Is it just me, or are nurses pushy?

Nurses General Nursing

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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?

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.

I do think that the nurse should inform the patient as you have stated above but rather than say, is this something you'd be willing to let me do.. explain to the patient WHY the Foley is necessary and then ask if they have any questions. There is a reason that each and every intervention is being done. The above statement is not really enough information for the patient either. You have told him/ her what you are going to do and what the foley will do but not why it is being ordered. I have found that if the rational is shared with the patient then they feel comfortable with pretty much everything. Always tell your patient why..the hows and whats are important but the why helps the patient to be confident in what you are doing and that this intervention is necessary/ beneficial in some way or another. We are not pushy there is a rationale behind all that we do.. it is all in the delivery. That being said.. giving patients a choice with each and every intervention is going make things tough. Ultimately they do have a choice but in order to give good medical care , you are going to have to do things to people that are not necessarily something that makes them comfortable... in the above scenario I would tell you, "He** no!! however, if you explained why the Foley was necessary and continued on I would be okay with it even though I would not like it all that much. Some patients may take that to mean that it is optional and they will tell you no.. then you will have to tell them why it is important and possibly drag the MD into the mix etc... I can just hear it... "Well she gave me a choice so it must not be that important"..... Just based on my experience.

Specializes in Neuro/Med-Surg/Oncology.

Without trying to sound condescending, sometimes you don't want to give the pt. the flagrant option of saying no. An example, I admitted a woman who came in with Community Acquired Pneumonia and was spiking temps. She refused to get a set of blood cultures with a needlestick. It's understandable. She's status post chemo and a very hard stick. She let them get them from her port-a-cath. They started her on the routine regimen for CAP and guess what? She's still spiking temps. When the 24 hour mark passed and we could get another set of cultures, I insisted that she let the lab draw a peripheral set. I told her several hours before that if she still had a temp at midnight I was going to have the lab come up and draw a set of cultures with a stick. Did I ask her if she wanted to? No, way! I explained to her that it was really important to rule out an infection in her port. It's going directly into her SVC. I told her that she could wind up with an infection in/around her heart or worse. I went in and told her the lab was on thier way up and to let them see if they could get the cultures. Could she have said no? Absolutely! Did I want to remind her of that? Absolutely not! It's like asking pre-schooler if he wants to wear his seatbelt. Can I physically hold it on him and drive at the same time? So technicaly he CAN ride in the car unrestrained, but do I want to tell him that option is his to be had? Nope. You try not to say there is a choice, if it's not a good idea for there to be one.

Specializes in Neuro/Med-Surg/Oncology.

As for your OB nurse, I would have handled that situation a little bit differently. I would have said that I wanted to put an IV lock into you now while it would be an easy procedure instead of later if something happened. I would explain to you that if, for some reason, we would have to get meds or fluids into you fast, I wouldn't want to be fumbling around trying to start an IV while the you-know-what was already starting to hit the fan. Especially if your labor had been long and you had little to drink. If your hydration is not up to snuff, starting an IV can be really difficult. If you were to hemmorhage or have a sudden drop in pressure and need a bolus, I don't want to be trying to hit your veins, missing them, and losing precious time.

Specializes in cardiac.

I agree with the previous posts. We as RN's need to be assertive. I guess it could come off as being "pushy." But, like everyone has stressed, it is important to explain certain procedures and the reasons why we are doing them. Most pt's will comply if they are educated on the "why's." It could be that the origional poster was experiencing bad "bedside manner." But, you must keep in mind what is going on outside the box. Nurses today are recieving heavy patient loads and have little time to educate at the bedside. But, procedures should still be explained to the pt no matter what.

I'm wondering, firstyearstudent, if you should be in nursing school. Why would you want to become part of something that you don't believe in and distrust? You're going to have some trouble if you continue with this belief.

During clinicals in nursing school you seriously see about 20% of the situation - if that. You usually have one patient at at time, and you aren't even aware of a million things the nurse is doing behind the scenes - not just for that patient, but also the other patients she/he is in charge of.

When you're a student and have one patient, you have time to ask questions like these, so it would make sense to always do that. But as a practicing nurse with much, much more on your plate, it's just not realistic. ----Or, you could do that with every patient, but you wouldn't have any time left to implement your other more important interventions, like working with the pharmacy to make sure you get the right meds, calling doctors with errors you caught, making sure someone shows up to take your patients to xray so you can find out if they have pneumonia, etc. As a practicing nurse, you have to prioritize! If you start a debate with a patient, you'll be stuck there for a while and your other patients with more pressing issues will suffer.

