I finally had the guts to say no!!!

Nurses General Nursing

Published

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).

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!!

Specializes in Hemodialysis, Home Health.

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. :)

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.

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.

Specializes in HIV/AIDS, Dementia, Psych.
Do nurses then HAVE a "boss" ( yes, I hate that word, too) or not? And who IS it?

As far as I know, your state's BON is your boss. As a nurse, you have the right to refuse anything you feel isn't safe. In my opinion, it's not safe to admit someone to a unit until you have the time to do proper assessments on previous admits. When push comes to shove, you have to stand up for yourself and your license!! :D

Thumbs up!

So, why didn't she ask the two that had an aide and room for one? Are they her friends?, or was she afraid to ask them because she knew what the response would be? Maybe they would have refused even though they were in much better shape than you.

I know what it's like to be dumped on.

Good for you.

Specializes in Hemodialysis, Home Health.

Thanx so very much RN-PA.

I totally agree that it is in the APPROACH, and would always do this tactfully, respectfully, with rationales...yet assertively. It's just such a liberating feeling to know you CAN do this... Always having been merely an "employee" on the "pee-on" level, it's just a matter of having to turn my thinking around. That may take some time, then again, knowing what goes on on med/surge, it may happen sooner than I think. ;)

We do not have this option where I work now as it is an entirely different setting.

I apprecaite so much all your input. I guess it's better to lose one's "job" than to lose one's licence... or worse yet, cause harm to a patient. I can always move on as long as I have my licence... but I can't replace a life I may be jeopardizing by taking more than I can handle.

Then again, there's always that little fingerpointing voice in the back of my head that taunts... "well, can't you HANDLE it? Are you INCOMPETENT?" Guess I need to learn to stuff a sock in that one's mouth, huh? :D

Lots to learn yet... lots and lots. Thanx for being there for me. Appreciate it more than you know.

By the way... I, too, love the Charles Swindall quote... as a matter of fact, I have his entire "ATTITUDES" quote laminated and posted on our breakroom door. Thee were a lot of "whineys" when I first started working where I have been the past 6 years, and after several months of listening to this, I just quietly and subtly posted that on the door... heh. (yeh, right... quiet and subtle ... ME?)

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Good for you!

As a charge nurse I must confess when we have to take an admission, if I've been busy myself, I'm not always aware when the nurses are seriously behind. But I can see it in their eyes when I assign a patient, I immediately say "saying 'no' is definately an option. " I'll move on or I'll take the patient myself. One can't always go by numbers or whose turn it is. We need to communicate what we need, what we can and can't do. If the charge nurse has a problem with that....oh well.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

thumbs.gif

woohoooooo you did it

doesn't it feel GREAT???

Yayyyyy stellaaaa !!! good for you ;)

It is a good feeling to stand up for your patients AND yourself 'eh?Guess the way I look at it is this...ask yourself what is important...

#1=patient- is it safe for my pt?

#2=myself- is it safe for me/does it put my liscense in danger?

#3=job- will I loose my job over saying NO?

If the answer to #1 and #2 reflects unsafeness for my pt or ME then #3 doesn't matter.

+ Add a Comment