Is it just me, or are nurses pushy?

Nurses General Nursing

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Despite being a nursing student, I've don't have complete confidence in the medical establishment and always question any treatment I receive and, as someone in their right mind, would expect to be asked if I want a treatment. Yet I notice during clinicals that nurses often don't ask or even explain what they're doing. They just sort of barge into a room and start doing procedures and making assumptions about what the patient wants. This is disturbing to me and I think that some patients may not even be aware that they have a right to know what's going on and to refuse any treatment. Do nurses do this because it makes their job easier or because patients really just want to leave all that to the nurses' and doctors' judgment?

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
But really, I can't ever quite resist whispering to myself, "up your nose with a rubber hose' everytime I put one in. . .

~faith,

Timothy.

Ah.......the sick humor of an experienced critical care nurse..........:monkeydance:

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I think debating is useful. It helps me to gathering information and opinions and form questions and think about things. I do not consider that a waste of time. I have two kids who are well looked after and a 4.0 average and a previous degree in philosophy. I'm smart enough so that this doesn't actually take up a lot of time for me (my brain can multi-task -- I'm also thinking about what to fix for dinner right now and wondering if it is okay to have an MRI immediately post-PCI). What I want to know is why are wasting your time reading or posting here if you think it's not worthwhile. (Tofu stir fry. The lastest studies say yes).

For some folks, debating is not useful because there is no real exchange of ideas; the participants end up having little more than parallel monologs. That doesn't seem to be the case here. Your posts demonstrate that you really are considering the thoughts and experiences that have been shared and that's to your credit.

I have also noticed an ongoing effort to incorporate new information into your approach and achieve a workable balance. That's what most of us strive to do on an everyday basis--achieve a balance between the patients' wants and their needs; between the ideal and the real; between pain and damage. Your responses indicate that you are continually learning, and that is one of the most important qualities in a great nurse.

Your account of the NG placement in the cognitively disabled woman revealed much about your thinking. With some who back off from difficult patient care situations, it's more about them than about the patients. THEY don't want to feel bad so they protect themselves at the expense of the patient's well-being. In this example, you were able to get past the surface unpleasantness, connect with and reassure the patient, and accomplish a necessary maneuver with the least amount of trauma possible. That says much about your character.

That your partner lacked sensitivity is sad, but you really helped that woman with your combination of compassion and determination. You helped her get what she needed even though the procedure was unpleasant. No, as you stated, not everone is retarded, but when it comes to lying in a hospital bed or in an exam room or on an X-ray table, I think most of us feel small and vulnerable. The trick is to connect with that frightened child without ever losing respect for the adult. I know that when I have received this kind of "dual treatment," I have been exceedingly grateful that someone recognized my compound needs. And that's in addition to taking care of my physical being.

One element that stands out to me about this scenario is that you were convinced of the need for the NG tube. Seems like that freed you to act without facing an ethical dilemma, and that's good. Unfortunately, not every situation will be as clear cut, and you may find yourself conflicted.

This is where I would like to raise a caution. It's one thing for you to have internal struggles that you work out in private. It's altogether a different animal when this becomes apparent to the patient, their loved ones, and other staff members.

I don't see you having a problem if you are truly convinced that an order is detrimental. You'd call the doc and try to work something out. "You've ordered Toradol for this patient, but her platelets are only 90. I thought you'd want to know that." Most decent docs welcome that kind of input as it can save their behinds. Even though it looks like you're backing away from an order, you're still being an ardent patient advocate.

I see you getting bogged down in two kinds of scenarios. One is where the doc wants to go ahead with something you feel is not justified or might actually be harmful. In such cases, you will have to look to other resources--co-workers, charge nurse, quick computer research--to help you either be able to go ahead or to make some kind of stand. Only you can count the cost of your decision, pro or con, but hopefully, you will have others to back you up if you feel resistance is called for. These same others may help you to understand more about the circumstances and give you information that will allow you to get on board with the decision.

The other scenario is one where I see the potential for more serious problems. That is when you yourself are in a quandary. You don't know if something is right or wrong, necessary or uncalled for. And this is where I must caution you to consider your approach with the utmost of care.

Think about such a situation from the point of view of the other participants. As a patient, I would find it unnerving, to say the least, to sense ambivalence in my nurse. I would wonder what I wasn't being told. I might even consider checking out AMA. As the doc, I'd find it very difficult to "answer to" a nurse who seemed to be undermining both me and my patient with her half-hearted support or outright negativity. As another nurse, I'd question the wisdom of projecting my moral dilemmas into decisions that aren't mine to make, AND I'd hope that you wouldn't be planting suspicions in any of MY patients. As a charge nurse, I'd probably sigh and close my eyes, hoping to think of a way to take care of everyone without a major malfunction.

