failure to build rapport immediately is not failure
the moment i saw G, i knew right away. i knew that i wasn’t warmly welcomed in her world.
her face was the definition of pissed, and her demeanor was the perfect description of the all familiar “leave me alone” look. whatever it was that i learned in nursing school about building rapport flew out the windows because i was convinced we will never have that connection.
despite the icy reception, i had to do what i had to do, so i gave it my best shot. i started with a timid smile and introduced myself, telling her i was going to be her nurse for the rest of the night.
“all i want is some sleep. i haven’t slept for three nights now, and all i want is sleep. do what you have to do, pull the curtains, and close the door.”
it sounded like a pretty decent request, so i said yes to everything. she was in the transplant unit for two nights, because we didn’t have bed available. with all the tests and chaos, she was always disturbed by this and that, and when finally, on that third night, when she was allowed a moment of peace, they told her she will be transferred to our unit.
before i left, i placed the call light next to her, telling her she can call me anytime, if she needed anything.
“they told me my liver was failing….”
i looked at her and walked back to her bed. i expected her voice to quiver, i expected her eyes to be teary. there was none of that. she was calm, but detached. i stood there waiting, hoping she wanted to talk about it, but she chose to be silent.
“close the door when you go out.”
an hour later, the charge nurse told me she needed to move G to another room, because a few patients needed to be transferred and shuffled to accomodate two more admits coming. i hate it when things like these happen, but i know sometimes, the charge nurses do not have a choice.
convinced that giving her a good sleep for the night was the only good thing i can give this patient, i begged and said everything i could to change the charge nurse’s decision. i even went to the extent of telling her that G will definitely go home AMA (against medical advice) if she will transfer her.
when she eventually gave in to my request, i found out she decided to transfer another patient to G’s room instead. i went to the other patient’s room and found out she was a confused old lady who constantly yelled all sorts of things. i had to beg, for the second time, to change the charge nurse’s plans and give my patient a quiet roomate.
for the rest of the night, everytime i checked on her, she appeared asleep.
when i left in the morning, G looked rested but she still had that unfriendly, cold gaze. i didn’t take that against her. i knew her head was stuffed with a lot of things that scared her. i did want to be there while she processed those fears, but she was not ready to share, and i didn’t push it.
i can only hope i set the tone, so her next nurse, or the one after next, can get through her.
who knows?
talking about it might help lessen her fear, might help lighten her load.

Wow! I’m stunned at the lengths that you went to for your patient. Excellent!
Comment by Awake In Rochester — March 29, 2008 @ 7:44 pm
A lot of work that we do for our patients goes on “behind the scenes” so to speak. Even if G does not come to appreciate what you have done on her behalf, at least know that you did the right thing.
You went to the mat for that patient. Excellent work. I am proud of you.
Comment by shrimplate — March 29, 2008 @ 9:08 pm
you’re such a compassionate nurse may. i’m sure you’re patients appreciate it. even G.
Comment by kimmyk — March 30, 2008 @ 4:58 am
yeh, your patients are lucky
Comment by Rygel — March 30, 2008 @ 5:59 am
nicely done
Comment by PD Warrior — March 30, 2008 @ 10:50 am
may:
I had a patient just like that, only post-transplant. I took care of him for nearly a month and it really got to me (and some of our other staff) that he had such a crappy attitude.
I had to work with him and grant his requests (most of which were just normal) in order to build a rapport with him. We developed a very good relationship, but there were definitely lines I could not cross.
I truly believe, and had this confirmed by our psych people (who he also gave trouble) that this was his way of coping. We just needed to keep going back, even if he was a pain in the butt, and eventually, he saw that we cared what was going on with him, even though, he didn’t always want to share.
Comment by RehabRN — March 30, 2008 @ 4:23 pm
You will not build a rapport with every patient. I usually “kill them with kindness” and they usually crack sooner or later. Most of the time they are just trying to keep the shields up to prevent themselves from thinking about the situation. You did a great job advocating for your patient and the much needed sleep probably did a world of good. Too often we forget that sleep is a great healer.
Comment by NPs Save Lives — April 6, 2008 @ 11:16 am