Is it just me, or are nurses pushy?

[firstyearstudent]

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 asked if I want a treatment. Yet I notice during clinicals that nurses often don't ask or even explain what they're doing. They just sort of barge into a room and start doing procedures and making assumptions about what the patient wants. This is disturbing to me and I think that some patients may not even be aware that they have a right to know what's going on and to refuse any treatment. Do nurses do this because it makes their job easier or because patients really just want to leave all that to the nurses' and doctors' judgment?

[augigi, CNS]

it has been very interesting to read the posts on whether or not nurses are pushy. based on my own experience as a triple coronary bypass patient, i do not feel the nurses were pushy at all. on my admission i signed a permission to treat form. an important part of the decision to undergo the surgery involves willingness to accept whatever the medical staff deems necessary in order to recover, for if you do not, the surgery itself was in vain. i did not question my physician's diagnosis of blocked coronary arteries so there seemed no reason to doubt their recovery recommendations. of course, i was very much aware that these "recommendations" would most likely involve procedures which were unpleasant, but then neither was the surgery. if any of this were made an option to me i would have made different decisions, and would also probably have resulted in a very different outcome.

about the only procedure that i would have problems dealing with is foley catherization. in my one and only experience my foley was placed after i anasthesized and was removed while still getting regular doses of morphine, so i did not even realize it was there. having the catheter inserted while awake and alert, however, is completely a different matter. i would not question the need of the intervention, but would have big problems dealing with its placement. i have read somewhere that foley catherization is a "man's worst nightmare" and it just seems so unnatural to insert a tube through your member into your bladder. simply thinking about this causes anxiety attacks and chills up the spine, and i have no clue as to why. it isn't that i want to refuse this, but i cannot see me lying relaxed and still and cooperating. so i inquire as to what options might be available. i know that this comes across as being a big baby and i'll drool and coo all the while, but are any of you aware of anyone else having this problem and if any compromises might be possible? also i am too new a student to have any experience at this, so i ask what is the typical reaction of a male patient as the catheter is inserted? just how much does it hurt? i think, in the end, i would most likely consent to this procedure but would sure like to save myself the anxiety of getting there. thank you very much. joe

We use lidocaine gel, it should only be uncomfortable. Not anyone's idea of a pleasant way to pass the afternoon, but better than the alternative!

[Slpask]

DudeRN..

As a first year student, first night on the floor, I agree.. As a THIRD time on the floor, I am learning that pushy may be a bit strong.. I would go with MOTIVATED.

I also was a bit let down by how hurried the Nurses are, but on the THIRD time, the acts of caring, patience and impowering were there, I just did not see them.

All it takes is to see some small acts of kindness to change your point of view.. and they are there.

Good luck,

[J.R.theR.N2b]

being a beginning student i have not yet had the opportunity to actually do these procedures i have read about and studied. this particular thread has been very informative to me as this the area of nursing that concerns me the most. before reading these posts it seemed cruel to poke and prod a patient and to perform procedures against their will. now, however, i have seen that these things are not cruel at all, but in most cases are very beneficial. i do agree that if the patient is in the hospital that they should expect to follow the treatment regimen recommended by their physician. it seems normal to ask questions and expect your nurse to explain what they are going to do, but i think it is wrong to ask permission or to give the patient an option of accepting it or not. it is a matter of "patient perception" if the nurse comes into the room, explains what they are going to do and why, and gives the patient a minute or so of time to question if they desire, and then begins the procedure, they are conveying to the patient the fact that they consider this procedure to be very important and necessary, and they expect the patient to comply, will result in likely compliance. i agree with the posts here that state if you approach the patient and present them the "option" or give them a "choice", conveys that it really doesn't matter much whether they accept or not and patient is more likely to choose whatever is most convenient. it is my humble opinion that, if the patient really does object they will certainly make this known to you. in post #99 by "gompers" it is stated that procedures such as nasogastric tube insertion, starting an IV, and foley catheter placement HURT and that, of course the patient will not want these. i have seen posts on foley catherization that state the procedure to be uncomfortable, but not painful, where other posts such as the above by "gompers" state that this hurts and is painful. is this uncomfortable or painful, and just what is the difference between the terms? finally, how long and how much experience does it require to become accustomed to causing patients pain in the process of helping them? joe

