Mind Your Bedside Manners

Today was the last day of clinical for the semester—hallelujah. No offense, but I was CICU’d out. I felt like I had the same patient everyday—afib, CHF, afib, MI, afib…

My clinical instructor assigned us two patients as usual (the nurses on that floor only have three themselves). I’d been working with the same nurse for the past couple weeks so I came in and let her know which two of her three patients I’d been assigned to. She automatically said, “Oh no, I don’t want you to have 47.” I assumed the patient was a “difficult” one (which usually meant interpersonally challenged) so I didn’t resist or even blink—it was the last day and besides that guy had about three pages of meds anyway. The nurse said he was just really mean and she didn’t want me to have to deal with that all day. Trust and believe, I’ve already been called my share of four- and five-letter words by patients so it really didn’t make any difference to me. But they ended up giving me her other patient—who ALSO had three pages of meds (cringe)! But hey, such is life…

So I’m going about my merry day, and “47” needed a bladder scan so the nurse ask me if I had ever done one (no) and if I wanted to watch (sure). We go in and she starts doing the scan—the guy’s condom cath was bone dry but he had about 650 mL being held hostage in the confines of his bladder. She told/reminded him that he’d had two accidents yesterday and that she needed him to ring the call bell when he needed to go. He rolled his eyes and told her he had been ringing the call bell, but “they” take too long to come (which sadly, I could believe). She kinda laughs and replies “Well, we’re busy.” Love her to death, but I didn’t think that was the most therapeutic response she could have given him but I kept a straight face. “47” asked her for some ginger ale and ice. While she finished up with his urine and left, I went to the pantry. I came back with a cup of ice and a diet ginger ale—he told me it was too much ice. So I said okay and went and dumped some in the sink—”how about now?” He said it was fine. I needed to raise his head of bed but knew that would cause him discomfort so I told him I would go slow and for him to tell me when to stop. “Is that too much?” I asked. I had to keep asking him to repeat himself because he didn’t talk very loud and I didn’t understand what he was saying. Meanwhile, the housekeeping guy was in there cleaning the room and I could feel him watching me—I guess he was waiting for me to lose my patience as I went back and forth with the patient nitpicking over this and that. I cracked open the can and poured the ginger ale over the ice and handed “47” the cup. He sipped. “What’s your origin?” he asked. Again, I wasn’t sure what he’d said and asked him to repeat it for me. “Where are you from?” I assumed he was asking about my nationality so told him I was from “here”—that I was born in Florida. “You speak so soft. But these nurses, they yell at me.” “I do ring the bell,” he continued, “but they don’t come for 15, 20 minutes sometimes. It’s too long.” I nodded, and apologized for his experience. He continued to talk, telling me how he had 2000 people working under him and how he had never been spoken to the way he has been spoken to in the hospital. He told me about how his brother was taking over the family business now that he was sick. I stayed and listened to his story. His nurse came in and asked if I was okay—I’m sure she was wondering why I was still in there. I said that I was. Clearly he wanted someone to listen, and I had the time. Usually I have all of my assessments and morning meds done by 9:30am anyway.

But I didn’t see the “mean” patient everyone else saw (and therefore wanted nothing to do with). The man was sick. And he was in pain. And he had been retaining almost 700 mLs of urine before being straight-cathed—you’d be a little irritable yourself. But all it took was for someone to listen, to give him a few extra minutes of attention, for him to mellow out. I realize that nursing staffing levels (and the insane amount of documentation) oftentimes makes it difficult for nurses to spend more time at the bedside, but this is something we need to work on—it can really make a difference in the quality of patient care. For a little food for thought, head on over to NurseTogether and check out Sue Heacocks’ article, Bedside Manners 101.