Is it just me, or are nurses pushy? - page 7

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   Tweety
    Quote from firstyearstudent
    I think you've hit the nail on my head (heh heh). This is what is getting to me in clinicals. I'm just not used to it. Hopefully, I'll grow to have more faith in the medical establishment/system/whatever.

    I understand. Maybe us old battleaxes are a bit hardened to it, and you being fresh can be more objectives.

    I personally have a LOT of problems with the current medical establishment and have to reconcile that sometimes with my day to day reality.

    I don't think you have to buy into to it 100% to be an effective nurse, just choose your battles.
  2. by   PANurseRN1
    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." 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.
    No, we just don't like your thinly veiled suggestions that many of us are out there committing assault and battery on our patients. Maybe we also don't care for someone who is still in her first year casting aspersions on those of us who have been doing this for years, decades even.
    Last edit by PANurseRN1 on Sep 29, '06
  3. by   PANurseRN1
    Quote from firstyearstudent
    Nurses shouldn't be permissive (for want of a better word). If a nurse believes a procedure or treatment is in a patient's best interest it's probably a duty to continue to argue for it. But, ultimately, we are dealing with adults who should have autonomy. There are plenty of people in situations that would prefer to take the risks rather than the treatment and they should have that right. Already I've seen so many old, frail people near death that are constantly poked and proded when they seem to want to be left alone. And then there are plenty of women who have had hospital births that they feel are unnecessarily medicalized.
    I am now starting to suspect that this is a troll post. The OP is in her first year, and already she has seen rampant abuses of patients in a variety of clinical areas? That just doesn't wash. I don't think we're getting the whole story.
  4. by   DusktilDawn
    i prefer the term "assertive" myself. firstyear, as you progress through the program, and when you start to practice, you may than view your previous bad experience in a different light. a patient has their own perception of the situation, not that it's necessarily wrong, it is their perception.
    for instance: the nurse did nothing while my abdominal wound leaked for hours. if the doctor hadn't come up to fix it, i don't know what i would have done.
    what the patient doesn't know: the nurse called the resident repeatedly (3-4 times) insisting something needs to be done, on the fourth call the nurse was basically yelling at the resident to get up there and do something about this and that waiting until morning was not an option
    there are many times you will advocate for your patient, and be strenuously assertive in doing so, that your patients will never know about. that patient will leave not knowing what you really did for them, and believing that you "did nothing."
    originally posted by tweety
    i agree. how many times has a physical therapist, pheblotomist, or cna, walked out of a room........."the patient refused"........and it's the nurse who, as the patient advocate went into the room "if you refuse your blood draw, we won't know how to treat your anemia", "if you refuse to get up the consequences could be pneumonia..do you still refuse?", only to have the patient immediately agree.
    excellent examples tweety, i've seen "patient refused" used one too many times. mr soandso do you want to bath? do you want your blood drawn? there's alot of things i would not want done as a patient, unlike most patients i also know that despite my not wanting something done that it is in my best interest to do so. there is a huge difference between wants and needs. i've followed many "nice" nurses who basically let the patient just lie in bed, no ambulation, no db/c, refuse scds, because the "patient didn't want to do it." did they explain why these things are important? nope, just charted that the patient refused. not only has the "nice" nurse made my job harder, i am now the b****, until i make it very clear why i'm insisting on these things being done. in essence, the easiest thing for me do would be to walk away and let the patient do what they want, i don't do that because i do care and want the best possible outcomes for that patient.

    a patient always has the right to refuse treatment, however, it is our job to ensure that if a patient is refusing, that they are making an informed decision regarding that refusal and the possible consequences of that refusal.
  5. by   PeachPie
    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!
    HAHAHAH I LOVE YOU!!!!!!!! Unfortunately, with all the concentration on customer satisfaction in healthcare facilities nowadays, this is exactly what patients are at risk for. Most people aren't educated in healthcare, so "the customer is always right" mindset could potentially result in a serious drop in improvement. I wish that administrators weren't too dumb to realize that.

    Don;t get me started on demented residents either. Imagine the terrible twos x1000, plus violence and the fact that you can't pick them up. Sure, you always try to cajole them into cooperating, but if someone is repeatedly refusing to move from her soaked diaper dripping feces, I'm going to have to be pushy.

