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A Q&A with Kathleen D. Pagana, Ph.D., RN

Q: Dear Nurse Pagana, One thing I never learned in school, and haven’t figured out as a nurse, is how to handle embarrassing situations in the clinical area. For example, if my patient “lets go of gas,” he and I both feel uncomfortable. Do you have any etiquette guidelines to help me handle uncomfortable situations? —Needs Help

A: Dear Needs Help,
You’ve raised an important concern. Unfortunately, the very fact that embarrassing situations make people uncomfortable is also the reason you probably never addressed this as a student and the reason your nursing colleagues don’t discuss this now. The best way to handle any embarrassing situation related to physiology is to clinicalize it—explain it in a clinical context. Here are three examples, with suggested responses or explanations:

• The patient “lets go of gas” (has flatus): “That’s a good sign. It means your intestines are working.”
• You’re in the operating room and your male patient has an erection: “General anesthesia causes vasodilatation. The patient has no control over this response.”
• Your post-operative patient is embarrassed because he fainted when he tried to get out of bed: “This happens often. Many patients feel lightheaded and pass out when they first get up after surgery. This dizziness will pass as your body fluids are replaced and the effects of the anesthesia are gone.”

Of course, there are many nonclinical examples of embarrassing moments. Here are three that are very common, with suggestions for handling them:

• You address a patient by the wrong name: Admit your mistake. For example: “I’m sorry, Mrs. Smith. This is the reason we depend on the name bands.”
• You address a doctor by his or her competitor’s name: Admit your mistake. For example: “I’m sorry, Dr. Bailey. I was just speaking to Dr. Carey on the phone and had his name in my head.”
• You bend down to empty a foley bag and your pants rip: Know where you can go to get some alternative clothing. A common solution may be getting scrub pants in the operating room.

Embarrassing moments are common in health care. Providing a clinical response is the best way to handle situations related to bodily functions. Being honest and maintaining a professional attitude will help in nonclinical situations. Learn from each situation. Remember, you’re only human.

Kathleen D. Pagana, Ph.D., RN, is a keynote speaker and bestselling author. She recently wrote The Nurse’s Etiquette Advantage: How Professional Etiquette Can Advance Your Nursing Career. She is also the coauthor of Mosby’s Diagnostic and Laboratory Reference and Mosby’s Manual of Diagnostic and Laboratory Tests. These books have sold more than one million copies and have five language translations. Please visit Kathleen’s Website at kathleenpagana.com.

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Q: Dear Nurse Pagana, As a new graduate, one of my biggest challenges has been calling a physician on the phone. I often feel flustered and unsure of myself. Then they get frustrated.

Can you help? Does this get easier with experience? —Flustered on the Phone

A: Dear Flustered,
You’ve hit on a challenge for new as well as seasoned nurses. We all want to sound confident and act professionally. Try these tips:

• Remind yourself that the purpose of your call is to advocate for your patient. The call isn’t about you—it’s about helping someone else, and you’re the person to do it.
• Collect and have pertinent information at your fingertips—for example, the latest set of vital signs, intake and output, assessment data, current intravenous solutions, recent lab reports, list of medications, allergy information and the patient chart.
• Be sure you’re contacting the right physician. The orthopedic surgeon won’t want to be called about an abnormal heart rate. That call should be directed to the hospitalist or family doctor.
• Contact the doctor by his or her preferred method of contact. Many doctors are using cell phones and don’t want to be contacted on their home phone.
• If you’re asking a unit clerk to initiate the call, be specific with your instructions — for example, “Please call Dr. Colony at his office and say that I would like to speak to him about the blood pressure on Sarah Parrish.”
• Be available for quick access when the call is returned. Make sure the unit clerk can quickly locate you.
• Have an order form available and ready to use for phone orders.

Following these tips will help you handle this challenge in a professional and confident manner.

