It's long, dangerous, but worth typing, to me!

BeachBayNurse · Oct 16, 2007

Just my humble opinion, but I think we are focusing too much on the example of obesity. I took the first thread to mean that she is burned out from unappreciative, demanding patients. Who wouldn't when you are understaffed and overworked? I could care less what the patient did to themselves to get them into the hospital, but when they start putting the care of other patients in jeopardy by their outrageous demands, is when I start to get upset. I know people are not perfect, I am in no way at all, far from it! However, I think support from management and safe patient ratios will make these patients seem less frustrating.

nursemike, ASN, RN · Oct 16, 2007

We must all, in a way, be judgemental as nurses. What do I mean? Well, if my pt is a smoker, I need to judge that to be unhealthy and something that he should quit. If I see a 300 lb. pt come in, I should judge that that is too much weight and that she needs to lose that weight. If I have a diabetic pt that states, "I keep my sugar in check", but his HA1C is in the clouds, I have to judge that he is not telling the truth and needs to adhere to his Dr's orders!! All of these are judgements that a good nurse will make. The solution, as I see it, is in nursing involvement. We must judge who needs to stay away from McDonald's and who needs to seek rehab. We must go into the room with smiles on our faces and a caring hand, but we should not just "give into the pt's unhealthy desires."

With all due respect to your good intentions, I beg to differ. I believe a nurse has to exercise judgement, but not be judgemental. I'm not just nit-picking over language, here. My nursing judgement informs me that smoking is unhealthy, and it's certainly appropriate to educate a patient as to the risks of smoking (if they are unaware) and possible means to stop smoking. I'll even buy into reinforcing what the patient already knows. But when I conclude that smokers are stupid, or foolish, or weak-willed, I'm no longer functioning as a nurse. It isn't up to me to decide which of my patients are more admirable.

Indeed, I'll go so far as to say it isn't up to me to decide that a patient should quit smoking, lose weight, or manage their blood sugar.

Rather, I must collaborate with my patients to maximize health in a manner consistent with their goals and values. That is not to say I should act as an enabler, but I am not the patient's mommy. My job is to report the facts, not to express my opinion.

That said, we are human, and we do have opinions. I have, on occassion, groaned when I heard I was getting an ortho patient. In my experience, a lot of ortho patients have significant pain, and are conscious enough to know they're in pain. I have even been human enough to think that a particular ortho patient was a cry-baby. But if I'm bold enough to declare that all, or most, ortho patients are just cry-babies, I don't expect to be told what a great nurse that makes me.

If a patient comes to me s/p lumbar diskectomy r/t lifting and turning morbidly obese patients, my job as a nurse is to look at managing her pain, preventing infection, encouraging mobility, and laying the groundwork for rehab. Telling her how dumb she was for not using proper body mechanics and getting lifting help plays no part in my plan of care. Education about proper mechanics might be indicated at some point, but I don't really think that would be a high priority while she is in acute care. That can be addressed when just getting up to the bathroom is less challenging.

jb2u, ASN, RN · Oct 16, 2007

With all due respect to your good intentions, I beg to differ. I believe a nurse has to exercise judgement, but not be judgemental. I'm not just nit-picking over language, here. My nursing judgement informs me that smoking is unhealthy, and it's certainly appropriate to educate a patient as to the risks of smoking (if they are unaware) and possible means to stop smoking. I'll even buy into reinforcing what the patient already knows. But when I conclude that smokers are stupid, or foolish, or weak-willed, I'm no longer functioning as a nurse. It isn't up to me to decide which of my patients are more admirable.
Indeed, I'll go so far as to say it isn't up to me to decide that a patient should quit smoking, lose weight, or manage their blood sugar.
Rather, I must collaborate with my patients to maximize health in a manner consistent with their goals and values. That is not to say I should act as an enabler, but I am not the patient's mommy. My job is to report the facts, not to express my opinion.
That said, we are human, and we do have opinions. I have, on occassion, groaned when I heard I was getting an ortho patient. In my experience, a lot of ortho patients have significant pain, and are conscious enough to know they're in pain. I have even been human enough to think that a particular ortho patient was a cry-baby. But if I'm bold enough to declare that all, or most, ortho patients are just cry-babies, I don't expect to be told what a great nurse that makes me.
If a patient comes to me s/p lumbar diskectomy r/t lifting and turning morbidly obese patients, my job as a nurse is to look at managing her pain, preventing infection, encouraging mobility, and laying the groundwork for rehab. Telling her how dumb she was for not using proper body mechanics and getting lifting help plays no part in my plan of care. Education about proper mechanics might be indicated at some point, but I don't really think that would be a high priority while she is in acute care. That can be addressed when just getting up to the bathroom is less challenging.

