Do You judge and treat patients differently depending on who they are ?

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The reason I asked this question is because we had an inservice at my job and they told us in so many ways nurses can show prejudices towards patients based on this. Does this happen with us not knowing what we are doing. Can you assume you know about a person based on their name ? Is this ethical ?

Specializes in Hospice.
RN Cardiac, I presume you live in a nice house, perhaps with your family? I obviously have no way of knowing any of this, but as a professional, it is the given norm. Given your post here, I'm somewhat astounded by your attitude. What do you know of your patient except for what you wrote? Anything? The second visit of the day, was the 217th of the year? Your ER doesn't have a clothes locker? Couldn't you have provided him with clean clothes during the first visit of the day? Did he get a bath and maybe a shave during his first visit? He had to be sober in order for you to D/C him the first time; did anyone try to place him anywhere? What does his H&P show? How did he end up on the street, has anyone bothered to try to find out? Does he have family that anyone can contact or does anyone care? You obviously don't. This man could be a Veteran, there are scores of them on the streets, but most people who are in a position to help are just like you, too damn busy judging them. If you were living on the streets and usually had to deal with what the average homeless person has to deal with, you would probably try to stay drunk most of the time as well. I know I would. There is an old saying about "not judging someone until you've walked a mile in their shoes." Then there is an even older one you might prefer, "Judge not, lest ye be Judged." I asked about your home, because what if suddenly you longer had it and you were forced to live on the streets? What exactly would you do? This isn't such a far out scenario, it happens to people everyday. It is worth considering.

FMF Corpsman, please be aware that I'm not addressing you personally ... I'm quoting your post as an example of a n assumption that bothers me a lot.

It's the assumption that feelings=behavior and are therefore subject to review or control by someone else.

While I've only skimmed through the thread, most of the posts I've seen in which the writer admits to an adverse emotional response also talks about the efforts made to provide good care in spite of them. I believe that's all we can expect of ourselves: self awareness and a commitment to finding ways to de-fuse our emotions so that they don't change the quality of our care.

The post I quoted would have been far more effective, in my opinion, if it had discussed the poster's own process and how it helped him/her provide better care. Instead, she/he chose to scold and attempt to dictate how another person should feel. This is dangerous and damaging behavior.

An example is vent threads ... places where nurses are attempting to unload some of the pressure we feel when our personal emotional responses are directly opposite to what we need to do for our patients. These threads invariably get shut down when someone from the compassion police jumps in (with the very judgementalism they so loudly condemn) and tries to dictate to us what we must feel in order to be "good" nurses.

Acknowledging a hostile emotion is the first step in transforming it ... when you shut us down, you block that step and pressure us into pretending that those responses don't exist.

How is that healthy?

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by definition-we are judged from the start of time and therefore we judge-BUT- we should be able to separate and give the care and concern we need to. alas, sometimes easier said than done.

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I wouldn't touch someone like that without gloves for my own safety and other patients' safety and I don't think that makes me a bad nurse. And I think that's gross. I do hope someone gave the guy a shower. You can dislike a patient or be grossed out by something the patient has done or has and still give them good care.

I certainly agree with you about gloves, however...

The nurse there had gloves on, and she was still very visibly grossed out. She made faces, made noises kind of like a guttural "ewww" and whatnot. I felt bad for the guy.

No idea if he had a chance to take a shower.

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Specializes in Hospice.

...The nurse there had gloves on, and she was still very visibly grossed out. She made faces, made noises kind of like a guttural "ewww" and whatnot. I felt bad for the guy.

Here's an example of the kind of thing that deserves criticism ... focus is not on what the nurse is feeling but how she is behaving. There is a difference.

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FMF Corpsman, I prefer:

Don't judge anyone until you've walked a mile in their shoes. That way, when you tell them what you think.............you have a one mile head start on getting away from them.

