I Remember What It Was Like To Be A Terrified Nursing Student

[Ruby Vee]

I can assure you that despite my 38 years of experience, I remember vividly what it was like to be a terrified student or new graduate nurse on the nursing unit for the first time. Most of us old nurses haven't forgotten what it's like to be new; we've just accumulated a whole lot more experience and quite a bit of wisdom as well -- and we can tell you that sometimes things aren't precisely the way you think they are.

Sometimes your work colleagues really don't like you -- and sometimes the reason is that you're unlikable.

I can say this with some surety because I remember vividly what it was like to be a terrified new grad on the nursing unit for the first year. I was so scared -- of the patients, of my co-workers, of the doctors, of my boss and of making a horrible mistake -- that I was tense, humorless and generally unlikable. Once I accumulated some experience and some knowledge and was able to relax just a bit, people started liking me.

It wasn't that they were horrible people intent on devouring new grads. It's just that some new grads aren't very likable.

I know that you're loaded down with compassion and empathy and all that, but the patient who is throwing his food trays at you because he doesn't like his diagnosis really doesn't have an excuse for his behavior. Sure he's upset and scared -- I get that -- better than most of you do, because I've been there. But being upset and scared doesn't give you a license for physical (or verbal) aggression directed at others.

"Customer Service" is a trend that will eventually die. No matter how many patients have to die because of customer service first. It makes no sense to base health care reimbursement or raises or anything, really, on the "customer service" model.

A happy customer is someone who has everything his way.

Patients don't get to have everything their way.

A nurse who gives them cupcakes when their blood sugar is 699 or a big glass of water when they're on a fluid restriction or anything when they're NPO is likely to get a great survey but an unhealthy patient. And aren't we in the business of promoting health?

Families who insist that it's "their right" to be at the bedside usually aren't there to be supportive of the patient. And they usually aren't supportive of the patient. If I have to wake you up because your mother is calling your name and wants you to hold her hand, you're not being supportive.

If you're there to translate for your father who doesn't speak English, you'll need to get out of your comfortable nest and translate when we need to give your father directions.

If you want to sleep, go elsewhere.

And before anyone snaps at me that I clearly don't get it, that of course families have a right . . . understand that I've spent more time as a patient than as a nurse in the past two years. I get it.

The family member who wants to be at the bedside to support the patient will tell you that, not insist upon "their rights." Family members who TELL you that they're there to support the patient may not always have that clear and unselfish an agenda, but those who insist upon their "rights" are unlikely in the extreme to be anything approaching supportive.

Nurses wouldn't mind family being at the bedside if the family knew how to behave in public. But that's a whole another thread -- one that I've already started and one that I may start again, just for fun.

[OCNRN63, RN]

I'm going through my orientation and absolutely abhor going to work. My preceptor didn't even want to precept me (constantly tells me) and this last week told me "I hate coming to work because i have to be with you". She's an experienced nurse of 17 years. I just started this career and am already thinking of leaving. How long should I deal with this? Should I put in my two week notice? I told the nurse educator and she doesn't seem to really care. I hate hate hate going to work. Any advice would be helpful. If I finish my orientation and then turn in my two week notice would that look better than just putting in my notice now? What would I tell my next employer?

If you have another job to go to, I would offer to give notice, though since you're still on orientation it's most likely they'll tell you to just leave; at this point your presence doesn't really help them.

​Also, please know that not every experienced preceptor is as impatient as you describe yours to be.

[Susie2310]

I also know that in my experience with difficult family members (and being a difficult family member myself) it appears as if the pain they're enduring turns into anger, blame, and the need to point out fault in the health care workers caring for their loved one. Perhaps they need to feel like they're actively engaged in treating their loved one, they need to feel of use, and pointing out fault in the care offers proof that they are needed.

I can offer some insight, having been a family member on multiple occasions to acutely and critically ill loved ones. For most people who care deeply about their family members, having their loved one acutely or critically ill is an enormously stressful experience. Many people who care deeply about their ill family member often know their ill family member better than anyone, and know what the patient would like from them in the way of support. They want to do whatever is in their power to help and support their sick family member. One does not have to be trained as a nurse to know that medical facilities often do not staff sufficiently, and that mistakes in nursing and medical care are sometimes made that can have severe or deadly consequences for the patient (their dearly loved, very sick family member). Most people who care about their family members do not, for example, want their sick loved ones to experience ongoing severe diarrhea without assistance, or to experience medication errors. They would like their family member with severe sepsis to not wait for hours for medical orders before fluid boluses and antibiotics are finally started.

