How are you judgemental?

[GardenDove]

I was reporting off this morning on a rule out chest pain pt. He was a 49 yr old guy who had an extensive family cardiac risk hx, he had had a CABG in his 30's, had been an alcoholic until 8 yrs ago, when he gave it up. He had abused recreational drugs. He previously had smoked 4 pks a day, but now was down to 1/2 pack a day. He still occasionally indulged in pot, was married for 30+ years, had had stents, was not overweight, had early COPD, and was just about to get on disablity for his multiple problems. He also had had some esophegeal surgery secondary to his previous ETOH dependence.

The guy was actually very nice and really above board and honest. He had been a traveling worker who had worked on railroads. He had made the effort to quit drinking for 8 years, had cut back to 1/2 pack a day, was not pestering me for morphine, and was really nice.

So, one of the nurses in report was pretty judgemental. Let me just say that this nurse tends to give a pass to all the out of control diabetics who are 100 punds overweight, and is a only too eager to point out how judgemental I am if I comment on that.

This all made me realize how each of us has something that makes us judge our pts. For some reason, this guy seemed up front and honest. He didn't mind my remarks like "How in the world did you manage to smoke 4 pks a day!?". I saw him as someone who WAS making an effort. Yes, I think that whiny, overweight pts who have complications from their food overindulgences bug me.

So, what is it that particularly sets you off about your pts? For me it's the overeating, abdominal chronic pain pts, they really aggravate me.

[cookiecuc]

I think that being in the nursing profession, you should not judge or stereotype anyone. As a nurse, you should look at everyone as an "unique" indivdual and that everyone has a reason for being the way they are and that you should acknowledge their differences and resolve the problem based on their situation.

[dmarie (GA)]

I'm still in nursing school so I can't relate to the experienced nurses who see these situations day in and day out. I might be judgemental too if I was in their shoes. Especially when it comes to the treatment and neglect of children.

It's easy for me --- someone who isn't jaded yet --- to point out that people who overeat, abuse drugs or alcohol, or smoke cigarettes are usually in the throws of addiction and usually struggle with these addictions on a daily basis. A certain level of compassion is needed. Sometimes these clients may be ignorant to the dangers of their addictions, and sometimes they might be aware of the dangers but are helpless to stop without help or intervention.

I don't doubt that experienced nurses, despite their private thoughts or judgements, continue to conduct themselves in a professional manner. We're all human, and sometimes judgemental thoughts creep into our minds. As long as we continue to do our jobs to the best of our ability, there's nothing wrong with venting, especially on an annonymous discussion board.

But I do worry about judgemental thoughts that are nurtured and eventually effect our behavior in a negative way.

[angel337, MSN, RN]

i am judgemental about the patient that has GERD or chronic gallstones, but continue to come to the ER because "I ate something spicy last night". now they are leaning over in excrutiating abdominal pain and take no responsibilty whatsoever in managing their illness. if you know certain foods give you an attack....why eat it??

I also have a problem with patients who walked in the ER from the parking lot with no difficulty, but need a wheelchair once they get into the waiting room.

(with the exception of ortho complaints)

[grammyr]

I guess you could call me judgmental about people who seek specific pain medications and the things theydo to get them. Have one patient we will call Doofus who has managed to accidentally shoot himself not once but twice with the same malfunctioning gun. the first trip to the hospital was a small entrance and exit wound to the foot, last night it was the calf. The first trip he left AMA because I refused to give him Morphine 60MG IVP for the excruciating pain. I have no doubt that he was hurting, but come on, I will not EVER give anybody that much morphine at one time. I'm not sure what happened last night because I left after his parents got there but before the show started. The parents are total enablers who actually took him to another hospital last time because we wouldn't give him what he wanted.

[UM Review RN, ASN, RN]

I find that I get a tad annoyed at the patient who's speech is slurring badly, cannot stay awake during assessment, and whose BP is trying to head for the toilet, yet can still push the call bell and mumble that the pain is 10/10 and needs more pain med.

Sorry. Not happenin'.

*But I might go in there and tell them why--"You are so sedated the only med I'm considering giving you right now is Narcan." It's amazing how many people with "pain control issues" know what that is, you know?*

[Quickbeam, BSN, RN]

When I was a work comp case manager (RN), I developed a hard heart towards malingerers and WC cheats. People claiming total disability from a questionable injury yet were able to reroof their house or drop a new engine into their truck (on surveillance). They'd always need OxyContin, could never work but managed to mow the lawn alright. There was so much outright fraud, I couldn't believe it.

