Patient Connections: Sharing Your Authentic Self While Maintaining Your Boundaries

Podcast Transcript

Carol Pehotsky:

As nurses, one of the most important things we do is establish connections with patients. It's the start of a workday, we go into that patient's room and in an instant, we're trying to create that connection that's empathetic, it's authentic, it's compassionate, but it's not about me. Today, we're gonna talk more about that topic with my friend and colleague Meredith Foxx.

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care to advancing your career to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, associate chief nursing officer of surgical services nursing.

So, the topic today is how much of your full self you [should] bring to work as a nurse? And reflecting on empathy and authenticity. When I think back to nursing school for me, they really drilled down that the relationship between the nurse and the patient should always be 100 percent patient-focused, to the extent that they'd even talk about if patients said, how are you? The answer is, I'm fine, how are you? Without any glimpse into who we are as human beings.

And so, as a very thoughtful, brand-new nurse, that's how I carried myself. I worked straight nights, so even though there were sometimes opportunities to have conversations, it very much turned into, I'm fine, how are you? No matter the question. And about a year into my career, I was getting ready to sign off at the end of a shift, and one of our patients who we'd had for quite some time was gonna be discharged that day.

And she was, I think, in her mid-40s or so, and had come to us for cancer care. What we learned throughout her time with us is that we were her last destination on a road for cancer treatment and had come to the very difficult, but very important conversation for her that she was going home on hospice; she worked with her family on that. So, it was my time to round on the patients one more time, and I went into her room, and that's when she shared with me that she wouldn't be there when I came back that night because she was going home on hospice. I burst into tears.

And then I felt horrible because I'm feeling guilty and I have just made this about myself and not about her, and she put her hand on me and said, the fact that you reacted that way tells me how much you care and tells me how much of difference I've made in your life, and that will stay with me. And clearly, that story's still affecting me 18 years later.

And so, it's really had me, ever since then, thinking about that relationship and how we connect as human beings with our patients. So, on that note, I'm so thrilled to welcome to the studio today a very empathetic and authentic leader, my friend, Meredith Foxx. She is executive chief nursing officer for Cleveland Clinic. Meredith, we're thrilled to have you. Thank you for joining us.

When I think about, you know, what I know about your career, you've been a peds nurse, you've been an advanced practice nurse, you're now a leader. Can you talk just a little bit about how empathy and authenticity has evolved in your journey as a nurse?

Meredith Foxx:

Well, Carol, I'm so happy to be here today to have this conversation, and I've thought a lot about this topic in my career. How do you bring that sense of empathy but authenticity? And then establishing those boundaries. And it is a happy mix every day. It's not black or white. It sometimes settles in the gray. There's literature out about it, but until you experience it yourself and [understand] how you manage that, whether good, bad, right, wrong, really reflects on you as a professional and then how you kind of carry yourself forward. You mentioned my background being pediatrics and pediatric oncology, specifically.

And so, when I think about those patients and as you shared your patient story and how that affected you as well as affected the patient and on their cancer journey, I think sometimes the longevity, or the chronicity of the disease plays a role in how we establish ourselves as authentic but empathetic. And, as well, you know, what are those relationships?

So, when I think back to me caring for that patient population, there are a lot of things that come to mind. What is it about us that we share? What is valuable to the patient? And for me particularly, it wasn't necessarily, sometimes, the patient and the sharing, but the parents.

Carol Pehotsky:

Oh, sure.

Meredith Foxx:

The family members that were sitting there and, you know, I reflect on some examples of how I was their lifeline. Or I and the other colleagues were their lifeline. We were the ones that understood what the cancer treatment was doing to their child, or the symptoms.

They could talk the talk and speak the speak; they didn't have to try and explain every word to a family member or friend who was calling to check on them. And it was hard not to get, sometimes, wrapped up in those relationships, how you support them, and how you think about, you know, what your words mean and what you say to them. I think it's tricky. I think about times, just thinking about the age-old question asked of many of us. We've have had patients or family members of our patients say, well, what would you do if you were in this situation?

Carol Pehotsky:

Yeah. Oh.