In that case you also get a free pair of shoes! :D

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Specializes in Peds Medical Floor.
You can be as grossed out as you want to be, but I certainly hope you still maintain your professional demeanor. It may not be the patients fault if some fungus has invaded his tissue or if he has some other integumentary system failure. If s/he is walking around like this and has already been the subject of stares and ridicule from the general populace, and you know s/he has, they don't need to get it from you as well.

Of course I would maintain my professional demeanor! If I was unprofessional with every person I took care of who had some gross infection or hygiene issue, I would have been fired a long time ago! I can be grossed out, but hide it and do my job.

If you acted grossed out and didn't help the guy get cleaned up and talked about him and made fun of him, that's very unprofessional and wrong! I wouldn't do that.

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Specializes in FMF CORPSMAN USN, TRUAMA, CCRN.
[color=#000000] [/color]the post i quoted would have been far more effective, in my opinion, if it had discussed the poster's own process and how it helped him/her provide better care. instead, she/he chose to scold and attempt to dictate how another person should feel. this is dangerous and damaging behavior.
[/color]considering that "judgment" a feeling of sorts, it is somewhat difficult to separate the two as it were and i am indeed attempting to help this nurse to become a better rn/person, by pointing out how s/he might better have assisted this patient. granted, i undoubtedly allowed my personal feelings to intrude, but where i wrote my words, rn-cardiac merely insinuated, otherwise my post never tried to dictate s/he feel anything except perhaps a little empathy towards her patient which isn't asking all that much for a nurse. [color=#000000]

"i agree with katie,...i do make judgments,...especially when this is the 217th visit to my er this year, twice today and you managed to get your bal back to 0.437 in under three hours! judge i do,...however,,...i will still stick a tube down your throat, give you a banana bag, and remove your nasty clothes and place you in a clean gown. i will treat you, and probably keep my mouth shut,. but yes i will judge. " rn-cardiac

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[color=#000000]perhaps all of my years in er have tainted my view, but i can put myself in the er at the same time as rn-cardiac and this patient and see exactly how this patient is being treated and it isn't exactly like the little old lady that is in the next cubicle. this patient is being treated with disgust and near abuse. her tone of voice is condescending and more that of a drill sergeant than of a nurse and she's treating the patient like the dirt she pictures him as instead of a human being in need of help. i've seen it far too many times, and i've had to write up far too many nurses for just this same thing. do i judge? yes, i do, and i judge nurses as well and for just this kind of thing. this patient needed serious help and all this nurse saw was the dirt, perhaps if s/he gave him a bath the view might have been a little different. people end up on the street for a variety of reasons, not all of them their own fault, and as i said in my post, the horrors out their would make a teetotaler drunk within a day or two, just to escape the reality of it all. i used to work 20 hours a week in a detox center for an agency and it was an experience like living in a third world country. the people affected by drugs and alcohol were doctors and nurses, lawyers, senators, everyone and anyone you wouldn't expect to be were represented. this patient might have been a judge, but i know it was someone's father, it may have been someone's husband or brother or dad and they deserved the same respect everyone else that came in the door to that er deserved and exactly the same treatment. and they didn't get it, because it was their 217th trip to the er. what if that patient had coded outside of the er, would you have just walked away and let them die, because you didn't want to touch them because they were too dirty to live? what if they hadn't changed the guidelines for cpr, would you have done mouth to mouth? honestly? you're a nurse; you've taken an oath, or were they just words? [/color]

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Specializes in FMF CORPSMAN USN, TRUAMA, CCRN.
My point is, you have to police yourself with regards to delivering unbiased care to your patients. You know when you are judging them for the right or wrong reasons. Don't get too caught up in the double talk that comes down from administration. They have no answers and take a "wait and see" approach. They wait and see the results, and if they don't like them..........they tell you that you should have known better and that there are policies in place for/against what happened. As I said before though, their policies and attitudes towards the whole issue reflects lack of understanding of the issue and are double sided.

