Crossing the line of Caring

NurseyBaby'05, BSN, RN · Nov 2, 2005

My :twocents: .

sjrn85 · Nov 3, 2005

Male Nurse Tweety,
Why do you have to set limits on how much you will care for a patient? I am still very new at this, so please don't take this the wrong way. Why does a nurse need to set limits on caring for a patient? You said your patient needed a presence and my patient needed water. How much more does it take to sit with the patient for a few minutes or rewash your hands? It seems to me that part of true patient care is also social and emotional care. I really want to understand, and maybe it will just take working daily as a nurse to understand, but I hope that I will always have time to stop and sit with a patient for a few minutes and wash my hands again.
Respectfully Carol Student Nurse

It does take actually working day in and day out to fully understand. Basically, you cannot give, give, give to every pt., every day. You'll burn out before you're finished with your new grad orientation.

There are some people out there who never get "enough," and if you don't set limits with them, they will suck you dry. Not to mention, they will bog you down with so many requests that you won't be able to manage your time, and your other pts. will suffer because you're tied up with a demanding pt.

I hate to be blunt, but you're going to have many days when you won't even have time to go to the bathroom, let alone sit with a pt. Unfortunately, that's the state of nursing these days, and it's not likely to change soon.

You absolutely must take care of yourself if you want to have any longevity in this profession.

Little Panda RN, ASN, RN · Nov 3, 2005

"If that is the case than she should have given the pt water. Maye she didn't want a precedent for the pt. snagging her as she was going out the door every time".

I agree with what you are saying, but I do believe that if this was the case for the reason why the nurse did not want to give this patient water, it could have been handled differently. If a patient has a habit of catching the nurse as she goes out the door to ask for something, then just before I left the room I would ask the patient "is there anything else I could get for you before I leave" giving the patient ample opportunity to verbalize any needs or wants. Then if it became a problem I would politely explain to the patient my reasoning behind asking if they need anything before I left the room. I am sure this is a simplistic view of a situation like this, but remember someday it could be anyone of us in that room and I am sure we would like a sip of water when we ask for it.

onconurseRT · Nov 4, 2005

I agree with ND MOM. I was the patient and I have also been the nurse. Once you have sat in your own filth/urine for a while and had your mouth crack and bleed because it was dry, the idea of providing that sip of water changes. I also do agree that patients can be manipulative and limit setting has to be done. I, as a patient, begged a housekeeper to get me a container of apple juice after I had been NPO for 4 days. (the clear tray does not sustain a person like myself that requires 3500 calories a day) During my hospitalization I entered weighing 120lbs 5'7" of mainly muscle and left 97lbs barely recognizable. When someone has lost almost every part of their dignity and then is trying to survive, they ask for things and do things that they possibly would not do in normal circumstances. I had an eye opening experience to say the least!

ClaireMacl · Nov 4, 2005

I agree with everything that everyone has said here about demanding pts, its just too physically draining and detrimental on the other pts care to continue with this line... however, if the nurse didn't state that to the student, I don't see why she couldn't have said to the student "can you do me a favour and do that for me, I'll be in room ... after you've done it", I know I've done that a few times... if there is no aspiration risk, there is no reason why a student cannot get a cup of water for the pt.

MarySunshine · Nov 4, 2005

I suspect that, like others have suggested, she knows this patient fairly well and was cutting off some needy behavior. I have no idea if this was right or wrong, without some actual context. She should have explained this better to a future nurse though.

Obviously, under normal circumstances, baring any medical issues, a patient should be given water if they ask. That's so obvious that it seems weird to state it.

HONEYBEAR · Nov 4, 2005

The nurse's answer shocked me and her rationale is even more bizarre. Can she not wash her hands again? I don't understand. I feel absolutely horrible for the patient.
Unfortunately my only advice is to step on the nurses' toes and get the patient some water.