Meredith Foxx:

Or, I had an easy out. They couldn't say to me, well, what would you do if this was your child? Well, I don't have children, so, yeah. Clean it up, that was an easy answer, but really thinking about that is, when they asked that question, you had to be careful. And, you know, what would you do if you were me? is posed to a lot of nurses. Young, old, experienced, new, mid-career, different specialties, and I think we have to think about how we answer that [while] trying to bring it back to the patient, bring it back to their family and around their values and what they find most important and how they think about things.

But that was one of the questions that you would get a lot, and that's a tough one because probably in textbook, it would say you don't answer that. But then not showing empathy, that's not being authentic, right?

Carol Pehotsky:

Oh my gosh, yeah. You know, when you think back to that journey, yeah, it's different. And we think about the trust that the family members have to have to go home at night. For inpatient care, right? What are some tips and tricks that, let's say I'm a brand-new nurse, and whether I'm in peds or adult, etc., I'm interacting with that patient. I'm interacting with their loved ones and trying to tell that loved one to go home and get some rest.

And how can I create that connection that says, you can trust me. I got this. Go get some rest so you can come back recharged tomorrow.

Meredith Foxx:

I think a couple ways you can do that is by thinking about your caring approach. What is it that makes you trustworthy? Is it asking questions to patients themselves? Directing it, getting that vibe of the developmental level of the child understanding the dynamics of the family. You know, everyone wants to say you can call anytime and you know, I promise you, we have this. But you know that fear that if they go and something happens and they're not there, but trying to ensure that they are taking care of themselves and being there for their child, I think is a balance. But I think it's developing that...the trust comes from the caring that's shown and how the interactions happen between you and the patient, you and the family members and all that.

Carol Pehotsky:

Absolutely. So, some of our audience members are probably nursing students; they're brand new in their career, so authenticity's tricky, right? Because you know it when you see it sometimes, but it's not necessarily easy to live it. So, I'm trying to figure out how to be my full self at work, but maybe not my full, full self. I need to be my professional full self. Any tips and tricks or things that you'd offer some of those newer nurses to say, here's how you feel comfortable in your own skin when delivering care to someone else?

Meredith Foxx:

So, this is something that I think you have to learn a little bit over time, but I'm gonna give all the newer folks and nursing students an advantage. Know yourself. Know yourself if you're an introvert, extrovert. You know, I'm an extrovert, so I will start talking to anybody and everything about anything and everyone and anything going on. And, you know, you have to balance that because what is it, does it seem authentic because you're trying to make a connection, or is it perceived as possibly not caring And, you know, I think back to, I don't have any specific examples, but I reflect on if something, say, was on in a room, the news, and there was a story. Even commenting on that could be intrusive, or it could be, wow, that's what they're thinking about right now? Or, you know, some of the best advice I gave to newer nurses is, you know, no one wants to hear about your commute and the traffic and that you forgot your lunch and that, this, that, and the other. You come into that room, and you start talking about that, and they're thinking to themselves, is this the worst thing you have to complain about, really?

Carol Pehotsky:

Yeah.

Meredith Foxx:

I have terrible post-op pain or I, you know, I'm so nauseous and I have been throwing up all night from my chemo, and you're complaining to me about your ride to work? And so, I think we have to be cognizant about what we can sometimes perceive as not influencing perceptions or how we perceive ourselves. There are many times when the conversation opens and that's okay, but I think sometimes, thinking about it from, again, starts with yourself. Thinking about what would that mean to you if you were feeling terrible in a bed space? Or came in to know you were gonna get bad news, and the nurse comes into the room and is immediately focused on themselves.

Carol Pehotsky:

Hair on fire, worried about and it goes, you know, when I think back to the story I shared, our nursing instructors weren't often their intent, and then they probably were showing the most extreme version of it because we were so green, right? But it still is about the patient and creating that connection that shows caring and not selfishness. You know, it's, we have this thing in common that can create this connection, but not the conversation is all about me.

Meredith Foxx:

Yep.