[tvccrn, ASN, RN]

I think that being in the nursing profession, you should not judge or stereotype anyone. As a nurse, you should look at everyone as an "unique" indivdual and that everyone has a reason for being the way they are and that you should acknowledge their differences and resolve the problem based on their situation.

True, that as nurses we SHOULDN'T judge. But, we are human and therefore DO judge people. Most nurses I know are able to keep the patient from knowing that they are being judged.

I know that I try my darndest to not judge people, but it's the ones that say they can't afford healthcare, yet are driving a Mercedes SUV, wearing numerous sparkling diamonds and smell like a smokestack that get to me. I don't treat them any different, but in my mind I have a running commentary on the medical care they could afford if they didn't throw the money away on all that other crap.

I am also judgemental about people who are supposed to be in a profession where charting is the be all and end all, yet can't seem to spell even simple everyday words. I'm not talking the usual e-mail abbreviations, it's the constant misspellings that just irk me. It makes me wonder about their level of education and the care they give. Wrong, I know, but that's just me.

tvccrn

[agoodusername]

I really don't appreciate this thread. Aren't we perpetuating stereotypes by highlighting them in a discussion? This is exactly how "drug seekers" and "complainers" are created, marked, studied and pegged -- before we ever even experience them!

I'm in nursing school, and I remember the first time I heard a nurse give me report on my very first patient. "She's got these open abcesses on her thighs that are really painful, she says. But if she's in so much pain, why is she still going downstairs to smoke every hour?" This made sense to me, a naiive, inexperienced nursing student, and so, before I even got a chance to begin my career in my own way of thought, I walked into my patient's room with a stereotype blocking my entire field of view. Because of this, the first thing I noticed about her was that she was sleeping with her cigarettes in her breast pocket (of course), and the first thing I assumed was that she would be crabby and want to smoke as soon as she woke up (of course), and that she really wasn't in all that much pain (of course not).

I'm really thankful that I took the time to try and get to know her, because I learned a lot about how wrong that nurse was. I learned that my patient was missing her son's first day of kindergarten, and that she had been diagnosed with Crohn's a decade ago with no end in sight. She really was in pain, which I could clearly see without years of experience under my belt, and yes, she smoked. But it made me realize: why wouldn't she? She had nothing else to get her through the day!

Stereotyping is really a huge issue with nurses, especially in the realm of report. You can make or break a nurse's DAY depending on how you describe your patient at end of shift. Think about it -- the outlook for your day can be completely different depending on the report you get: "This patient is really great. She's sweet, she doesn't really complain, and she definitely knows how to get up and go to the bathroom by herself. Really easy," versus, "Oh my gosh. What a nervous nancy. This lady shakes, and she's a smoker, but she's not allowed off the monitor so she just bugs you all the time about going downstairs. She always asks for pain medicine, but when you walk in she's asleep, and she has been incontinent three times. It's not going to be a good night for you." Everyone knows how each of these reports gives you a totally different outlook for your shift, and how you treat your patient.

This is my argument: both examples are wrong. Both examples of report put an idea into the receiving nurses mind, and immediately create a stereotype that molds and alters the rest of the shift and every dealing with the patient. I think that report should STRICTLY be confined to report -- medical, objective information that is PERTINENT and important to nursing care, NOT nurse opinion.

Stereotyping is a HUGE problem in nursing. Let's STOP glorifying it by giving petty examples of people who bother us. Our patients are sick, and regardless of what they are sick with or how sick they are, they deserve respect, and good, unbiased, un-stereotyped care.

[morte, LPN, LVN]

When I was a work comp case manager (RN), I developed a hard heart towards malingerers and WC cheats. People claiming total disability from a questionable injury yet were able to reroof their house or drop a new engine into their truck (on surveillance). They'd always need OxyContin, could never work but managed to mow the lawn alright. There was so much outright fraud, I couldn't believe it.

because you mow your lawn twice a week, doesnt mean you can hold a 40 hour a week job....and maybe you couldnt even do the lawn without the oxy.....hm droppng an engine is usually done with a hoist.....not sure how much work is really involved there......guess what, YOU just hit one of MY buttons,lol........ until you have walked a mile,.......