I may have this all wrong, but I think that is where your greatest challenge will lie--those times when you don't see a clear path and find it difficult to throw your support behind things you don't understand.

Your hope in this is twofold. One is that the more you learn, the more you will begin to grasp and appreciate the rationale behind things that previously seemed incomprehensible. As your wisdom and knowledge grow, so will your discernment.

The other is that you will begin to develop trust in the many good folks that are out there practicing medicine and using their nursing skills to better the lives of their patients. You might not always be able to get your mind around the "what," but you'll have enough confidence in the "who" to give you some sense of peace and satisfaction.

I appreciate your candor and your thoughtful approach. At first, it seemed you were perhaps not cut out for nursing, but now I think you have much to contibute. I hope you will keep posting your thoughts and insights.

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Miranda:

Thanks for your thoughtful post. If I choose to be flattered by your opinion then I would also have to take other more negative opinions to heart. At his point I believe only actually becoming a nurse will tell me if I'm cut out for it.

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firstyear student,

well there ya go! congrats on your previous degree, your 4.0, your children, dinner, multi tasking and the joke ( i tend to be slow-so it will need to be explained) I never said this web site was a waste of time. You never answered my questions either. that's fine.

I'm beginning to smell a rat. Now i wonder if indeed you are a nursing student. so. . . whaz up.

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Specializes in Day Surgery/Infusion/ED.

I was just thinking how Miranda gave a very nice, well-thought out reply, and the response from the OP was really uncalled for and downright rude. Oh well, just another example...

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firstyear student,

well there ya go! congrats on your previous degree, your 4.0, your children, dinner, multi tasking and the joke ( i tend to be slow-so it will need to be explained) I never said this web site was a waste of time. You never answered my questions either. that's fine.

I'm beginning to smell a rat. Now i wonder if indeed you are a nursing student. so. . . whaz up.

Aha. You got me! I'm a troll with 338 posts who's been coming here for almost a year.

By the way, I'm actually a second year student student now...

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Specializes in Cardiac.
Aha. You got me! I'm a troll with 338 posts who's been coming here for almost a year.

By the way, I'm actually a second year student student now...

I don't think the OP is a troll....

I think what rn/writer said was very articulate and appropriate.

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Specializes in Acute Care Psych, DNP Student.
I don't think the OP is a troll....

I think what rn/writer said was very articulate and appropriate.

Agree. Rn/writer is one of those posters that I intentionally look for because I learn so much.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Aha. You got me! I'm a troll with 338 posts who's been coming here for almost a year.

By the way, I'm actually a second year student student now...

I think if you see the benefit of a treatment, you're not going to be one of those nurses that just walks in and does it. You're going get their input and their permission, and have some compassion if it's uncomfortable like a catheter or an NGT.

There are plenty of these moments in nursing, not only when we see the benefit of a painful treatment, but when we see the family and docs permitting futile treatment that you just know in your heart the patient probably doesn't want. Or if when a patient expresses "I'm tired and just want to be left alone." and you're face with MD ordered treatment with the families consent and blessing.

It challenges us daily. I had a 70 something patient crump out on me yesterday. She was weak, old and frail. I needed a 20 guage in her a/c for a CT thorax to look for a PE, and after three sticks she said, "please, I don't want an IV". She was a full code, and I asked her husband......."what do you want to do? If she goes into distress and quits breathing, or needs a breathing machine?"..........He said "do whatever you have to do!". I felt horrible as on the 4th stick, we finally got her IV (I only stuck her once). I didn't think the treatment was futile, and I feel if we put out this fire she could have returned to her pre-surgical state (all she had was a gall bladder surgery), but still part of me felt horrible for forcing her to see it our way and agree to be stuck over and over again.

Unfortunately you do see the nurses that just go through the motions without compassion or patient/family involvement.

That you might struggle with some of this doesn't mean you aren't cut out for it.

I hope in the end you do find yourself cut out for it, because we need more nurses like you.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Agree. Rn/writer is one of those posters that I intentionally look for because I learn so much.

RN/writer ROCKS!!!

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Coming up on a year, I am actually starting to feel something like affection for some of the people who post on this board which is weird because I have no idea who any of you really are...

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Specializes in Peds ICU, ECMO, IABP.

I remember coming out of nursing school. I was idealistic about the whole thing. Kind of the way you think you leave school with all sorts of knowledge and realize on your first day that you don't know squat and won't for about five years. The "real world" is lots different than that Florence Nightengale stuff that you have in your head leaving school. Don't get me wrong, nursing is a very compassionate and nurturing profession, but it is necessary to sometimes just do your job so that you can provide good care while taking care of all the charting and other CYA items that have become an integral part of nursing these days. Invasive procedures and such need to be discussed. Every little thing you do in that room does not.

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