    To the OP: I think that you've been socialized to have "the customer is always right" mindset. Have you worked a lot of retail or other service industries? Most people ask questions when they want, so most people assume that things are fine if no questions are asked and the patient accepts.
  6. by   ortess1971
    Quote from PeachPie
    HAHAHAH I LOVE YOU!!!!!!!! Unfortunately, with all the concentration on customer satisfaction in healthcare facilities nowadays, this is exactly what patients are at risk for. Most people aren't educated in healthcare, so "the customer is always right" mindset could potentially result in a serious drop in improvement. I wish that administrators weren't too dumb to realize that.

    Don;t get me started on demented residents either. Imagine the terrible twos x1000, plus violence and the fact that you can't pick them up. Sure, you always try to cajole them into cooperating, but if someone is repeatedly refusing to move from her soaked diaper dripping feces, I'm going to have to be pushy.

    To the OP: I think that you've been socialized to have "the customer is always right" mindset. Have you worked a lot of retail or other service industries? Most people ask questions when they want, so most people assume that things are fine if no questions are asked and the patient accepts.
    Excellent post! I REFUSE to call my patients "customers" for several reasons-by using the word customer, you are reducing the interaction between healthcare provider and patient to a business transaction. Using the "C word" also implies that there should be a money back guarantee if things don't go right. Also, even a A/O x3 person may act irrationally in the hospital setting. I'm NOT saying that patients shouldn't be educated, only that depression, anxiety and denial can make some people regress to a point-they feel powerless, so they only way they can assert themselves is by refusing to get up, take meds etc. I don't believe in hauling them out of bed forcibly, but you can bet that I would be in that room "nagging" them(and educating them too) Actually, I think I am pushy but I'm glad for my patients that I am. I'll take a patient's maybe disliking me for a while over a DVT anyday!
  7. by   TazziRN
    I have never seen an effective nurse or doctor who explained what was about to happen/needed to happen and ask "Is that okay with you?" The effective caregiver explains compactly the whys and wherefores and then does. As someone previously stated, patients who are sick enough to be in the hospital do NOT want to be asked questions all the time, just explain what you need to do to get me better and then do it. If I object or don't understand, I will say something. If I object or don't understand and don't say anything, that's on me. I give my pts plenty of time to say something but I don't ask if they want me to do something....something I learned many years ago when dealing with small children: do NOT give them a choice that would be detrimental. If I said "I need to put a foley in because of your upcoming surgery, is that okay with you (or "Do you want me to do that?") is giving the pt a chance to say No. Then what? I spend my time explaining why it's necessary and the pt feels as though I gave him a choice and then didn't honor it.
  8. by   firstyearstudent
    Quote from PeachPie
    To the OP: I think that you've been socialized to have "the customer is always right" mindset. Have you worked a lot of retail or other service industries? Most people ask questions when they want, so most people assume that things are fine if no questions are asked and the patient accepts.
    I've never worked in retail. I guess it's just a personal thing with me. I don't like to be touched, poked or proded by strangers who don't ask permission first -- even if I'm in the hospital and not feeling well. (I'm sure if I was in eminent danger of death I wouldn't care...) The few times I've been in the hospital I haven't felt safe like competent professionals were taking good care of me. I felt confused about what was going on, intimidated and didn't have a sense of control. But that's just me...

    Or maybe it isn't just me. The other day I was passing some meds and I asked the guy, "Would you like me to tell you what these are for?" And he said kind of desperately, "Yes, please! People keep giving me these pills and I have no idea what they are." I know the hospital isn't a hotel and I know that nurses would love to spend more time educating and supporting patients.
  9. by   Altra
    Quote from TazziRN
    I have never seen an effective nurse or doctor who explained what was about to happen/needed to happen and ask "Is that okay with you?" The effective caregiver explains compactly the whys and wherefores and then does. As someone previously stated, patients who are sick enough to be in the hospital do NOT want to be asked questions all the time, just explain what you need to do to get me better and then do it. If I object or don't understand, I will say something. If I object or don't understand and don't say anything, that's on me. I give my pts plenty of time to say something but I don't ask if they want me to do something....something I learned many years ago when dealing with small children: do NOT give them a choice that would be detrimental. If I said "I need to put a foley in because of your upcoming surgery, is that okay with you (or "Do you want me to do that?") is giving the pt a chance to say No. Then what? I spend my time explaining why it's necessary and the pt feels as though I gave him a choice and then didn't honor it.
    Excellent analogy. How does it benefit the patient to offer "choices" where there are none? Plans of care are individualized, but evidence-based practice means utilizing known effective treatments. Take away one piece of the treatment plan, because, say, the patient objects to a foley, and you've taken away an important piece of the overall picture.

