Just five minutes to make an impression: Building trust before the OR

By Rachel Wolfe, MSN, CRNA

As a practicing nurse anesthetist, I’ve worked with patients who are 35 hours old up to patients over 100 years old. Regardless of the patient’s age, background, or reason for care, when I walk in the room and we meet for the first time, I have about five minutes to make a positive impression and earn their trust.

In that time, my mission is to create a rapport before we head to the operating room (OR). Building trust is central to a positive patient experience. Surgery—specifically anesthesia—is often scary for patients. An important part of my job is to help patients feel comfort, reduce anxiety, and help them understand how I will keep them safe through their journey.

In my career, I’ve made it a priority to build a connection in a short amount of time. The way I accomplish this may change, depending on if I am caring for a pediatric patient and parents, a young adult patient, or an elderly patient with adult children. But the foundation is always the same. These steps are ones any clinician can apply to enhance every patient’s anesthesia experience.

Formally introduce yourself with a warm smile

When you walk into a room, start by letting the patient know who you are and why you are there—what role will you play in this patient’s care. Acknowledge the patient by name and be present. Even with a busy caseload, this pre-op time is dedicated for this patient. Depending on the patient’s age, the patient’s demeanor, and the surgical case, my overall approach may vary throughout the interview.

Connect personally

While a pre-surgical medical interview is essential, I don’t use the first five minutes to ask medical questions. I can read the patient’s chart and do a head-to-toe analysis without asking a direct medical question. Instead, I use soft skills of eye contact, friendly gestures, and warmth. During this time, it is important to slow down your decision-making process and focus on reading the patient and the room to make sure you get it right.

When appropriate, build trust on a social level with a personal connection. For example, with a pediatric patient, I might ask what he is watching on a device and connect that way. With an adult patient, maybe I notice she looks cold, and I offer a blanket, or I realize a shared birthday or middle name. Look for ways to humanize the experience and make a connection, not as a clinician but as a fellow compassionate human being.

Build confidence and trust

One question I never ask is: “Why are you here today?” That suggests I do not know, which can cause undue worry for the patient. Instead, I validate the reason for the patient being there: “I see that you’re here today for [insert procedure here]. Let me ask you further questions about that.” This approach is important because it helps a patient feel confident that I understand his or her specific case and identify this as a time to bring up questions or concerns about the procedure or illness.

In the pediatric world, this is especially important because you are engaging with parents or family members who need to trust you with their child. I’ll never forget a 2-day-old patient who was profoundly ill, and the mother was obviously distraught. I looked her in the eyes and said: “I am bringing your child back. This is the general surgery timeframe. Your child will be in a better position after. Your child will be going home well.” Validating that mother’s 48 hours of fear and providing directions about the process brought hope to her eyes.

Offer options and empower 

Whenever possible, engage patients to be involved in making decisions that affect their care and recovery. Listen to their concerns for comfort or preference and address them with realistic solutions. For my pediatric patients, I let them choose the flavor of air they’ll breathe or color on their mask. A sense of control can help eliminate fear. Flexibility helps as well. If a pediatric patient is struggling to get those pajamas off, I let it go. We can take pj’s off after sedation when it is less traumatizing. We tend to want to say “no” to everything, but I think there’s a lot of room to say “yes.” And that “yes” can build trust.

Using the first few minutes of a medical interview this way can do more than enhance the patient’s experience. In some cases, it can potentially change a life. When a patient feels safe and heard by a clinician, it may also become an opportunity to counsel that patient on a comorbidity, such as sleep apnea or smoking. That patient may also feel more comfortable sharing an intimate health detail, which could be critically important to the impending surgical case.

For me, there is nothing more fulfilling than to have a parent look at me and say, “I trust you with my 6-month-old,” having built trust in the care that child will receive in my hands.

Rachel Wolfe, MSN, CRNA, is a Certified Registered Nurse Anesthetist (CRNA) providing care at the University of Pittsburgh Medical Center (UPMC) Hamot, University of Pittsburgh Physicians, and Children’s Hospital of Pittsburgh of UPMC. She is also an associate director at the UPMC Hamot School of Anesthesia/Gannon University MSN Program. She divides her time between providing patient care for individuals of all ages and training future CRNAs.