Is it just me, or are nurses pushy? - page 2

Despite being a nursing student, I've don't have complete confidence in the medical establishment and always question any treatment I receive and, as someone in their right mind, would expect to be... Read More

  1. by   goats'r'us
    yes, nurses are pushy.

    if nurses weren't pushy, tonsillectomy patients would eat jelly and icecream for a fortnight, then return because they ate scratchy food, knocked off a huge clot and started bleeding, joint replacements would never get out of bed because it hurts too much, abdo surgery patients would all get pneumonia because deep breathing and coughing hurts, patients with limited mobility would get pressure sores because no-one wants to be woken every few hours to be turned, and no-one would shower because it's so much easier to just wash their face, hands and privates in bed.

    think about it. we don't do it for OUR health!
  2. by   traumaRUs
    I have been so very fortunate to work with some wonderfully smart, hard-working and talented nurses throughout my career. They have taught me so many things. As a new CNS, I'm still learning from the techs, nurses, managers.

    What my point is, everyone's learning style and nursing style is different. My background is ER nursing in an inner city level one trauma center. I loved it. I let the patient set the tone for our interactions - however, I got my job done too. But...you gear your conversation to the appropriate level of the patient: what they want to understand and what they can understand.

    Maybe you need to follow other nurses around? All of us have different styles too and maybe you just didn't click with that particular nurse?
  3. by   Natkat
    Quote from firstyearstudent
    Despite being a nursing student, I've don't have complete confidence in the medical establishment and always question any treatment I receive and, as someone in their right mind, would expect to be asked if I want a treatment. Yet I notice during clinicals that nurses often don't ask or even explain what they're doing. They just sort of barge into a room and start doing procedures and making assumptions about what the patient wants. This is disturbing to me and I think that some patients may not even be aware that they have a right to know what's going on and to refuse any treatment. Do nurses do this because it makes their job easier or because patients really just want to leave all that to the nurses' and doctors' judgment?
    I see many of my classmates being self-righteous about how nurses work. I say over and over "withhold judgement until you're a nurse."

    Until you've actually been in their shoes, you don't know how difficult a job it is. Sure, we all want to sit with our patients, hold their hands and find out what's troubling them, what they like, what would make them feel better. The reality is management pushes you do so much work in less and less time. You can't sit and explain every single thing that happens every single time it happens. For better or worse, nurses are pushed to get things accomplished and sometimes things are done the way we're taught, but it has to be done nonetheless.
    Last edit by Natkat on Sep 28, '06
  4. by   daisey_may
    I agree with TraumaRUs, I think that it would be beneficial to follow a few nurses around and see different 'styles'. Yes, a nurse can come off as pushy, but it doesn't have to be that way.

    I will graduate school soon, but I know I have a foot in the door by working at the hospital and seeing how other nurses work--and I've learned so much. I also see some of the new nurses that graduated ahead of me. You can tell which nurses are 'out to change the world'--who tend to be pushy and sometimes narrow-minded, and which ones are letting their new career sink in, because they are, after-alll, brand spanking-new nurses.

    I agree that 'pushy' may be a harsh term, and 'firm' may be better. Sometimes, patients are upset, scared and agitated, and being firm gives them reassurance that you are doing what is best for them. Often, there are cues you can see that a patient doesn't understand what is going on or is unsure of making decisions such as distanced silence, confusion, agitation, saying inappropriate things for their medical care, etc.

    I think that you should voice your fears to your instructor. It's important to enter the clinical area with no judgment, because making judgments will make you narrow-minded. And this may be something that you want to keep in mind when you are a nurse to provide education to the client whenever you able to!
  5. by   General E. Speaking, RN
    Quote from goats'r'us
    yes, nurses are pushy.

    if nurses weren't pushy, tonsillectomy patients would eat jelly and icecream for a fortnight, then return because they ate scratchy food, knocked off a huge clot and started bleeding, joint replacements would never get out of bed because it hurts too much, abdo surgery patients would all get pneumonia because deep breathing and coughing hurts, patients with limited mobility would get pressure sores because no-one wants to be woken every few hours to be turned, and no-one would shower because it's so much easier to just wash their face, hands and privates in bed.

    think about it. we don't do it for OUR health!

