Is it just me, or are nurses pushy? - page 5

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   SmilingBluEyes
    And how many OTHER nurses are out there, doing research or learning evidence-based practices in order to provide the best care for their patients? Believe me when I tell you they are out there, too.

    You seem to have a great grasp of "right and wrong" here, and that, I applaud. Now, I challenge you to look for GOOD examples in experienced nurses and emulate them. Learn from all of them, the good and not-so-good, and be the best nurse you can be. But do take time to understand the gray areas and know, there are many constraints on any given staff nurse's time and energy to always give patients choices in every given situation. Also, understand, many patients come to us taking virtually ZERO responsibility for their OWN wellbeing, meaning, they are not interested in being educated (really so many are not), nor taking on the responsibility to make healthier choices for THEMSELVES when they come into our care. SOMETIMES we have to take the proverbial bull by the horns in such situations.

    There is no perfect world, nor do we, as nurses, practice in a vacuum. We are forced to take on all manner of situations and cases and deal with them with expediency, integrity and safety. And along the line, there is no real margin for error as any given error or omission can result in calamity. It's not always easy to balance those things and go home feeling good about everything you had to do that day. You will really come to understand this more as you enter professional practice yourself one day.

    Take care.
  2. by   firstyearstudent
    Quote from MLOS
    Can you explain your expectations for a critically ill patient with multi-system disorders assuming responsibility?
    The patient could know before he or she is critically ill that doctors and nurses don't have all the answers and are only doing the best that they can with the tools that they have. One way we could convey that is by not pretending we have all the answers. Then there would be less blame when something went wrong.
  3. by   Altra
    Quote from firstyearstudent
    The patient could know before he or she is critically ill that doctors and nurses don't have all the answers and are only doing the best that they can with the tools that they have. One way we could convey that is by not pretending we have all the answers. Then there would be less blame when something went wrong.
    To return to the suggesion of several posters earlier in the thread, a conversation with a trusted instructor, academic adviser or a health care professional you know is probably in order.

    Good luck to you.
  4. by   firstyearstudent
    Quote from MLOS
    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?
    I would think that the more acute and complex the medical situation, the more the nurse would question accepted standards and feel the need to keep current with evidence-based practice, and, possibly, seek out opportunities to participate in research. And to also question physician's orders.
  5. by   SmilingBluEyes
    We do those things, most of us, already. We DO question orders that seem wrong and DO advocate for our patients whenever possible. It seems to me, good examples are in short supply in your experience. That is sad. I have been fortunate in that I can think of MANY great examples of the type of nurse that does the right things---I was mentored by them early in my career and have the great pleasure of working with nurses like this, as well.

    Really, like others said, I think it's high time you seek counsel with a trusted instructor. It seems you have a lot of issues that need working out prior to going further in your program/career in nursing. I am not trying to discourage you, rather ENCOURAGE you further. But nursing may not be for you, in the end. Only you can decide. I wish you the best.
    Last edit by SmilingBluEyes on Sep 29, '06
  6. by   Tweety
    Quote from SmilingBluEyes
    We do those things, most of us, already. We DO question orders that seem wrong and DO advocate for our patients whenever possible. It seems to me, good examples are in short supply in your experience. That is sad. I have been fortunate in that I can think of MANY great examples of the type of nurse that does the right things---I was mentored by them early in my career and have the great pleasure of working with nurses like this, as well.

    I 100% agree Deb. While we might feel trapped by a system that advocates futile care, I don't see a whole lot of us not being patient advocates and educators, and in the case of critical care patients, not including their families.

    Even when we are advocating unpleasant things like getting out of bed post op, or a foley catheter, we present them with the treatment and the rationale, give them options when appropriate, but we always allow them the right to refuse.

    We're not just robots blindly following doctors orders and forcing our will upon patients. Nurses more than anyone else care about their patients and their outcomes.
  7. by   Altra
    Quote from firstyearstudent
    I would think that the more acute and complex the medical situation, the more the nurse would question accepted standards and feel the need to keep current with evidence-based practice, and, possibly, seek out opportunities to participate in research. And to also question physician's orders.
    To echo what SmilingBluEyes said, this is a normal part of nursing practice for many, and of course research leads to changes in practice over time.