A well written and thought out article Pennywise, Thank you. The only piece of advice you didn't deliver was probably the most important, which I'm sure you thought of but neglected to include was CYA. Most have heard of it, but for the new Nurses and students I will spell it out. It's Cover Your ASSets. The "wait and see" approach I highlighted in Pennywise's article translates to which way the tides turn and if they are favorable, then you are okay, if not, well let's just say, it's best to have your curriculum vitae updated, because they will drop you like a rock, and deny any association with you. Kind of like the old Mission Impossible tape, where the Secretary disavows any knowledge of... Having been a part of it at a couple of different Institutions, I can say with all honesty, Administration is not your friend. Pennywise was being kind, I'm a retired, cantankerous old fool. I don't believe in political correctness as I think it's just an excuse to lie to someone's face. My email signature is "Hurt me with the truth, ...but never console me with a lie." People will eventually get over hurt feelings, but lies can kill.

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Specializes in Hospice.
Considering that "judgment" a feeling of sorts, it is somewhat difficult to separate the two as it were and I am indeed attempting to help this Nurse to become a better RN/PERSON, by pointing out how s/he might better have assisted this patient. Granted, I undoubtedly allowed my personal feelings to intrude, but where I wrote my words, RN-CARDIAC merely insinuated, otherwise my post never tried to dictate s/he feel anything except perhaps a little empathy towards her patient which isn't asking all that much for a NURSE.

"I agree with Katie,...I do make judgments,...especially when this is the 217th visit to my ER this year, twice today and you managed to get your BAL back to 0.437 in under three hours! Judge I do,...however,,...I will still stick a tube down your throat, give you a banana bag, and remove your nasty clothes and place you in a clean gown. I will treat you, and probably keep my mouth shut,. but yes I will judge. " RN-CARDIAC

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Perhaps all of my years in ER have tainted my view, but I can put myself in the ER at the same time as RN-CARDIAC and this patient and see exactly how this patient is being treated and it isn't exactly like the little old lady that is in the next cubicle. This patient is being treated with disgust and near abuse. Her tone of voice is condescending and more that of a Drill Sergeant than of a Nurse and she's treating the patient like the dirt she pictures him as instead of a human being in need of help. I've seen it far too many times, and I've had to write up far too many nurses for just this same thing. Do I judge? Yes, I do, and I judge Nurses as well and for just this kind of thing. This patient needed serious help and all this nurse saw was the dirt, perhaps if s/he gave him a bath the view might have been a little different. People end up on the street for a variety of reasons, not all of them their own fault, and as I said in my post, the horrors out their would make a teetotaler drunk within a day or two, just to escape the reality of it all. I used to work 20 hours a week in a Detox Center for an Agency and it was an experience like living in a Third World country. The people affected by drugs and alcohol were Doctors and Nurses, Lawyers, Senators, everyone and anyone you wouldn't expect to be were represented. This patient might have been a Judge, but I know it was someone's Father, it may have been someone's Husband or Brother or Dad and they deserved the same respect everyone else that came in the door to that ER deserved and exactly the same treatment. And they didn't get it, BECAUSE IT WAS THEIR 217TH TRIP TO THE ER. What if that patient had coded outside of the ER, would you have just walked away and let them die, because you didn't want to touch them because they were too dirty to live? What if they hadn't changed the guidelines for CPR, would you have done mouth to mouth? Honestly? You're a Nurse; You've taken an Oath, or were they just words?

OK, since you're taking it personally anyhow, I'll try again.

my post never tried to dictate s/he feel anything except perhaps a little empathy towards her patient which isn't asking all that much for a NURSE

So ... you are dictating what s/he must think and feel in order for you to approve of her nursing behavior ... all the more interesting since you have no idea of how s/he actually behaves during those 217 visits.

Furthermore, without ever actually working with him/her, you claim that you can:

"see exactly how this patient is being treated and it isn't exactly like the little old lady that is in the next cubicle. This patient is being treated with disgust and near abuse. Her tone of voice is condescending and more that of a Drill Sergeant than of a Nurse and she's treating the patient like the dirt she pictures him as instead of a human being in need of help."

So ... you are, as I pointed out, confusing feeling with behavior and assuming you know what s/he is doing based on what s/he's feeling.

