I've learned a bit in nearly four decades at the bedside -- and I still remember what it was like to be brand new. Here's some wisdom -- and an invitation for my fellow senior nurses to add their own.
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.
Medicine and healthcare isn't just about the patient. While he or she is our focus, we need to also realize that the loved ones need support. They are often scared and don't understand what is going on. We need to help them, when we have cared for our patient, and ensure they know what's going on with the family member and what we need them to do to help. Sometimes, a family member can be an invaluable part if the mending process for the patient.
Ruby, as always you crack me up and I love your posts. And to be very clear with the newbies that complain about the "old nurses" are mean to them, I JUST started my first RN job (was an LPN for a few years) and I'm pretty sure those "old nurses" are right. Now, I do have this one older LPN who I am fairly positive has not completed a CEU in years and is honestly threatened by RNs. And when she does crap like rub lotion into a stage I pressure ulcer and I call her on it, she really doesn't like it. Those type of older nurses tork me off. But when they have honest safety concerns about the newbies, get over it.
Conclusion, I agree. Families that can't behave suck. The ones that can, are awesome. I had a family member tell me less than 24 hours ago he held a special place for people like me in his heart. Could have hugged him. Had another last week that asked why I was 7 minutes late with the semi-scheduled PRN pain med. Wished to God I could have kicked her out.
Keep calm and nurse on, Ruby!
Ruby, I just have to say that it strikes me that you dislike young people and new nurses. My perception is that you rail against them just as much as you decry their categorizing all older nurses as "crusty old bats."In my observations, it seems like you dismiss contrary opinions as "you're young, you just don't know" or "you're new, you just don't know" without giving any credit for life experience or intelligence. And this is coming from someone who is neither young nor new, but just an observation.
I don't agree with everything Ruby says, but I've never gotten the vibe you describe. Ruby has been a nurse ~ 8 years longer than me and works in a specialty I always said I wouldn't step foot in. When she describes how she handles nurses who are new to ICU, however, it makes me think that I might have tried out ICU if I'd had a preceptor like her.
I get the feeling that a lot of this animus is generational. There's nothing that I can do about being 51, except turn a year older every year. I've tried to treat everyone as I wished to be treated. I haven't always been successful, but I try.
Since the crusty old bat moniker was initially an insult levied at several of us, I plan on keeping it until nurses of all range of experience and age are expected. Which essentially means it's going to stick.
I don't know why it is hard to understand the difference between
A supportive family member versus one who is simply present, balks when the lights are turned on, complains the next AM that we make too much noise and they have to shift their recliner/cot so you can tend to the patient. Yes, that means if you are staying overnight with your grandma, dad, sister and you have to work at 9am the next day, I cannot alter all the patient care so that you are undisturbed.
A family member that asks questions to seek understanding about the plan of care and be well informed about medications and side effects versus one is is looking to find fault and nit pick every action by staff, pit staff against the other and so on.
I LOVE answering questions and providing education. I consider the family member as part of the team. So I would rather work together than against each other.
At this point, you gotta just make it humorous. Every time she tells you something negative, just laugh (inside, not at her) or smile -- because, seriously, it's comical how horrible she's being to you. You ever hear the quote, something along the lines of, "I sometimes think the universe is a big practical joke and I'm the only one not in on it." (lol, botched it)? If your preceptor is this terrible, you just gotta find humor in it. When people are so radically awful, you just have to laugh at them because there is absolutely no need to put any energy in to taking them seriously. Every day, just say to yourself, "Let's see what funny thing my preceptor is going to do to me today." It helps a lot. THIS WILL PASS. Orientation is a temporary condition and you will make it through. It will also build you a good bit of character and this will give you the sense to remember not to be so terrible to others you work with. Do not try to impress her or find favor with her. Cut your loss and move on. One day, she may end up being fine with you. But seriously, she should not be a preceptor and it's a JOKE that she is one. Just take it as a joke and make sure you learn what you need to. It'll be a reflection on her if there are any deficiencies you have post-orientation.
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.
I only made it up to this post, and it's the best one so far. I agree 100%. And, note that it is by a nurse who has only 1 year of experience. Kudos to you for your thoughtful, composed, and considered response!
Now on to read the rest of the blood bath.
