By continuing to use the site you agree to our Privacy & Cookies policy

'I find it really hard to say no to patients'

Before I started my training, I imagined I would sweep around the wards, being at my patients every beck and call.

I imagined that only patients who needed my help would ask for it. I imagined that patients would strive to be out of hospital as soon as possible. I didn’t imagine that the word ‘no!’ would come out of my mouth as frequently as it does.

We (despite what the media would have the country believe) are caring and kind people

It’s probably the thing that I have found most difficult as a student nurse. We (despite what the media would have the country believe) are caring and kind people. Of course we are! We want to look after people, help people and care for people. I would love to do exactly what my patients and their relatives want me to do. My experience of the working world before nursing was in hospitality, and it still is, part time. I very much have the mind-set of ‘the customer is always right’. And in some respects, this has been extremely valuable. It is hard for me to be grumpy or rude or even less than smiley in the work place, because in my other job I would be disciplined for behaving in such a way.

Patient’s often remark on how cheerful and pleasant I am, even at the end of a very long night shift. It’s because being relentlessly perky is something of a pre-requisite for a hotel employee. All good things, and I am proud to say my patients receive excellent care from someone who seems happy to be there, even if I really just want to be in bed.

I find it very challenging to tell patients and their relatives that they are wrong

However, I find it very challenging to tell patients and their relatives that they are wrong. In fact, it was a fulfilling day when I refused to wipe the bottom of a gentleman who was very much capable of doing it himself, but was just too hospitalised. When I encouraged an elder lady to walk to the toilet, rather than use the commode, I was over the moon. Because I was finally realising the importance of promoting my patient’s independence, and encouraging them to look after themselves, rather than rely on me. They were truly getting better, and I needed to let this happen, rather than help them take to the sick role. Every task they did themselves was a step closer to home. And let me tell you, privacy and four solid walls instead of flimsy curtains can do a patient with constipation wonders.

Harder still I found, was standing up to relatives. Many come into hospital nowadays having read stories of terrible care and expecting the worst. They challenge us on many aspects, which I suppose is a good thing as it should keep us in line. But Mrs Smith, your father doesn’t have a blanket on because he kicked it off seven times and told me he was warm. So no, I won’t get him one, he doesn’t want it. Mr Brown, I’m sorry but no, your son can’t have any more morphine, because it was only ten minutes since his last dose and I don’t want to harm him. Those are examples of things I’ve actually had to say, because I’m finally realising that I am a clever, intelligent and well-educated nurse, and I might know a little bit more about my patients care than their loved one. I’ve realised I need to be assertive. I’ve realised that by becoming this person, I really am helping them.

I meet my patient’s needs. If they need me to feed them, wash them, help them drink and attend to their toilet needs, then I am more than happy to be that nurse. But if they need me to push them and make them realise how much better they are getting, then I will be that nurse too. But I am always the nurse who ensures that her patients are comfortable, pain-free and most importantly, receiving the fundamental levels of care a human being deserves. And then a bit more. It’s really not that difficult.

Sarah Jones is the adult nursing branch student nurse editor of student nursing times.

Readers' comments (63)

  • Good, interesting article.

    Doesn't it all come down to attitude and commitment? Nevertheless the customer is not always right and the patient's safety and well-being take priority.

    Saying "no" or telling pts/relatives that they are wrong need not be challenging or difficult. Said in the right way and in partnership c. the pt. can make it much easier - at least (as a second-year student) that's how it works for me.

    Unsuitable or offensive?

  • good article

    highlights the main points of care, ensuring patients are confortable, pain free and encourage to do what they can for themselves within their own physical and mental capacity and pain limits.

    Giving a good reasons, as pointed out, also goes a long way to the acceptance of no for an answer.

    the concept of partnership at all levels still needs to be strongly emphasised

    Unsuitable or offensive?

  • This is an utterly brilliant and insightful blog - well done. It is a fine balance and I often think that this is where the ART of nursing comes into play

    Thank you for sharing this

    Unsuitable or offensive?

  • "It is a fine balance and I often think that this is where the ART of nursing comes into play "

    well said Ms Chinn

    Unsuitable or offensive?

