‘Cold Calls’: Tips for Nurses When the Patient Just Got the Bad News

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author.

Julianna_Illustration_Cold_CallsIt’s difficult to choose which is more difficult: That moment before dialing the number of someone I’ve never met soon after they’ve received a cancer diagnosis, or the moment standing in the doorway before entering the hospital room occupied by someone I’ve also never met soon after their cancer diagnosis.

These scenarios are the health care version of a cold call. I manage them daily.

The term cold call generally refers to marketers calling someone without prior introduction with hopes of convincing them to buy their product. In the arts community, cold calling refers to an artist walking in off the street with a portfolio in the hopes of convincing a gallery owner to exhibit their art. Rarely are either appreciated.

Most nurses involved in patient care make cold calls. Walking into the room of a patient you’ve never met is a cold call. Starting an IV on someone else’s patient or in one you’ve just met is a cold call. A cold call occurs when the unconscious patient brought to the ED opens his eyes and your face is the first thing he sees.

Lots of things about nursing are difficult. For the novice and experienced alike, walking into a patient’s room after they’ve received news they or their loved one will not recover is towards the top of the list, the worst kind of cold call.

For the next 12 hours you are part of the patient’s nightmare. The first few minutes after entering the room determine if you’re cast in the role of angel or devil. Make no mistake, your words and actions will become part of the family’s lore, repeated for years by the survivors—if these are perceived poorly enough, a customer complaint will be filed against the nurse, guilty or not.

As an oncology nurse navigator, for me a cold call means introducing myself to patients recently diagnosed with cancer. The introduction often occurs over the phone without the luxury of facial expression or body language to convey the depth of spoken words. The opportunities for misunderstanding are daunting.

Each patient is unique and no single approach is right for everyone. However, there are general principles to provide guidance.

  • First, understand that the patient’s emotional state is heightened. They are hypersensitized to words, gestures, and body language. Remain as neutral as possible during initial encounters until they become comfortable with you. When speaking, stand or sit fully facing them, and make eye contact. Resist leaning against counters or furniture—it can be mistaken for a cavalier attitude, despite your intention to take some weight off of your feet or back. Use of slang or making an unsolicited joke may be interpreted as flippancy.
  • Keep in mind that you are treating the whole person, not just their disease—a perspective that’s one of the hallmarks of the nursing profession.
  • Be sensitive to the fact that it takes time to absorb disastrous news. People receiving a life-threatening or life-changing diagnosis almost universally describe the following first days or weeks as “surreal.” I envision a famous painting by Dali, The Persistence of Memory, with its melted clocks: time is meaningless for the traumatized. Patients will need to hear parts of their diagnosis and treatment plan over and over for a while, so be patient. Whenever possible, it’s helpful to use the same words their providers use in order to aid retention and avoid confusion.
  • Don’t overlook expressions of empathy when all else fails. The simple phrase “I’m sorry for your diagnosis” can be a powerful conversation opener, one too often followed by the response, “Thank you, you’re the first person to say that to me.”

Cold calls to patients are never easy, but all nurses can learn to convey empathy and concern, making them easier to bear—for us, and for our patients.

About the Author:

JParadisi RN, OCN, finds inspiration where science, humanity and art converge, creating compelling images as both a writer and a painter. She is the author of JParadisiRN, and blogs frequently for TheONC.org, and Off the Charts, the blog of the American Journal of Nursing.

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