Carol Pehotsky:

You know, as we talk about this connection, you mentioned earlier on in the podcast, but how can you get this feeling when maybe you should be setting some boundaries? You know, you've tried to create this connection with the patient or the family members, and that little voice inside your head is saying, ugh, this is not headed where I want to. How do you set some of those boundaries in a way that's still focused on the patient and compassionate, but really maintaining that professional relationship?

Meredith Foxx:

So, it's easy to get pretty black and white here. You know, we have HIPAA. We have rules and regulations and policies we have to follow. We know what we shouldn't be sharing in terms of what their patients' rights are and, for example, they are entitled to know our full names and that's something on our side. I've talked with many nurses and different individuals who take care of patients saying, you know, sometimes that feels intrusive to them in terms of the situation. And then you flip to the whole internet, social media exchanging information, and that's really moving into that unauthorized boundary. We should not be exchanging personal information and phone numbers. The whole becoming friends on social media just is not really in the nature of a boundary between a patient-to-nurse relationship. But that's tough because all of a sudden, you might be having to put up some firm boundaries with a patient or their family members; if they don't understand why you're doing that, it can be perceived as Meredith doesn't want to be friends with me. Or does she not, you know have, yeah, have we not had a connection? I thought we had a connection here.

Carol Pehotsky:

Yeah.

Meredith Foxx:

Or you, you know, in the nature of just where people work and live, you find out you have mutual connections through schools or church or social activities and, you know, you have to respect those boundaries. But I think keeping it clean as you can, just say, you know, these are the expectations of us as professionals, and not making it about you and the person. But it's easier said than done, for sure.

Carol Pehotsky:

Sure.

Meredith Foxx:

They want to talk about stuff or the, you know, you find something you have in common, and I think it's trying to find those things that are in common that allow that relationship and that authenticity, but it's not intrusive or invasive.

Carol Pehotsky:

You know, you think about, it's one thing if a family member brings in a pizza for everybody to share, but if they're saying, thank you, here's this extravagant gift.

Meredith Foxx:

Yes.

Carol Pehotsky:

Or, you know, brand new nurse and, oh, you can come stay at our condo in Florida anytime. Thank you, but no thank you! (laughs) I'm very flattered, that's really, that's not appropriate, but the gesture is very much appreciated, but it comes from a good place, but it's really, sort of, understanding, goes back to you, like you said, knowing yourself and your profession and where those boundaries have to live.

Meredith Foxx:

Well, I can think of a specific time where I was trying to get a young girl with leukemia to eat. And her family brought in these great, I lived in Philadelphia at the time, so they were called hoagies. And brought in these great, you know, hoagies, sandwiches, and I was kind of going on a little bit, probably a little bit too zealous about it to her and, uh, trying, oh, my god. That looks so good, and that bread, and oh, and blah. And then, you know, two days later, the family's like, oh, you know, you were talking so much about that, we brought you one too and I was like, no, that wasn't the purpose.

Carol Pehotsky:

I'm trying to motivate her but thank you.

Meredith Foxx:

Yeah, I was really motivating your daughter, not trying to get myself a good sandwich here for lunch or dinner or break. But, I mean, it sounds silly, and that's a silly example, but it is the perceptions of just how they think and react to their interactions, especially, again, back to the chronic illnesses you're in these people's lives. So, you know, this is their life now, day in and day out, in the hospital setting for some time, and they don't have those outside connections as much as they used to, nor do they sometimes want them because of what they're going through.

Carol Pehotsky:

Right. When you think about the spectrum of patients that we care for, some people are outpatients or they're going to see somebody for only one injection, and that's the only time they interact with them, all the way to long-term relationships and it's about finding that, knowing yourself well enough to show how you show up and be empathetic with those individuals, whether you're going to meet them once in their lifetime or basically develop this lifetime relationship with this person that requires maintaining that professional boundary. One of the nurse leaders I've had the pleasure of interacting with over the years would always say, every day on this side of the stretcher's a good day. And, and back to your point about, you know, it's the traffic might be bad, but, and it's not, thankfully, it's not a requirement for nursing to have been on the wrong side of the stretcher, but I think it definitely changes your perspective when you have.

