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I finally had the guts to say no!!!

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I do not know if anyone remembers my posts about being more assertive and such. I never want to say anything to the charge nurse because I do not want her to think that I can not handle things. Well, last night I was VERY busy will a fresh knee, fresh hip, and three other patients. The CN wanted to give me another admission. I was keeping my head above water but just barely. I said I can not take an admission right now. Maybe in a few hours once these two are settled but not now. She gave me a disgusted look but I felt so good. Maybe I am actually getting a spine. You know what is weird....she asked the three nurses that were maxed out to take the admission. Not the two who had an aid with them and room for one. We all said no. Sometimes I just do not know what she is thinking. The patient did not end up staying (it was an outpatient who was on the borderline of needing to spend the night). Yah me!!! Small victorys. (it would have been a different story if they was not room for this patient anywhere and he absolutely had to stay, but in this case, I could say no).

As a chronic but recovering people-pleaser myself...yay!

jnette, ASN, EMT-I

Specializes in Hemodialysis, Home Health. Has 10 years experience.

OK... I keep reading this stuff... and I keep wondering... I must be really out of the loop, or used to the "olden days" ( yeah.. I'm OLD! Ask Tweety ! He'll tell ya ! :D)

Or perhaps it's because I've always just been an "employee" as opposed to a "professional" until recently. So please forgive what might appear to be a truly STUPID question here... can we.. MAY we as nurses "refuse" to take a patient if your CN or whoever says you have to take one? Somehow, it just goes so much against what I have been so used to all my 50+ years ! :rolleyes:

Not that I DISAGREE with your choice in this situation.. au contraire ! It's just that I probably would never have thought I had the "right" to refuse... not out of "people pleasing", but out of "habit", "upbringing".. or "whatever"... you understand?

Do nurses then HAVE a "boss" ( yes, I hate that word, too) or not? And who IS it? Do we get to make our own decisions as you did without repercussions, or are we expected to do as the "boss" (whoever that might be) directs?

I know I sound really dumb with this, but I really need this clarified. I read about you all not accepting assignments, or units, or a particular patient load, or admissions... and perhaps the "Germanness" in me says "WHAAAAAAT!!!??? Can dey DO dis??? " :eek:

You know... that submission to authority or "perceived authority" thing... of course being in the military myself plus being raised by a military officer and strict Austrian mother on top of all that only further contributed to this work ethic... so I'm kinda in the fog here as to what we can/may or can/may NOT do ! Still in my first year as an RN here, so please forgive my ignorance regarding these matters ! :imbar

renerian, BSN, RN

Specializes in MS Home Health.

Good for you Stella! renerian

Like I said there were other people that could have taken it. In situations where we are all maxed out but the admissions keep coming, I never say no. This just was not the case. This CN is famous for lopsided assignments. The CN leaves at 9pm, after that we do very well deciding as a unit who should take any admissions. We also team up and do them together to get them done. Sometimes I think we do better when the CN is not there.

RN-PA, RN

Specializes in Med-Surg, Long Term Care.

Originally posted by nurse2be in ny

As a chronic but recovering people-pleaser myself...yay!

:chuckle Me too! Me too! Hooray for you, Stella! I remember your original post about the lop-sided assignments.

Originally posted by jnette

OK... I keep reading this stuff... and I keep wondering... I must be really out of the loop, or used to the "olden days" ( yeah.. I'm OLD! Ask Tweety ! He'll tell ya ! :D)

Or perhaps it's because I've always just been an "employee" as opposed to a "professional" until recently. So please forgive what might appear to be a truly STUPID question here... can we.. MAY we as nurses "refuse" to take a patient if your CN or whoever says you have to take one? Somehow, it just goes so much against what I have been so used to all my 50+ years ! :rolleyes:

Not that I DISAGREE with your choice in this situation.. au contraire ! It's just that I probably would never have thought I had the "right" to refuse... not out of "people pleasing", but out of "habit", "upbringing".. or "whatever"... you understand?

Do nurses then HAVE a "boss" ( yes, I hate that word, too) or not? And who IS it? Do we get to make our own decisions as you did without repercussions, or are we expected to do as the "boss" (whoever that might be) directs?

