Unfortunately, over the past few months, a member of my family and myself have been on the other side-patient or family member of a patient. I was appalled at the acts of unprofessionalism I witnessed or suffered at the hands of various health care providers. Now I truly believe the majority of health care providers are caring, compassionate professionals. However, a few bad apples can taint the rest of us. Nurses have the responsibility to act professionally; however, some of us do not.
Here are some examples of unprofessional behavior I either witnessed or suffered during the frequent visits to the other side or those identified by others1-3:
1. The failure of health care providers to identify themselves when they enter the room. Now, they all had large name tags with initials (RN for registered nurse, RT for respiratory therapist, or NA for nursing assistant). However, if the patient wears glasses and does not have them on at the time, they are unable to read these large tags. It was easier to identify a nurse when he/she wore white uniforms and caps, not that I am advocating this. Now everyone wears scrubs, and it makes it difficult to identify certain health care professionals. I like the different colored scrubs. Just identify yourself to the patient and family even if you are wearing a large name tag.1 The days of wearing white uniforms and caps are gone, thank goodness.
2. One nurse told me I did not have the right to ask questions about the procedure I was to undergo. I found this appalling. Patients have the right to ask questions and receive answers as long as the questions are appropriate. All I asked was how long this person had been a nurse.
3. I have noticed several physicians refuse to answer questions about procedures they are planning to perform. I noticed one just walked out of the room.
4. When I asked the registered nurses (RNs) and physicians why they left the room when I still had questions, the RN replied they are busy, knew what they were doing, and that I should trust them. I had never met any of them before.
5. Violation of privacy. If my physician had bothered to stay around and answer my questions (she was too busy; by the way, I was her only patient of the day), I had wanted her to tell me the results of the procedure before anyone else. If it was bad news (it was not), I wanted to be the one to tell my family. Not her. The health care providers in charge of my care should have asked if I wanted my family to know the results. As a result, my family knew the results long before I did. Both RNs and the physician violated my right to privacy.
6. The patient has the right to know who is in the room and why. Twice, I observed people in the procedure room who had no business being there, and I asked them to leave. I was told it was a busy day, and they just wanted to watch. Again, a violation of the patient's trust and privacy.
7. One family member became unresponsive to painful and verbal stimuli. I was this with this patient at the time. She was brought to the emergency department barely responsive, hypotensive, and clammy to touch. It took over 1 hour before a physician saw her. Meanwhile, her blood pressure fluctuated, and she drifted in and out of consciousness. Each time, I went for an RN to get a physician. This was to no avail.
8. Remember people are listening. I have heard health care providers speak of other patients in the hallway by name within easy earshot of other patients and family members. Also, remember not to discuss a specific patient or patients in the elevators.
9. Dress like a professional when you attend a conference. I recently attended a conference where I saw nurses and respiratory therapists wearing very short shorts and sleeveless tanks. I am not advocating wearing a business suit, but do dress business casual. If you want to be treated as a professional, dress and act as one.
I want everyone to realize that the majority of health care providers are excellent in their practice. They far outweigh the negative behavior of a few bad apples. However, patients tend to remember the negative experiences more than the positive ones. Be sure to praise the positive behavior of your colleagues. I recently wrote several thank-you notes to those health care providers (RNs, physician, and emergency medical technician) who provided excellent care to myself and my family. I also sent letters to the heads of each facility involved, outlining the negative behaviors of some of their employees. I ended each letter with a positive note depicting the good behavior I witnessed. To my surprise, 2 representatives called me to apologize, get more information, and to ensure me measures had been taken to improve the patient/family/health care provider relationship.
So What Is Professionalism?
I found that it is much easier to find the attributes of professionalism rather than the actual definition of professionalism. However, I was able to find the following definition: "(1) The competence and skill expected and required of a professional. (2) The status of practice, and methods of a professional as opposed to an amateur."5(p1780)
The following is a list of attributes of professionals that include, but are not limited to the following1-5:
1. a role of influence
2. act and dress like a professional
3. good reading and writing skills
4. excellent communication skills
5. willing to share pertinent information with the patient
6. show the values of altruism, caring, human dignity, and social justice
7. join professional organizations
8. integrate your values of professionalism into your everyday behavior (everyday)
9. honesty
10. compassion
11. curiosity
12. altruism
13. self-assured
14. ability to show and feel empathy
15. social responsibility
16. accountability
17. answer your patient's questions to the best of your ability
So, what can we do as critical-care nurses? Some examples include the following1-3:
1. Make a good first impression.
2. Make certain the patient knows who you are and why you are there.
3. Never blow off a patient because you are busy. We are all busy. Answer his/her questions if you can, or call someone who can. If the question is inappropriate, just say, "I do not feel comfortable answering that" instead of telling the patient he/she has no right to ask questions.
4. Encourage your patient and their family to ask questions.
5. Safeguard the patient's privacy at all costs.
6. Ask the patient if any of his/her health care information can be provided to others than the third-party payers, such as family members. Some patients want to be the first to know. Honor their wishes.
7. Know the patients' and health care providers' rights and responsibilities.
8. Make your patient feel like he/she is your only patient, and give him/her your full attention. Again, I know this can be frustrating at times. The exception, of course, is in the case of an emergency involving another patient, such as a cardiac arrest. Then go back and explain to the patient why you had to leave in such a hurry.
9. Respect all patients and their family members.
10. Be your patient's advocate.
11. Nurses must act professionally according to the standards of our profession. Please remember you are representing not only yourself, but also the institution, your colleagues, and your profession.
12. If you notice unprofessional content, report it immediately to the person in charge.
13. Maintain excellent communication skills with patients, family members, and colleagues.
14. Obey the Health Insurance Portability and Accountability Act.
15. Avoid gossip.
Remember, I realize the majority of nurses are truly caring and compassionate people, or we would not have become nurses in the first place. Let us show this to our patients. Keep up the good work.
Vickie A. Miracle, EdD, RN, CCRN, CCNS, CCRC
Editor-in-Chief, DCCN, Lecturer
Bellarmine University School of Nursing
Louisville, KY
[email protected]
References