[nurse4theplanet, RN]

i was on a website earlier geared at training new MDs in the art of physical assessment, and in one particular paragraph it stated something to the effect: Be aware that you will feel awkward when you perform your first physical assessments because it IS intrusive in comparison to everyday social interaction. You will be acutely aware of this as a newcomer, however, seasoned Physicians are desensitized to this because it has become their everyday routine...therefore they may appear to lack compassion/concern

Not the exact wording, but you get the gist...

Perhaps, that is why nurses come off as hurried/pushy...

It seems so easy to get caught up in the hustle and bustle, especially in the hospital setting. After years of performing the same nursing tasks, it seems like commonplace to you although it may be a very frightening/uncomfortable experience for your pt...just food for thought.

[General E. Speaking, RN, RN]

i have seen posts on foley catherization that state the procedure to be uncomfortable, but not painful, where other posts such as the above by "gompers" state that this hurts and is painful. is this uncomfortable or painful, and just what is the difference between the terms? finally, how long and how much experience does it require to become accustomed to causing patients pain in the process of helping them? joe

Joe, it will depend on your patient. Everyone has a different pain/discomfort tolerence. That's why we use the pain scale because what is painful to one may not be to another. I have found that some people do not flinch or show any facial grimacing during an IV start and others wiggle around and sometimes moan or even yell out. How painful a foley insertion may be can depend on anatomy. Frequently older gents have BPH and trying to get a regular cathetar in can be impossible. Many times a foley with a wire guide is necessary. This can be unpleaseant.

As far as getting "accustomed" to causing pain, I'm not sure we do. I mean, you know certain things are going to hurt and your job is to get your patient well. You always have the end result in mind. You are thinking of the patient as a whole. You have to do A). so you can get to B.) As you mentioned, the nurses approach can make all the difference.

I'll probably get flack for my definitions but I look at it like this: You must be able to empathize with your patient. By empathize, I mean a sort of an engaged detachment. You understand their pain but are still able to function. If you sympathize with your patient, you share their pain as your own making it difficult (if not impossible) to care for that patient.

Let the rebuttals begin!

[bethin]

Admission to hospital generally has implied consent for certain things. Of course, others need additional consents taken. You'd never get anything done if you asked every patient if they wanted to refuse every treatment. Do you not put in an IV for a patient about to arrest from shock because they "don't like needles"? No.

Ditto. I don't ask every pt if they want their vitals taken. I go in there and state "I need to get your vitals" or "I need to get your blood sugar." Same thing with hooking up telemetry to a pt with chest pain. I think this is implied consent and the pt knows it. I've never had a pt refuse a bp or bs. They realize we are doing our job and it is helpful to the dr, and it helps with diagnosis.

If a pt refused the telemetry monitor, but came in with chest pain, then what's the point of them being there? If we can't diagnose their problem then we can't treat them so they may as well go home.

[bethin]

I'll probably get flack for my definitions but I look at it like this: You must be able to empathize with your patient. By empathize, I mean a sort of an engaged detachment. You understand their pain but are still able to function. If you sympathize with your patient, you share their pain as your own making it difficult (if not impossible) to care for that patient.

Let the rebuttals begin!

No rebuttal here! I have had plenty of IV's, and when I'm helping a nurse start an IV, I empathize with that pt. I know it hurts, but it is going to help them. You have to think about the end result.

I've had NG's before too and they are no walk in the park but it helped me. It's temporary discomfort (or pain), even if you have an NG for days.

[bethin]

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).

You say you suspect, so I'm assuming you've never witnessed a less than sterile technique. I think the problem is assuming. In my job, I've learned never to assume anything. I have never witnessed a foley inserted with anything less than a sterile technique. Nurses will go back 3 times to get a new kit if they insert it in the lady parts.

