Is it just me, or are nurses pushy? - page 8

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   TazziRN
    I didn't say pts need to be treated like children. I said that I learned from working with children that you do not give choices unless either choice is an acceptable answer. Using the exchange that you wrote, I can see the realistic pt saying "Then why did you ask me if I wanted you to do that?" A better exchange might be:

    "Mr. Green, your doctor ordered a foley catheter for you. It's a tube that goes into your bladder through your penis. Have you ever had one before?"

    "No, why do I need that?"

    (Give explanation)

    "Does it hurt?"

    (Explain how it might feel)

    In that exchange the procedure has been explained, the pt has had time to ask questions, and the nurse has been able to justify the foley. If, at that point, the pt refuses, then you take it from there. That, by your argument, has the pt being treated more like an adult than asking for permission.
  2. by   TazziRN
    Oh.....and by the example you gave, if the bladder is filling up the pt will be BEGGING for a foley!


    Sorry.......I'll go away now......I knew I should have stayed out of this thread.....
  3. by   firstyearstudent
    Quote from MLOS
    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?
    I would question the order in my mind before presenting the treatment to the patient. Why does he need it? Does he really need it? What might happen if he didn't get it? Are there other, less invasive ways to treat the problem? The answers to those questions could impact our exchange.

    In terms of mistrusting the medical system, I suspect that Foley caths are over-ordered and often inserted with less than sterile technique, and, once in, peris aren't cleaned as well as they should, resulting in infections. In some situations it might make sense to try a little harder to get the patient to urinate on his/her own. Sometimes the Foley is for the doctor's convenence (like a patient undergoing an angiogram in light sedation).
  4. by   DusktilDawn
    Quote from firstyearstudent
    I would question the order in my mind before presenting the treatment to the patient. Why does he need it? Does he really need it? What might happen if he didn't get it? Are there other, less invasive ways to treat the problem? The answers to those questions could impact our exchange.

    In terms of mistrusting the medical system, I suspect that Foley caths are over-ordered and often inserted with less than sterile technique, and, once in, peris aren't cleaned as well as they should, resulting in infections. In some situations it might make sense to try a little harder to get the patient to urinate on his/her own. Sometimes the Foley is for the doctor's convenence (like a patient undergoing an angiogram in light sedation).
    Do you not think nurses discuss different methods of treatment or ever question an order? In fact those are the very questions you should discuss with the doctor, and those answers you should have BEFORE presenting the treatment to the patient.

    I think what people are trying to caution you against is putting the patient in the position of saying "no" in the first place. Once a patient refuses treatment, it's not always that easy to convince them to change their mind despite it being in their best interest.

    Firstyear, I'm not against anyone wanting to research or try to improve communications between patients and nurses. However, I do think you need to make sure your own past issues are not projected into how you provide care or communicate with patients.

    This may be OT but what about the physician's responsibility to explain treatment and procedures to the patient? When possible, I think they should be talking more to the patient in this regards since they are responsible for ordering the treatment or procedure.
  5. by   cardiacRN2006
    Quote from firstyearstudent
    Sometimes the Foley is for the doctor's convenence (like a patient undergoing an angiogram in light sedation).
    Well, the Foley in this situation is not for Drs convience. I'm guessing you've never had to take a pt fresh from a cath before? First off, they need a lot of fluids to flush out the contrast. It's not always in the pt's best interest to have a pt rolling all the time to get on a bedpan. It sometimes puts too much pressure on the Fem artery, especially if they are just hemostased. If they are a man, I've found that they can't urinate lying down, and frequently request a Foley if they know their bedrest will be longer than a few hours.

    Firstyear, I think that your constant inner conflict with your doubts will ultimately lead to your dissatisfaction with nursing. Like mentioned before, your ability to be "pushy" may very well be the thing that saves your patients' lives.
  6. by   augigi
    Seems to me you are not asking for information, as you are ready to refute every scenario/advice given. If you are set in your thinking, that's fine, and just see how you do in real life. Personally, I do feel defensive that you continually post that nurses seem to follow "doctor's orders" blindly and stupidly. Do we do things for the "doctor's convenience"? Of course not!! We are the barrier between the doctor and the patient, and no competent nurse does things without thinking about the rationale and risk/benefit of such action. Our license depends upon it, and most if not all of us take that responsibility seriously.

    To some degree, patients NEED us to be confident and convinced in our therapies. Generally they are afraid and sick, and they need to know that we know what we're doing. Most of the time, we do. Of course, sometimes we don't, and in that case we say "we are not sure what's wrong with you, but we're going to try ________ because it will tell us ________ and that may help us with our diagnosis".

    A great part of nursing is making sure that our personal prejudices are not projected onto our patients. You may need to address your personal issues without inflicting them onto your patients, in order to be an effective advocate.
  7. by   leslie :-D
    Informed Consent is restricted for only those procedures considered high risk and invasive.
    otherwise, a simple explanation should suffice...not permission.
    i always inform my pts of anything i'm about to do.
    but never, "do you mind if i...." but rather, " i need to do this because..."
    and needing to perform a procedure is not pushy.
    it's called treatment.

    leslie
  8. by   Gompers
    Quote from earle58
    Informed Consent is restricted for only those procedures considered high risk and invasive.
    otherwise, a simple explanation should suffice...not permission.
    i always inform my pts of anything i'm about to do.
    but never, "do you mind if i...." but rather, " i need to do this because..."
    and needing to perform a procedure is not pushy.
    it's called treatment.

    leslie
    Exactly!

