Is it just me, or are nurses pushy?

Nurses General Nursing

Published

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 Acute Care Psych, DNP Student.

Thing is, you are projecting your own wishes of how you would like to be treated onto all patients in general. Many would be un-nerved by the very ambiguity that you like to explore. Your job will be to tailer your approach to each individual patient's needs, and within practice guidelines. Many patients don't feel how you do. By treating them how you individually would like to be treated you are doing them a disservice.

Also, while few matters are black and white - the reality is that nurses do not have endless time to porifice details and complexity for everything. That reality does matter. There are finite resources. That is important. You can argue all you like about how things should be. All that arguing about how things should be doesn't do anything for the here-and-now. The rubber meets the road with doing the best you can with what you've actually got - to benefit the most.

Thing is, you are projecting your own wishes of how you would like to be treated onto all patients in general. Many would be un-nerved by the very ambiguity that you like to explore. Your job will be to tailer your approach to each individual patient's needs, and within practice guidelines. Many patients don't feel how you do. By treating them how you individually would like to be treated you are doing them a disservice.

Also, while few matters are black and white - the reality is that nurses do not have endless time to porifice details and complexity for everything. That reality does matter. There are finite resources. That is important. You can argue all you like about how things should be. All that arguing about how things should be doesn't do anything for the here-and-now. The rubber meets the road with doing the best you can with what you've actually got - to benefit the most.

It's also about responsibility. Some part of me doesn't want to take it all on. I want the patient to assume some of it. I wonder how the nurses who prepared patients for and assisted with lobotomies felt after the tide turned. Maybe nothing... But something like that would have the potential give me unbearable guilt.

For a less dramatic example, another post mentioned getting reluctant patients up and ambulating whether they want to or not. But our instructor told me that not so very long ago patients were instructed to stay in bed and rest after surgery with unfortunate outcomes. How many nurses bullied patients into staying in bed?

Specializes in Emergency & Trauma/Adult ICU.
I don't want to be a confident nurse: "This is best for my patient." I want to be a douting nurse: "Is this best for my patient?" And I would hope that my doubts grow, not lessen, as I become a practicing nurse.

As a first year student, I'll assume that the patients you are encountering right now (selected by your instructors as appropriate for your level of clinical experience) are likely to be fairly stable, with well-known, common diagnoses -- COPD, diabetes, various common post-op issues, renal insufficiency, etc. These are great learning experiences.

As you move on to patients with more acute & complex medical issues, can you explain how you envision the statement above will guide your practice?

Specializes in Emergency & Trauma/Adult ICU.
It's also about responsibility. Some part of me doesn't want to take it all on. I want the patient to assume some of it. I wonder how the nurses who prepared patients for and assisted with lobotomies felt after the tide turned. Maybe nothing... But something like that would have the potential give me unbearable guilt.

For a less dramatic example, our instructor told me that not so very long ago patients were instructed to stay in bed and rest after surgery with unfortunate outcomes. How many nurses told patients to "Get back in bed!"?

Can you explain your expectations for a critically ill patient with multi-system disorders assuming responsibility?

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

And how many OTHER nurses are out there, doing research or learning evidence-based practices in order to provide the best care for their patients? Believe me when I tell you they are out there, too.

You seem to have a great grasp of "right and wrong" here, and that, I applaud. Now, I challenge you to look for GOOD examples in experienced nurses and emulate them. Learn from all of them, the good and not-so-good, and be the best nurse you can be. But do take time to understand the gray areas and know, there are many constraints on any given staff nurse's time and energy to always give patients choices in every given situation. Also, understand, many patients come to us taking virtually ZERO responsibility for their OWN wellbeing, meaning, they are not interested in being educated (really so many are not), nor taking on the responsibility to make healthier choices for THEMSELVES when they come into our care. SOMETIMES we have to take the proverbial bull by the horns in such situations.

There is no perfect world, nor do we, as nurses, practice in a vacuum. We are forced to take on all manner of situations and cases and deal with them with expediency, integrity and safety. And along the line, there is no real margin for error as any given error or omission can result in calamity. It's not always easy to balance those things and go home feeling good about everything you had to do that day. You will really come to understand this more as you enter professional practice yourself one day.

