Is it just me, or are nurses pushy?

[firstyearstudent]

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?

[Tweety, BSN, RN]

It can also be equally uncaring to make a half-hearted attempt to educate a patient, hear their concern, and leave it at that ... charting "patient refused" is easier than using all your interpersonal skills and some applied psychology to turn things around.

It goes both ways ...

So you've seen some nurses whose communication skills you rate as poor, and you're striving to do better. Glad to hear it.

I agree. How many times has a physical therapist, pheblotomist, or CNA, walked out of a room........."the patient refused"........and it's the nurse who, as the patient advocate went into the room "if you refuse your blood draw, we won't know how to treat your anemia", "if you refuse to get up the consequences could be pneumonia..do you still refuse?", only to have the patient immediately agree.

A little information and patient education often makes the difference in whether the patient refuses or not. It's easy to say "you don't want to get out of bed do you?".

It sometimes makes work for ourselves to advocate treatment, but we do more often than not.

[firstyearstudent]

I agree. How many times has a physical therapist, pheblotomist, or CNA, walked out of a room........."the patient refused"........and it's the nurse who, as the patient advocate went into the room "if you refuse your blood draw, we won't know how to treat your anemia", "if you refuse to get up the consequences could be pneumonia..do you still refuse?", only to have the patient immediately agree.

A little information and patient education often makes the difference in whether the patient refuses or not. It's easy to say "you don't want to get out of bed do you?".

It sometimes makes work for ourselves to advocate treatment, but we do more often than not.

Nurses shouldn't be permissive (for want of a better word). If a nurse believes a procedure or treatment is in a patient's best interest it's probably a duty to continue to argue for it. But, ultimately, we are dealing with adults who should have autonomy. There are plenty of people in situations that would prefer to take the risks rather than the treatment and they should have that right. Already I've seen so many old, frail people near death that are constantly poked and proded when they seem to want to be left alone. And then there are plenty of women who have had hospital births that they feel are unnecessarily medicalized.

[ladyinred667]

I can tell you that I have some *personal* issues of needing control for myself. When I am a patient in the hospital - I want to know what is being done before it is done. That is satisfied by a bried "hi there Multi, putting in a catheter for your surgery now. I'm going to do xyz and you might feel xyz." Wham bam done. That is fine. However, if my nurse asks me if I want to be catherized, if I want/ approve of having pre-op ab's, etc etc I would get exhausted from trying to decide what is really going on, etc. I would also question if she really thinks I ought to have these things or if she is trying to 'tell' me something. It is not my job as a patient to porifice thru so many details, and if I'm sick enough to be in the hospital I'm not exactly functioning highly on Maslow's well enough to think all this thru. We must surrender a certain amount of control when we are patients in the hospital. I hope that makes sense.

Now BIG things, like should I have xyz surgery...you bet I want full discussion. But for every single little thing it is overload. If I have a question or concern I'll ask. If I'm stymied or hesitant about something my nurse should pick up on that, pause and question me.

:yeahthat::yeahthat::yeahthat:

[Tweety, BSN, RN]

I don't think being permissive is in the best interest of the patient either. If a nurse a procedure or treatment is patient's best interest it's probably a duty to continue to argue for it. But, ultimately, we are dealing with adults who should have autonomy. There are plenty of people in situations that would prefer to take the risks rather than the treatment and shouldn't they have that right. Already I've seen so many old, frail people near death that are constantly poked and proded and they seem to want to be left alone. But that's a whole 'nother issue...

I appreciate what you're saying, I'm going to bow out now because I'm getting a bit repetative.

However, I wasn't talking about being permissive and expecting patients to blindly follow my advice. I expect that patients will ask questions and make informed decisions and participate in their plan of care. I was merely talking about making sure they had all the information of the risks and benefits of the nursing actions they were refusing, and if they wanted to refuse, by all means, they can refuse.

We don't drag these people out from the streets and force them as inpatients, sometime along the line the presented themselves and said "help me".

I know what you're saying times it does get to be a bit much. Often our expectation is that they be a "good patient", don't complain, submit to endless testing, blood draws and discomforts, and it's a bit dehumanizing.

Note that above I interpreted your post as patients being the one's who are permissive, you latered edited to say the nurses shouldn't be permissive and that changed the entire meaning of your post to me, but I'll leave this post as is.

Have a nice day and good luck in school.

[firstyearstudent]

I know what you're saying times it does get to be a bit much. Often our expectation is that they be a "good patient", don't complain, submit to endless testing, blood draws and discomforts, and it's a bit dehumanizing.

I think you've hit the nail on my head (heh heh). This is what is getting to me in clinicals. I'm just not used to it. Hopefully, I'll grow to have more faith in the medical establishment/system/whatever.

[SmilingBluEyes]

I think you've hit the nail on my head (heh heh). This is what is getting to me in clinicals. I'm just not used to it. Hopefully, I'll grow to have more faith in the medical establishment/system/whatever.

I hope so, too, as you will be part of it. Good luck.

[Tweety, BSN, RN]

I think you've hit the nail on my head (heh heh). This is what is getting to me in clinicals. I'm just not used to it. Hopefully, I'll grow to have more faith in the medical establishment/system/whatever.

I understand. Maybe us old battleaxes are a bit hardened to it, and you being fresh can be more objectives.

I personally have a LOT of problems with the current medical establishment and have to reconcile that sometimes with my day to day reality.

I don't think you have to buy into to it 100% to be an effective nurse, just choose your battles.

[PANurseRN1]

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.

No, we just don't like your thinly veiled suggestions that many of us are out there committing assault and battery on our patients. Maybe we also don't care for someone who is still in her first year casting aspersions on those of us who have been doing this for years, decades even.

