I thought it would be fun to do a series that teases out my strategies for building rapport with my patients and caregivers.
It’s easy to think of my job as a medical job. Legally, it is a medical job. The reality is that being an RN Case Manager is more about interpersonal communication than medicine. Most of my patients come into service with a lot of misconceptions regarding end of life care. They don’t understand the services provided by the Medicare hospice benefit. They don’t understand the medications we use. They don’t understand what to expect at end of life. This isn’t anyone’s fault. Most people just don’t have much experience with death and dying.
I discovered that if I don’t build rapport with my patients and caregivers quickly, I become frustrated when I’m met with resistance as I introduce new concepts.
For my first installment, I want to talk about “time.”
For the purposes of these posts, the words “patient” and “caregiver” are interchangeable.
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Imagine for a moment that you are a patient. Your nurse sees you one-to-two times per week. You are stable, but your doctor has put you on hospice. Your nurse calls you on the phone and tells you, “I’ll be there in twenty minutes to see how you are doing.”
It’s been two weeks since you started service with hospice. You like your nurse. He’s friendly and polite. He always greets your pets and takes a minute to show them some attention. He just always seems to be in a hurry. He barely gets to a chair before he pulls out his computer, stethoscope, blood pressure cuff and oxygen saturation monitor. He asks a few questions from his computer, the same questions he has asked every other visit. He attaches the battery-powered blood pressure cuff to your wrist, puts the oxygen monitor on your finger and listens to your lungs, heart and abdomen all at the same time. He types for a few minutes longer, but as soon as the room gets a little too quiet, he asks if you have any questions, excuses himself and goes out to the car where he spends another 20 minutes doing whatever it is hospice nurses do in their car.
That is how I did my visits in my second month in the field. My first month was the polar opposite. I would spend two hours at each visit trying to fix every single problem I could find. It was exhausting. I changed to the above strategy when I realized that I can’t fix every single problem during every single visit. The fast visit is very time efficient. I can make lots of visits in a single day. The problem was that when my patient began to decline, I had no relationship so they were still struggling to trust me. It was when I began to move into the third month of work that I learned my first strategy for building rapport with my patients.
Act like you have all the time in the world.
I know it sounds silly and maybe even impossible, but it is a powerful tool in building rapport with your patient. After I enter the home, and greet the pets, I find a place to sit. I put down my bag and just relax with my patient for a few minutes. My goal is ten minutes without doing anything medical. I allow the patient to direct the conversation. Sometimes they go straight to the medical issues at hand. Sometimes they want to tell stories about their life. Sometimes they don’t want to talk about anything, they just like the companionship. The point is to give them the assurance that you have time for them. You want to give them the feeling that you could be there all day if required.
Compared to your patient, you do have all the time in the world. The average time that a person is on hospice is less than two weeks. This means that most of our patients will die within the first few weeks of coming on service. Most of them can feel how little time they have left. The biggest compliant that I have heard about other hospice organizations is that the patient felt like their nurse was always in a hurry. Being in a hurry is just plain insulting. It’s like saying, “Yeah, I know you’re dying, but I have stuff to do.”
Generally, as those ten minutes come to an end, my patient will give me an opportunity to start my assessment. They will come up with an issue or concern that will allow me to address the items on my check list. If they don’t bring up any issues at the end of the ten minutes, I can easily start a conversation based on what I have observed so far. Maybe they have been arching their back frequently during the visit. Maybe they have been coughing a lot. Maybe they have been pursed-lip breathing throughout the first ten minutes. By mentioning what I have seen so far, I am sending the message that I am engaged in the conversation, and I am paying attention. I have been assessing my patient for ten minutes and never said a word.
Now I have thirty minutes to address their concerns and do my charting. Like I mentioned in my story, I used to do a lot of charting in the car once the awkward silence crept into the room. I have found that I was the one who felt awkward. I think my patients like it when I stay in the home and finish my charting. I’ve never had someone ask me to leave. I think they like having the extra time with a medical professional who actually has time for them. They have felt like cattle being herded by an angry dog for so many years. No doctor office or hospital has had much time for them.
Isn’t it the right thing to do, at the end of their life, to give them the gift of your time?