Studies show that people who are sick benefit from the unrestricted presence of their loved ones (surprise!), and yes, of course I am referring to family members who behave reasonably and considerately. I can say, having been a family member, that it is tremendously painful to watch your critically ill loved one experience delays in care that contribute to their suffering, and that yes, my family member's increased, needless, suffering did cause me to feel angry and extra protective of my sick family member. Family members want their sick family member to receive good, timely, nursing and medical care, from staff who are competent, and preferably also caring. What is so hard to understand? No, the short staffing is not your fault, and no, you are not responsible for the delay in the patient receiving medical orders, but you can try to put yourself in the family member's position and try to do your best for the patient and for the family. Why are you surprised/annoyed when the family questions you or questions the care? They are doing what a caring, diligent person who wants their loved one to receive good, timely and appropriate care would do.

[LadyFree28, BSN, LPN, RN]

Why is this thread have been derailed by posting about the OP?

Can we please adhere to the TOS and debate NOT the poster, but the subject at hand?

Some of these posts may have been reported; and although there may people who disagree; we can least be objectionable instead of making assumptions of the OP's demeanor; it really doesn't have it's place in this discussion.

We can agree to disagree professionally, no?

WOOSAH....

[OCNRN63, RN]

I doubt most nurses take issue with answering questions, and most want the best for their patients. It's when family becomes disruptive that I have a problem. No, I don't have time to keep fetching warmed blankets for visitors. No, I do not have time to take multiple meal/snack orders for family members. No, I don't have time to keep remaking the other bed in the room because visitors keep trying to sleep in it. Yes, it's a problem when multiple visitors raid the refrigerator that has drinks and snacks for patients. No, I cannot give a visitor the code to make a long-distance call that is not of an urgent nature. No, I can't stop taking VS just because doing so wakes you (the visitor) up.

Visitors can do a lot of good, but they can also do a lot of harm.

[OCNRN63, RN]

Why is this thread have been derailed by posting about the OP?

Can we please adhere to the TOS and debate NOT the poster, but the subject at hand?

Some of these posts may have been reported; and although there may people who disagree; we can least be objectionable instead of making assumptions of the OP's demeanor; it really doesn't have it's place in this discussion.

We can agree to disagree professionally, no?

WOOSAH....

​Holla!

[TU RN, DNP, CRNA]

Two good points by Ruby, and I'm glad she brought them up.

Firstly, the "prophecy" that 'customer service-directed healthcare is going to die' is a beautiful thing and I look to those days with great anticipation. Consumer healthcare is creating a toxic culture that I can only foresee dragging US healthcare further down the tubes. One would believe that the beneficent and good-willed natures of those that would sacrifice much of themselves to become nurses and doctors would suffice... but this added scrutiny and oversight of our life's work by multiple agencies divides us. We find ourselves on the defensive at all times, with those that are entitled by the knowledge of the new customer service-driven culture creating hurdles at every move. We find phrases like "if you didn't chart it you didn't do it" and "cover your ass" garnering more relevance to our practice than the delivery of care. Great nurses are resigning or being forced to resign because they can't keep up with the mountainous documentation required by state and federal regulations for "meaningful use of electronic health records." I just watched the The presence of family is another great point because these individuals are also "in" on the customer service-driven, consumer healthcare culture that has been handed to us.

And Scott, as an APRN, not sure how much you remember the days at the bedside.. but Ruby, I know exactly what you're talking about. There's a distinct difference between the family members that are there to be supportive and those that love to wave their rights in your face. I believe the latter are empowered (or entitled) by the culture of customer service created in this modern healthcare environment. The ones who will sleep next to the patient all night only to demand that the nurse come to turn the patient, or get a new blanket, or wash the patient. It's true that these are tasks that nurses are charged with and will do as part of their job. It's also true that we don't need yet another person telling us to do our job. Finally, it's true that if you really did want the best care for your loved one.. you'd participate in it yourself instead of treating the nurse like some servant, or better yet a robot. Just press the little red button and this being is deployed to your whims.