Also, you will find that many patients are manipulative. No one enjoys getting poked or moving after surgery, but would you consider yourself a good nurse if you caved in and let your patients do whatever they wanted, however they went home with an illeus, got pneumonia, never healed, etc?

I always explain what I'm doing to a patient, and explain the rationale behind it, but it is first and foremost your job to get these people well and back home if possible. The hospital is not a hotel, and we are not a business trying to lure repeat customers by catering to their whims.

I understand what you mean, but as a student you are not seeing the entire picture here.

Specializes in Med-Surg, , Home health, Education.
yes, nurses are pushy.

if nurses weren't pushy, tonsillectomy patients would eat jelly and icecream for a fortnight, then return because they ate scratchy food, knocked off a huge clot and started bleeding, joint replacements would never get out of bed because it hurts too much, abdo surgery patients would all get pneumonia because deep breathing and coughing hurts, patients with limited mobility would get pressure sores because no-one wants to be woken every few hours to be turned, and no-one would shower because it's so much easier to just wash their face, hands and privates in bed.

think about it. we don't do it for OUR health!

I couldn't agree more! Thank God some of us "push" our patients. I don't consider myself "pushy" but I like to think I know what's in the best interest of the patients. I also can become "pushy" to a Dr when I am advocating for my patients.

Specializes in Emergency, PACU, ICU,.
Despite being a nursing student, I've don't have complete confidence in the medical establishment

Why do you even WANT to be a nurse?

Kev

Specializes in Neuro/Med-Surg/Oncology.

Try not to be critical or take what the OP said personally. That being said,the posters questioning why you're attempting to enter a field you "don't trust" bring up a valid point. A heart-to-heart with an instructor or someone who's opinion you respect who has been a nurse for a few years is probably a good idea. Some soul searching on your own would probably do you good too. I think you may be letting one bad experience with nurses as a patient combined with lack of "non-ideal world nursing" professional/student experience discolor your view of the medical profession. If you reflect on things and find this is not the case, nursing may not be the career for you. Or maybe the time for you to be a nurse is just not now. You may feel differently about the medical profession in a few years. If I were you, I would sit down and try to discern these things before proceding any further with your nursing degree. There's no sense in you spinning your wheels and being part of something you don't have faith in. Do I think you'll be an awful nurse? Probably not. Do I think you won't enjoy what you do and will feel uncomfortable practicing in a field you don't believe in? Yes. Not to start a flame war or pro-life/pro-choice debate, but feeling as you do now and continuing to practice in the nursing/medical field would be like a vehemently pro-life person assisting in elective abortions for a living. Good luck!:icon_hug: I know this can't be easy for you.

Specializes in Progressive Care.

I have to make a confession, only 6 months ago I was a GN in a busy teaching hospital. And because I have a naturally polite personality, I was the nurse who always asked if it was okay if I did my assessment or this or that and was told so many times to come back later for reasons like The Price is Right was on and such that I had a horrible time with time management. Not so anymore. While I do not think of myself as "pushy" by any stretch of the imagination, I will tell you that once I got to understand that I wasn't inconveniencing my patients, rather I was treating them in a timely manner thus getting them better and back home faster, assertiveness has become a second nature. Patients for the most part understand that nurses aren't trying to do wicked things to them just because the doctor says so. The ultimate goal is to get the patient well and get them home. I explain the reason behind what I am doing and if the patient has any problem with it then they will tell you. I think it is commendable that you want to protect the patient's independence and decision making. However I challenge you to work as a nurse before judging. It is much easier to apply hollistic care and provide hours worth of patient education when you are a student than it is once you have a 6 patient load of your own and might I add, students of your own.

I am pushy, I am also calm, happy, quiet, assertive, loud, serious, funny. I am a different nurse for each patient, all the while trying to get everyone to their highest level of functioning.

Specializes in Neuro/Med-Surg/Oncology.

This is why else nurses have to be "pushy":

https://allnurses.com/forums/f31/heparin-emergency-draw-ptt-not-176541.html

Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
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I have some basic distrust of the medical system and, frankly, what I see doesn't make me feel more confident. I've seen people walk into the hospital for back surgery who are still there a year later with a drug-resistant infection. And guess what, the surgery didn't even fix their back!

Not to sound calloused or flippant here, but bad things do happen. Sometimes they are nobody's fault.

I've seen people have bad allergic reactions to the penicillin they were given for their strep throat. You can avoid an allergic reaction by not treating the strep. Of course, I've also seen a young man on dialysis because of kidney failure from untreated strep throat.

Most of the "pushing" that nurses do are done to keep bad things from happening.

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