  • Yes definitley an insightful and interesting blog. but please becareful that the "I might know a little bit more about my patients care than their loved one" could lead you down the path of complacency or openess to the family/carers knowledge and experience of their loved one(or even their professional knowledge)

    Good luck with the rest of your training

    Unsuitable or offensive?

  • Anon above, I agree we need to be careful about assuming we know more or have more experience in the care of a patient than their loved ones. Some of aspects of their condition and care they may be far more knowledgeable about and experienced in than we are and we should always respect their opinion and be attentive to any information and/or advice they share with us. Again it is a question of working in partnership and sharing information, knowledge, experience and expertise and adapting to an ability to adapt the level and depth of all of that above that we share with them.

    Unsuitable or offensive?

  • from Anonymous | 18-Dec-2012 12:58 pm

    sorry about the grammar and typos above - written in a hurry whilst multitasking and hit the submit button before reading it through attentively! Hopefully the gist can still be understood without going through all the corrections.

    Unsuitable or offensive?

  • michael stone

    This is an interesting piece, but I have only one very specific comment.

    'Mr Brown, I’m sorry but no, your son can’t have any more morphine, because it was only ten minutes since his last dose and I don’t want to harm him.'

    Presumably, the concern expressed by Mr Brown is because he perceives an unacceptable level of remaining pain, despite the pain-relief already being provided - shouldn't that prompt an investigation into how well the pain relief is working, and a assessment by an expert in pain-relief about whether a different drug/dose is necessary ? I am assuming that morphine acts within 10 minutes, when I pose this question.

    Unsuitable or offensive?

  • Love this article Sarah, excellent as always and very relatable.

    It reminds me of when I was working with a patient with really severe anxiety. She kept asking me the same questions over and over. At first, dutifully, I answered them. I wanted to reassure her as that is my job role, right? I found out very quickly that actually was the worst possible thing I could have done. "Tough love" probably isn't the best phrase to use but you know what I mean!

    I agree that it's about getting a balance between helping your patient and helping your patient to help themselves. Like Teresa said, it's an art.

    Unsuitable or offensive?

  • "tough love" is a good phrase but may be seen as unprofessional terminology by some.

    What you are doing Natalie & others is 'empowering' , 'facilitating', 'enabling' and 'supporting' your patients. The line between a patient's or a relative's 'needs' and their 'desires' is often a thin one filled with pychological ambiguity - this is where the art of nursing accentuates the science.

    Unsuitable or offensive?

  • This article illustrates yet again why patients are not - and will never be - customers. A customer pays directly for a private service so the unsurprisingly the customer is King. What a patient (and their relatives) want is often very different from what the patient needs.

    Unsuitable or offensive?

  • tinkerbell

    you will come to find it easier if you remember that you are always doing it in their best interests to promote independence wherever possible rather than the 'sick role' whereby they become more dependent. We shouldn't be encouring others to become 'passive receipients, avoiding any responsility for their improvement' but empower them to be active participants wherever possible.

    Sometimes it's easier and less time consuming to do something for someone rather than encouraging to do it for themself but it doesn't actually help them.

    It's best to help people help themselves within their maximum potential.

    Unsuitable or offensive?

  • Be careful who you say no to, a lot of patients and families feel that they deserve one-to-one care above all others, say no to these and it'll be a complaint for you!

    Unsuitable or offensive?

  • Like the author I initially found it hard to say no to my patients, but now after 15 years of working as a nurse it has got a lot easier! Merry Christmas one and all!

    Unsuitable or offensive?

  • To Mike Stone 18 Dec, difficult answer this one as all cases need to be assessed on an individual basis. Sometimes family think a patient is in pain because they are restless or agitated, but there are other reaons for this. Increasing analgesia is not always the answer. The answer lies in through assessment of the patient's needs at any particular time.

    Unsuitable or offensive?

  • michael stone

    Anonymous | 22-Dec-2012 1:23 pm

    'The answer lies in through assessment of the patient's needs at any particular time.'