Take care.

Can you explain your expectations for a critically ill patient with multi-system disorders assuming responsibility?

The patient could know before he or she is critically ill that doctors and nurses don't have all the answers and are only doing the best that they can with the tools that they have. One way we could convey that is by not pretending we have all the answers. Then there would be less blame when something went wrong.

Specializes in Emergency & Trauma/Adult ICU.
The patient could know before he or she is critically ill that doctors and nurses don't have all the answers and are only doing the best that they can with the tools that they have. One way we could convey that is by not pretending we have all the answers. Then there would be less blame when something went wrong.

To return to the suggesion of several posters earlier in the thread, a conversation with a trusted instructor, academic adviser or a health care professional you know is probably in order.

Good luck to you.

As a first year student, I'll assume that the patients you are encountering right now (selected by your instructors as appropriate for your level of clinical experience) are likely to be fairly stable, with well-known, common diagnoses -- COPD, diabetes, various common post-op issues, renal insufficiency, etc. These are great learning experiences.

As you move on to patients with more acute & complex medical issues, can you explain how you envision the statement above will guide your practice?

I would think that the more acute and complex the medical situation, the more the nurse would question accepted standards and feel the need to keep current with evidence-based practice, and, possibly, seek out opportunities to participate in research. And to also question physician's orders.

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

We do those things, most of us, already. We DO question orders that seem wrong and DO advocate for our patients whenever possible. It seems to me, good examples are in short supply in your experience. That is sad. I have been fortunate in that I can think of MANY great examples of the type of nurse that does the right things---I was mentored by them early in my career and have the great pleasure of working with nurses like this, as well.

Really, like others said, I think it's high time you seek counsel with a trusted instructor. It seems you have a lot of issues that need working out prior to going further in your program/career in nursing. I am not trying to discourage you, rather ENCOURAGE you further. But nursing may not be for you, in the end. Only you can decide. I wish you the best.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
We do those things, most of us, already. We DO question orders that seem wrong and DO advocate for our patients whenever possible. It seems to me, good examples are in short supply in your experience. That is sad. I have been fortunate in that I can think of MANY great examples of the type of nurse that does the right things---I was mentored by them early in my career and have the great pleasure of working with nurses like this, as well.

I 100% agree Deb. While we might feel trapped by a system that advocates futile care, I don't see a whole lot of us not being patient advocates and educators, and in the case of critical care patients, not including their families.

Even when we are advocating unpleasant things like getting out of bed post op, or a foley catheter, we present them with the treatment and the rationale, give them options when appropriate, but we always allow them the right to refuse.

We're not just robots blindly following doctors orders and forcing our will upon patients. Nurses more than anyone else care about their patients and their outcomes.

Specializes in Emergency & Trauma/Adult ICU.
I would think that the more acute and complex the medical situation, the more the nurse would question accepted standards and feel the need to keep current with evidence-based practice, and, possibly, seek out opportunities to participate in research. And to also question physician's orders.

To echo what SmilingBluEyes said, this is a normal part of nursing practice for many, and of course research leads to changes in practice over time.

But my patient having an MI may be long dead before I finish explaining why the heparin infusion is a good idea, and have obtained his explicit verbal consent to it, as I understand you envision your future nursing practice.

To return to the suggesion of several posters earlier in the thread, a conversation with a trusted instructor, academic adviser or a health care professional you know is probably in order.

Good luck to you.

I'm starting to get the feeling that posters here feel I'm somehow unfit to be a nurse because I'm turning these ethical issues over in my mind...

And I do ask my instructors questions. I asked my instructor once during class when she was explaining how to place an NG tube on an uncooperative patient why it was okay to do it if the patient didn't want one and she said, "For the patient's own good." Then she quickly followed that up with, "Unless the patient is me and then I don't want you to do that to me ever." Everyone laughed until she added, "I am not kidding." (She is elderly.)

Another older instructor was quite serious when she told the class that if she was ever in a nursing home and they happened to be her nurse, to please, please don't restrain her.

+ Add a Comment