How are you judgemental?

Long Term Care Columnist / Guide · Dec 11, 2006

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 couldn't agree more. Well said!

Over the years I've been here at allnurses, I've had quite a bit to say on the subject of prejudice toward certain types of patients, with the general theme being "judge not, lest ye also be judged". A lot of that has to do with the fact that as a severely obese ex-smoker with a history of ETOH abuse who was on Medicaid in the past, I've BEEN one or another of those patients.

However, as "undesirable" as I might have been as a patient, I wasn't dumb. I knew perfectly well what some doctors and nurses thought of me. It showed in the way they spoke to me, as if being poor also made me stupid. It showed in the way they dismissed my complaints, from migraines to carpal tunnel, as a result of being overweight and thus unworthy of treatment until I lost 100 pounds. It also showed in the way they would send me home from the ER, still in status asthmaticus after three hours of breathing treatments and a dose of Solu-Medrol brought my sats up from 75% to 90%, while the woman in the next cubicle with Blue Cross and a cough was ushered up to the medical floor within thirty minutes. :devil:

So, yes, I disapprove of health professionals walking around with bad attitudes toward patients with certain problems. While I know almost everyone tries to treat all patients equally regardless of circumstances, I don't believe we succeed as well as we'd like to think. Something of the way we feel almost always comes across, and patients pick up on it. I know I personally disliked the frequent flyers---almost always females in their 30s and 40s---who would come in complaining of severe abdominal pain, nausea, and 'intractable' vomiting for which no cause was ever found, but that would respond only to massive doses of morphine, Phenergan, and Ativan. They also had a way of suddenly being completely incapable of reaching a water glass on the table a foot away, going to the bathroom by themselves, or using the built-in remote control to change the TV channel........but then you'd see them pushing their IV poles toward the elevator as they headed downstairs to the smoking area.

Now, I did try my best to be as professional and non-judgmental as possible when dealing with this type of patient, but I'm sure I wasn't able to hide it completely..........I remember one lady who said to me one night, "None of you knows what this is like---you all look at me like I'm some sort of psych case." Well, she wasn't too far off the mark, but I was stung a little because I really had tried to be kind to her.

The point I'm trying to make is, there is nothing wrong with FEELING a certain way towards patients with certain problems, and venting here is one of the safest ways of blowing off steam. If we can't safely talk here about our frustrations, they will surely manifest themselves in other ways, and acting out those frustrations might be one of them. We must take great care to separate how we feel from how we behave, and that is one of the hardest things on earth to do.

Let's continue to have civilized discussions such as this, and students, please consider that when you have walked a few hundred miles in our worn-out nursing shoes, you may feel very differently. This does not relieve us of our duty to give EVERY patient our best efforts, of course, but we are human and we are subject to the same weaknesses as everyone else.

ktliz · Dec 11, 2006

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 think the big difference between your post and the nurses who have posted is that you are focused on pre-conceived notions, while the more experienced nurses are talking about specific behaviors they have witnessed time and time again. Yes, it is unfair to stereotype someone, of course!! But unfortunately negative stereotypes are perpetuated by the people who DO exhibit those behaviors, and those are the patients that nurses, I think, find themselves frustrated with.

GardenDove · Dec 11, 2006

Well put, Maria, exactly my sentiments! This thread supposed to be cathartic and confessional. We need to have an outlet, and it's also good for us to realize, yes, we are all judgemental in some way. One point of this thread it to point out that we should try to withhold our judgements on another nurse's pet peeves, since we all have one. We shouldn't get too high and mighty with one another, but try to be supportive and be good listeners.

When I walk into a pt's room, however, I try to be the best actress in the world, who is playing the role of the angel of mercy. There's always something lovable in each person, we have to keep an open mind.

Valanda · Dec 11, 2006

I'd have to say I am extremely judgemental when I see a pregnant woman smoking. Patient or not, it infuriates me. I did not smoke while pregnant, yet I had 3 babies born prematurely. 2 of them have on-going disablities from being so premature (30,28,27 weeks). It just makes me so mad I want to slap these women and I know I cannot be civil. I chose to work as far away from pregnant women as possible. I guess that's one of the best things about nursing. If you know something seriously bothers you there are so many areas to practice in it's often possible to steer clear of things that really upset you.

scribblerpnp · Dec 11, 2006

I'd have to say I am extremely judgemental when I see a pregnant woman smoking. Patient or not, it infuriates me. I did not smoke while pregnant, yet I had 3 babies born prematurely. 2 of them have on-going disablities from being so premature (30,28,27 weeks). It just makes me so mad I want to slap these women and I know I cannot be civil. I chose to work as far away from pregnant women as possible. I guess that's one of the best things about nursing. If you know something seriously bothers you there are so many areas to practice in it's often possible to steer clear of things that really upset you.

A little off topic, but this reminded me of something. A couple of years ago (maybe more recently), there was an article about a pregnant woman who was furious about some construction work going on next to her home. She was worried the jack hammer and large sounds would harm her unborn baby. The local news station did a bit on this as well. The BEST PART of the whole article was that the photographer had taken a picture of her outside near the construction site and MOM WAS VISIBLY PREGNANT AND SMOKING A CIGARETTE! :lol2: I've always wondered if the photographer took that exact picture on purpose, or if the understood meaning wasn't meant at all.