I understand your point, but to exercise judgment IS the definition of judgemental. We often use it as "casting a MORAL judgement." Although casting moral judgement is also a correct definition of judgemental, that is not the definition that I am refering to. I agree we should never cast moral judgement on others. But to use our nursing judgement is important to the benefit of our pt. Again, I believe that all pts should be taken care of equally! I also agree that we should not "lump" all pts of a certain type together. Like I said, I've had very appreciative obese pts and very nasty other pts.

pagandeva2000, LPN · Oct 16, 2007

we can do the 'right' thing by our patients, yet still have a personal opinion that is contrary to all of the nursing theories that tell us to be compassionate, empathetic and professional. many of us have personal biases walking in the door. the difference is how we are treating the patient. are we ignoring them or being negligent in their care because of our personal biases? if so, then, that is unethical. but, we can have opinions. the op didn't say that she told the patient that is addictive or obese that it is their fault. whether she actually did or not, nobody knows. we only know what is printed here. i am sure there are many times that we think to ourselves that a certain patient brought some of their situations on themselves, somehow, even if it is just out of frustration.

i feel that in some way, we have all fallen short of what nurses should be or think somehow. what makes the difference to me is acknowledging that we have, learn from it, and try to do things differently the next time we encounter these things.

to the op; i am glad that you acknowledged a shortcoming. i wish i had answers for you. maybe a change in where you work may be in order, where you might see less of this, or have less demands placed on you with the daily care for these sorts of patients. how much time do you have in this position? is there a way to change where you are working? i know that floor nursing is not really for me. i plan to work med-surg per diem to gain skills in bedside nursing. but, i know that i can't keep up with the constant demands of the bedside. there simply is not enough support from administration, management or co-workers for me to deal with this daily. i am very grateful to work for the clinic as my main job because of this. see what other avenues of nursing is more appealing to you.

pagandeva2000, LPN · Oct 16, 2007

motorcycle mama >>I think I understand how you feel because I have felt the resentment and

bitterness you describe only it was directed at a different (and I know,

undeserving) aggregate: old people.

Right or wrong I'll tell how I got to feel about old people, and it didn't start

out this way. My heart was gold when I started working in the nursing home but

after ten years and a lot of frustration and thankless working conditions my

gold heart turned into steel and while I realized when it was time to move on,

right or wrong I still struggle to some expent with certain issues pertaining to

my experiences.

I got to the point where I was fed up with the neediness, the complaining and

moaning, the feelings of entitlement to have access to healthcare that could

help younger people with a future but who couldn't afford healthcare. I would

see tube fed vegetables in bed using up untold amounts of money to be basically

a living corpse (but NO, it never even crossed my mind to "pull the plug", I was

disgusted, NOT psycho!) and it would disgust me because I knew a 40 yr. old

woman with breast cancer who was uninsured and turned down by Medicaid. I vowed

I would not be a drain on society and in my mind this was what most old people

turn out to be. I'd see news reports about studies done on the elderly and I'd

sneer and wonder why society is wasting so much money on old people when there

are so many diseases young people suffer from that should be studied. The way I

saw it old people need to shut up and get out of the way and make way for young

people because it was a losing battle. I'd see old people out in public

shuffling around and say to whomever was with me, if I start to get like that

shoot me. And what might seem bad is this prejudice was even carried over to

myself. I'd forego getting my teeth fixed seeing it as a waste of money and now

I look like somebody out of Deliverance. It briefly crossed my mind to get a

hair coloring when I noticed some grey in my hair but then I thought, why would

I waste money on something like that on an old used up nobody like me? I saw

this woman belly dancing and thought if I was slim that would be a neat thing to

do, then I thought who wants to look at some ol' 30-something year old hag

lumbering around when there are scores of young beauties for people to feast

their eyes on?