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A Q&A with Kathleen D. Pagana, Ph.D., RN

Q: Dear Nurse Pagana, My hospital is considering a dress code (as in certain colors and styles of scrubs) for nurses. I’m unhappy with this idea because I like being able to wear whatever scrubs I want. Do red polka dot vs. yellow striped scrubs really have an impact on how I perform as a nurse? —Unhappy Individualist

A: Dear Unhappy Individualist, Yes, you may be just as good at inserting a catheter wearing an evening gown as you are wearing hot pink scrubs, I understand. But how nurses dress has a bigger impact than most nurses realize. The way you dress either adds to or detracts from your professional image. It sends a message about how you see yourself and how you want to be perceived by others. Like most nurses, you probably want to be viewed as professional, intelligent and competent. Does your appearance mirror that image? Here are some ideas to think about:

• Patients often associate appearance with trustworthiness and ability. If nurses dress too casually, patients may question their professionalism and attention to detail.
• Does a nurse dressed in cartoon scrubs (outside of the pediatric floor) establish immediate trust, authority and credibility? Probably not!
• Many patients complain that everyone in a clinical setting looks the same. Patients want their nurses to be clearly identifiable.
• Family members, physicians and other members of the health care team also have trouble identifying nurses. This impacts communication.
• Some institutions are adopting a dress code to distinguish personnel. For example, a hospital may dictate that only nurses wear one print and medical technicians wear another print.
• Many health care systems are aiming for uniformity in dress. Wouldn’t you be surprised if, say, the copilot on your airplane was dressed in a jogging outfit? You would question an airline that permitted pilots to dress as individuals rather than as uniformed professionals.

Proper attire is important for nurses in every kind of setting. This includes hospital, clinics, meetings and conferences. Make sure your uniforms, lab coats, scrubs and shoes are clean, neat and professional.

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A Q&A with Kathleen D. Pagana, Ph.D., RN

Q: Dear Nurse Pagana,
There’s a doctor in our unit who is notorious for being in a bad mood…all of the time. He’s unfriendly to the patients, barely tolerates his fellow physicians and is a monster to the nurses. Fortunately for the people in his care, he’s brilliant. Unfortunately for me and the rest of the staff, he’s also a jerk. Until now we’ve just gone about our jobs, but the other day he actually threw a chart down near the feet of a nursing student and made her jump about a foot in the air. It didn’t hit her, and a technician just picked it up and handed it back to him. But now what?
—Tired of the Bad Apple

A: Dear Tired,

This is a classic example of bullying behavior. The bad news: For many of us, bullying behavior has been a pervasive aspect of our jobs. The good news: Something is finally being done about it. The Joint Commission (a national hospital accrediting agency) is now tackling the issue of negative work environments and behaviors that undermine a culture of safety and has instituted new requirements to identify, arrest and prevent this behavior.

The doctor you describe embodies almost all of the bullying behaviors described below:

• Demeaning behaviors (e.g., speaking to others in a condescending manner)
• Outburst of anger (e.g., yelling and screaming)
• Criticizing caregivers in front of others
• Disrespectful language or behavior
• Throwing charts and instruments
• Comments that undermine a nurse’s confidence in caring for patients
• Disruptive behaviors including anything that interferes with the ability of others to effectively carry out their work

A survey on intimidation by the Institute for Safe Medication Practices found that 40 percent of clinicians have kept quiet rather than question a known intimidator. This has obviously serious potential consequences for patients. These behaviors also impact staff morale, leading to decreased job satisfaction and increased staff turnover.

So, what can you do about bullying behavior? Here are some suggestions:

• Don’t tolerate it and don’t ignore it. Report it. Starting in January 2009, the Joint Commission is requiring hospitals to establish codes of conduct and create plans for dealing with inappropriate behavior. You should be able to file a report with your administrators and be protected from retaliation.
• Be assertive with bullies. For example, say, “Your negative behavior is impacting our ability to work together and provide quality patient care.”
• Attend educational programs about professional etiquette and encourage your administrators to require all staff to attend.
• Model professional etiquette in your interactions with others in person and on the phone.

Hold your team members accountable for a professional code of conduct. Beginning right now, look at your encounters with other health care professionals through a new pair of eyes. Nip bullying behavior in the bud so you can ensure patient safety and improve job satisfaction for you and your colleagues.