    I agree. Post ops rarely jump out of bed the next morning. That's why patient teaching is so important. Before they go to surgery you should explain what they can expect when they get out. "After recovering downstairs you will return to this room. Tomorrow a.m. you will need to get OOB. Tonight you will be instructed on IS and cought turn and deep breath" "This is to prevent pneumonia and blood clots..." Despite doing this many times I have to become "pushy" to get my patients OOB. I tell them in advance and assess their pain (in case they need medication) then follow thru.
  6. by   santhony44
    Quote from goats'r'us
    yes, nurses are pushy.

    if nurses weren't pushy, tonsillectomy patients would eat jelly and icecream for a fortnight, then return because they ate scratchy food, knocked off a huge clot and started bleeding, joint replacements would never get out of bed because it hurts too much, abdo surgery patients would all get pneumonia because deep breathing and coughing hurts, patients with limited mobility would get pressure sores because no-one wants to be woken every few hours to be turned, and no-one would shower because it's so much easier to just wash their face, hands and privates in bed.

    think about it. we don't do it for our health!
    my thoughts exactly.

    and sometimes it is these same "pushy" nurses who "coerce" the docs into ordering adequate pain relief, paying attention to what the patient is telling us, doing something about the lab values or vital signs, etc etc. sometimes they also "push" pharmacy into sending up the meds, dietary into getting the correct meal for the patient, etc etc.

    as someone else pointed out, in us hospitals at least, patients sign a "consent for treatment" form. that doesn't cover everything but it does cover things like iv's, foleys, getting people out of bed, etc. most people really want to get better, even if they don't enjoy the process very much.

  7. by   firstyearstudent
    "I know from times when I have been a patient, I wanted to feel like I was being guided through the obstacle course by someone who was "in charge" in a respectful way."

    I guess I'm just projecting onto patients my own feelings. Maybe I'm a control freak (heh heh), but I don't want to put anyone else in charge of anything as important as my health. (And I absolutely want to know what the plumber's doing, too!)

    I have some basic distrust of the medical system and, frankly, what I see doesn't make me feel more confident. I've seen people walk into the hospital for back surgery who are still there a year later with a drug-resistant infection. And guess what, the surgery didn't even fix their back!

    Anyway, I often hear nurses say "You have to" have something or other done. What does that mean? Does it mean, it's necessary for your health and recovery or does it mean that's what the doctor wrote down and I'm too busy to deal with a resistant patient (and I do know that nurses really are too busy, it's not an excuse)? Some patients might think it means I don't have the ability to say no. I know I felt this way when I went to the hospital to deliver and the nurse told me I "had to" have a routine hep lock that I didn't want or need (in my opinion and the opinon of plenty of experts). Looking back, what was she going to do if I said no, call security while I'm in transition? But I was too stupid and confused them to figure it out.

    I'm not blaming or judging nurses, I'm just trying to understand what's going on (and some of the posts here are really helping me understand the dynamic).
  8. by   angel337
    it comes very natural to me to always explain to the patient what i'm going to do. even though we live in the age of advanced technology and people have access to more information than ever before...people are still intimidated by the health care environment. i want my patients to know what's going on. it only takes a second to say "hi ms. jones, the dr. ordered morphine for your pain. are you ok with that?". i never just barge into a room with a blank syringe and push it in the IV and leave. i have seen nurses do this quite a bit and then the patients are afraid to ask what medicine they received. that's ridiculous. i treat the patient how i would want to be treated which is i want to know what i'm getting and if it's something i don't understand i will ask why and what.
  9. by   MarySunshine
    I can see it now...my confused, agitated, drunk patient writhing around, and me saying "Billy Bob, I'm going to hang a bag of normal saline with 20meq of potassium and run it at 75ml/hr into your IV. How do you feel about that?"

    I'm not making fun of your question, op, but some funny scenarios popped into my head. I would venture to guess that you met a couple of nurses who were a bit agressive and intense in their approach (maybe it's their personality or maybe they were unusually stressed). It is not normal for nurses to barge into a room and start performing a procedure without explaining it to the patient. If it's a very basic, routine procedure we don't typically ask them if they want it or not...we explain what will happen and open ourselves up to questions or concerns, but I can't imagine many situations where, for instance, a foley was appropriately ordered and we just asked them if they wanted it or not -- I agree with the poster who said that would just add more stress. Of course they don't want a tube stuffed up their urethra! But if we are confident in our treatments and reassuring and available the patients will notice and appreciate it.

    I agree that "you have to" is not an appropriate answer to a patient concern. Though I've told many a post-op patient that they "have to" ambulate because of "pneumonia, blot clots, increased length of recovery time, etc." So, I do explain it but I'm very firm.

    To address your "distrust" issues with medicine. I understand them. A lot of us nurses are wary of going to the hospital because we've seen things go badly. It's far from a perfect system. However, I strongly believe that more patients are helped than hurt and that nurses are one of the main reasons that patients are HELPED in most cases.
    Last edit by MarySunshine on Sep 28, '06
  10. by   htrn
    If we are talking about a situation that would cause serious harm if the patient didn't comply - you better darn well believe I am pushy!!!

