Yes, we are pushy. Yes, I do assume that if the patient is in the room, alert and oriented to time, place, and person, that they want the treatment and consent to it. So I don't ask permission for most things. "Hi, I'm soandso, I'll be your nurse tonight, and I'm going to take your vital signs" doesn't leave a lot of room for argument.
I've realized a few things when working with people in this setting. One, they don't always want to know everything, even when sometimes they might need to! Two, there are large portions of the population that are very uneducated about healthcare and think, really think, that the nurse/doctor can do whatever they want to the patient. I feel sorry for people in that situation and treat them with respect. I do try to be less pushy and educate when possible. Yano, sometimes you come up against someone who is ignorant of most things healthcare-wise, yet has a good amount of life wisdom and isn't stupid by a long shot, and may have had a bad experience- so they question you.
I had such a case once, she refused IV amiodarone drip for bouts of Vtach. That's all. I'll be danged if the doc didn't write a DNR order on her, and I come out of report with the info that "she is refusing all her meds." Hmm.
Really? I sat down and had a little talk with her, or rather, her with me. She got pneumonitis from the drug before, and wasn't having that again, and was feeling really defensive about everything else too. I had to take all her pills in there, and her MAR, and explain what meds I wouldn't give (low bp, held some meds) and why, and what meds I proposed to give and what they would do for her. Took a while longer than normal, but she got her meds. I poked my head in the door when she had runs of VTach and eventually got to explain to her what it was, and why we were concerned.
This lead to a discussion of end of life issues and she didn't have any wish to be a DNR! Just one drug that she didn't want! Omigosh. Noted to physician, got it changed on AM rounds, lucky for me she didn't code that night!
Now that case I put down to sloppy/pushy nursing from the nurse who initially had the patient when she refused the drip. Attitude made the difference and helped fuel the misunderstanding.
But in my experience, people who really, seriously, question treatment, stand out because they aren't the norm in the population I see. I would welcome more people asking questions, as I enjoy explaining how things work. There's also a certain amount of "pushy-ness" that helps get the work done faster and more efficiently; if the patients all thought you wanted to stand there and watch TV with them for a while, instead of taking their pills pretty quickly, we'd be doing evening meds at two AM. I am more pushy in the first hour, so I can get vitals and assessments done, then I relax and am available for more interaction. But really, there are families, and patients, out there who, if you don't barge in a little bit, won't allow you to get your work done.