To truly understand the perspective of a family member in the hospital, I imagine a role reversal. Suppose that I am the family member and my parent is the patient (a scenario that probably every nurse has imagined themselves in). While I sympathize with Scott that medication errors, negligence, and other delays in care should be avoided at all costs -- even if a visiting family member has to be the one to bring them to attention -- blame and accusation are not the right approaches. Too many cheesy commercials with leaking IVF bags paid for by "Dewey, Cheatem, & Howe law offices" are in the minds of those families with accusatory dispositions. If you really want what's best for the patient... how I imagine I would approach a question or delay in care... you'd approach the nurse (and CNA, MD, DPT, etc) as a respected member of your team.

I sort of got carried away, but thanks for bringing up some good points Ruby. Always worth it to get insight from the experienced.

[TU RN, DNP, CRNA]

I doubt most nurses take issue with answering questions, and most want the best for their patients. It's when family becomes disruptive that I have a problem. No, I don't have time to keep fetching warmed blankets for visitors. No, I do not have time to take multiple meal/snack orders for family members. No, I don't have time to keep remaking the other bed in the room because visitors keep trying to sleep in it. Yes, it's a problem when multiple visitors raid the refrigerator that has drinks and snacks for patients. No, I cannot give a visitor the code to make a long-distance call that is not of an urgent nature. No, I can't stop taking VS just because doing so wakes you (the visitor) up.

Visitors can do a lot of good, but they can also do a lot of harm.

Thank you!

[icuRNmaggie, BSN, RN]

I can also assure you that things are not as you seem as well. Being a nurse with a lot of experience simply means that you have managed to not lose you licence, be employed and haven't died off. Years of experience may mean you you have a lot of wisdom but it may also mean you are out of date with your knowledge and so jaded that you are worth less than a new grad. I will pay attention to how the individual performs-not how many years they have or haven't worked.

As a new grad they should not care how nice you are or aren't they should care about if you create a professional work environment. If you are an experienced nurse who gossips at the nurses station or and eats new grads alive you are part of the problem not the solution. If you have one new grad you find unlikable it is probably them if you find most or all new grads unlikable the problem is probably you.

Different people experience things differently and have different reactions. The simple fact you have been a patient makes no difference in whether or not you "get it". That said if someone throws a food tray it is more than appropriate to walk into the room and say "I realize this is a hard time but the behavior you just exhibited is unacceptable in the hospital is there anything I can do to help?"

Customer service as now defined will change in the future but good customer service is not exclusive from providing good care. I have a patient who was upset he couldn't have a glass of water until it was explained to him why it would make his surgery risky. Now every time he comes in the clinic I grab a couple glasses of water before I go into his room and we laugh about it while we do his follow up. You can't please everyone all of the time but you can take the. time to give reason a chance.

And I actually will take the opportunity to snap at you. The fact you stereotype families who assert their right to be at the bedside is completely unprofessional and a disgrace. If the hospital has chosen to allow visiting during that time it is their right to be there.

Maybe the reason I feel it is necessary to tell you it is my right to be there is because the night nurse was about to violate my Dad's healthcare directive and then tried to get me kicked out of the hospital afterwards. I have been around nursing long enough to know that when report was given I was mentioned as a difficult family member. I am sorry that your coworker put me on the defensive but that is life.

Maybe the person who asserts their right to be there is the person's life partner who has been kicked out of the hospital before by the family previously so they feel they need to be clear they know they have the right to be there. But you have already decided that person is "unlikely in the extreme to be anything approaching supportive." The bias is sickening.

And you dare to tell me if I am going to sleep to go somewhere else. I would love to be home in bed after staying awake the past 72 hours since my Dad's emergency surgery but frankly the care at the hospital has been a joke. In addition to the nurse who tried to ignore his advanced directive I have prevented 3 medication errors and had to come and get a nurse several times to titrate drips since they were too busy chatting at the desk to take care of their 1:1 patient appropriately.

Maybe the work I have seen from you has finally convinced me that my Dad is in good hands so I can sleep a few minutes. But at the same time you and I both know he is going to die-probably during your shift so forgive me if I want to stay close so he isn't alone when he dies. He asked me that before he slipped into a coma.

The fact you have been a patient has no effect on how I want to be treated if I am your patient. I have grown tired of nurses who say they treat patients the way they want to be treated or how they want their part treated. how about asking the patient how they want to be treated?

Eek! This is the most narcissistic and abusive post that I have read on this forum.

[klone, MSN, RN]

I'll be glad when the "crusty old bat" thing falls by the wayside. I find condescension and patronizing to be so obnoxious.