    I do try very hard to explain the reasoning for a plan of care and answer questions to help patients understand what and why. I also try to give them the high points of what may happen - for ex. a labor patient will get a brief course in monitor strips and what I will do if the baby gets naughty. Something along the lines of 'if I am very concerned about what is going on, I may ask you to roll to one side or the other - even in the middle of a contraction - and you will roll under your power or mine, but you'll roll'

    I try to give them a clue about what the possibilities are and what the reasoning is - but if that doesn't work - I can be perceived as a *itch. If you don't allow us to try to stop your labor (at 32 weeks) you're baby will have to be shipped, have difficulties breathing which could require a breathing tube, IVs, tubes in their stomachs - in other words all those pictures of preemies with all the tubes coming out of everywhere - that could be your baby.

    Usually gets them to cooperate:wink2:
  11. by   angel337
    Quote from MarySunshine
    I can see it now...my confused, agitated, drunk patient writhing around, and me saying "Billy Bob, I'm going to hang a bag of normal saline with 20meq of potassium and run it at 75ml/hr into your IV. How do you feel about that?"

    I'm not making fun of your question, op, but some funny scenarios popped into my head. I would venture to guess that you met a couple of nurses who were a bit agressive and intense in their approach (maybe it's their personality or maybe they were unusually stressed). It is not normal for nurses to barge into a room and start performing a procedure without explaining it to the patient. If it's a very basic, routine procedure we don't typically ask them if they want it or not...we explain what will happen and open ourselves up to questions or concerns, but I can't imagine many situations where, for instance, a foley was appropriately ordered and we just asked them if they wanted it or not -- I agree with the poster who said that would just add more stress. Of course they don't want a tube stuffed up their urethra! But if we are confident in our treatments and reassuring and available the patients will notice and appreciate it.
    you are absolutely right. i'm referring more to the patient that is Alert and oriented and that can communicate with me. i work in ER so most patients are able to make decisions. of course a combative, drunk or intubated patient is something entirely different. i am a big patient advocate and i encourage patients to ask questions and be proactive in their health care management/treatment.
  12. by   emrrn915
    Quote from firstyearstudent
    Personally and politically I'm very much against coercion. It's upsetting to me when I see nurses and doctors making decisions for others "for their own good" and seeing patients disempowered. I'm seeing it sometimes during clinicals. I don't think it's all in my head.

    Why don't nurses ever say things like, "Your doctor has ordered a Foley cathether. It's a tube that we can put into your bladder to help you urinate. Is that something you'd be willing to let me do?" That allows a yes or no answer and further dialogue from there, including educating and convincing and/or finding other options and treatments if the answer is no. It's the difference between working on the patient and working with the patient.

    I do think that the nurse should inform the patient as you have stated above but rather than say, is this something you'd be willing to let me do.. explain to the patient WHY the Foley is necessary and then ask if they have any questions. There is a reason that each and every intervention is being done. The above statement is not really enough information for the patient either. You have told him/ her what you are going to do and what the foley will do but not why it is being ordered. I have found that if the rational is shared with the patient then they feel comfortable with pretty much everything. Always tell your patient why..the hows and whats are important but the why helps the patient to be confident in what you are doing and that this intervention is necessary/ beneficial in some way or another. We are not pushy there is a rationale behind all that we do.. it is all in the delivery. That being said.. giving patients a choice with each and every intervention is going make things tough. Ultimately they do have a choice but in order to give good medical care , you are going to have to do things to people that are not necessarily something that makes them comfortable... in the above scenario I would tell you, "He** no!! however, if you explained why the Foley was necessary and continued on I would be okay with it even though I would not like it all that much. Some patients may take that to mean that it is optional and they will tell you no.. then you will have to tell them why it is important and possibly drag the MD into the mix etc... I can just hear it... "Well she gave me a choice so it must not be that important"..... Just based on my experience.
  13. by   NurseyBaby'05
    Without trying to sound condescending, sometimes you don't want to give the pt. the flagrant option of saying no. An example, I admitted a woman who came in with Community Acquired Pneumonia and was spiking temps. She refused to get a set of blood cultures with a needlestick. It's understandable. She's status post chemo and a very hard stick. She let them get them from her port-a-cath. They started her on the routine regimen for CAP and guess what? She's still spiking temps. When the 24 hour mark passed and we could get another set of cultures, I insisted that she let the lab draw a peripheral set. I told her several hours before that if she still had a temp at midnight I was going to have the lab come up and draw a set of cultures with a stick. Did I ask her if she wanted to? No, way! I explained to her that it was really important to rule out an infection in her port. It's going directly into her SVC. I told her that she could wind up with an infection in/around her heart or worse. I went in and told her the lab was on thier way up and to let them see if they could get the cultures. Could she have said no? Absolutely! Did I want to remind her of that? Absolutely not! It's like asking pre-schooler if he wants to wear his seatbelt. Can I physically hold it on him and drive at the same time? So technicaly he CAN ride in the car unrestrained, but do I want to tell him that option is his to be had? Nope. You try not to say there is a choice, if it's not a good idea for there to be one.
    Last edit by NurseyBaby'05 on Sep 28, '06

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