So here I go hitting the submit button.

Now, I believe I can put things in perspective better and I know I"m not right

but once prejudices develop it takes a lot of work to let go.

Still, I'm ashamed of myself now.

I think it is time for you to do what I did and get out of that situation that

is causing you the stress. It is understandable that you may feel the way you do

but it is not okay to stay in a situation where you resent the very people you

are there to help.>>>

Motorcycle Mama;

I think that is very reasonable. You see what frustrated you, discovered that you could no longer handle it, and the best decision to make for all parties involved is to cut out. That is basically what I feel the OP should do at this point. Find another area in nursing that is more appealing and go for it.

missrose · Oct 16, 2007

Bottom line is that different things frustrate different people. What is most important is that we try to do our best for each patient. What the difference is; is that our best depends on several internal and external factors. If we are sick, tired or irritable, the best may be different than when we are well rested, have the support of our administrators, co-workers, familes of the client as well as our own support system available to us during our private times.
I also see that the OP asked for a solution to her feelings and it seems as though she was looking for suggestions on how to manage care for both, the addicted patients as well as those that are unable to physically help themselves. She admitted it was very difficult for her at this time. I can commend her for her honesty. I work in a clinic, so, my problems are not as deep as those that work on the floors, but, I have often toiled over how to help many patients I see on a daily basis. And, I go home and scream as well many, many times. I am no saint.

thank you thank you thank you!

leslymill · Oct 16, 2007

I treat all of my pts with respect and care for them equally.

missrose is saying she is treating them with respect,but THE unhealthy lifestyles that brought them to her is BURNING HER OUT. Most of us have a vice of some sort (alcoholic to chocoholic) and hopefully we are working on them. Some people ignore their vice, don't improve and get worse and it effects us all. It is just frustrating.

doe9181 · Oct 16, 2007

The type of patient's that aggravate me are MVC patients that are the result of a drunk driving accident. They are almost always whiny babies that complain too much. I have absolutely no sympathy for drunk drivers in the hospital. Two of my friends were killed in high school indrunk driving accidents. I had one the other night and he told me he didn't like the expression on my tech's face so he had me in there every half hour repositioning his head, begging me to take off his c-collar, wiping his face with cool wash cloths, giving him something to drink, etc. all things my tech could've done. It was my first night in charge and I we also have JACHO (sorry if I spelled it wrong) coming this week so I was very busy making sure everything got done. We also had another patient admitted that was an MVC, high on cocaine, marijuana, and alcohol that killed a man in the accident. He was in police custody and I tried to have him sign his visitor restriction form and he refused!:angryfire I notified the nursing supervisor who informed me that the police can sign for him because he is under arrest so he has no choice. So the cop happily signed for him. Of course all night he whined about his condition. I felt like telling both of them "well maybe if you hadn't decide to get inthe car and drive like an idiot not in your right mind then you wouldn't be in this situation." Of course I didn't and I did the best to make sure they were taking care of. Although I did request a different assignment for the next night.

nursemike, ASN, RN · Oct 16, 2007

I understand your point, but to exercise judgment IS the definition of judgemental. We often use it as "casting a MORAL judgement." Although casting moral judgement is also a correct definition of judgemental, that is not the definition that I am refering to. I agree we should never cast moral judgement on others. But to use our nursing judgement is important to the benefit of our pt. Again, I believe that all pts should be taken care of equally! I also agree that we should not "lump" all pts of a certain type together. Like I said, I've had very appreciative obese pts and very nasty other pts.

I don't think we're disagreeing a lot, here, but I am referring to more than just moral judgement. To cite your example of the 300 lb patient, I'm saying we don't decide what their target weight should be. If she is satisfied to weigh 300 lbs (or, I should probably say, resigned, because no one is truly satisfied being obese) I believe it's more appropriate to focus on how live at that weight as healthfully as possible. Whether or not we agree with the choice, it's her choice, not mine. A BMI of 45 doesn't automatically mean someone needs to be on an 1800 kcal diet. But, sure, we can talk about a diet they can live with, making sure the calories they consume are nutrient dense, and about activities, such as walking, that they can do everyday at a level of exertion they can tolerate.