Again, I will say that neither I nor most of the nurses I know have a problem with family being at the bedside to be supportive of the patient. (And I'd assume that you would be supportive of the patient if it were your family member.) What I have a problem with are those who are the bedside because it's "their right" and they have no intention of actually interacting with the patient. They aren't there overnight to get a good night's sleep (supposedly); they're there to hold the patient's hand when she is frightened, wet Dad's lips with the swabs left conveniently at the bedside, change the channel for Grandpa and tuck Grandma's blanket up under her chin. If all they want is a good night's sleep, they are unlikely to get it in the ICU. Good visitors understand that the patient comes first. Those visitors who want to be the center of attention are the ones I have issues with.
I disagree with this to a point. Not completely, but I must bring my own experience as a family member LOOOONG before I was ever even thinking about being a nurse.
I was a family member to my ENTIRE family in the hospital. Two peds, one adult. I, in a sense, was a patient, too. It never dawned on my to ask for anything--whether it be food or a blanket or even a pillow. I ended up bringing those from home for myself. In that sense, I was a "good" family member. What I *didn't* do was care for my kids nor my husband. I was scared to. I thought I would hurt them or I would "do it wrong" or it was a nurse's task that family members shouldn't do. I had changed my kids' diapers for years, but when it came to changing them in the hospital, I was frightened to.
Ok, instead of changing everything I've written, there was one thing I did do for my husband. He can't even remember my doing it because he was in so much pain and had a PCA so he was a bit doped up to remember. In the middle of the night, he asked me to help him with the urinal. I did. I cried as I did it, and he didn't even notice. The love of my life, my rock, my everything needed help peeing. I realized in that moment, I was alone with everyone, including my two small children in the hospital. The loneliness, the fear, was overwhelming and I just sobbed while he urinated. And he didn't even notice.
When it's a child (NICU and PICU nurses, please add your observations), parents may be scared to help do what they've done every day pre-hospitalization. I know for a fact that if it was my parent (before I was a nurse, mind you), wetting my Dad's lips with a swab would be downright painful. Before my husband came into my life, my Dad was my rock, my mentor, and doing that kind of care would be too difficult to do because I couldn't stand seeing him so vulnerable. Nursing has changed me so that I *might* be able to do it now, but certainly not before I became a nurse.
So, now that I'm a nurse, that brings up a point I would like to make. If I see a patient's family member doing nothing for the patient, it doesn't faze me. I must teach them to do so, if they so choose. If they choose not to, I have to remember that they, like I was, are scared. Depending on the relationship people have with their parents, especially, some can't bear to see their parents vulnerable and may wish to NOT be involved in their care which would somehow solidify the parents' fragility.
With all that I've just posted, I would like to suggest that people who have been nurses "from the beginning," meaning no other professional job but nursing since they were in their 20s, understanding what it is like to be a family member or a patient without healthcare experience is nearly impossible.
Just something to think about. :)
One thing I will admit that will probably set me up for a couple "How dare you!" posts. But, I have to admit it to make a point about nurse-to-family communication, or lack thereof.
When one of my kids got moved from the PICU to a regular peds floor, I would sleep next to him in bed because, at home, we were still struggling to get him out of our bed!! One night, in the middle of the night, two nurses walked in to change his IV. It was still his field IV from what they said to each other (not me, mind you), and it was practically falling out. I sat up, groggy, and they took his arm and moved it toward them. From where they were standing, it was difficult for me to remove myself from the bed, as much as I tried. Finally, one of them snapped at me, "Um, we need to change this, but we can't because you're in the way."
They strolled in, didn't introduce themselves, didn't tell me what they were doing, then made me feel as if I was the problem. I was embarrassed. I got out of the way as quickly as I could, and they still didn't speak to me. Some might counter, "Well, that is anecdotal, and not all nurses are like that." Yes, that's true. However, it happens more often than ANY of us are willing to admit, firmly grounded in attitudes that some nurses have against family members.
By the same token, dudette10, I've encountered plenty of patients and family members who mistook my politeness and inclusion of them in the care as an invitation to treat me like some servant/doormat. There is a distinct, professional way of handling every family encounter (one that in my limited experience I haven't quite nailed, but am pretty close). The nurses in your situation took a completely ass-backwards approach. I must say that working in an urban center I am exposed to a wide diversity of personalities, and the correct approach to handle them is always changing. Not to imply that you (personally) are anything closely resembling "difficult," but I've seen the type.
The people who will boldly question the way a nurse does a dressing, then pose the same skepticism towards the surgeon who does it? Yeah, those people are of no use to anybody (patient included). There's a reason why nurses and doctors aren't just any Joe on the street, but exceptionally qualified individuals who undergo rigorous education and training. This consumer healthcare, where the customer is always right, is destructive to the will and spirit of dedication that drives people to work in healthcare.
