How are you judgemental?

[GardenDove]

I was reporting off this morning on a rule out chest pain pt. He was a 49 yr old guy who had an extensive family cardiac risk hx, he had had a CABG in his 30's, had been an alcoholic until 8 yrs ago, when he gave it up. He had abused recreational drugs. He previously had smoked 4 pks a day, but now was down to 1/2 pack a day. He still occasionally indulged in pot, was married for 30+ years, had had stents, was not overweight, had early COPD, and was just about to get on disablity for his multiple problems. He also had had some esophegeal surgery secondary to his previous ETOH dependence.

The guy was actually very nice and really above board and honest. He had been a traveling worker who had worked on railroads. He had made the effort to quit drinking for 8 years, had cut back to 1/2 pack a day, was not pestering me for morphine, and was really nice.

So, one of the nurses in report was pretty judgemental. Let me just say that this nurse tends to give a pass to all the out of control diabetics who are 100 punds overweight, and is a only too eager to point out how judgemental I am if I comment on that.

This all made me realize how each of us has something that makes us judge our pts. For some reason, this guy seemed up front and honest. He didn't mind my remarks like "How in the world did you manage to smoke 4 pks a day!?". I saw him as someone who WAS making an effort. Yes, I think that whiny, overweight pts who have complications from their food overindulgences bug me.

So, what is it that particularly sets you off about your pts? For me it's the overeating, abdominal chronic pain pts, they really aggravate me.

[scrmblr]

I really don't appreciate this thread. Aren't we perpetuating stereotypes by highlighting them in a discussion? This is exactly how "drug seekers" and "complainers" are created, marked, studied and pegged -- before we ever even experience them!

I'm in nursing school, and I remember the first time I heard a nurse give me report on my very first patient. "She's got these open abcesses on her thighs that are really painful, she says. But if she's in so much pain, why is she still going downstairs to smoke every hour?" This made sense to me, a naiive, inexperienced nursing student, and so, before I even got a chance to begin my career in my own way of thought, I walked into my patient's room with a stereotype blocking my entire field of view. Because of this, the first thing I noticed about her was that she was sleeping with her cigarettes in her breast pocket (of course), and the first thing I assumed was that she would be crabby and want to smoke as soon as she woke up (of course), and that she really wasn't in all that much pain (of course not).

I'm really thankful that I took the time to try and get to know her, because I learned a lot about how wrong that nurse was. I learned that my patient was missing her son's first day of kindergarten, and that she had been diagnosed with Crohn's a decade ago with no end in sight. She really was in pain, which I could clearly see without years of experience under my belt, and yes, she smoked. But it made me realize: why wouldn't she? She had nothing else to get her through the day!

Stereotyping is really a huge issue with nurses, especially in the realm of report. You can make or break a nurse's DAY depending on how you describe your patient at end of shift. Think about it -- the outlook for your day can be completely different depending on the report you get: "This patient is really great. She's sweet, she doesn't really complain, and she definitely knows how to get up and go to the bathroom by herself. Really easy," versus, "Oh my gosh. What a nervous nancy. This lady shakes, and she's a smoker, but she's not allowed off the monitor so she just bugs you all the time about going downstairs. She always asks for pain medicine, but when you walk in she's asleep, and she has been incontinent three times. It's not going to be a good night for you." Everyone knows how each of these reports gives you a totally different outlook for your shift, and how you treat your patient.

This is my argument: both examples are wrong. Both examples of report put an idea into the receiving nurses mind, and immediately create a stereotype that molds and alters the rest of the shift and every dealing with the patient. I think that report should STRICTLY be confined to report -- medical, objective information that is PERTINENT and important to nursing care, NOT nurse opinion.

Stereotyping is a HUGE problem in nursing. Let's STOP glorifying it by giving petty examples of people who bother us. Our patients are sick, and regardless of what they are sick with or how sick they are, they deserve respect, and good, unbiased, un-stereotyped care.

I appreciate the fact that you actually got to know your pt before you passed judgement.

Passing judgement on my pt's is Very VERY hard for me...I am quick to judge the smoking overweight diabetic drug seeking pt. I am quick to judge the drug seekers. I get irritated by the pt's with the "gold card" or medicare express cards... But, the bottom line is that I give the same standard of care to everyone. I decided a long time ago that I would not let myself get involved in everyones drama. I would give the care and move on.

Your post was well thought out and intelligent. But, you seriously need to walk a mile in nurses shoes, not student shoes, before you can judge us.

[KIAN]

I have no patience for people who do not help themselves. The smokers who say they can't quit but want samples of inhalers because they can't afford them. The 300 lb short people with hip and knee problems who don't want to be helped to lose weight, just do surgery and pass the pie.

Also posters who tell us we should be non judgemental on a post that asked for our judgements. Go figure!

