Is it just me, or are nurses pushy? - page 4

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   Altra
    I agree with the other posters who have suggested that a heart-to-heart conversation with one or more of your instructors and/or other medical professionals you know personally is in order ... STAT. You would probably benefit greatly from exploring whatever is the source of your stated "distrust of the medical system" and your personal reasons for pursuing nursing as a career choice. We don't need to know those details here, but I agree that it's very important that you understand them.

    Some relevant facts of life:

    1. Bad things sometimes happen which are beyond our control. Post-op infections, disease complications, or the myraid permutations of a patient's lifestyle, personal values & family dynamics are simply reality -- not necessarily someone's fault.

    2. Human beings are mortal.

    3. Modern civilization has become sufficiently complex that responsibilities, knowledge bases and skills are specialized. None of us know everything about everything that we need/use in our daily lives. We maintain the basic variety of skills necessary to function well in society (including interpersonal skills), cultivate expertise in an area which suits us, and leave the rest to other "experts." To go back to the plumbing example ... my plumber will gladly explain why my bathtub is leaking into my basement and what he proposes to do about it. But he is the expert - that's why I pay him.

    4. Psych 101: broadly applying a loaded pejorative term like "pushy" to describe a set of behaviors as varied as the the millions of professionals who practice nursing is not likely to be received well. You might still get your question answered, but you've opened yourself up to unnecessary bad karma in the process.
  2. by   Altra
    Clarification: many posts have described various educational/persuasive techniques used in patient care. After re-reading the entire thread twice, I personally read the OP to mean not so much that she objected to individual nurses' whose personal styles she may have perceived as being aggressive, but she is objecting to any patient care/procedure which is not completely explained and verbally agreed to by the patient, as in her foley catheter example.

    I could be wrong.
  3. by   rambisisking
    Quote from Kev702
    Why do you even WANT to be a nurse?

    Kev

    I'm not sure this is fair. This poster is asking a question concerning the wellfair of people. That shows me that she has the patients welfare utmost in mind. No where did she say that we should not act in an emergency when needed. She only questioned why she has not seen an overall attitude regarding this issue for patients and even for herself as a patient.
    To question her desire to be a nurse does not seem to be the issue here as she is already showing concern for patients rights. As nurses, you bet we have the responsibility to explain procedures to our patients, That attempt must be made, and then yes...for crying out loud...if you have an 89 year old confused patient flailing about you may have to just act and not continue to try to explain. That is a nursing judgement, and certinally in emergency situations this would hold a different priorety. But please do not let our ego's deny her stand which she is stating most respectively. What she is asking for is respect back and wanting to give this to her patients. I have been a nurse for 33 years, and yes, I would call out any nurse, doctor, or tech. for not explaining to me or to a loved one or to anyone what they are about to do and why. And I have! Because this is the profession that you choose does not mean that you have to agree with all that you see to be a part of it. I think it is very good to have new eyes to point out some things that we forget or overlook in our very busy schedules. This is how we continue our high standards and progress.
  4. by   firstyearstudent
    Thanks for more great responses. I am reading and thinking about everything that is posted.
  5. by   Multicollinearity
    I can tell you that I have some *personal* issues of needing control for myself. When I am a patient in the hospital - I want to know what is being done before it is done. That is satisfied by a bried "hi there Multi, putting in a catheter for your surgery now. I'm going to do xyz and you might feel xyz." Wham bam done. That is fine. However, if my nurse asks me if I want to be catherized, if I want/ approve of having pre-op ab's, etc etc I would get exhausted from trying to decide what is really going on, etc. I would also question if she really thinks I ought to have these things or if she is trying to 'tell' me something. It is not my job as a patient to parse thru so many details, and if I'm sick enough to be in the hospital I'm not exactly functioning highly on Maslow's well enough to think all this thru. We must surrender a certain amount of control when we are patients in the hospital. I hope that makes sense.

    Now BIG things, like should I have xyz surgery...you bet I want full discussion. But for every single little thing it is overload. If I have a question or concern I'll ask. If I'm stymied or hesitant about something my nurse should pick up on that, pause and question me.

    I am very tired so I know I'm not explaining myself well. I can tell you that I had an attorney once who called me daily during a routine lawsuit explaining detaaaaaaaaail by detaaaaaaail and asking me for permission to proceed. It was to the extent that it was overkill. It got me confused and zapped my energy. I needed him to be clear and brief about details and ASSUME leadership and get it done. He sucked me dry parsing details. I think the same can apply with patients in the hospital.

