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Discussion

Please don't get the wrong impression

In nursing school, I remember being appalled by the way staff treated patients on a psych unit. I remember when I got my first job on a psych unit, I was appalled by the way staff spoke to patients.

I know of a few classmates who refused to go into psych nursing because they did not want to be a part of such treatment of patients.

A few weeks ago while students were on the unit, we had an incident with a patient. One of our very needy, attention seeking patients always, and I mean ALWAYS, tries to get the attention of staff when we are trying to deal with an incident. Of course, every time she tries, we have to be stern and firm with her. We tell her, in a very firm manner, "This is NOT the time SO and SO. You need to back it up and move somewhere else. This does NOT involve you." When she refuses to leave, we have to be even more firm with her. We do not use profanity. We do not degrade. We do not demean.

And this was how those nurses spoke to those patients when I was a nursing student and when I was a brand spanking new nurse.

However, when I tried to set limits with this patient in this manner in front of the nursing students, I had a feeling they were judging me the way I was judging those other nurses.

It actually bothered me a little bit to feel that they viewed me as a cruel nurse. I'm not sure if they did....but I felt that's how they judged me.

But I'm not. None of the nurses I work with are. Setting limits with some difficult patients with personality disorders most especially requires being firm and it doesn't require the use of profanity or degradation. Actually, most of the limit setting is done on those with personality disorders.

So, please, next time you're on a psych floor, and you hear a nurse being firm with a patient, please don't assume its not warranted. As long as the nurse or nursing assistants don't use profanity or degrade a patient, there is a reason why the nurse is speaking to a patient in such a way. Playing nicey nicey with a "pretty please" doesn't work.

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    As a nursing student, I certainly wouldn't judge you. I understand the difficulties of dealing with that particular patient population. And like you said, it's not like you were using profanity or demeaning the patient in any way.

    You sound like a good nurse. And if the way nursing students may perceive you is truly bothering you, maybe next time when you have a student teach them the importance of being stern with these particular patients. But if they are judging, then I don't think they mean to. So many of them are not experienced in healthcare or with psych patients. It's just a lack of knowledge...and that is why you are there to teach and inform.

    I give you props for working with psych patients, and hope no one ever judges you for doing what is appropriate for your patients.

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    I'm a nursing student who just finished my last psych clinical rotation last night. We had a very similar situation occur where there was a situation with one patient that the nurse and psych techs were trying to handle, and another patient was working to distract them. When the nurse had to be firm with the "distractor," not one of us students judged her for that. We understood it was necessary to maintain the safety of everyone in that area given what was going on.

    I've seen lots of interesting things happen during psych clinicals, and the only time I have really caught myself negatively judging the actions of a nurse happened on my very first night at the hospital when the nurse in our unit seemed to completely ignore the patients. She was planted in front of the computer charting the entire time we were there, and if a patient were to approach her she would immediately get a psych tech to intervene so she wouldn't be bothered by them. Even our preceptor mentioned that this particular nurse did not appear to be very helpful, and as students this made us feel badly about the care the psych patients were receiving. Fortunately, every other nurse we encountered past that night was fabulous and interacted with the patients (and us!) much more.

    Anyway, I wouldn't get too hung up on what nursing students think of you when you are working. After all, you're the one who really knows what it's all about - not the students! As long as you are confident in your abilities and you think that you are a good nurse, that's really what counts the most.

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