My Work Personality

My brother, Lee, was making fun of me last night. He said I was using my “work” voice, or more accurately, my “clinical tone” with our parents.

I guess we all have are tones/voices/personas. We act differently with our co-workers, bosses, family, parents, friends, husbands/wives…This is a necessity, especially for me, because I am naturally pushy and “in your face”. It has been a life long challenge for me to learn how to use those parts of my personality appropriately. Lee however, seems to think I use my work voice too often when I’m not at work.

I have to admit, when my kids start to frustrate me I sometimes practice my customer service skills on them. Is that so wrong? Can I use that voice with my parents also? Why not? (Hopefully my mother doesn’t take offense to this) Lee says I’m coddling them. I don’t  think so. I’m being supportive. Is that so terrible? Believe me, I know how to speak my mind. If I say it in a super respectful tone of voice and my parents feel respected, is that so terrible?

I think not! Sorry Lee, I think you’re wrong here.

tone-of-voice3When I teach a class on dementia I always say, “Never argue with a patient with dementia.” Then I pause for a second and always follow-up with, “Don’t argue with any of your patients.” It’s not our job to be right, its our job to help our patients make better decisions. We can’t force them to do anything.

Don’t even bother and try.

This is another thing I practice on my kids. I can try to force them to do things, but I know better. From my 3-year-old to my 22 year old, I can only make suggestions (threats). If I try to put the 3 year old in a coat she doesn’t like, she may just take it off, no matter how many times I put it on her. If I try to force my teenage daughter to wear her clothing a certain way (that I find acceptable) she is still going to do what she wants. There have been suggestions that this practice makes me an ineffective parent, but I know how to choose my battles.

I am not going to insist that my child wear a winter hat or eat their vegetables. I try my very best to be a model of good behavior and I try to find other ways to help them see my point of view. It’s in these situations that I use my tone of voice to help appeal to their sense of reason.

As a salesman and a parent I am sure that Lee would agree that your tone of voice and how you say something can often make all the difference.

Its important when I use my work voice that it should never sound fake. After all,  I don’t want to sound insincere. I want to sound super intelligent, patient, empathetic and professional. In fact, now that I think about it, maybe I should be using my work voice all the time.  After all, intelligent, patient, empathetic and professional isn’t bad in any situation I can think of.

Now I’m confused.

The way I see it, we can’t force people to do things, but if we say things in the right tone, we have a better chance of success and getting our point across.

At work, my job is a sort of nurse-ish-customer-service-y type of position.

One of my patients called me recently to tell me she wasn’t feeling well. I had to use both my nurse skills and my customer service skills to assess the situation. After several questions I determined that she was experiencing symptoms that could be life threatening. While sounding intelligent, patient, empathetic and professional I had to convince (force) her to seek immediate medical attention. It was not easy.  I called her cousin to enlist his help ( More work voice here). I had to calmly relay the information to the cousin without freaking him out but yet I still needed to communicate the seriousness of the situation. Then my patient explained to me that she would not go the hospital unless her physician was aware and ready and waiting for her upon her arrival. After trying to convince her otherwise I promised to call the physician. I called the doctor’s office and was immediately put on hold. This was actually an emergency. Eventually someone came back on the line and put me on hold again. When someone finally asked me why I was calling I was told that the physician wasn’t in the office until later that day. I asked (hopefully), “Is he at the hospital now?” The secretary said he was. I continued to explain why I was calling and she said to call 911.

Duh.

I called back the patient happy to tell her that the physician is in fact at the hospital and I once again explained to the patient that her symptoms could be something serious and that she really should call 911 , I even offered to call for her. Again she refused, leaving me with no choice but to use my work voice to (threaten) convince her of the need to go to the hospital. My work tone was very important here. I was desperately trying to force someone to do something with my special work voice.

You see, it’s a balance. While I usually work as nurse-ish-customer-service-y type, sometimes my job does involves life and death. So while  it important that I come across as super intelligent, patient, empathetic and professional, it’s also super important that I keep my patients alive by almost any means necessary.

So, its complicated. Yes, I have a work voice, but its a necessity. When I go to work in my suit and heels it may not look life and death, but sometimes it is. Yes, most days I am just a regular plain old nurse supervisor. But on some days I have to break out my work voice to keep people from doing things that could kill them.

