I have a vivid memory of being in class in fourth or fifth grade. The teacher kicked me out of class for talking. This was a common experience for me, I was always getting kicked out of class. I remember thinking that this was some gross injustice. I didn’t feel that I deserved to always be in trouble, always in the hallway, always in the principal’s office. But somehow, that’s where I was.
I asked the teacher why she kicked me out if everyone in the classroom was talking.
“You were talking the loudest”.
There it was, irrefutable.
She didn’t realize that she was dealing with a budding professional talker.
I am a professional talker. I talk for a living. All day long, I talk. I give short speeches and long speeches. Both formal and informal. Sometimes I talk to large crowds and sometimes to one or two people. As I spend hours in my car every day, sometimes I even talk to myself. When I want to relax I listen to podcasts and audio books-more talking. Some of my favorite podcasts are topics in nursing, writing, and beginner Spanish. More talking and how to talk. My favorites.
Over the years as a homecare nurse I have developed some pretty standard stock speeches. I have the diabetes speech (sugar is sugar, even natural sugar is sugar, carbohydrates are sugar), the hypertension speech (anything in a can is bad, salt free food tastes terrible, low salt options, TV dinners are death), the constipation speech (more water, no rice, Colace is your friend), the why-you-shouldn’t-be afraid-to-take-pain-medications speech (no you won’t become addicted, taking less isn’t better, seeing how long you can go without it is bad), the how-to-eat-less speech (I never give this speech, that may make me a bad nurse but the patient has heard it all before), the how-to-eat-more speech (high quality foods, water will fill your stomach, drink after meals, eating less makes you less hungry which causes you eat less which causes you to be less hungry…) the stop smoking speech (I recommend one less cigarette per week or per month, whichever is most realistic, I preach any change is better than nothing, I wonder if anyone listens), the you’re-the-patient-so-you’re-the-boss speech (you have the right to question and refuse treatments and medications at any time) the I-know-you-worked-your-whole-life-and-now-medicare-doesn’t-cover-all-of-your-medical-costs (all I can be is empathetic to this one), the healthcare-system-isn’t-what-it-used-to-be (the doctors don’t give you enough time, mistakes are made, illnesses are overlooked or misdiagnosed).
I don’t do anything during my visits without asking permission or explaining what I am going to do.
“Would it be ok if I put my bag here?”
“Where would be the best place for me to sit?”
I always explain the services we will be providing, when the approximate date of discharge will be and possible inevitabilities of their disease can we anticipate and prepare for. I ask what they know about their diagnoses and medications. I always offer to answer any questions. I was taught to ask, “Is there anything else I can do for you?” And I always explain that they should contact us with questions or concerns.
That is another speech I give. The please-let-us-know-if-you-have-any-complaints-or-questions-of-any-kind-we-truly-prefer-to-address-them-immediately-instead-of-having-you-hold-it-in-for-weeks-or-months. I tell people that they are not a bother, not getting anyone fired, not complaining, not rocking the boat, not messing with a good thing.
I wonder about people who worry about speaking up. These people are like mysterious creatures to me. There is not one leaf in my entire family tree who is quiet, shy or timid. I come from a long line of outspoken men and women. The women are particularly notable. The women in my blood line run from strong willed to overly opinionated to downright pushy. My husband and I are personally responsible for creating several more of these specimens. Of course my husband’s maternal and paternal grandmothers where no different, both of whom clearly live on through my extremely strong willed children.
Of course for some patients and their families complaining is not an issue, all they do is complain. I actually like “those” people. They’re a challenge. I like that. I enjoy finding the real complaint, the real root of the problem. It’s often surprisingly easy to fix.
This is when I stop talking.
Sometimes just apologizing and promising to work on the problem solves the problem. Even if there is no solution, just listening and identifying the bottom line, can be the solution.
When I first started to work in hospice nursing my instructor told me I had to stop talking, stop giving speeches. I had to just listen. This was a life changing moment for me. Because I was doing so much talking I was missing out on the opportunity to listen. It’s hard, and I catch myself about to start one of my speeches and I stop. I ask the patient what she thinks would be the right thing to eat/correct medication to take/best way to solve the problem at hand. I put the responsibility on them.
It’s easier for me to just talk and talk. And it’s easier for them to just let me talk and talk. The hardest thing for me, as a nurse, is to do nothing. Listening can feel like I’m doing nothing. I know this is not the case. But when I’m talking I feel like I am really “doing” something. When I am listening appropriately I am also “doing” something. That’s why it’s called active listening. Listening is an interaction, therefore it is not a passive act.
My silence is a signal that the patient recognizes. The patient understands that she has to be accountable. This is not a one way street. This is a collaboration that will fail without the patient playing her full role.
Lessons I’ve learned
- There is a time, a place and a limit for talking/preaching/lecturing patients.
- Listening is a valuable tool that is underutilized, especially by me.
- Talking is “doing” but listening is “doing” more.