Let me be clear: disrespectful or abusive behavior is unacceptable and should be confronted whenever you see it.

Extending that to include some divine right to dictate what goes on in the privacy of another's mind and heart is over the line and can do significant damage in itself.

I say again that your post would have been more helpful if you had shared your process for dealing with your own hostile responses in order to provide good, respectful care to those who might push buttons.

If you claim that you never react emotionally or experience a hostile response, then you are either lying or need to seek help.

One thing I can tell you is that your ongoing attacks against those who are being honest about how they are feeling are not helpful.

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Specializes in ortho, hospice volunteer, psych,.
RN Cardiac, I presume you live in a nice house, perhaps with your family? I obviously have no way of knowing any of this, but as a professional, it is the given norm. Given your post here, I'm somewhat astounded by your attitude. What do you know of your patient except for what you wrote? Anything? The second visit of the day, was the 217th of the year? Your ER doesn't have a clothes locker? Couldn't you have provided him with clean clothes during the first visit of the day? Did he get a bath and maybe a shave during his first visit? He had to be sober in order for you to D/C him the first time; did anyone try to place him anywhere? What does his H&P show? How did he end up on the street, has anyone bothered to try to find out? Does he have family that anyone can contact or does anyone care? You obviously don't. This man could be a Veteran, there are scores of them on the streets, but most people who are in a position to help are just like you, too damn busy judging them. If you were living on the streets and usually had to deal with what the average homeless person has to deal with, you would probably try to stay drunk most of the time as well. I know I would. There is an old saying about "not judging someone until you've walked a mile in their shoes." Then there is an even older one you might prefer, "Judge not, lest ye be Judged." I asked about your home, because what if suddenly you longer had it and you were forced to live on the streets? What exactly would you do? This isn't such a far out scenario, it happens to people everyday. It is worth considering.

This is exactly how I have tried to live my life, both at home and at work. I worked at a state

psych hospital and occasionally got pulled to the forensic building. It was much much easier for me to care for these men if I never found out what crime/act they committed. That way, I could just care for the man without whatever he did getting the way.

Race and nationality have never been a major issue for me. I think because when I was small enough to begin to form negative opinions, I was around my parents' friends and their kids and they were many races, colors, and nationalities.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

So ... you are, as I pointed out, confusing feeling with behavior and assuming you know what s/he is doing based on what s/he's feeling.

Let me be clear: disrespectful or abusive behavior is unacceptable and should be confronted whenever you see it.

Extending that to include some divine right to dictate what goes on in the privacy of another's mind and heart is over the line and can do significant damage in itself.

I say again that your post would have been more helpful if you had shared your process for dealing with your own hostile responses in order to provide good, respectful care to those who might push buttons.

If you claim that you never react emotionally or experience a hostile response, then you are either lying or need to seek help.

One thing I can tell you is that your ongoing attacks against those who are being honest about how they are feeling are not helpful.

Evidently HE does react emotionally, and experiences hostile responses toward nursing staff. Especially those who are being honest about how they feel.

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Here's an example of the kind of thing that deserves criticism ... focus is not on what the nurse is feeling but how she is behaving. There is a difference.

I like this statement as well. I feel that you can feel what you want to feel, but don't let it show and don't let it affect the level of care you give. If you can't do that (within reason) you can't give appropriate care.

Was the guy's rash unsightly? A bit. Was it contagious? Maybe. Then again, if you choose to work in a hospital you should have figured out somewhere along the way that you're going to be elbows deep in this kind of stuff all the time. ALL THE TIME. You need to be ok with the risks of these sorts of things that can persist even after all the precautions are taken.

I don't know anything about that nurse other than my observation. She might have been new to the practice, perhaps. However, that's something I remember when soon-to-be Nursing students are running out of A&P labs to go barf. Or when starry-eyed indoorsy types talk about how gross poo is and that they "aren't going to deal with it, just go get a CNA" when they get to work. I hope they will toughen up when the time comes.

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