How are you going to get a pt to urinate that hasn't went in 16 hrs and you have tried running the faucet, gallons of water, etc? Even if you do get them to urinate on their own, they only go 100 cc and you know with an input of 1500 that they must have more than that in their bladder. Then, when you do a bladder scan you find them holding hundreds and hundreds of cc of urine. And why would a doctor insert a foley for their convience? Often times a doctor does not insert a foley and they do not do peri care. Nurses do. Also, many times a foley is inserted to get a correct I&O, especially if the pt is in renal failure, post op, or on Lasix and not able to make it to the BR and/or incontinent. A foley will be inserted for pts with bed sores who are incontinent so they don't lay in their own urine and get the dressing soaked - which is gross. Imagine having a dressing on your coccyx soaked with urine. Foley's in pts with a blood clot would be expected as you don't want the pt to move around too much. Personally, I think foley's are alot better than laying in your own urine, even if it results in a UTI. I'd rather take antibiotics than have diaper rash - which pts get when they lay in urine - even if you check them q 2hrs.

I guess I have faith in the medical profession. I think a nurse would question a dr's order that stated to insert foley catheter on 19 yo pt with a broken arm who is otherwise healthy.

[JessicRN]

I remember years ago we had an nice older ITalian gentleman who had just had major surgery when I came on I was told he refuse to do coughing and deep breathing and was getting ateletasis. I went in found out he did not like to listen to young females. So I brought in a doctor explained the reason for the coughing and deep breathing and use of inspirometer. He still was reticent but after being very pushy he did what I asked and his lungs got back to normal. 2 days later he was transfered to a regular floor and I guess the nurses were not as pushy. two days later he landed hiself back to the ICU with severe atelectasis and pneumonia and had to be intubated. He did not survive. So if you were his daughter which nurse would you have prefferred the one who pushed or the one who let him do as he pleased. I push as needed. I decide if the treatment ordered would be detrimental to a persons health and if it is I push. That is a good nursing care not bad care.

[TweetiePieRN]

I would think that the more acute and complex the medical situation, the more the nurse would question accepted standards and feel the need to keep current with evidence-based practice, and, possibly, seek out opportunities to participate in research. And to also question physician's orders.

We already do this!

[J.R.theR.N2b]

if i approach being hospitalized from the viewpoint of the patient, i would want to run the show and do exactly as i please. however, you are in the hospital because you are either sick or injured to the point where you cannot care for yourself. you are preoccupied with the worry of what will happen to you and whether you will be incapacitated for the rest of your life. it seems easy to understand this situation is certainly not conducive to intelligent decision making. being a patient, however, you still desire to in control. this is human nature. this creates a problem. you want to make decisions and are most likely considered competent to do so, however, as i said before, you are not in a situation in which you are capable of doing so. when your nurse enters the room to do a procedure you definitely have the right to and can refuse. this would be an unwise choice. the nurse, because you are competent, cannot force you to comply. but the procedure is necessary to your well being, nurses must develop strategies to overcome the patients objections and coerce them to accept. the worst thing i can imagine having to endure as a patient is insertion of a foley catheter. if presented with a choice i would most likely refuse. my fear and anxiety of the procedure would trump the benefits. even though i have never experienced catherization while awake and alert and do not really know how it may feel, it nonetheless scares me to death. i have read that this procedure, while it may be uncomfortable and/or painful, is of such short duration that is considered very tolerable. the fact that foley insertion is done without sedation would certainly indicate that it is really not that bad. add that to the fact that many people self catherize four times daily and it is hard to imagine this procedure being untolerable. the nurse must attempt to override my objections by compromising, cajoling, whatever it may take to obtain my consent. in the above post one can certainly see the benefits from being assertive and insistant. it would be extremely rare for a patient to feel anything but gratitude for your efforts.

[carol72]

Back to the first question.

Do I think nurses are pushy.

Yes.