I know I sound really dumb with this, but I really need this clarified. I read about you all not accepting assignments, or units, or a particular patient load, or admissions... and perhaps the "Germanness" in me says "WHAAAAAAT!!!??? Can dey DO dis??? " :eek:

You know... that submission to authority or "perceived authority" thing... of course being in the military myself plus being raised by a military officer and strict Austrian mother on top of all that only further contributed to this work ethic... so I'm kinda in the fog here as to what we can/may or can/may NOT do ! Still in my first year as an RN here, so please forgive my ignorance regarding these matters ! :imbar

First of all, you do NOT sound dumb asking this. I'm getting near 50 myself, jnette, and have 1/2 German blood in me, as well, so I understand your questions. I also have had trouble being assertive and remaining passive with those in authority. But being a nurse for 10 years has made me stronger (and ANGRIER at times), and I have, at least once, refused to take another patient. I know it made the supervisor mad (we don't have charge nurses, unfortunately), but I KNEW it wasn't safe-- OR fair. But the hospital was low on beds that night and I ended up taking the patient, but another nurse admitted and took care of them. I also have frequently called the supervisor after an assignment was made to state my case for either delaying the patient coming to the floor or asking them to be reassigned elsewhere.

As it stands now, our nursing supervisor assigns beds through our unit clerk without asking a nurse. :( I am working on getting that changed.

"I am convinced that life is 10% what happens to me and 90% how I react to it." (Charles Swindoll)

That is so weird that you have this in your post. I was having a really hard time at work a while ago. My anxiety level was at an all time high. My mom told me about this 90-10 thing. She saw it on TV. It works for me. Whenever I am starting to get really stressed at work, I think 90-10, 90-10. She had a nice story and example to go along with it too.

Your response was not only for your benefit, but for the benefit of the patient's for whom you are caring. I used to feel guilty about saying no, but now, if I feel justified, I do not.

RN-PA, RN

Specializes in Med-Surg, Long Term Care.

Originally posted by stella123 rn

"I am convinced that life is 10% what happens to me and 90% how I react to it." (Charles Swindoll)

That is so weird that you have this in your post. I was having a really hard time at work a while ago. My anxiety level was at an all time high. My mom told me about this 90-10 thing. She saw it on TV. It works for me. Whenever I am starting to get really stressed at work, I think 90-10, 90-10. She had a nice story and example to go along with it too.

I love the quote too, and can say I aspire to follow the 90-10 thing, but struggle with anxiety and being a bad "reacter" to that 10% more frequently than I'd prefer.

Stella, you took a step towards independent thinking and patient safety. Keep it up. You are the only advocate you have in situations like these, and the only advocate for patient care and safety at times. Do Not feel guilty .

Jnette;

I read with interest your question. I too am older and was brought up to be a people pleaser. Now, that said, if you read the above post, you will understand why at times we, as nurses and patient advocates, must say no. It does not show weakness or an inability to do the job we are asked to do each day. It shows we are thinking of what is best for the patient and our own ability to do the best job possible. I often have to ask the CN why she assigns certain patients the way she does, if the answer is just "you are the one able to take care of the patient", I point out that I am maxed out and she needs to rethink her options, like covering a less experienced nurse with this admit, or giving one of my patients to another nurse, since this patient requires so much care. No I do not always get my way, but I do feel that I have spoken up and attempted to point out concerns that she way have overlooked or alternate ways to do the assignment. Hope this helps.

The only problem I have with that 90-10 thing is it discounts the truly problematic system we work in. Management uses sayings like that to suggest our workload is not a problem...the NURSES are. I disagree with that.

There comes a time to say no. If my coworkers in ICU didn't say no we'd have 4 patients in ICU every night....dangerous and totally against all critical care guidelines. I work with a few newer nurses who ARE afraid to say no and they invariably have three patients. Some nurses who won't say no are in charge and have a full load themselves, plus play secretary. I won't do that anymore. So I don't do charge anymore...not worth it to me.

I leaned how to say no from my older and wiser coworkers.Codependence runs rampant in nursing, but we must look at our ability to meet our duty. I still occasionally catch myself wanting to help someone else at the expense of myself or MY patient load. It's a hard habit to break.