BlueEyedRN · Dec 11, 2006

I actually get way more judgemental with my patient's families than with my patients. I think a big part of it is that I'm new and so I don't know how to be firm but diplomatic with families. I also need to learn better to understand their point of view, how they're scared and powerless. But seriously. I had one patient with 1500 daughters and grandaughters who would come running out of the room and make it this big emergency and it turns out that they wanted me to stick a swab in his mouth because it looked dry. Or "oh, he's in pain, give him something!" Mr. X, are you in pain? Shakes he head and rolls his eyes. "But his respiratory rate went from 20 to 24 and his heart rate went from 65 to 70!" The worst is when they have a medical background. "It's okay for me to do this because I was a critical care nurse 30 years ago." Yeah, touch that vent again and I'll smack you into next week. And I obviously don't have anything better to do than wait on their loved one hand and foot. I had a daughter demand a cup of ice from me and then went and found the charge nurse and complained about how I wasn't taking care of her mom because I wasn't back yet 2 minutes later. Meanwhile, I'm in the next room assessing a patient who just had a big run of Vtach. GRRRR! Families make me crazy. :bugeyes:

82airborne · Dec 11, 2006

Some of the things that irritate me are the person who call the ER to ask how long the wait is. My standard response... there is no wait for a true emergency. Pt. who come to the ER by squad for some minor complaint thats been going on for 47 years( yes we had a man come via call 911 get the chopper on standby squad) for a bump on his face thats been there for 47 yrs. and the migraine pt. who is in 10/10 pain, N/V and photophobia allergic to everything but dilaudid who I can't triage because they have the TV 6 inches from their face and eating McDonalds and talking on a cell phone.

grammyr · Dec 11, 2006

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.

For those of us who have been nurses for a while, this site is better than XANAX!!! I am able to come here after a bad shift and see that I am not alone and that others have as bad or worse things happen and if I feel the need to vent, I know I can do so without a patient,family, or others overhearing what or whom I am talking about. We can curse,cry, discuss and then go on about our business of taking care of people. I like to call my visits here therapeutic communication.

nursesaideBen · Dec 12, 2006

Yeah, touch that vent again and I'll smack you into next week. :

:roll Too funny!! I have noticed even though I'm not a nurse yet just an aide that families way too often seem to get in the way and do more harm than good especially when they decide to sit with the patient overnight :zzzzz One time I had this woman who hunted me down into another patient's room where I was holding a patient so the nurse could give him an IM of Haldol and taps on my shoulder saying she needed a blanket NOW :angryfire :smackingf I felt like saying sure, you hold my violent patient down and I'll go get the blanket hehe. One of my favorite's is when you go in to VS and you're putting the b/p cuff on and the patient's daughter or son who is in their 40's is asks "Oh my God is this going to hurt my momma?" Yes it will we just didn't want to say anything about it.

moongirl · Dec 12, 2006

I had a pt today that got up and went outside to smoke. She then later rang the bell, I went in and she wanted a bed pan to pee. I was like "uh nope, but I will help you to the bathroom" you can get up and go smoke, but you want to lay in your bed to pee.... sooper. My name tag may say "student" but it certainly doesnt say " stupid"

scribblerpnp · Dec 12, 2006

My name tag may say "student" but it certainly doesnt say " stupid"

Good for you! HA. :rotfl:

RN mom of 2 · Dec 12, 2006

This is a good topic, because I think as nurses we aren't supposed to judge our patients, but human nature makes us judgmental in some ways.

I am bothered by pg women who are smoking, drinking etc., because they are responsible for another life. I kind of put these women in a different category than the average person who may be abusing themselves, but no one else.

Other than that, I try not to judge people. Let's face it...life can be difficult, and most of us find ways (not always healthy ones) to cope. Some people really lose their way, for example drug addicts, alcoholics, and those with serious eating disorders (to name a few). Also, report is for relaying the medical facts and not for passing our own personal judgments along. When you state your own personal feelings to the next nurse, it sets up her psyche to feel the same way about that patient.

I remember being in the ER during nursing school and a guy came in who had overdosed. He was unconscious and in restraints, and these nurses were making fun of him. It still hurts my heart to think about it. They were laughing about the contents of his stomach, which he almost aspirated on (ohhh yeah..that's sooo funny). They were saying he ate a big mac, or something like that. The whole thing made me sick. They thought he was a big looser, because he was an addict. When I looked down I saw a human being who was in pain (emotionally, spiritually) who was coping the best he knew how. The weirdest thing was, he had on an inexpensive ring and I couldn't stop staring at it. It made him so real...so human. It reminded me that we are all the same, and even someone "in the gutter" may want to wear something that makes them feel good about themselves. I'll never forget that guy or the ring he had on.

I know people joke around, because it's how they cope, but I think it's important to always remain professional, and remember that it is a fellow human being entrusted to our care. You never know when you may be lying on that table, and you'd want the same grace shown to you.