I don’t know about you, but I struggle with being a people-pleaser. I want patients to leave an encounter happy. Yet, we’ve all had an experience where a patient comes into sick call reciting symptoms right out of a medical book and requesting a specific medication or treatment. They may even say that they are allergic to other options or that only this one medication will work. Often, their requested medication has high abuse potential and is valuable on the prison black market.
Correctional nurses can meet up with some demanding patients and need to be comfortable saying ‘no’ to unreasonable patient requests. Here is a guide for ways to say ‘No’ while still helping your patients.
Say ‘No’ After
When you are familiar with the patient population and in a rush, it is easy to think a few steps ahead. Rather than listen to what you suppose will be a meandering fictional account of why a medication or treatment is needed, you may head off the request with an abrupt decline. While this may seem time effective, it is neither caring nor good practice.
Instead, allow the patient to fully explain their symptoms and reasons for the request. Document as objectively as possible. Listening and documenting have several advantages:
- Discovering the ‘why’ of the request
- Documenting assessment findings for future comparison and evaluation
- Revealing discrepancies in presentation and symptoms, if any
- Confirming to the patient that the request is being seriously considered
- Allowing the patient to feel heard and validated
Say ‘No’ But
Once your patient has provided all the information, your clinical decision may still be to turn down the request. Rather than stop at ‘No’, include a ‘But’. State the need to decline the request but state what you can do. Here is an example: “Mr. Thomas, we won’t be sending you for an MRI of your ankle at this time, but here is what we will do. I’ll wrap your ankle and ice it, then we’ll set up a return visit next week to see how this is progressing.” Providing a ‘No, but’ shows that you are responding to the request, just not in the requested manner.
Say ‘No’ And
Like the ‘No, but’ approach, the ‘No, and’ approach provides something to your patient, although it is not the specific request. At the conclusion of your assessment and listening, you may have discovered some misinformation or misconceptions held by your patient. While you are declining the specific request, clarify misinformation and misconceptions to help your patient understand the reasoning for the decline. Avoid using rules and regulations as a reason for not proceeding with a request (See Higher Authority) below. Here is an example: “Mr. Thomas, I can see you are uncomfortable with your cold symptoms and I am going to provide you with some medications to help with that. Antibiotics do not affect viruses, only bacterial infections, so we won’t set you up with an appointment with Dr. Soo just yet.”
Use “I Don’t” and not “I Can’t”
While either can be effective, saying ‘I don’t’ rather than ‘I can’t’ indicates your control over your professional practice. Nurses can sometimes play the victim card and use words that indicate powerlessness. For example, instead of saying “I can’t give you that cream” say “I don’t provide cortisone cream unless there is redness, inflammation, or swelling.”
Call in a Higher Authority
While we don’t need to be victims, we do work within a nursing scope of practice. Some patient requests are outside of evidence-based practice guidelines or beyond licensure boundaries. This is the appropriate time to seek a higher authority. For example, you might say: “Mr. Thomas, I see that you want to be placed on a medical diet. The general prison diet meets national nutrition standards. You have not been diagnosed with a chronic condition like diabetes.”
Depending on your personality, one of the hardest actions when dealing with a demanding patient is keeping your cool. It is easy to react defensively or in frustration when confronted by some patient personality types. Remember, this is not a battle and you don’t need to weaponize your responses to inappropriate requests.
Use Empathy and Encouragement
When it seems like every patient wants something from you it can be hard to be empathetic. There are many incarcerated patients who are not trying to work the system and are in significant need of care. They may have been told by other inmates that the only way to get health care is to demand it. Being confrontational may be a way-of-life for them; both behind bars and in their neighborhood. They have few comforts in their current living situation. You can be seen as a gatekeeper to getting what they think they need. Showing understanding and encouragement, even when the answer is ‘no’, can sweeten the outcome.
OK, now it is your turn. How do you say ‘no’ to your patients? Share your thoughts in the comments section of this post.