    Of course patients will "mind" if you put in a Foley, start an IV, draw labs, etc. Those things HURT! If they are in the hospital, your job is to treat them. If you agree with the doctor's orders, then going to the patient and telling them, "I'm going to do this..." is absolutely fine and NOT pushy.

    The the OP, once you've worked as a nurse for awhile you'll see that many of the things we do in the hospital (Foleys, NG tubes, heplocks placed "just in case", etc.) are very important so that we can care for these patients. They aren't for convenience, they are part of the treatment plan. If the patient is in the hospital, their health is OUR responsibility. We're going to do whatever it takes to make them well. Sometimes this includes painful procedures or tubes. Just because we don't ask the patients if they want these treatments or not doesn't make us pushy - it makes us confident that the patient NEEEDS these things. Our job is to carry out the doctor's orders and to care for the patient. We will explain these procedures before we do them and answer the patient's questions - but we won't give them the option to refuse treatment. If they protest, then that's one thing. But 95% of your patients want to get well and they'll accept that whatever you're doing is part of their treatment.

    Now, if you've run across nurses who simply barge into a room and start shoving an NG down someone's nose or a Foley up their urethra without a single word - then yes, that's a problem. But that is NOT the norm. If you are seeing that, then that is an issue with that hospital or that nurse.

    On the other hand, you seem to be questioning the doctor's orders more than anything. Just because we, as nurses, place NGs and Foleys, that doesn't mean that we're doing it blindly! We're doing it because we agree with the doctor that these things are needed. If you constantly question every single order that the doctor gives you, then there is a major power struggle going on. Maybe you'd be happier being an MD or NP, so that you're the one that writes the orders as you see fit?
    Last edit by Gompers on Oct 1, '06
  9. by   PANurseRN1
    "Because the doctor thinks so..." sure makes the nurse look like some blind handmaiden just follows doctors orders.

    I agree with the other poster who said the OP really doesn't want input as she already has her mind made up. It seems the sole purpose of this thread is to agitate.
  10. by   txspadequeenRN
    :yeahthat:
    Quote from Gompers
    Exactly!

    Of course patients will "mind" if you put in a Foley, start an IV, draw labs, etc. Those things HURT! If they are in the hospital, your job is to treat them. If you agree with the doctor's orders, then going to the patient and telling them, "I'm going to do this..." is absolutely fine and NOT pushy.

    The the OP, once you've worked as a nurse for awhile you'll see that many of the things we do in the hospital (Foleys, NG tubes, heplocks placed "just in case", etc.) are very important so that we can care for these patients. They aren't for convenience, they are part of the treatment plan. If the patient is in the hospital, their health is OUR responsibility. We're going to do whatever it takes to make them well. Sometimes this includes painful procedures or tubes. Just because we don't ask the patients if they want these treatments or not doesn't make us pushy - it makes us confident that the patient NEEEDS these things. Our job is to carry out the doctor's orders and to care for the patient. We will explain these procedures before we do them and answer the patient's questions - but we won't give them the option to refuse treatment. If they protest, then that's one thing. But 95% of your patients want to get well and they'll accept that whatever you're doing is part of their treatment.

    Now, if you've run across nurses who simply barge into a room and start shoving an NG down someone's nose or a Foley up their urethra without a single word - then yes, that's a problem. But that is NOT the norm. If you are seeing that, then that is an issue with that hospital or that nurse.

    On the other hand, you seem to be questioning the doctor's orders more than anything. Just because we, as nurses, place NGs and Foleys, that doesn't mean that we're doing it blindly! We're doing it because we agree with the doctor that these things are needed. If you constantly question every single order that the doctor gives you, then there is a major power struggle going on. Maybe you'd be happier being an MD or NP, so that you're the one that writes the orders as you see fit?
  11. by   txspadequeenRN
    Ive been reading this from the beginning and this has become quite the little discussion. I think pushy is too harsh a term ..assertive is more like it. There is no need to sugar coat or reduce the procedure the patient must have . If you need it then you need it. I read somewhere back in the previous post that you did not want to be a confident nurse. You might need to work on that because your gonna get walked all over and end up crying alot , some patients feed off that kinda stuff ( mind you I typically work in lock down units). Now as for this post.... There ahould be autonomy for the patient up to some point , if you consistantly would rather take the risk rather than the treatment then you probably need to go home. Why be in the hospital if you are going to refuse your treatments .. When your in nursing school it is all textbook and students are blinded because even while a student you are not fully on your own and get to experience 100% the beauty of being a nurse. Then you graduate and reality hits and now you are in the real world. Real world nursing and Textbook/nursing school are 2 different monsters.... No body is saying that you shouldnt be a nurse. But you have come to a place for adivse, where the nurses work in real hard -core reality and your talking to MANY MANY years of experience when you ask a question on this board.


    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.
  12. by   UnchainedFever
    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.
    Bless your heart....
  13. by   CCURN
    For the most part I ask my patient permission with procedures, unless they are intubated or confused. I had a patient once that was so scared of everything, I had to tell her what I was doing with the IV pump. Nurses do tend to assume that if the patient is admitted then they want treatment, and if you give them too many options then they might refuse, and then you are stuck if they really need the treatment. When I start and IV I tell the patient I am going to do this, but I do try and give them the option of which arm....Just do your best and stick to your own morales and you will be a great nurse....

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