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.
Specializes in med/surg, telemetry, IV therapy, mgmt.
I'm with the few handful that have been able to say that they don't judge. Part of the challenge of working as a nurse is maintaining that professional image and keeping my mouth shut about any opinion I might have about the patient's lifestyle or his/her actions. Many people talk about freedom for all, but don't really want to practice that either. None of us, not one, is perfect. If we were, we wouldn't even be here on this earth to be discussing this.
I'm with the few handful that have been able to say that they don't judge. Part of the challenge of working as a nurse is maintaining that professional image and keeping my mouth shut about any opinion I might have about the patient's lifestyle or his/her actions. Many people talk about freedom for all, but don't really want to practice that either. None of us, not one, is perfect. If we were, we wouldn't even be here on this earth to be discussing this.
Hmmmmm..........what I'm thinking is do we have to keep our mouths shut? I know there is a time to keep my mouth shut, and 99.9% of the time I do with the patient population I have, whose traumas are largely drug and alcohol induced.
I think sometimes however we let those "teachable moments" pass us by.
I know from these boards when we talk about obesity and smoking among our profession, it's always "how dare you judge, none of us are perfect". Sad that we treat the diabetic foot on the 300 pound patient, the COPD in the smoker, the cocaine snorting anetpartum patient and the consequences but feel we have to keep our mouths shut lest we be judgemental.
spelling correctly is a gift, just like being good at math.......nothing to do with intellect.....and if you cant, you arent going to know that it is wrong....
Morte, I thought it was more a matter of learning. I know that some subjects come to a person more easily than another but the ones that are harder can still be mastered if a person wants to. :smilecoffeecup:
Words that I see misspelled here all the time include
consistant (consistent is correct)
dependant (dependent is correct)
There are more that do not come to mind right now.
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.
A few things in response to my previous post:
1. I in no way want to get across the message that I am perfect and never judge. Clearly, when I said that my very FIRST patient was an example of following a judgment and making it my own, I was hoping to get across the point that it is easy to fall into and something that I have struggled with. You're right -- it is IMPOSSIBLE to get through a day without judging, and it is impossible not to want to spout off to your co-workers about frustrating patients, etc. I've done it, we've all done it and that's life.
2. Despite the fact that it happens, I don't think it has to. And despite the fact that I'm still a student, does not mean that I haven't felt the effects of the horrible situation nurses are in because of the shortage and the strain of working 40+ hours a week on the unit. I may be just beginning my journey, but in nursing, every step is JAM PACKED with hard times, so please give me the benefit of the doubt -- as another poster said -- just because we're students, doesn't mean we don't have brains or experience.
3. What I do want to get across is that being judgmental is a huge problem on units, which CAN be stopped. In an externship experience this summer, where I worked for 5 week rotations on two units, I experienced a unit withOUT gossipy judgment, and a unit WITH it. The nurses on the first unit simply did not talk badly about their patients -- or talk about their patients at all. Most of our conversations were about each other, our lives and our families -- not bitter gossip about patients that might have bothered us. Because of this expectation on the unit, people worked together, helped each other out and appreciated the patients for who they were as PEOPLE. The attitude of the unit was happy and exciting and yes, there were stressful time and yes, people got grumpy, but for the majority, the unit was progressive, exciting, fun to be on and really beneficial, regardless of what role you filled. The second 5 weeks of the summer, I worked on a floor where all the nurses did was complain. They complained about the patients, about the hospital, about the staff members, about the shortage, about the schedule. They complained behind the patient's backs, in front of the patients, with faculty, etc, etc. People rarely helped each other out, everyone was always stressed and the unit was very disorganized and not fun to be on. Report went for over an hour because of gossip, and was full of stereotyping, slander about patients and useless information. And you know what happened? Within two weeks, I saw my positive, proactive, purposeful attitude, which I had learned, and gained on the first unit, turn sour. I began to complain, I began to give my patients derogatory nicknames, and most of all, I really dreaded coming to work because I had no idea what my co-workers were saying to me behind my back. NOT a fun place to work.
4. Venting/sharing judgments of patients is NOT appropriate in report. Hands down. It's easy to do -- I've done it, I've seen tons of nurses do it, and I hate it every time. As I said before, and I will continue to say, I HAVE to choose to be a nurse that DOES NOT contribute to this, even if it is only by giving objective, non-biased report on a patient. Yes, the oncoming nurse needs to know how her night/day will look, but not through personal judgments. It is always refreshing to receive report that is unbiased, clean, short and full of pertinent information.
All in all, what I'm trying to say now, and what I was trying to say in my previous post, is that judging patients is a huge problem that we can change. Yes, you need to let things out and yes you need stress release, and yes, sometimes you need to get in your car at the end of the day, call someone who is completely unrelated to your job and vent (or come onto a website like this and vent - I understand the purpose of this now, thank you for making that clear). But too many units are CONSUMED with this slanderous, gossipy talk and it RUINS nurses, nursing students, assistive personnel and progress in general. It is NOT FUN to be around and it is SO EASY to get sucked into. That's all I'm saying. There is a time and place for venting, but when it consumes and controls the attitude of the unit so much so that everyone hates work...that's not cool.
Nursing is a hard job, and any job that deals with people has its serious downsides, but I think we have a choice to make: we can either continue to propagate emotionally-charged workplaces that compromise the quality of care and attitude of the unit, or we can choose to stop. I know I'm just getting into this world of nursing, and I know there will be times when I feel burnt out -- there already have been -- but I HAVE to make this choice now, or else I'll never be able to. I HAVE to go into this deciding how I'm going to act, and what I'm going to participate in. I HAVE to remind myself daily that my patients are HUMANS, and of how it would make me feel if I was the one sitting in the bed, and just happened overhear my nurse complain about me in the hallway or call me a name.