Likewise, the patient with the sky-high A1c may not be lying. Maybe they do fingersticks QID, but at the same time of day everyday, but at the wrong time of day. Or maybe (probably more likely) they are non-compliant, and maybe a target FSBS of 160 would be more realistic, for now. Maybe they can't deal with a diabetic diet, but they can take a ten minute walk once or twice a day.

I'm not saying these goals are right--or wrong. I'm saying that by being judgemental, we try to impose the goals we think are best, but in my judgement, the goals that have a chance of working are patient-driven goals.

As I say, I think we're arguing some fairly fine points, here. The attitudes you expressed would not preclude giving appropriate care. I just think the attitude I'm trying to express is both more respectful and more realistic. If you walk into the room with the idea that patients' goals for themselves are valid ones for them, you don't have to put a smile on your face and bite your tongue. Helping a 300 pounder avoid becoming a 400 pounder is a victory. Encouraging a three-pack-a-day smoker to go for a walk every day is good. Watching a brittle diabetic eat a Snickers is discouraging, but maybe they can make up for it by eating less carrots or potatoes--and maybe that's the best we can do for them.

pagandeva2000, LPN · Oct 16, 2007

The type of patient's that aggravate me are MVC patients that are the result of a drunk driving accident. They are almost always whiny babies that complain too much. I have absolutely no sympathy for drunk drivers in the hospital. Two of my friends were killed in high school indrunk driving accidents. I had one the other night and he told me he didn't like the expression on my tech's face so he had me in there every half hour repositioning his head, begging me to take off his c-collar, wiping his face with cool wash cloths, giving him something to drink, etc. all things my tech could've done. It was my first night in charge and I we also have JACHO (sorry if I spelled it wrong) coming this week so I was very busy making sure everything got done. We also had another patient admitted that was an MVC, high on cocaine, marijuana, and alcohol that killed a man in the accident. He was in police custody and I tried to have him sign his visitor restriction form and he refused!:angryfire I notified the nursing supervisor who informed me that the police can sign for him because he is under arrest so he has no choice. So the cop happily signed for him. Of course all night he whined about his condition. I felt like telling both of them "well maybe if you hadn't decide to get inthe car and drive like an idiot not in your right mind then you wouldn't be in this situation." Of course I didn't and I did the best to make sure they were taking care of. Although I did request a different assignment for the next night.

Perfect example of how nurses come with their own demons and memories that we have to face. I may have been quite angry also, to deal with an alcoholic that was responsible of a motor vehicle accident if anyone I cared for was killed or injured. I would have done what I was supposed to do, but, it would have been simply because this person is not worth me losing my way of living and survival, not because of him personally. Sometimes, all we can ask for is that the person does the right thing no matter that is actually in their heart.

Jo Dirt · Oct 19, 2007

I can't argue with whoever said some of the people objecting to the OPs remarks about obesity were overweight, themselves. I'm overweight. I'm not happy about it, although I'm happy enough in general. Obesity is not all there is to me. I'm a kind, intelligent, thoughtful, caring, honest, fun-loving, patient, decent, courteous person who doesn't wear speedos in public. I'm actually pretty healthy, in spite of my vices, and at the risk of sounding self-righteous, I'm sort of glad I'm flawed enough not to judge others too harshly.
So yes, let the OP blow off steam. But if she is going to generalize and pass judgement, I don't see anything wrong with calling her on it.

Thank you. She can give her opinion, but other people shouldn't?

I read somewhere that when you love yourself you have learned to forgive your imperfections, but when you are vain you don't realize you have them.

There are a lot of vain people out there.

nursemike, ASN, RN · Oct 21, 2007

Thank you. She can give her opinion, but other people shouldn't?
I read somewhere that when you love yourself you have learned to forgive your imperfections, but when you are vain you don't realize you have them.
There are a lot of vain people out there.

That's a good saying. Once, as I was sort of reviewing a very good night, more talking to myself than anyone else, a friend jokingly observed, "You aren't afraid to pat yourself on the back, are you?"

I hadn't even realized I was talking out loud, but in a rare moment of knowing the right thing to say, I told her, "Well, I would never leave something that important to someone else."

I'm not impressed with vain people or those who look down on others (usually equivalent), but I'm all for people loving themselves. If I don't love myself, who will?