‘What I Said,’ ink and crayon on paper, Julianna Paradisi 2018

Nurses and writers understand the importance of well-chosen words. Precision of language is important for both. But nurses learn the emotional impact of words, wisely or poorly chosen, on the job, directly from our patients. There’s seldom an opportunity to edit or revise on the floor of a nursing unit. Words cannot be unsaid.

As an oncology nurse navigator, my nursing practice is almost entirely based on words. My stethoscope, which rarely left my body when I was a PICU nurse, now rests coiled like a snake in a basket, nestled among the art supplies I used to illustrate this post.

Since patients rate my nursing skills by my words, the ability to pass the ‘bs test’ is more important than ever before in my career. As a navigator, I have impressed a patient or two (and helped them get proper care) by recognizing over the phone that the symptoms they described were cardiac related and not the side effects of cancer treatment. But for the most part, words are the tool I rely on to prove my value.

It’s the nature of nurses to want to comfort our patients. We understand their emotions run high when they are faced with a diagnosis of life-threatening disease or hospitalized for a traumatic, life-changing injury. Choosing the right words to comfort them, or at least to decrease their fear and anxiety, while at the same time treating their illness or injury is challenging. It’s realistic to expect that once in a while we will choose the wrong words, despite our good intentions.

Using scripts takes practice.

Therapeutic Communication was a required course at the nursing school I attended. We learned a communication model to use when conversations floundered under the stress of difficult circumstances. Some hospitals offer nurses and staff scripts for the same purpose. Initially, it’s uncomfortable using scripted dialogue. Practice, and adapting the tool into a personal, conversational style, is crucial to prevent artificial “crisis talk,” which can make already strained communication worse in the same way telling a person to “calm down” usually provokes the opposite effect.

Cancer patients, myself included, collect thoughtless remarks said to them from the time of diagnosis through treatment. It’s been nearly 20 years, and I have developed a sense of humor about most of them—however, I still remember. One of my particular favorites came after telling someone I’d been close to that I would have chemotherapy and lose my hair. Their first response was, “Just think about all the money you’ll save on shampoo and conditioner.” I’m not making this up. A perk of being an oncology nurse navigator who is also a cancer survivor is sharing these experiences with patients suffering similar indignities.

What are the right words to use when confronted with a patient who has just learned their life has been profoundly changed? Begin with “I’m so very sorry this is happening to you.” Once, in anger, a patient, retorted, “What are you sorry about? You didn’t make me have cancer!” I acknowledged the observation, and simply responded, “I know, but I’m sorry anyway. I hate cancer.” That was enough to put our conversation back on track.

Addressing the underlying emotion.

Nurses are aware patients initially don’t hear everything they’re told, and need to hear bits of information over and over. I can’t emphasize this truth enough. When I sat in the surgeon’s office hearing I had breast cancer for the first time, white noise drowned out everything she said. Silently in my head, the phrase “this time, they’re talking to me” was all I heard, as images flashed before my eyes of all the physician consults full of bad news I’d sat through with my patients.

From this memory, I developed a personal script that acknowledges the feeling of being overwhelmed. It goes like this: “I know this news is overwhelming. It may feel like you’re standing on a track, while a freight train slams into you over and over, one car at a time.” I have yet to have a patient disagree with this metaphor. I go on, “My job as an oncology nurse navigator [but it’s a useful approach at the bedside too!] is to help transform the train track into a staircase. We are going to manage this diagnosis one step at a time.”

A caution on clichés.

Another point to remember is that nurses, like writers, should use clichés sparingly. Many have a core of truth, which is why they became clichés, but make sure you look at them from multiple perspectives before using. They can get you in trouble. A common example is telling a family member their deceased loved one “is in a better place.” Nurses intend it to mean the patient is no longer suffering, but a bereaved parent is unlikely to agree with the statement at its face value. Their child was in a pretty good place right where they were, in their arms.

Using words to comfort and heal is a skill expected of nurses, whether we aspire to become writers or not. While choosing the right words takes practice, and sometimes self-forgiveness, providing comfort with well-chosen words is one of the most rewarding aspects of nursing.