Criticism, Criticizing and being Criticized

I remember the first time I got reprimanded at work.

I started my first nursing job in November, and I got called into my supervisor’s office in March. I had no idea what to expect. There were two people behind the desk. They told me that my patient had been hospitalized for a stroke and I should have noticed and reported the symptoms. I was shocked and horrified that I had missed something so important. I asked a couple of questions about the details and then signed my write up. I couldn’t stop crying and had to desperately try to hide it because I had things to do before I left the office. When I calmed down I took a look at my calendar and realized that the dates that I was supposed to have noticed the client’s decline were dates that I did not have a scheduled visit. I was being reprimanded for symptoms that started after the last time I had seen the patient.

This was clearly not my fault. I didn’t know who to talk to, I tried talking to my supervisor and it didn’t help. Finally I called the in-house recruiter who had hired me. He was very sympathetic and listened to my complaint about their complaint. He even followed up with me. I appreciated that. I learned a valuable lesson from this experience. My supervisors and managers didn’t care about me. They only cared about covering their asses.

It was years before I was reprimanded again.

The next time it was a complaint made against me by a nurse from a facility. I was too aggressive, my attitude was pushy. My supervisor was wonderful. She consoled me and was very kind and understanding. I apologized and promised I would work on it. This complaint was made against me 3 more times over the next year and a half. Sometimes it was a patient, sometimes it was a referral source, but it was always the same complaint. One actually called me abrasive. My supervisor was always non accusatory. The last time she brought me into her office I actually got teary. I was genuinely embarrassed. Even through my tears I was grateful to my supervisor for being gentle with me. I promised her it wouldn’t happen again and I made a conscious effort to be more careful.

I have been at my new job for almost 6 months. I have been interviewing, hiring, reprimanding, and counseling from (literally) the first day. I have no experience being on the other side of the table in these situations. My only preparation for this role was my past experiences. As usual I have tried my best to learn from my previous encounters. As a result I am very deliberate with my tone, verbiage, hand gestures and body language so that the person I am speaking to feels the respect that I know I would want.

First, I now know not to talk to anyone while I am angry. Of course, in order to come to this realization I had to reprimand someone while I was very upset. Yes, it went badly. I don’t know what I was expecting when I called the nurse. Its true she dropped a non-ambulatory patient that was not supposed to be transferred. It’s true that she was disrespectful to the client and to the other nurse. Its true that she was defensive from the moment I got her on the phone and started yelling at me. But I never should have called her while I was so upset and embarrassed by what she had done.

I also know that each interaction that involves a reprimand should be clearly documented. I have a patient who lives at a facility that is super particular about dress code for our home health aides.I met with a home health aide at this facility and she was wearing a sweater over her uniform. I asked her take it off and her response was “Why? No one said anything to me about it.” I asked her again and she said “Are you serious?” I assured her that I was and that as her supervisor it is my responsibility to ensure that the dress code is adhered to. She made several other unprofessional and disrespectful comments. A couple of months later we had another issue with this caregiver and I used this incident as a president for her lack of professionalism. The absence of clear documentation from the previous issue meant that I had not followed policy and could not use it against her.

I recently had an incident where I needed to terminate a caregiver. This was the first time I ever had to do this. I promised myself I would be patient and respectful even though I was incredibly disappointed with the caregiver. I explained to the caregiver what her infractions were and why we weren’t going to be able to employ her. I was calm and direct. She asked to speak to the vice president and I gave her his number. I felt that I was fair. I hope that I was.

I need to talk less and really listen to the other side of the story. I need to document clearly and objectively. I need to put my opinions away and consider what the caregiver is saying.

The other new experience since I have been at my new job is being reprimanded by the patients’ families. I am the person that gets the call with any complaints.

In my effort to be empathetic I have done my best to validate the complaint and agree with the patient. A patient’s daughter recently told me she appreciates my eagerness to agree with her but it isn’t helpful. So I stopped agreeing when people called me to complain. Instead I decided to just listen and apologize. Then I either offer an immediate solution or tell them I will call them back shortly with a solution. I am trying really hard to stay with this plan.

My last blog post generated my first negative comments. I have truly honored that someone felt so strongly about what I had written. I was glad that I was able to read the comments for what they were and not take them personally. I don’t think that my writing is juvenile and I know that the stories I tell are meant to illustrate my points but are not exact replicas of what actually happened…so…I wasn’t insulted by the comments

I hope I am on my way to learning how to respectfully accept criticism and offer criticism. I hope that I can continue to learn from each experience and improve my techniques. I hope that I can listen honestly to what is being said to me and what I am saying to others.

The good news is I have plenty of opportunities to practice.

Lessons I’ve Learned:

  1. Take a deep breath
  2. Document, document, document
  3. Just Listen

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.


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


How to stop being a follower

Before I became a nurse I held a variety of jobs that were all “supporting roles”. I mostly worked in offices as a secretary or assistant. I was always happy with my jobs and I was lucky enough to never have a bad or mean boss. Looking back I really feel that I always did my best (except that first real job where they fired me for making too many personal calls-horrible memory).

When I became a nurse I got my first job in a large home care agency. I was completely on my own. When I did ask for help or guidance I seldom got it. Often I would ask multiple people for help and get conflicting responses. My lack of guidance at this job was concerning to me but I was a new nurse and I didn’t want to stir the pot. I stuck it out for several years and managed to (mostly) stay out of trouble. I quickly learned to do what was easiest for me. I asked for a raise and got it. I worked quite a bit of overtime and was impressed with all of the money I was making. If nothing else, I was very happy with the money. I left this job because I moved out of state but I also recognized that I was in a potentially dangerous position.

