have the knowledge, skills, and attitudes to provide high quality care to patients and their families. A certified nurse is a lifelong learner who cares about the quality of care they deliver. Nurses who are certified feel more confident that the care they are delivering is based on the most up-to-date evidence. Certified nurses are proud of their achievement and are role models for nurses and other health care professionals. Certification shows that nursing is a profession that cares about safety, quality, and excellence of health care delivery.
What’s the difference between board certification and being certified in a specialty?
Board certification means that certification is required for licensure, such as in the example of advanced practice registered nurses (APRN). In this case, a board of experts at the state level in the field of nursing examines the credentials and qualifications of a nurse in order to determine eligibility for licensure. Certification in a specialty indicates that a nurse has acquired additional knowledge, skills, and expertise in a specialty area of nursing such as acute and critical care.
How do you know you’re ready to become certified?
Preparation for certification requires that the nurse meet the eligibility requirements such as gaining experience in providing direct care for a required period of time for the relevant patient population. It also involves setting certification as a specific target goal, studying, and acquiring the knowledge needed to pass the certification exam. There are courses, study materials, and practice tests that can help a nurse to prepare for certification. Progress on self-assessment practice exams can help nurses know if they are ready to sit for the exam to become certified.
Do you need additional education to become certified? What are the requirements to apply?
To become certified as a critical care nurse (CCRN) or progressive care nurse (PCCN), a nurse does not need additional formal education. However, it is helpful to prepare—and there are prep courses, study materials, and practice tests that can help prepare for certification. You do need additional education at the master’s or doctoral level in order to become certified as an advanced practice registered nurse (APRN), such as an adult-gerontology acute care nurse practitioner (ACNPC-AG) or adult-gerontology clinical nurse specialist (ACCNS-AG).
What does it take to maintain your certification?
Nurses who maintain their certifications must meet renewal criteria that involve continuing education and, in some cases, continuing practice experience and an unencumbered nursing license.
What have been the greatest rewards for you that happened because you earned your certification?
Earning my certification makes me feel proud of the care that I deliver; it makes me feel more confident and self-assured. Certification enables me to feel more satisfied with my career—that I’ve provided competent care. It’s also opened doors to opportunities that I might not have had otherwise. Certification has introduced me to knowledgeable compassionate nurse mentors and to a community of nurses who care about delivering excellent care to acutely and critically ill patients and their families.
What would you say to someone considering becoming certified in any field?
I would encourage anyone to seek certification in their field to demonstrate they have the competence, knowledge, and skills to excel in their profession.