    Now mind you I'm a control freak personally and this is my outlook.
    Last edit by Multicollinearity on Sep 28, '06
  6. by   bubblesthenurse
    Before i was i nurse, i was never pushy, never stood up to anyone...
    now i'm a bit of a power freak... and am pushy... in the nicest way possible.

    as it has been said through-out this thread, as soon as i explain what i'm doing, there is co-operation. and lets face it. if a patient REALLY has a problem with in IDC or NGT being inserted... they'll arch up. which is fair. but its not in their best interest.

    i also always tell my patients and family to continue to ask questions, so if the are unsure of what is happening, they are not afraid to ask...

    but it also works both ways... i may be pushy with the Pt's, but i can also be pushy with the doctors... have you seen this patient yet? i'm not happy with how this patient is.. i dont think that x is appropriate...


    it gets results

    Nikki
  7. by   Elisheva
    I prefer the word assertive.
  8. by   General E. Speaking, RN
    I have told patient's that they have the right to refuse anything we want to do to them. It is their right. And I do explain it in a nice way. I have also told a few patient's that (if the situation calls for it) that they have the the right to leave AMA. They shouldn't be made to feel like a prisonor.
  9. by   firstyearstudent
    But it isn't always cut and dry what's the best medical or nursing decision in each individual circumstance. Don't doctors and nurses need to work with patients to figure out what the best course of action is and individualize care, taking into account the patient's needs and preferences? Isn't that why we need educated, experienced nurses who know how to work with people. Otherwise we could just get computer programs with protocols and flow charts to tell aides what to do.

    And I know that takes more time than nurses have, and I know that nurses can't really get to know their patients because they're in the hospital for such a brief period of time now. But ideally, and doing what they can with the time they do have.

    Maybe it's just me. People like to see confident doctors and nurses. They tell us this in school and I guess it's true. But I see a facade or worse (professionals who do really think they know it all!) and it's one I don't like. Medicine and nursing is at its very best when it's making its best guess about a course of action using scientific evidence, intiution and psychosocial knowledge about the patient. My favorite doctor was the one who when I asked "What's wrong with me?" said, "Heck if I know! Let's try X and see if it works."

    I don't want to be a confident nurse: "This is best for my patient." I want to be a douting nurse: "Is this best for my patient?" And I would hope that my doubts grow, not lessen, as I become a practicing nurse.
  10. by   Multicollinearity
    Thing is, you are projecting your own wishes of how you would like to be treated onto all patients in general. Many would be un-nerved by the very ambiguity that you like to explore. Your job will be to tailer your approach to each individual patient's needs, and within practice guidelines. Many patients don't feel how you do. By treating them how you individually would like to be treated you are doing them a disservice.

    Also, while few matters are black and white - the reality is that nurses do not have endless time to parse details and complexity for everything. That reality does matter. There are finite resources. That is important. You can argue all you like about how things should be. All that arguing about how things should be doesn't do anything for the here-and-now. The rubber meets the road with doing the best you can with what you've actually got - to benefit the most.
  11. by   firstyearstudent
    Quote from multicollinarity
    Thing is, you are projecting your own wishes of how you would like to be treated onto all patients in general. Many would be un-nerved by the very ambiguity that you like to explore. Your job will be to tailer your approach to each individual patient's needs, and within practice guidelines. Many patients don't feel how you do. By treating them how you individually would like to be treated you are doing them a disservice.

    Also, while few matters are black and white - the reality is that nurses do not have endless time to parse details and complexity for everything. That reality does matter. There are finite resources. That is important. You can argue all you like about how things should be. All that arguing about how things should be doesn't do anything for the here-and-now. The rubber meets the road with doing the best you can with what you've actually got - to benefit the most.
    It's also about responsibility. Some part of me doesn't want to take it all on. I want the patient to assume some of it. I wonder how the nurses who prepared patients for and assisted with lobotomies felt after the tide turned. Maybe nothing... But something like that would have the potential give me unbearable guilt.

    For a less dramatic example, another post mentioned getting reluctant patients up and ambulating whether they want to or not. But our instructor told me that not so very long ago patients were instructed to stay in bed and rest after surgery with unfortunate outcomes. How many nurses bullied patients into staying in bed?
    Last edit by firstyearstudent on Sep 29, '06
  12. by   Altra
    Quote from firstyearstudent
    I don't want to be a confident nurse: "This is best for my patient." I want to be a douting nurse: "Is this best for my patient?" And I would hope that my doubts grow, not lessen, as I become a practicing nurse.
    As a first year student, I'll assume that the patients you are encountering right now (selected by your instructors as appropriate for your level of clinical experience) are likely to be fairly stable, with well-known, common diagnoses -- COPD, diabetes, various common post-op issues, renal insufficiency, etc. These are great learning experiences.

    As you move on to patients with more acute & complex medical issues, can you explain how you envision the statement above will guide your practice?
  13. by   Altra
    Quote from firstyearstudent
    It's also about responsibility. Some part of me doesn't want to take it all on. I want the patient to assume some of it. I wonder how the nurses who prepared patients for and assisted with lobotomies felt after the tide turned. Maybe nothing... But something like that would have the potential give me unbearable guilt.

    For a less dramatic example, our instructor told me that not so very long ago patients were instructed to stay in bed and rest after surgery with unfortunate outcomes. How many nurses told patients to "Get back in bed!"?
    Can you explain your expectations for a critically ill patient with multi-system disorders assuming responsibility?

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