    But my patient having an MI may be long dead before I finish explaining why the heparin infusion is a good idea, and have obtained his explicit verbal consent to it, as I understand you envision your future nursing practice.
  8. by   firstyearstudent
    Quote from MLOS
    To return to the suggesion of several posters earlier in the thread, a conversation with a trusted instructor, academic adviser or a health care professional you know is probably in order.

    Good luck to you.
    I'm starting to get the feeling that posters here feel I'm somehow unfit to be a nurse because I'm turning these ethical issues over in my mind...

    And I do ask my instructors questions. I asked my instructor once during class when she was explaining how to place an NG tube on an uncooperative patient why it was okay to do it if the patient didn't want one and she said, "For the patient's own good." Then she quickly followed that up with, "Unless the patient is me and then I don't want you to do that to me ever." Everyone laughed until she added, "I am not kidding." (She is elderly.)

    Another older instructor was quite serious when she told the class that if she was ever in a nursing home and they happened to be her nurse, to please, please don't restrain her.
    Last edit by firstyearstudent on Sep 29, '06
  9. by   Tweety
    Quote from firstyearstudent
    I'm starting to get the feeling that posters here feel I'm somehow unfit to be a nurse because I'm turning these ethical issues over in my mind...
    Absolutely not. Didn't you read that Smilingblueyes applauds to you? I applaud you too. I wish more nurses and students challenged themselves as you are doing.

    Please don't take offense. And please don't feel judged as unfit to be a nurse, no one is saying that.

    However, you did make the post, so pardon the feedback from us in the real world. Take it or leave it. What we are trying to say is that the real world and your ideals may cause some inner conflict later on, because reality verses how we'd like things to be are different.

    Also, some of us disagree that all nurses are like the few you observed and are making judgements upon. Many of us are striving for high ideals and patient choice/advocacy.
    Last edit by Tweety on Sep 29, '06
  10. by   Altra
    Quote from firstyearstudent
    I'm starting to get the feeling that posters here feel I'm somehow unfit to be a nurse because I'm turning these ethical issues over in my mind...

    And I do ask my instructors questions. I asked my instructor once during class when she was explaining how to place an NG tube on an uncooperative patient why it was okay to do it if the patient didn't want one and she said, "For the patient's own good."
    Of course patients have the right to refuse any procedure. But are you saying that it's "OK" to not decompress the stomach of patient w/severe vomiting due to esophogeal varices?

    I'm all for exploring hypothetical ideas, as a little exploration will reveal whether or not they are workable in a real setting.
    Last edit by Altra on Sep 29, '06
  11. by   SmilingBluEyes
    No, in no way, do I see you unfit. I see you as a person who is a critical thinker with integrity. Exactly what nursing needs. I just want YOU TO BE SURE you want to be a nurse. Maybe you need more time. Maybe you need to talk to some trust instructors or nurses (other than here) about what you are feeling. I am legitimizing your feelings and thoughts here, not putting you down.

    Listen, there are times I want to walk away from nursing. I have 9 years' in it. But there ARE things that bother me greatly. The litigiousness of it---the endless mounds of paperwork that take me from the patients who need me---the constant jumping through hoops to please people whose priority is NOT necessarily to do what is best for our patients. It's not easy to practice nursing today---nor has it ever been.

    I want you to take time to think really hard if this is for you....for all the right reasons. I really do wish you the best.
  12. by   firstyearstudent
    Quote from MLOS
    Of course patients have the right to refuse any procedure. But are you saying that it's "OK" to not decompress the stomach of patient w/severe vomiting due to esophogeal varices?

    I'm all for exploring hypothetical ideas, as a little exploration will reveal whether or not they are workable in a real setting.
    You cut off the rest of my post. What I thought was interesting was that the instructor thought it was perfectly fine to do do things against a patient's will for their own good -- unless, of course, the patient was her!"
  13. by   Altra
    Quote from firstyearstudent
    You cut off the rest of my post. What I thought was interesting was that the instructor thought it was perfectly fine to do do things against a patient's will for their own good -- unless, of course, the patient was her!"
    I quoted the part of the post I was responding to. My response was a real-world example of what your instructor referred to as, "the patient's own good."

    My point is that you are free to dislike your instructor's attempt at humor ... but would it be worthwhile to critically think about *why* a patient would require an NG tube in the first place, and then re-evaluate the potential consequences to the patient of not dropping the NG tube? Would these considerations be present in your explanation of the procedure to the patient, and influence your further conversation with the patient if he/she initially refused the procedure?

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