I had a patient who was originally admitted for DKA, at the time had already been transitioned, arguing about his sliding scale coverage. I explained for 350+ blood sugar you get 10 units of lispro, only to be met with "oh well I take 2 units for that at home, I'm not taking that much." Immune to re-education on the sort of glycemic control that had prevented him from dying this admission, he adamantly refused. It sort of reminded me of that scene in "I Am Sam" where Sean Penn goes on a tirade about how "the customer's always right! the customer's always right! the customer's always right!" What I wanted to say was "well, idiot, you were admitted for DKA so maybe your home regimen isn't working," but what I actually did was notify the young physician of the refusal who then put in an order to only give 2 units. Thus the patient, whose ignorance was fueled by consumer healthcare, proceeded down his path of medical mismanagement, with a new resolve that he is just as smart as the doctors and nurses. The customer is always right. "See you when you need your toes amputated" I say!
One thing I will admit that will probably set me up for a couple "How dare you!" posts. But, I have to admit it to make a point about nurse-to-family communication, or lack thereof.When one of my kids got moved from the PICU to a regular peds floor, I would sleep next to him in bed because, at home, we were still struggling to get him out of our bed!! One night, in the middle of the night, two nurses walked in to change his IV. It was still his field IV from what they said to each other (not me, mind you), and it was practically falling out. I sat up, groggy, and they took his arm and moved it toward them. From where they were standing, it was difficult for me to remove myself from the bed, as much as I tried. Finally, one of them snapped at me, "Um, we need to change this, but we can't because you're in the way."
They strolled in, didn't introduce themselves, didn't tell me what they were doing, then made me feel as if I was the problem. I was embarrassed. I got out of the way as quickly as I could, and they still didn't speak to me. Some might counter, "Well, that is anecdotal, and not all nurses are like that." Yes, that's true. However, it happens more often than ANY of us are willing to admit, firmly grounded in attitudes that some nurses have against family members.
I feel that some nurses, because of their own negative experiences with some family members, tend to project those experiences onto other family members too readily, and perceive offensive, threatening behaviors in family members often when the family members are not obstructing care or presenting other threats. The majority of experiences I have had with nurses when my family members have been hospitalized have been positive; some have been so-so, and a few have been negative. I will share one example of a negative experience:
After an extensive surgery for cancer, my family member was in the critical care unit. I was fully co-operative with the nursing staff, supported my family member quietly, left the room for change of shift, sat for several hours of the first night, and then part of the next night in the waiting room opposite the unit. The first nurse who took care of my family member was extremely competent and very caring. My family member, on a ventilator, gave a thumbs up and expressed as much appreciation as possible. I expressed appreciation too. The second nurse was very good too. Then the third nurse, who was not as pleasant, but still appeared to be a good nurse taking good care of my family member. The nurse asked the question "Where are you staying?" I replied "I'm staying in the waiting room." The nurse's demeanor changed completely, and she/he said in front of my family member, who is not even two days post-op: "Eew, you're sleeping in your clothes." Now, I was not reclining in my underwear in a cot next to my family member, or obstructing care, or being threatening or abusive. Frankly, what do critical care nurses expect family members to do? We are there to support our loved ones and even when we are respectful of the nursing staff we receive such comments in front of our family member. As family members we can't just vanish. If we are not permitted to be present by our family member's bedside around the clock, is it not even acceptable for us to sit on a stool for hours of the night in the waiting room, albeit fully clothed? Please put yourself in our place and keep such thoughts to yourself, and in particular don't say such things in front of my family member who I am trusting you to take care of. If you can't be supportive of family members, keep your negative comments to yourself.
Struble4
3 Posts
I've been a working RN for 18 months or so. I graduated December 2012 and started my job in cardiac in Feb 2013. I love it but was scared to death when I went off orientation. My residency program was fantastic and I have supportive coworkers but I was still scared. Now, I love looking back and seeing how far I've come. I'm confident in myself and mini longer terrified of a patient having an MI while I'm caring for him. It's great to be able to talk to the "new" new grads and tell them that it will be ok. A year makes a grand difference and I was once in their shoes. Heck, now, experienced RNs and some of the docs are amazed to find out I'm a fairly new nurse. They think I've been doing it for years. That, btw, feels fantastic to hear.