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?

I have never seen an effective nurse or doctor who explained what was about to happen/needed to happen and ask "Is that okay with you?" The effective caregiver explains compactly the whys and wherefores and then does. As someone previously stated, patients who are sick enough to be in the hospital do NOT want to be asked questions all the time, just explain what you need to do to get me better and then do it. If I object or don't understand, I will say something. If I object or don't understand and don't say anything, that's on me. I give my pts plenty of time to say something but I don't ask if they want me to do something....something I learned many years ago when dealing with small children: do NOT give them a choice that would be detrimental. If I said "I need to put a foley in because of your upcoming surgery, is that okay with you (or "Do you want me to do that?") is giving the pt a chance to say No. Then what? I spend my time explaining why it's necessary and the pt feels as though I gave him a choice and then didn't honor it.

Up Vote Up Vote ×
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.

I've never worked in retail. I guess it's just a personal thing with me. I don't like to be touched, poked or proded by strangers who don't ask permission first -- even if I'm in the hospital and not feeling well. (I'm sure if I was in eminent danger of death I wouldn't care...) The few times I've been in the hospital I haven't felt safe like competent professionals were taking good care of me. I felt confused about what was going on, intimidated and didn't have a sense of control. But that's just me...

Or maybe it isn't just me. The other day I was passing some meds and I asked the guy, "Would you like me to tell you what these are for?" And he said kind of desperately, "Yes, please! People keep giving me these pills and I have no idea what they are." I know the hospital isn't a hotel and I know that nurses would love to spend more time educating and supporting patients.

Up Vote Up Vote ×
Specializes in Emergency & Trauma/Adult ICU.
I have never seen an effective nurse or doctor who explained what was about to happen/needed to happen and ask "Is that okay with you?" The effective caregiver explains compactly the whys and wherefores and then does. As someone previously stated, patients who are sick enough to be in the hospital do NOT want to be asked questions all the time, just explain what you need to do to get me better and then do it. If I object or don't understand, I will say something. If I object or don't understand and don't say anything, that's on me. I give my pts plenty of time to say something but I don't ask if they want me to do something....something I learned many years ago when dealing with small children: do NOT give them a choice that would be detrimental. If I said "I need to put a foley in because of your upcoming surgery, is that okay with you (or "Do you want me to do that?") is giving the pt a chance to say No. Then what? I spend my time explaining why it's necessary and the pt feels as though I gave him a choice and then didn't honor it.

Excellent analogy. How does it benefit the patient to offer "choices" where there are none? Plans of care are individualized, but evidence-based practice means utilizing known effective treatments. Take away one piece of the treatment plan, because, say, the patient objects to a foley, and you've taken away an important piece of the overall picture.

OP, I wish you well, but IMHO your "distrust" & "control" issues need to be addressed, not by us here, but by you. You will be inherently unhappy practicing nursing if you are uncomfortable in the nurses role.

Up Vote Up Vote ×
The other day I was passing some meds and I asked the guy, "Would you like me to tell you what these are for?" And he said kind of desperately, "Yes, please! People keep giving me these pills and I have no idea what they are." I know the hospital isn't a hotel and I know that nurses would love to spend more time educating and supporting patients.

Nurses should always name the meds they are handing over ("Here are your Norvasc and Lasix, Mr. Green"). At the same time, if the pt doesn't know what they are for, he needs to ask "Why am I taking Lasix?" Ignorance is no excuse for anyone, including pts. The pt you just told about should have been asking his nurses why he was taking those meds.

As for your personal experiences, same thing goes. You can only feel intimidated if you let other intimidate you. You can take back the control by asking questions. The nurse who gets upset at pts who ask questions and insist on understanding what's happening is not a good nurse. We may not always ask the pt what they think about what we're doing (in fact, we rarely do) but those of us who really care about what we're doing do not mind explaining when the pt asks why.

Up Vote Up Vote ×
Specializes in Acute Care Psych, DNP Student.

Firstyear-

I think you are over-thinking matters. I also think you don't know what you don't know yet.

Up Vote Up Vote ×
I have never seen an effective nurse or doctor who explained what was about to happen/needed to happen and ask "Is that okay with you?" The effective caregiver explains compactly the whys and wherefores and then does. As someone previously stated, patients who are sick enough to be in the hospital do NOT want to be asked questions all the time, just explain what you need to do to get me better and then do it. If I object or don't understand, I will say something. If I object or don't understand and don't say anything, that's on me. I give my pts plenty of time to say something but I don't ask if they want me to do something....something I learned many years ago when dealing with small children: do NOT give them a choice that would be detrimental. If I said "I need to put a foley in because of your upcoming surgery, is that okay with you (or "Do you want me to do that?") is giving the pt a chance to say No. Then what? I spend my time explaining why it's necessary and the pt feels as though I gave him a choice and then didn't honor it.

Frankly, the mother/child analogy doesn't work for. Patients aren't children and nurses aren't mothers. And I wouldn't want to treat patients like children unless they were in a state where I felt they were welcoming that. But maybe that's were most sick people are. I don't know.

I'm not trying to be argumentative. But my guess, and it is a guess because I'm not an experienced nurse, is that the patient in this scenario wouldn't feel you gave him a choice and didn't honor it. I think he would feel that someone cared enough to ask and, if he says no, explain the procedure thoroughly in a way that would convince him why it was necessary and make him feel better about getting the procedure.

"Would you be willing to let me insert a tube into your bladder?"

"No."

"Well, the doctor thinks you really need it. If the urine continues to build up in your bladder there could be serious complications."