[RedInScrubs, ASN, RN]

While I agree that not all aspects of the "customer service" focus are optimal (to say the least), I do have to say that certain parts of it are better for healthcare than some professionals are willing to acknowledge. Patient-centered care for a long time was what WE thought the patient SHOULD want or need, rather than what they actually DID want or need, and that trend needed to change, since it was never really patient-centered by definition.

Fact is, for years patients were tied down, lied to, tricked, or downright told off for speaking up about their rights in healthcare, and for years, they were consistently ignored. Because it was always "for their own good". Yes, patients make really bad decisions. Yes, they are impossible, hard to deal with, and downright stupid at times.

But they also have a right to be that way, and they also have a right to be heard. Should so much of reimbursement towards institutions and professionals rely on positive surveys? No. That's entirely too arbitrary to be the biggest source for reimbursement, but having some focus on a patient's perception of their healthcare is really not a bad thing at all. It keeps the rest of us accountable, and gives us feedback to help improve outcomes down the road for everyone.

Do we have to like it all the time? No, of course not. But it's not something that needs to die entirely, that's for sure.

[ThePrincessBride, MSN, RN, NP]

I agree with most of your post, OP. I have been in healthcare for awhile, and oftentimes I feel that too many visitors and patients mistake the hospital for a hotel. Usually, when I am in the patient's room and I have some spare time, I don't have a problem getting a visitor a drink or snack. However, I have had way too many visitors ask constantly for things, snacks all the time. Some seem to think that they are entitled to everything in our food galley. I take real issue when a visitor becomes more needy than the patient. I had one visitor who would ALWAYS ask for sandwiches and drinks. That got to be really old after awhile and it takes a LOT for me to get ticked off.

I remember when I interviewed for my current job that the assistant manager stated (verbatim) "you will feel more like a waitress than an aide." That really bothered me.

However, I strongly disagree with your second to last paragraph. I am very supportive of family members being at the bedside, especially with a confused or anxious patient. I have found many family members to be extremely helpful. I also feel that a family member has a right to stay at the bedside so as long as they aren't disruptive to patient care. Not too long ago, my mother rushed all the way across the country to visit her VERY sick mother. This was the second time my grandmother was on the verge of death. You bet she stayed at her mother's side. We didn't know if she was going to pull through. I know when the time comes, I want to be there until my mother's last breath, and I know she wants the same. I would be devastated if I missed my mother's final moments, and I would get the manager involved if the nurse told me I couldn't stay at my mother's side.

And I have been the patient before after a suicide attempt. You bet I wanted my folks with me!

[Ruby Vee, BSN]

Being old and crusty does not give you a pass to stereotype entire groups of people. My post was written to offer viewpoints that you have thrown away without consideration.

And to the snide comment about me being touchy and that you hope I feel better soon? Do you think there is anything more arrogant and condescending that you could say? Do you treat your patient's the same way by belittling their feelings? What a sign of poor self confidence to have to act that way.

You speak of improving health but you ignore the evidence that shows removal of visiting hour restrictions improve patient outcomes.

And your attitude, expressed in your two posts is quite nasty. But never mind. Lets talk about the issue, not whether or not you like me.

Some people think I'm both spot on and somewhat funny. Sorry you don't.

I wish someone would do a study on the QUALITY of visiting as opposed to just the QUANTITY. I don't think having a wide open door policy helps anyone's patient outcome if the family doesn't know how to behave. So many family members don't, including, from your first post, you. You are in a position to know how to behave. Many family members don't have a clue.

No nurse that I know, me included, objects to visitors who are actually supportive of the patient. But if you're visiting overnight to be supportive of the patient, that means you need to actually BE supportive of the patient, not just pull the covers over your head when your mother is frightened and begging for someone to hold her hand. I may not have time to sit and hold her hand, but YOU do. That's what you're there for -- to support your mother. No nurse that I know of objects to visitors who know how to behave. But when you've taken over a conference room, locked out everyone who doesn't know "the secret knock" and are hoarding hospital supplies, drinking from your full bar and bathing your mother with Cavi-wipes (not for use on humans) after the nurse has expressly asked you not to because a) your mother's temperature is 34 and she doesn't need to be "cooled down" and b) Cavi-wipes are toxic to humans -- well, you aren't being particularly supportive to the patien. You might be insistent upon your "right to visit", but visiting is a privelege, to quote our medical director, not a right. I cannot believe that visitors of this type improve patient outcomes, and that was just in one week.

Let's see a study that compares/contrasts the quality of visitors, how supportive they are to the patient, and the patient outcome.