    OP, I wish you well, but IMHO your "distrust" & "control" issues need to be addressed, not by us here, but by you. You will be inherently unhappy practicing nursing if you are uncomfortable in the nurses role.
  10. by   TazziRN
    Quote from firstyearstudent
    The other day I was passing some meds and I asked the guy, "Would you like me to tell you what these are for?" And he said kind of desperately, "Yes, please! People keep giving me these pills and I have no idea what they are." I know the hospital isn't a hotel and I know that nurses would love to spend more time educating and supporting patients.
    Nurses should always name the meds they are handing over ("Here are your Norvasc and Lasix, Mr. Green"). At the same time, if the pt doesn't know what they are for, he needs to ask "Why am I taking Lasix?" Ignorance is no excuse for anyone, including pts. The pt you just told about should have been asking his nurses why he was taking those meds.

    As for your personal experiences, same thing goes. You can only feel intimidated if you let other intimidate you. You can take back the control by asking questions. The nurse who gets upset at pts who ask questions and insist on understanding what's happening is not a good nurse. We may not always ask the pt what they think about what we're doing (in fact, we rarely do) but those of us who really care about what we're doing do not mind explaining when the pt asks why.
  11. by   Multicollinearity
    Firstyear-

    I think you are over-thinking matters. I also think you don't know what you don't know yet.
    Last edit by Multicollinearity on Sep 30, '06
  12. by   firstyearstudent
    Quote from TazziRN
    I have never seen an effective nurse or doctor who explained what was about to happen/needed to happen and ask "Is that okay with you?" The effective caregiver explains compactly the whys and wherefores and then does. As someone previously stated, patients who are sick enough to be in the hospital do NOT want to be asked questions all the time, just explain what you need to do to get me better and then do it. If I object or don't understand, I will say something. If I object or don't understand and don't say anything, that's on me. I give my pts plenty of time to say something but I don't ask if they want me to do something....something I learned many years ago when dealing with small children: do NOT give them a choice that would be detrimental. If I said "I need to put a foley in because of your upcoming surgery, is that okay with you (or "Do you want me to do that?") is giving the pt a chance to say No. Then what? I spend my time explaining why it's necessary and the pt feels as though I gave him a choice and then didn't honor it.
    Frankly, the mother/child analogy doesn't work for. Patients aren't children and nurses aren't mothers. And I wouldn't want to treat patients like children unless they were in a state where I felt they were welcoming that. But maybe that's were most sick people are. I don't know.

    I'm not trying to be argumentative. But my guess, and it is a guess because I'm not an experienced nurse, is that the patient in this scenario wouldn't feel you gave him a choice and didn't honor it. I think he would feel that someone cared enough to ask and, if he says no, explain the procedure thoroughly in a way that would convince him why it was necessary and make him feel better about getting the procedure.

    "Would you be willing to let me insert a tube into your bladder?"
    "No."
    "Well, the doctor thinks you really need it. If the urine continues to build up in your bladder there could be serious complications."
    "Well, if the doctor thinks so. Does it hurt?" (Although, I guess you believe the patient would say, "Well, then of course. Why are you pestering me with these stupid questions? Can't you see I'm sick!" Or, "You asked and I said no.")
    "There might be a little discomfort, but it only lasts a few seconds and goes right away. You can help me by staying relaxed and not moving around."

    In case you're wondering where I'm coming from with this request stuff, I've been reading and taking courses in something called non-violent or compassionate communication which was developed by Marshall Rosenberg http://www.cnvc.org/ during the civil rights movement. In his book, he recommends it for use by healthcare professionals.
    Last edit by firstyearstudent on Sep 30, '06
  13. by   Altra
    Quote from firstyearstudent
    "Would you be willing to let me insert a tube into your bladder?"
    "No."
    "Well, the doctor thinks you really need it. If the urine continues to build up in your bladder there could be serious complications."
    "Well, if the doctor thinks so. Does it hurt?" (Although, I guess you believe the patient would say, "Well, then of course. Why are you pestering me with these stupid questions? Can't you see I'm sick!" Or, "You asked and I said no.")
    "There might be a little discomfort, but it only lasts a few seconds and goes right away. You can help me by staying relaxed and not moving around."

    In case you're wondering where I'm coming from with this request stuff, I've been reading and taking courses in something called non-violent or compassionate communication which was developed by Marshall Rosenberg http://www.cnvc.org/ during the civil rights movement. In his book, he recommends it for use by healthcare professionals.
    Can you elaborate on how this simulated exchange between you & your patient jibes with your earlier posts on your "mistrust of the medical system" and being the "doubting nurse" (your term) in questioning physician orders?

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