I decided to look for a big name home care agency. I applied to two and got one offer and took it. I had to take a pretty big pay cut but I figured it was worth it.

It was. Sort of.

I had incredible mentors and tons of support from amazing nurses and other professionals. All of the higher ups expected me to preform at my very very best and I liked that. I was sure that my hard work would be rewarded, and it was. I was promoted several times and given more  responsibility. I was never given a raise and actually made less money over time because I couldn’t work overtime in a management position. I requested to return to my field position and permission was granted. I became more and more resentful as I realized that although my hard work was truly valued I was not going to be financially reimbursed. I left the job because I was totally overwhelmed with the amount of work and was not being adequately compensated.

My new job was significantly less work with essentially the same amount of money. Here I learned the importance and advantages of real friendships in the office. I loved the people I was caring for and the people I was working with. I gained insights about business and finances. I took on new responsibilities and always tried to go “above and beyond”. I googled “When to ask your boss for a raise” and “How to ask your boss for a raise”. I read article after article. I was NOT going to make the same mistake I did at my last job where I never even asked for a raise. It would not have taken much for me to feel appropriately compensated. I agonized over the conversation I would have with my boss and I imagined all of the potential responses and all of my potential come backs. When I finally worked up the nerve to ask my boss, I got a vague response and a promise to re-visit in several months. That next conversation never took place. I left that job because a friend dropped my name to a recruiter who just happened to have an opening he was trying to fill.

I let the recruiter guide me in the interview and negotiation process. I felt I had learned from my past mistakes. I presented myself confidently and I asked for a salary that I truly felt reflected my value as an employee. Then I googled “How to tell your boss your quitting”. I read article after article. I spoke to my boss with a well measured, pre-planned speech.

Me: Can I speak to you for a couple of minutes? (I close the door to her office)

Boss: Wow, this must be serious.

Me: Yea.

Me: I was offered another job and I have decided to take it….

Boss: What? Why?

Me: They made me an offer I couldn’t refuse.

Boss: When is your last day?

Me: 4 1/2 weeks from today.

She said she understood and I had promised myself I would not say more. My research explained that I didn’t need to explain or justify. So I didn’t. It was a completely different feeling than I had experienced professionally in the past. When I quit my first job I practically whispered the information to my superior. When I left my second job I literally burst into tears and told my boss “don’t be mad at me”. The conversation with my most recent boss was not just the right decision for me but it also marked a change in the way I saw myself as a professional

hiresSo, here I am. Three months in to my new job. It is completely different than what I expected. I am challenged every day to be more and do better. I wear pantyhose, heels and makeup. I learn something new every day and I push myself to make the best decisions for the company and the best decisions for the employees that I supervise. I use the lessons I have learned from the followers and the leaders throughout my career.

But most of all, I spend time wondering how I could have done things differently and if that could have changed my career path. I look back on the missed opportunities and wonder where I could have ended up. I wish I had had some guidance or a mentor to help me navigate through the world of a new nurse and a new professional.

I have committed myself to be the kind of leader I wish I had when I became a nurse. I give advice and gentle criticism, I offer encouragement and counsel, I suggest alternatives and solutions. I refer clients to other companies where I have relationships-because that is what I would hope others would do for me. I have had opportunities to help people with professional connections for new jobs.

I am not perfect and I have so much to learn. But I am grateful every day that I am here.

Lessons I’ve Learned:

  1. Trust your instincts.
  2. Take risks.
  3. Don’t be afraid to ask for help and offer help. 

How’s the Weather?

I work as a field nurse supervisor for a home care agency. This means I do a lot of supervising. I don’t provide a lot of “hands on care” to my patients. Don’t get me wrong, I love, LOVE, what I do. But I get really excited when I have a chance to get down and dirty with some bodily fluids.

I have a very special patient who receives visits from a nurse from my agency for a urinary catheterization. This means that there is a small tube inserted into her urethra in order to drain urine from her bladder. If you are interested in a more in depth explanation, feel free to click here or for a ridiculous video demo, click here.

I went to see my patient every month for several years. My function was to “supervise” her care. We would talk about her children and her grandchildren, about her medications and her doctors’ appointment, and about anything else that she wanted to talk about. Sometimes we spoke about her childhood in Europe, how her grandmother was a caterer or how she came to America. I always enjoyed our visits.

One day I went to see her for a regularly scheduled visit and it became apparent that she needed a urinary catheterization. There’s a long back story that I won’t get into, but the bottom line was that my patient was not happy with the new nurse’s technique  so she had cancelled her last visit. Of course, this was not a great idea because the procedure needed to be done, I knew that the best thing for the patient was for me to take care of her at that moment.

Right away I realized a couple of issues:

  1. I hadn’t done a urinary catheterization in quite a while
  2. Well, see #1

I asked her where her supplies where and moved my ID badge into my shirt (yes, that’s a thing we do to prevent gross stuff from getting on our IDs). Then I put a pony tail in my hair, then it broke. I attempted to tie my hair in a knot to keep it out of my face, I was partially successful. I followed procedure beautifully and set up my supplies and began the procedure. It quickly became apparent why the new nurse was having trouble with the procedure. If you have every done this procedure on a woman, you know, some are easy and some are…not. This was one not easy. The patient was patient (lol) with me and we managed just fine. Of course by this time I was sweating and my hair was partially obstructing my view but I was thrilled because the urine was successfully draining.

Quick urine lesson. Healthy pee is light yellow. Dark pee usually indicated dehydration. “Cloudy” pee or sediment (shmutz) often means that there is an infection present.

I was trying to make conversation and appear noncholant while I waiting for the urine to drain.

Me: Are you ok? Are you having any pain?

Patient: Is it cloudy?

Me: No, its nice out today.