It's hard to be positive, and many days I DO NOT meet my own expectations, but I have to go back to the old adage: life is 10% what gets served to you and 90% what you do with it. I think that's really true - in terms of nursing, in terms of everything.
I'm pleased to see we have some living saints amongst us who never judge others. I hope they are able to bear the rest of us flawed humans, I wish I were so perfect but I'm not. Meanwhile, for the rest of you, carry on!
Er, Tweety, I see you misspelled judgmental Did you miss the spelling lesson?
Regarding spelling, I definately think that some have an inate ability to visualize words in their heads, and I'm not one of them. No, I don't take the gentle correction personally, it was done with good humor...
I know from these boards when we talk about obesity and smoking among our profession, it's always "how dare you judge, none of us are perfect". Sad that we treat the diabetic foot on the 300 pound patient, the COPD in the smoker, the cocaine snorting anetpartum patient and the consequences but feel we have to keep our mouths shut lest we be judgemental.
You can't save people from themselves.
As far as I know it's called being a nurse. It's what we signed up for.
I can understand venting to others privately, but not in the workplace, or where there's a possibility a pt may hear you (including unconscious pts). It seems you'd even need to be careful on these boards, as you never know who may be lurking. I realize the probability is low, but you just can't be sure.
From a spiritual point of view, we can recognize that instead of judging some of these patients, we can take pity on them. The obese person isn't always obese because of the extra piece of pie, the person with lung cancer isn't always a smoker, etc. etc.
Maybe there's an opportunity for teaching in these frustrating situations? Maybe the mother who smokes while pregnant needs further teaching and opportunities for help quitting? Maybe the cranky lady in Room 1 needs someone to give her a hug and listen to her for a few minutes?
Everybody's situation is unique.
And thoughts, whether you realize it or not, do affect your behavior, albeit subtly at times, but manifest in behavior nonetheless.
Some patients and people in general are frustrating, definitely, and I'm no saint. I just hope that when I'm sick one day, laying in the hospital, the nurse caring for me will have compassion and understanding for my limitations. We're all human after all.
Er, Tweety, I see you misspelled judgmental Did you miss the spelling lesson?
Regarding spelling, I definately think that some have an inate ability to visualize words in their heads, and I'm not one of them. No, I don't take the gentle correction personally, it was done with good humor...
As I'm the instigator of that spelling lesson, I pardon Sir Tweety for his unintended error.
"4. Venting/sharing judgments of patients is NOT appropriate in report. Hands down":w00t:
I sooo agree with the above - report should be short, sweet and pertinent. I do get frustrated with folks who go on and on about personal judgments about whether a patient really has pain or is faking it because surely you can't be in pain if you are asleep, right? (and many other things too, not just pain).
Just a little personal anecdote from the last three days - I've had the headache from hell. Not a migraine. I think a tension headache as it is mostly in the back of my head and down my neck. Nothing touches the pain - I took ibuprofen and acetominphen at work yesterday and last night resorted to my son's codeine w/phenergan cough syrup. But it still hurt - my husband started rubbing my neck and I was so tired of the darn headache I started crying a bit. I did end up falling asleep but woke up with the same intense pain. Plus I worked yesterday from 3 a.m. to 3 p.m. and we were very busy but unless I told someone, no one knew I had a headache.
I truly think judging someone else's pain is just not fair.
So, yes people can be in pain and still look normal.
Specializes in PICU, Nurse Educator, Clinical Research.
I understand what you are saying, but at the same time that person may very well be in pain too. I was in the hospital several months ago with kidney stones and the pain was horrible. I was given demarol PO q 4hr prn and believe me those pills wore off in 3.5 and I was asking my nurse for my med because it hurt!!! I didn't think she minded because aside from my asking for my medicine I tried not to be a nagging patient. Well, on one of my rotations this semester I numerously heard some of the nurses call patients drug seekers because they wanted their pain med when it was due. It made me wonder if the nurses thought the same of me or if they secretly thought this of all pt's who request their medicine. I was really appalled by this because these people could very well be in pain like I was. I'm not saying that all nurses are this way, I worked with some wonderful women who treated their patients with so much respect and never judged. We aren't perfect, but I have learned a lesson....I will never judge someone's pain. It isn't my pain to judge.
Amen. Read my recent post about having hip surgery, a failed epidural, and NOT getting any pain meds for several hours post-op. And how my surgeon almost put me in a coma at hour 36 because nothing could touch my pain by then.
The biggest problems we seem to have with being judgmental are pain, obesity, and alcohol/drug abuse. (and yes, I've had those same thoughts.) In a perfect world, we'd all see something of ourselves in our patients. If only!! Where's Ghandi when you need him? :wink2:
As far as so called "drug seekers", yes I sometimes have my doubts about people who say 10/10, while they blithly snack on a twinkie, but it never affects my care. If pain med is ordered and they want some, they get some. I figure, whatever they want, they get, and if they're not in physical pain, then it must be emotional pain that motivates them. I am there to please the pt.
Pain is so utterly subjective, and who am I to be on a moral crusade? I like to make the pts happy. If they're still in pain, I document and never hesitate to call the doc. Yes, there are people who manipulate the system, but I'd rather err on the side of pain relief on my shift.
Did you miss the spelling lesson? 
Daytonite, BSN, RN
1 Article; 14,604 Posts
I'm with the few handful that have been able to say that they don't judge. Part of the challenge of working as a nurse is maintaining that professional image and keeping my mouth shut about any opinion I might have about the patient's lifestyle or his/her actions. Many people talk about freedom for all, but don't really want to practice that either. None of us, not one, is perfect. If we were, we wouldn't even be here on this earth to be discussing this.