[Quickbeam, BSN, RN]

Quote:

Originally Posted by Quickbeam

When I was a work comp case manager (RN), I developed a hard heart towards malingerers and WC cheats. People claiming total disability from a questionable injury yet were able to reroof their house or drop a new engine into their truck (on surveillance). They'd always need OxyContin, could never work but managed to mow the lawn alright. There was so much outright fraud, I couldn't believe it.

because you mow your lawn twice a week, doesnt mean you can hold a 40 hour a week job....and maybe you couldnt even do the lawn without the oxy.....hm droppng an engine is usually done with a hoist.....not sure how much work is really involved there......guess what, YOU just hit one of MY buttons,lol........ until you have walked a mile,.......

I was referring to people claiming total disability and refusing all light duty work....yet are able to do things like reroofing the house, play full court basketball or yes, drop an engine. It's outright fraud. And I am disabled. I work full time.

[Tweety, BSN, RN]

because you mow your lawn twice a week, doesnt mean you can hold a 40 hour a week job....and maybe you couldnt even do the lawn without the oxy.....hm droppng an engine is usually done with a hoist.....not sure how much work is really involved there......guess what, YOU just hit one of MY buttons,lol........ until you have walked a mile,.......

I think that poster was talking about people who fraud the system, not judging the people who truly need diability. Best not to read too much into the post with the examples given.

Not that you're wrong, because you make a good point. We shouldn't make snap judgements on appearances.

I don't know, someone who climbs up on a roof and reroofs doesn't sound like they need total disability to me.

[GardenDove]

I guess I could say that I'm judgemental against people who judge nurses for being judgemental until they've walked a mile in our shoes.

Just because nurses tend to be judgemental after seeing the same behavior patterns time after time doesn't mean that we think our pt's don't "deserve respect, and good, unbiased, un-stereotyped care". We didn't say it was OK to be judgemental, however, nurses are human too, thus it happens.

Do this...post back after you've been a nurse for 6 months, and then tell us that you still don't have times where you've been judgemental in some aspect. Whether it be in re: to the pt family, meds request, sheer laziness, or non-compliance, I'll bet you'll understand a little bit better.

I agree with this post. I started this thread not to trash the pts, but just an acknowledgement that every nurse has a pet peeve pt, and it's nice to share. This is how nurses generally cope. It's also nice to let your collegues at work spout off without getting all huffy and calling them judgemental.

As I explained in my opening post, the gal I was reporting off to does occasionally have her self rightous moments when another nurse complains about a pt. She has been very protective of a few of our more demanding and aggravating frequent flyers. So I did find it interesting that she was so instantly judgemental of my pt that I had had, without even meeting him. I really like this particular co-worker, incidentally, she's a great nurse and a wonderful person.

So give your co-workers a break and let them vent in a safe enviornment, and acknowledge that what pushes their buttons may not push yours. Also remember that we are not all Mother Teresa of Calcutta, and actually I've heard that she had her opinions too.

[Tweety, BSN, RN]

I really don't appreciate this thread. Aren't we perpetuating stereotypes by highlighting them in a discussion? This is exactly how "drug seekers" and "complainers" are created, marked, studied and pegged -- before we ever even experience them!

Excellent post and you certainly are right in theory. But seriously some of us in the trenches for year after year have a different experience than you the student. Most of us are kind and compassionate professionals, but we have our buttons that are pushed and we get a bit weary sometimes.

Aren't you as a student being a little judgemental of us? :lol2:

Labeling a patient can be dangerous. I get a red flag when I hear someone is a whiner, drug seeking complainer. I can right off the bat think of three such patients, one had a bowel rupture, one had a torn bile duct and one had compartment syndrome............it's so dangerous to presume the worst about a person without adeuately assessing and listening to the patient.

[Tweety, BSN, RN]

My take on all of this is like someone above, I have to acknowledge that I'm human.

For example, I recently took care of a drug dealer who was shot during a deal gone bad. I am probably the most compassionate person you will find when it comes to setting aside someone's lifestyle and taking care of them. This man was not abusive, but just foul-mouthed, angry, impatient and ugly. Being the human I am I had to think "it's no wonder you got shot".

Also, the ones whose lifes revolve around their next pain shot can be draining after 12 hours. I do try to look at the whole picture and usually they don't get to me, and I'm understanding.....usually, but sometimes.........

I need to be self-aware of my feelings and honest with myself. Just because the ideal that I strive for is total nonjudgementalism, doesn't mean I should stuff my feelings and sugar coat them when they are truly there.

[nurse4theplanet, RN]

I think some people are confusing the natural human tendency to find fault with other's behavoir that does not match our own values with being outright judgemental/bias/prejudice. Every person on this earth is judgemental: whether they act upon it, speak about it with others, or simply think about it to themselves. You can be skeptical of someone, annoyed by their actions, or even judgemental of their lifestyle choices and still be completely able to separate those feelings and provide safe, competent, and equal care. That is the foundation of what you are taught in nursing school: not to be non-judgemental, that is humanly impossible, but to provide non-judgemental care. There is a difference.