Meredith Foxx:

For sure.

Carol Pehotsky:

And what we can do to encourage nurses around us if they haven't had that experience, to at least imagine what it's like and that creates that connection, but also can help create that boundary that says, you know, you aren't on that side of the stretcher, you aren't on that side of the hospital bed, is this something that's gonna bring connection or is this going to create distance?

Meredith Foxx:

We are gonna have connections with different people and different patients and different visitors, different people we work with. It's just nature, it's human nature.

Carol Pehotsky:

Yeah.

Meredith Foxx:

We connect differently with different folks based on experiences, upbringing, whatever that is. So, flipping it around, the connections we have, we also have to be mindful of what that perception is to, possibly, other patients. And what that you know how that affects them. I always think, around the holidays, you know, the idea is, like, let's collect for this, you know, patient and their family. Well, what does that say about the rest of the patients and their families that possibly are on that unit? That we don't care that much about everyone else who has to spend Christmas in the hospital? Why did we, you know, we understand, possibly, why we picked this particular individual, knowing, you know, some of their challenges or what it can mean to them, but what does that mean to everybody else? And thinking about how we care for people across, you know, equally.

Carol Pehotsky:

So, it comes down to what you said early on, knowing yourself. What you value, what brings you to this profession. Taking some time, getting uncomfortable with yourself. Thinking about it a little bit, so you know how to show up.

Meredith Foxx:

Yeah.

Carol Pehotsky:

Awesome.

Meredith Foxx:

And I can reflect, I mean, there's patients and family members that I still have connections with.

Carol Pehotsky:

Sure.

Meredith Foxx:

And is that right, wrong, good, bad? I'm sure we can find a little bit of each of those concepts in there. But ultimately, it's made me into the nurse, the person that I am, and I value those connections and I can reflect on them to ensure that the connections for the future with any of those patients and families brings out the best in me and is the most beneficial for them.

Carol Pehotsky:

Absolutely. Well, that's a perfect time to transition, then. So, thank you so much for sharing your expertise. Now we're hoping we can let our audience know a little bit more about you as a person and nurse.

Meredith Foxx:

Let's do it.

Carol Pehotsky:

Let's do some fun speed-round questions.

Meredith Foxx:

Let's do it.

Carol Pehotsky:

So, what's something you do to recharge when you have time to recharge in your busy life?

Meredith Foxx:

Well, I have committed to one of my methods of recharging is truly exercise. So, I know a couple things about myself, recharging, whether that's starting the day with exercise makes me better for the day in terms of thinking or at the end of that day, that time just by myself on the treadmill or on the Peloton or walking my dogs in the neighborhood is just a good reset. It gets the endorphins going, the physical movement and, uh, to me, that's really a priority. Now, I, you know, I've had to reset some boundaries in terms of what my expectations are. You know, to commit to that every day, but just finding time to, you know, be away from technology, not having to make decisions, just be in my head, moving my body.

Carol Pehotsky:

Nice.

Meredith Foxx:

It's really my way of recharging.

Carol Pehotsky:

Excellent. And then, my only other speed-round question, you know, a lot of bad things, maybe, have come out of the pandemic, but what's a silver lining that's come out of all this for you?

Meredith Foxx:

So, for me, a silver lining is much more gratitude. Again, that idea of being on the other side of the bed. When we think about some of the tragic things that patients and families had to endure.

Carol Pehotsky:

Sure.

Meredith Foxx:

I feel fortunate that I didn't have anyone, myself or my family, you know, going through those tumultuous times when we didn't know a lot about what was going on with COVID. But we think about, really, that gratitude. I'm thankful for the life I have, I'm thankful for the friends and family I have, and really, just being thankful. It really is about that because life could be a lot worse.

Carol Pehotsky:

That's right. All right, well, Meredith, thank you so much for joining us today.

Meredith Foxx:

Absolutely, it's been a pleasure.

Carol Pehotsky:

So fun. Thanks.

As always, thanks so much for joining us for today's discussion. Don't miss out! Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.