And if I'm always taking the admit while a little friend of the charge nurse has her feet up, you BET I'm complaining.

Good for you for standing up for yourself AND your patients!!

jnette, ASN, EMT-I

Specializes in Hemodialysis, Home Health. Has 10 years experience.

Thanks Barefootlady, and others.

It's really not so much being a "peoplepleaser" as it is a matter of "respect" (?) for your "superior"? Shew.. it's kind of hard to describe... I'm used to doing what is asked of me in a job.. not questioning the "higher-ups" or your "employer/boss/supervisor", etc. While I AGREE with the questioning and asserting one's self in these circumstances, and considering how much you can do without jeopardizing the welfare of your patients... it's something I'm not USED to having the option to do.

I agree with the independent thinking... just not used to be able to do so without thinking that "THEY" will think I'm being "insubordinate"... it's a whole mentality thing... I'm not sure what my limits are... when it's ok to say 'NO' without "being fired". I have never had this option before, do you understand where I'm coming from?

So CAN one "get fired" for saying no? Do we have a "boss"... is it the NM? The CN? What "powers" do they have over the staff nurse?

I'm very fortunate where I work now, as our NM in our dialysis clinic is a wonderful example of everything a NM should be... and so I never have to "disagree" with her. But I'm getting ready to orient to med/surge at another hospital for some PRN work there, and the hospital will be a whole different ballgame. So I'm trying to figure out just where I stand in the larger scheme of things.

Thank you all for your patience with me. :)

RN-PA, RN

Specializes in Med-Surg, Long Term Care.

Jnette, I suppose we COULD be reprimanded and/or fired for insubordination. I think much of how we deal with these sort of problems is in how we approach the supervisor. I do it with a respectful attitude, but firm and assertively-- not aggressively-- with reasons and explanations to back my requests up. Nursing probably doesn't change as much as it could because so many of us DO back down and acquiesce to those in authority instead of fighting for what is right.

A few years ago, our manager couldn't get enough people signed up to be pediatric or chemotherapy certified, so she said we had to choose one or the other. I thought, "Oh well. I just wanted to do general med/surg nursing, but I guess I'll have to choose a specialty." I was at a committee meeting with just coworkers a few days later and some of the older nurses were discussing their reactions to this ultimatum from the manager. They basically said that they weren't going to do it. They only wanted to do med-surg, that's what they were hired for, and they weren't going to choose. "What can the manager do? Fire all of us?" they said.

I sat there dumbfounded and asked, "Gosh! Can you DO that?" They said, "of course!" and we did. Eventually they split up our 65 bed unit into 2 units, one with Peds emphasis (we hardly EVER get any kids) and one with Oncology emphasis, but no one's being railroaded into being certified anymore, although a few nurses quit because they didn't want to choose either specialty.

I totally understand your feelings and am more like you than you know, jnette, but once you get to med-surg, I think you'll understand what can drive you to be an advocate for your patients and for your license, and to occasionally question authority.

BadBird, BSN, RN

Specializes in Critical Care.

Good for you Stella, you rock!!!!!

Jnette,

Sure you can be fired. I am living proof. But I am not Sorry! I tried to be a advocate for good nursing care at my last job and will continue to be one in the future. Being fired is a way of evaluation. I know I do good care, pay attention to order changes, patient condition changes, and a whole host of other things we do in a shift. But, I am only one person, I can only do so much, while others are gossiping, not completeing assigned tasks, or not following up on patient requests then that leaves me and other dedicated nurses to pull up the slack. There is only so much slack one can pull up and keep going. I am respectful and attempt to form my questions in a nonabrasive way, that does not always work. I attempt to present a solution when I make a request or say "No", but that is not always appreciated. I know that nursing is demanding, difficult and deceptive. We want to do our best for people who are ill, money, insurance coverage, and length of stay are often not on our list of importance. It is on the mind of administrators, supervisors, and HN/CN today. I just hope you can do a good job in this new PRN position without finding you have to say No more times than not. Please let me know how it is going, I don't think we live that far apart, and I am actively looking for a nursing position that allows me to be a nurse, not a bookkeeper or a racehorse.

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