[PANurseRN1]

Nurses shouldn't be permissive (for want of a better word). If a nurse believes a procedure or treatment is in a patient's best interest it's probably a duty to continue to argue for it. But, ultimately, we are dealing with adults who should have autonomy. There are plenty of people in situations that would prefer to take the risks rather than the treatment and they should have that right. Already I've seen so many old, frail people near death that are constantly poked and proded when they seem to want to be left alone. And then there are plenty of women who have had hospital births that they feel are unnecessarily medicalized.

I am now starting to suspect that this is a troll post. The OP is in her first year, and already she has seen rampant abuses of patients in a variety of clinical areas? That just doesn't wash. I don't think we're getting the whole story.

[DusktilDawn]

i prefer the term "assertive" myself. firstyear, as you progress through the program, and when you start to practice, you may than view your previous bad experience in a different light. a patient has their own perception of the situation, not that it's necessarily wrong, it is their perception.

for instance: the nurse did nothing while my abdominal wound leaked for hours. if the doctor hadn't come up to fix it, i don't know what i would have done.

what the patient doesn't know: the nurse called the resident repeatedly (3-4 times) insisting something needs to be done, on the fourth call the nurse was basically yelling at the resident to get up there and do something about this and that waiting until morning was not an option

there are many times you will advocate for your patient, and be strenuously assertive in doing so, that your patients will never know about. that patient will leave not knowing what you really did for them, and believing that you "did nothing."

originally posted by tweety

i agree. how many times has a physical therapist, pheblotomist, or cna, walked out of a room........."the patient refused"........and it's the nurse who, as the patient advocate went into the room "if you refuse your blood draw, we won't know how to treat your anemia", "if you refuse to get up the consequences could be pneumonia..do you still refuse?", only to have the patient immediately agree.

excellent examples tweety, i've seen "patient refused" used one too many times. mr soandso do you want to bath? do you want your blood drawn? there's alot of things i would not want done as a patient, unlike most patients i also know that despite my not wanting something done that it is in my best interest to do so. there is a huge difference between wants and needs. i've followed many "nice" nurses who basically let the patient just lie in bed, no ambulation, no db/c, refuse scds, because the "patient didn't want to do it." did they explain why these things are important? nope, just charted that the patient refused. not only has the "nice" nurse made my job harder, i am now the b****, until i make it very clear why i'm insisting on these things being done. in essence, the easiest thing for me do would be to walk away and let the patient do what they want, i don't do that because i do care and want the best possible outcomes for that patient.

a patient always has the right to refuse treatment, however, it is our job to ensure that if a patient is refusing, that they are making an informed decision regarding that refusal and the possible consequences of that refusal.

[PeachPie]

yes, nurses are pushy.

if nurses weren't pushy, tonsillectomy patients would eat jelly and icecream for a fortnight, then return because they ate scratchy food, knocked off a huge clot and started bleeding, joint replacements would never get out of bed because it hurts too much, abdo surgery patients would all get pneumonia because deep breathing and coughing hurts, patients with limited mobility would get pressure sores because no-one wants to be woken every few hours to be turned, and no-one would shower because it's so much easier to just wash their face, hands and privates in bed.

think about it. we don't do it for OUR health!

HAHAHAH I LOVE YOU!!!!!!!! Unfortunately, with all the concentration on customer satisfaction in healthcare facilities nowadays, this is exactly what patients are at risk for. Most people aren't educated in healthcare, so "the customer is always right" mindset could potentially result in a serious drop in improvement. I wish that administrators weren't too dumb to realize that.

Don;t get me started on demented residents either. Imagine the terrible twos x1000, plus violence and the fact that you can't pick them up. Sure, you always try to cajole them into cooperating, but if someone is repeatedly refusing to move from her soaked diaper dripping feces, I'm going to have to be pushy.

To the OP: I think that you've been socialized to have "the customer is always right" mindset. Have you worked a lot of retail or other service industries? Most people ask questions when they want, so most people assume that things are fine if no questions are asked and the patient accepts.

[ortess1971]

HAHAHAH I LOVE YOU!!!!!!!! Unfortunately, with all the concentration on customer satisfaction in healthcare facilities nowadays, this is exactly what patients are at risk for. Most people aren't educated in healthcare, so "the customer is always right" mindset could potentially result in a serious drop in improvement. I wish that administrators weren't too dumb to realize that.

Don;t get me started on demented residents either. Imagine the terrible twos x1000, plus violence and the fact that you can't pick them up. Sure, you always try to cajole them into cooperating, but if someone is repeatedly refusing to move from her soaked diaper dripping feces, I'm going to have to be pushy.

To the OP: I think that you've been socialized to have "the customer is always right" mindset. Have you worked a lot of retail or other service industries? Most people ask questions when they want, so most people assume that things are fine if no questions are asked and the patient accepts.

Excellent post! I REFUSE to call my patients "customers" for several reasons-by using the word customer, you are reducing the interaction between healthcare provider and patient to a business transaction. Using the "C word" also implies that there should be a money back guarantee if things don't go right. Also, even a A/O x3 person may act irrationally in the hospital setting. I'm NOT saying that patients shouldn't be educated, only that depression, anxiety and denial can make some people regress to a point-they feel powerless, so they only way they can assert themselves is by refusing to get up, take meds etc. I don't believe in hauling them out of bed forcibly, but you can bet that I would be in that room "nagging" them(and educating them too) Actually, I think I am pushy but I'm glad for my patients that I am. I'll take a patient's maybe disliking me for a while over a DVT anyday!