DITTO :angryfire :angryfire :angryfire :angryfire

Tweety, BSN, RN · Nov 4, 2005

Male Nurse Tweety,
Why do you have to set limits on how much you will care for a patient?

Why set limits? Because my ratio is 7:1 most days and all them deserve my best and my time.

I always end my interactions with patients "is there anything at all I can do for you know while I have the time?" If a patient has repeatedly said "no", but calls me back over and over, then it's time to set limits, because that's manipulation and it's not fair to my other patients.

I agree, the few minutes it takes to wash my hands and give a glass of water is nothing. That's not what I'm talking about, I always go the extra mile for my patients.

But I wouldn't be so quick to judge this nurse. There are manipulative patients, most do it unconsciously, or they are confused, but in order to provide the best for everyone with my limited time and one body, sometimes I have to say "I'll get to that later, but now I must tend to other patient needs" or something like that.

I'm not saying this applies to your case. It does sound like the nurse was lazy and uncaring.

CrunchRN, ADN, RN · Nov 4, 2005

Yes, but she had a student, and she could have had the student get them their drink of water while she moved on. I totally understand the need to set limits, but in this situation I don't feel they had to be set. How awful must it be to want a drink of water and you cannot get it for yourself and have 2 able bodied people in the room who will not give it to you? I know limits must be set, but I think some are way more appropriate than others and this situation stunk.

GrnHonu99, RN · Nov 4, 2005

I was in clinical the other day and my patient had a spinal cord injury asked for a sip of water before my nurse and I left the room. The nurse said "No, Speach Therapy can do it in a few minutes when they get here." After we left her room, I innocently asked what the medical reason was for not giving her the water and why we needed to wait for Speach Therapy. The nurse said "There wasn't a medical reason. We already washed our hands." I was shocked, but didn't know how to respond. The patient did not have a MRSA or any other communicable disease. What should I do the next time this happens??? Any advise on how to help the patient without stepping on the nurses toes. I want to always cross the line of caring, even if my hands are clean.
Thank you

How awful. Hopefully there was a better reason than the handwashing things...if not...well it makes me sad to see these kinds of nurses still in practice...I just keep thinking, what if that were my mom or fiencee in there???? How would I feel or want them to be treated?! Its a HUGE pet peeve of mine that some nurses act like patients and their families are a pain in the you know what...come on!! How would YOU feel if your loved one or yourself were in that bed!

Q. · Nov 4, 2005

I've read some of the posts here related to demanding patients and setting limits. I agree with that, but unless I have the context of the situaton, given what the OP stated at face value, I still have to say that the patient should have been given water.

Setting limits is one thing, but come on folks, we're talking about a sip of water. Water. It sounds ludicrous to sit here and think that a discussion about setting limits could arise out of a hospitalized patient asking for water. We give prisoners water. We give suspected criminals water under interrogation and IF it's denied, it's done to psychologically mess with the person in hopes of enticing an answer. I see no reason to do that to a patient in a hospital and on a regular medical floor.

Bottom line is, when we're not patients in a hospital, we can pretty much get up, get some water or food or whatever at our own whim and desire. Why would we deny that basic thing to patients simply because they are in a hospital? They are under our care, not control.

GrnHonu99, RN · Nov 4, 2005

I've read some of the posts here related to demanding patients and setting limits. I agree with that, but unless I have the context of the situaton, given what the OP stated at face value, I still have to say that the patient should have been given water.
Setting limits is one thing, but come on folks, we're talking about a sip of water. Water. It sounds ludicrous to sit here and think that a discussion about setting limits could arise out of a hospitalized patient asking for water. We give prisoners water. We give suspected criminals water under interrogation and IF it's denied, it's done to psychologically mess with the person in hopes of enticing an answer. I see no reason to do that to a patient in a hospital and on a regular medical floor.
Bottom line is, when we're not patients in a hospital, we can pretty much get up, get some water or food or whatever at our own whim and desire. Why would we deny that basic thing to patients simply because they are in a hospital? They are under our care, not control.

well said.