[RunningWithScissors]

I wore myself out last night giving IV Nubain every 1-2 hours to a woman c/o a sore throat...ff who (surprise) is "allergic" to all theother usual PO pain meds. Once you get a diagnosis of heart disease ( previous cath/plasty/stent) you can get your foot in the door here quicker than anything c/o chest pain, then get your pain meds for any and all complaints, forget about anything going on in your chest.

We have several pts addicted to pain meds who practically live here, go home when THEY are ready after weeks of PCA or IVP pain meds, Fentanyl patches, and sometimes PO methadone also.

I have a sneaking suspicion that we can thank JACHO for this in some ways...(pain is what the pt says it is and MUST be controlled to the nth degree!!!!!). We have become a soft nation of drug-seeking, feel-nothing robots.

[RazorbackRN, BSN, RN]

I really don't appreciate this thread. Aren't we perpetuating stereotypes by highlighting them in a discussion? This is exactly how "drug seekers" and "complainers" are created, marked, studied and pegged -- before we ever even experience them!

I'm in nursing school, and I remember the first time I heard a nurse give me report on my very first patient. "She's got these open abcesses on her thighs that are really painful, she says. But if she's in so much pain, why is she still going downstairs to smoke every hour?" This made sense to me, a naiive, inexperienced nursing student, and so, before I even got a chance to begin my career in my own way of thought, I walked into my patient's room with a stereotype blocking my entire field of view. Because of this, the first thing I noticed about her was that she was sleeping with her cigarettes in her breast pocket (of course), and the first thing I assumed was that she would be crabby and want to smoke as soon as she woke up (of course), and that she really wasn't in all that much pain (of course not).

I'm really thankful that I took the time to try and get to know her, because I learned a lot about how wrong that nurse was. I learned that my patient was missing her son's first day of kindergarten, and that she had been diagnosed with Crohn's a decade ago with no end in sight. She really was in pain, which I could clearly see without years of experience under my belt, and yes, she smoked. But it made me realize: why wouldn't she? She had nothing else to get her through the day!

Stereotyping is really a huge issue with nurses, especially in the realm of report. You can make or break a nurse's DAY depending on how you describe your patient at end of shift. Think about it -- the outlook for your day can be completely different depending on the report you get: "This patient is really great. She's sweet, she doesn't really complain, and she definitely knows how to get up and go to the bathroom by herself. Really easy," versus, "Oh my gosh. What a nervous nancy. This lady shakes, and she's a smoker, but she's not allowed off the monitor so she just bugs you all the time about going downstairs. She always asks for pain medicine, but when you walk in she's asleep, and she has been incontinent three times. It's not going to be a good night for you." Everyone knows how each of these reports gives you a totally different outlook for your shift, and how you treat your patient.

This is my argument: both examples are wrong. Both examples of report put an idea into the receiving nurses mind, and immediately create a stereotype that molds and alters the rest of the shift and every dealing with the patient. I think that report should STRICTLY be confined to report -- medical, objective information that is PERTINENT and important to nursing care, NOT nurse opinion.

Stereotyping is a HUGE problem in nursing. Let's STOP glorifying it by giving petty examples of people who bother us. Our patients are sick, and regardless of what they are sick with or how sick they are, they deserve respect, and good, unbiased, un-stereotyped care.

I guess I could say that I'm judgemental against people who judge nurses for being judgemental until they've walked a mile in our shoes.

Just because nurses tend to be judgemental after seeing the same behavior patterns time after time doesn't mean that we think our pt's don't "deserve respect, and good, unbiased, un-stereotyped care". We didn't say it was OK to be judgemental, however, nurses are human too, thus it happens.

Do this...post back after you've been a nurse for 6 months, and then tell us that you still don't have times where you've been judgemental in some aspect. Whether it be in re: to the pt family, meds request, sheer laziness, or non-compliance, I'll bet you'll understand a little bit better.

[snowfreeze, BSN, RN]

What really makes me not like a patient is the ones who suddenly become totally incapacitated of all aspects once they hit the unit, but won't accept any medical interventions. Nausea and vomiting but refuses NG, skin itches but refuses benadryl or creams, claims allergy to most everything. I can understand being overwhelmed with being sick, having surgery and recovering from the pain, but being needy after the first 48 hours really bugs me. At this point you need to be looking on how you can function at home. Maybe we need to address mental health issues more agressively prior to doing any intervention on any patient. The PCP needs to have more time alloted to really get to know a patient, from first hand experience that does not happen. A car going through a car wash gets more touch experience.