"Well, if the doctor thinks so. Does it hurt?" (Although, I guess you believe the patient would say, "Well, then of course. Why are you pestering me with these stupid questions? Can't you see I'm sick!" Or, "You asked and I said no.")

"There might be a little discomfort, but it only lasts a few seconds and goes right away. You can help me by staying relaxed and not moving around."

In case you're wondering where I'm coming from with this request stuff, I've been reading and taking courses in something called non-violent or compassionate communication which was developed by Marshall Rosenberg http://www.cnvc.org/ during the civil rights movement. In his book, he recommends it for use by healthcare professionals.

Up Vote Up Vote ×
Specializes in Emergency & Trauma/Adult ICU.

"Would you be willing to let me insert a tube into your bladder?"

"No."

"Well, the doctor thinks you really need it. If the urine continues to build up in your bladder there could be serious complications."

"Well, if the doctor thinks so. Does it hurt?" (Although, I guess you believe the patient would say, "Well, then of course. Why are you pestering me with these stupid questions? Can't you see I'm sick!" Or, "You asked and I said no.")

"There might be a little discomfort, but it only lasts a few seconds and goes right away. You can help me by staying relaxed and not moving around."

In case you're wondering where I'm coming from with this request stuff, I've been reading and taking courses in something called non-violent or compassionate communication which was developed by Marshall Rosenberg http://www.cnvc.org/ during the civil rights movement. In his book, he recommends it for use by healthcare professionals.

Can you elaborate on how this simulated exchange between you & your patient jibes with your earlier posts on your "mistrust of the medical system" and being the "doubting nurse" (your term) in questioning physician orders?

Up Vote Up Vote ×

I didn't say pts need to be treated like children. I said that I learned from working with children that you do not give choices unless either choice is an acceptable answer. Using the exchange that you wrote, I can see the realistic pt saying "Then why did you ask me if I wanted you to do that?" A better exchange might be:

"Mr. Green, your doctor ordered a foley catheter for you. It's a tube that goes into your bladder through your member. Have you ever had one before?"

"No, why do I need that?"

(Give explanation)

"Does it hurt?"

(Explain how it might feel)

In that exchange the procedure has been explained, the pt has had time to ask questions, and the nurse has been able to justify the foley. If, at that point, the pt refuses, then you take it from there. That, by your argument, has the pt being treated more like an adult than asking for permission.

Up Vote Up Vote ×

Oh.....and by the example you gave, if the bladder is filling up the pt will be BEGGING for a foley!

Sorry.......I'll go away now......I knew I should have stayed out of this thread.....

Up Vote Up Vote ×
Can you elaborate on how this simulated exchange between you & your patient jibes with your earlier posts on your "mistrust of the medical system" and being the "doubting nurse" (your term) in questioning physician orders?

I would question the order in my mind before presenting the treatment to the patient. Why does he need it? Does he really need it? What might happen if he didn't get it? Are there other, less invasive ways to treat the problem? The answers to those questions could impact our exchange.

In terms of mistrusting the medical system, I suspect that Foley caths are over-ordered and often inserted with less than sterile technique, and, once in, peris aren't cleaned as well as they should, resulting in infections. In some situations it might make sense to try a little harder to get the patient to urinate on his/her own. Sometimes the Foley is for the doctor's convenence (like a patient undergoing an angiogram in light sedation).

Up Vote Up Vote ×
I would question the order in my mind before presenting the treatment to the patient. Why does he need it? Does he really need it? What might happen if he didn't get it? Are there other, less invasive ways to treat the problem? The answers to those questions could impact our exchange.

In terms of mistrusting the medical system, I suspect that Foley caths are over-ordered and often inserted with less than sterile technique, and, once in, peris aren't cleaned as well as they should, resulting in infections. In some situations it might make sense to try a little harder to get the patient to urinate on his/her own. Sometimes the Foley is for the doctor's convenence (like a patient undergoing an angiogram in light sedation).

Do you not think nurses discuss different methods of treatment or ever question an order? In fact those are the very questions you should discuss with the doctor, and those answers you should have BEFORE presenting the treatment to the patient.

I think what people are trying to caution you against is putting the patient in the position of saying "no" in the first place. Once a patient refuses treatment, it's not always that easy to convince them to change their mind despite it being in their best interest.

Firstyear, I'm not against anyone wanting to research or try to improve communications between patients and nurses. However, I do think you need to make sure your own past issues are not projected into how you provide care or communicate with patients.

This may be OT but what about the physician's responsibility to explain treatment and procedures to the patient? When possible, I think they should be talking more to the patient in this regards since they are responsible for ordering the treatment or procedure.

Up Vote Up Vote ×
Specializes in Cardiac.
Sometimes the Foley is for the doctor's convenence (like a patient undergoing an angiogram in light sedation).

Well, the Foley in this situation is not for Drs convience. I'm guessing you've never had to take a pt fresh from a cath before? First off, they need a lot of fluids to flush out the contrast. It's not always in the pt's best interest to have a pt rolling all the time to get on a bedpan. It sometimes puts too much pressure on the Fem artery, especially if they are just hemostased. If they are a man, I've found that they can't urinate lying down, and frequently request a Foley if they know their bedrest will be longer than a few hours.

Firstyear, I think that your constant inner conflict with your doubts will ultimately lead to your dissatisfaction with nursing. Like mentioned before, your ability to be "pushy" may very well be the thing that saves your patients' lives.

Up Vote Up Vote ×
+ Add a Comment