[Tweety, BSN, RN]

I think some people are confusing the natural human tendency to find fault with other's behavoir that does not match our own values with being outright judgemental/bias/prejudice. Every person on this earth is judgemental: whether they act upon it, speak about it with others, or simply think about it to themselves. You can be skeptical of someone, annoyed by their actions, or even judgemental of their lifestyle choices and still be completely able to separate those feelings and provide safe, competent, and equal care. That is the foundation of what you are taught in nursing school: not to be non-judgemental, that is humanly impossible, but to provide non-judgemental care. There is a difference.

I totally agree, very well put. Thanks.

[rach_nc_03]

patients or family members who want to talk partisan politics. for some reason, I ran across these types a lot- in the neuro ICU, it was the SAH or MG patients who were totally alert, but stuck in their beds- I refused to engage, and tried to diplomatically change the subject, but this type just gets more riled up when you do that. (And I'm talking about conservatives *and* liberals- regardless of how I feel, I'm not going there at work!) I usually found myself wanting to get in and out of their rooms at lightning speed- name calling is name calling, but people (patients or not!) somehow think using the terms democrat, liberal, republican and conservative as pejoratives is totally acceptable. no thanks.

oh, and family members who don't want the terminally ill patient, who is clearly near the end of the line, to receive pain meds because they 'might overdose them'. Huh?? Sometimes this is cleared up with a little education, but I've seen plenty of family members (sadly, a lot of parents) refuse to allow us to make the patient comfortable. It hurts me to see someone suffer needlessly like this.

[*RubySlippers*]

I really don't appreciate this thread. Aren't we perpetuating stereotypes by highlighting them in a discussion? This is exactly how "drug seekers" and "complainers" are created, marked, studied and pegged -- before we ever even experience them!

I'm in nursing school, and I remember the first time I heard a nurse give me report on my very first patient. "She's got these open abcesses on her thighs that are really painful, she says. But if she's in so much pain, why is she still going downstairs to smoke every hour?" This made sense to me, a naiive, inexperienced nursing student, and so, before I even got a chance to begin my career in my own way of thought, I walked into my patient's room with a stereotype blocking my entire field of view. Because of this, the first thing I noticed about her was that she was sleeping with her cigarettes in her breast pocket (of course), and the first thing I assumed was that she would be crabby and want to smoke as soon as she woke up (of course), and that she really wasn't in all that much pain (of course not).

I'm really thankful that I took the time to try and get to know her, because I learned a lot about how wrong that nurse was. I learned that my patient was missing her son's first day of kindergarten, and that she had been diagnosed with Crohn's a decade ago with no end in sight. She really was in pain, which I could clearly see without years of experience under my belt, and yes, she smoked. But it made me realize: why wouldn't she? She had nothing else to get her through the day!

Stereotyping is really a huge issue with nurses, especially in the realm of report. You can make or break a nurse's DAY depending on how you describe your patient at end of shift. Think about it -- the outlook for your day can be completely different depending on the report you get: "This patient is really great. She's sweet, she doesn't really complain, and she definitely knows how to get up and go to the bathroom by herself. Really easy," versus, "Oh my gosh. What a nervous nancy. This lady shakes, and she's a smoker, but she's not allowed off the monitor so she just bugs you all the time about going downstairs. She always asks for pain medicine, but when you walk in she's asleep, and she has been incontinent three times. It's not going to be a good night for you." Everyone knows how each of these reports gives you a totally different outlook for your shift, and how you treat your patient.

This is my argument: both examples are wrong. Both examples of report put an idea into the receiving nurses mind, and immediately create a stereotype that molds and alters the rest of the shift and every dealing with the patient. I think that report should STRICTLY be confined to report -- medical, objective information that is PERTINENT and important to nursing care, NOT nurse opinion.

Stereotyping is a HUGE problem in nursing. Let's STOP glorifying it by giving petty examples of people who bother us. Our patients are sick, and regardless of what they are sick with or how sick they are, they deserve respect, and good, unbiased, un-stereotyped care.

First off, I never read one nurse say they treated their patient unproffessional, in this thread. 2nd this is a way for Nurses to get things that bother them out in the open, which is good old Psych if you have had that yet. Next-what are you going to do when you experience this.....and you will one day, just wait???? Are you going to hold it in, not talk about it because you think it is wrong? You will be waiting for a Stroke, or to go off on a patient. This is good intervention for anxiety, stress, things that can lead to depression. I learned that is Psyh;) .

And last, my pet peeve is patients who can bathe themselves, but say "I am going to let you do it honey"....... No you are not, you will do what you can, and I will help with what you can't. And I am thinking (Because, you can sure hit that call bell and change that TV station, and get up and go to the bathroom, and on and on). There are some very Lazy patients out there, that think they are in a SPA, when they are in the hospital????:smackingf What is wrong with these patients???? I would want to bathe myself:o

[sissyboo]

I really have a problem with patients who need a translator for their entire hospital stay, however, they can speak enough English to let you know they are going to smoke and to ask when their next dose of pain meds are due. I have no problem with translators, they are a very valuable resource to a hospital (especially in my area). I feel some pts take advantage of them to some degree. You can't get the patient admitted until the translator gets there, but nurses can give any pain med at any time with or without the translator there.