Things I’ve Learned: 

  1. How something is said can be more important that what is said
  2. I really respect my brother
  3. Sometimes he’s  wrong

 

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Family Ties

Family.

It’s a funny thing when someone in your family is sick.

There are many different types of reactions that the family members typically have.

I had a patient who lived alone in a senior building on the beach. When Hurricane Irene was predicted we called all of our patients and their family members who were being evacuated. My patient’s daughter did not want to talk to me and did not care to discuss her mother’s evacuation. I explained that according to the documents that the daughter signed when care began, she is responsible for her mother if the home health aide cannot make it to her mother’s home due to illness, weather or “acts of G-d”. This patient’s daughter made it very clear that this was my problem, not her problem.

Once I saw a patient for monthly visits who had recently moved in with her son and daughter in law. The patient was near the end of her life and her son felt they should spend this time together. The son spent all day, every day with his mom. He planned activities, took her to get her nails and hair done and to visit her friends. The funny thing was his mother couldn’t really appreciate the outings. She was just too sick and too weak to appreciate or understand what was going on in her surroundings. The nurse I work with joked that the son is busy with his mother’s schedule and his mother is “asleep in her soup”. Maybe this patient’s son was “over doing it”.

One patient I saw was home after a recent hospitalization for a fracture as the result of a fall. She was fine before the fall so she wasn’t receiving any help from family. After she came home she needed some help. I talked to her son about setting up services for his mother. He didn’t know anything about her. He didn’t know where she got her medications or how she usually shopped for food. I was a little surprised that he wasn’t more “on board” and didn’t seem particularly concerned.  Over the next several days and weeks I encouraged the son to be more involved and educated him regarding his mother’s needs. The son “stepped up” and began to worry that his mother was not improving like she should. He took her to see a specialist and she was diagnosed with a terminal illness. The patient died soon after with her son by her side.

I used to see a patient for wound care who had arterial disease (i.e black toes). The patient had a stroke years earlier and her daughter took care of her full time. The patient was bedbound and required complete care, which the daughter lovingly provided. I advised the daughter that her mother’s wounds would not heal and her blackened toes would likely self amputate. The daughter insisted on trying multiple different wound care options and even insisted on a certain type of gauze. I showed the daughter how to wrap the patient’s feet but the daughter insisted on wrapping each individual toe. When I was nine months pregnant this patient’s daughter requested that I be removed from the case. Why? Because she was afraid that it wasn’t safe for me on her stairs. She had four stairs.

I saw a patient recently who had recently had her second stroke. This stroke left her unable to speak and paralyzed on her left side. The patient lived with her daughter and her daughter’s family in a small apartment. The daughter cared for her mother full time including changing her diapers and transferring her with a hoyer lift. This patient required total care and her daughter was happily providing it. I complimented the daughter on what a great job she was doing with her mother, she thanked me with tears in her eyes.

I received a complaint from a home health aide that a patient was developing skin breakdown in her diaper area. I called her husband to ask how often he was changing her diaper. As it turns out, he wasn’t changing her diaper at all. The home health aide was changing it in the morning and the evening and the husband wasn’t changing any diapers in addition to those. I (patiently) explained the importance of keeping the patient’s diaper dry and the husband (claimed) to understand. I followed up with one of their adult children just to be sure that they were aware of the situation.

I want to understand why some families are so attentive to their elderly and sick loved ones and some are so absent. Maybe there’s nothing I can do about it, but I really want to get it. I want to understand so I can help everyone take care of their loved ones so everyone can live (and die) happily ever after. I am aware that this is unrealistic but it is my heartfelt desire. I may have to accept that there is no rhyme or reason to this.

I have worked with a wide spectrum of patients. The majority of my nursing experience is with low income, underserved and poorly educated population. I found that most of my patients felt a strong responsibility to take care of their loved ones. They often didn’t understand their illness or their treatments but they truly seemed to care.  I recently started working with more wealthy and highly educated patients. I was sure I would see a difference, some type of benefit to all of their money and education. It’s been almost a year and I now see there is no difference. The families are the same. Some are hardly involved, some much more so.

I guess its as simple as that. Most people take care of their family because that’s what they are-family.

Lessons I learned:

  1. Always compliment the caregiver
  2. Never assume the family is aware of the client’s needs.
  3. Treat everyone the same regardless of financial and educational status.