    Yes, that is in theory the answer, an answer which is also obvious - however, the tension between expertise guiding decisions and tick-box guidance for the less expert, and the pressure on time and resources, seems to mean it is possible to slip into 'bad habits' when people start to blindly follow 'normal procedures' without thinking hard enough about their actions.

    Your clinical comments are of course correct, but they are part of the assessment stage - I have got something of an issue with under-expertise and consequently tick-box guidance, because when tick-box fails (unusual situations), it tends to fail disastrously. But I also accept that frequently the level of expertise isn't high enough for 'just use your brain' to work well enough: this is a really tricky area to resolve !

    Unsuitable or offensive?

  • DH Agent - as if ! | 23-Dec-2012 12:41 pm

    are you taking into account all the levels of expertise on a ward, in the staff looking after a patient on any one shift or 24 hour period or during their entire hospital stay and indeed in any organisation the size of the NHS? You get the experts and you get people in training, and all the levels in between with professional autonomy but not necessarily expertise in every single task they have to carry out. You get full timers and part timers. Autonomous professionals medical or nursing cannot be supervised every minute of the day which is why so many controls, guidelines, tickboxes, peer assessment, ward rounds, oral reports, documentation, etc. has become necessary in an attempt to ensure that no patient falls through the net. It is a highly complex area ensuring that this is not allowed to happen. Maybe it is because of this very complexity and failure to manage it adequately that so many errors are now happening.

    Unsuitable or offensive?

  • michael stone

    Anonymous | 23-Dec-2012 1:01 pm

    Yes, I'm aware of the complications of variable levels of expertise - indeed, so are the people who created the recent NEWS system, which is intended to flag up possible problems and to then ensure that a possible problem is considered by someone who possesses adequate expertise.

    My point was solely that pain-relief which appears inadequate, assuming that the intention of the prescribed treatment was to provide adequate pain-relief, should always be a 'flag': if the person who notices the continuing pain lacks the expertise to make an informed judgement, someoen more skilled in doing that needs to be summoned (I'm not keen on leaving people in pain, if it ought to be relievable and if the patient has requested pain relief).

    Tick-box versus expertise is very tricky to resolve !

    Unsuitable or offensive?

  • DH Agent - as if ! | 24-Dec-2012 11:48 am

    from Anonymous | 23-Dec-2012 1:01 pm

    I agree with you 100% re pain control. There may have been several problems there which should not occur
    1. the nurse concerned felt she had done her bit, or least for the time being, and moved on to other tasks. It could be that she had the patient under her observation to monitor whether the pain control was effective as not all works miracles and within the first few minutes of administration

    2. failed to recognise or acknowledge that she did not have adequate expertise

    3. there was no other more experienced staff available or she had to wait until they came

    4. the patient's pain control needed reassessment and all pain control requires constant assessment. there are various different methods such as algorithms and the WHO STEP system, etc. which should be followed as is reliant on adequate reporting and availability of the relevant expertise to monitor and make any adjustments. It is strictly against orders to take any prescription for medication or changes of dosage over the phone. this has to be clearly written.

    Hope this is a sufficient response in the light of the fact I have no time at the moment to re read the posts which refer to this particular topic and on Christmas Eve I have other preoccupations.

    Unsuitable or offensive?

  • michael stone

    Anonymous | 24-Dec-2012 12:58 pm

    Thank you, I agree - however:

    It was apparently a student nurse who wrote this article - so it seems unlikely she is an expert in pain relief ?

    She wrote:

    'Mr Brown, I’m sorry but no, your son can’t have any more morphine, because it was only ten minutes since his last dose and I don’t want to harm him. Those are examples of things I’ve actually had to say, because I’m finally realising that I am a clever, intelligent and well-educated nurse, and I might know a little bit more about my patients care than their loved one. I’ve realised I need to be assertive.

    having earlier written:

    'It’s probably the thing that I have found most difficult as a student nurse.'

    Unsuitable or offensive?

View results 10 per page | 20 per page | 50 per page |

Have your say

You must sign in to make a comment.

Related Jobs

Sign in to see the latest jobs relevant to you!

newsletterpromo