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Preceptor bases care on moral judgements of patients. HELP!!!

Nurses   (10,254 Views 59 Comments)
by TexMex22 TexMex22 (New Member) New Member

TexMex22 has 30 years experience .

4,055 Visitors; 161 Posts

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Please bear with me while I try to explain my dilemma.

I'm an RN student, doing rotations in a large hospital. I've rotated off and on a med/surg unit over the past few weeks. There is a nurse (Nurse R) on the unit that has been assigned as a preceptor (of sorts) for the students while we are there.

Here's my "issue." Nurse R seems a bit psychotic. During report she makes comments (judgements really) about the patients social situations. Some of the remarks are based on ethnicity, some are about class, stupidity, being sleezy, being an annoying patient... you get the idea.

She is projecting an attitude of that care (or lack of) is based on if SHE thinks the patient is deserving. Poor patients that make bad choices in life, lower class people, needy elderly, obese, minorities, certain ethnic groups are put into her category of "bad" patients. Bad patients don't deserve the same level of care as good patients. She even goes so far as to look up history (including social work reports, financial information, etc.) on patients she is not assigned to take care of "just in case." She gossips in a way that is mind boggling. I've actually had to just get up and leave the area. I feel sick to my stomach sometimes when she starts a rant about a patient.

Am I naive? Is this normal? I heard the other nurses doing it to a minor degree, but nothing anything near this level. Maybe the everyone does it, maybe I just don't hear them. This nurse talks badly about patients in front of other nurses in the med room, the break room, at the desk -- EVERYWHERE!!! I am mortified. I want to crawl under a rock.

I guess what I'm trying to say is ... what do I do .. as a student when my preceptor seems borderline psychotic and is behaving in morally and ethically inappropriate way? Talk to someone at my school? Talk to someone at the hospital? Write up an anonymous comment and send it to HR a few weeks from now. Oh and she's not new. She's been a nurse at this facility for 10+ years. Please don't tell me this is the reality of nursing in a big hospital. I'll just quit now. :mad:

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6,035 Visitors; 686 Posts

Looking up patient info on a patient you aren't assigned to is a violation of HIPAA. It's shameful she does it and even worse she is doing it in front of students. She deserves to be fired.

Make your instructor aware ASAP. She is behaving in an illegal, unethical, and discriminating matter. It shouldn't be tolerated.

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Whispera works as a working in a free clinic.

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First, I have to say, as a psychiatric clinical nurse specialist, that she is not borderline psychotic. I have trouble when someone equates an illness with a form of evil. This is one sort of attitude that promotes lack of care for those with mental illnesses.

Having said that, she is morally and ethically totally inappropriate. Most nurses would be sickened by her attitude and open patient-slamming. What do the other nurses do when she's doing this? Do they go along with her? Do they walk away?

As a student, you have to be careful, at least somewhat, because to a certain extent your future is in the staff members' hands. If I was working with her, as an equal peer, I'd probably say something like, "Wow, that's just so inappropriate" to her and walk away. If she did it again, I'd talk to the manager. If the manager did nothing, I'd go to the DON. Right now you should talk to the person at your school who is overseeing your experience. Perhaps she can intervene.

This shouldn't continue. Someone (the manager) needs to have a talk with the nurse.

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punkydoodlesRN has 3 years experience and works as a L&D RN.

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As a recent student, I would go to my clinical instructor. But, I knew mine had our back and he made it clear many times over, that we were to go to him with ANY staff issues.

Wow... I don't even know what to say...

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dudette10 has 14 years experience as a MSN, RN.

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You should go to your clinical instructor, at least, to help ensure that no more clinical placements are made on this unit. Even if you can't protect the hospital's patients from this nurse, at least you might be able to protect future students at your school from her.

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Five&Two Will Do has 3 years experience and works as a RN MICU.

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When your in school, it is difficult to bring up poor practice issues because you are afraid of repercussion, etc. I had an issue during my semester long OB/Peds rotation. Which on a side note was the most difficult semester being a guy. I didi not get to do a whole lot during mother baby clinical and certainly not much during LD. I did end up calling my main instructor one morning because of the behavior of the clinical instructor. I was afraid I would get kicked out or whatever. The most important thing that I was taught is that I do not have the right to judge my patients. Some may disagree, but it is not ethical to base the level of care that one receives from me on my preconceived ideas about their social status or lack thereof. Even if a patient is on government assistance or is an unemployed drug addict with yet another baby or a drug seeker, don't we still have the obligation to care for them in the best way possible? We all have skeletons in the closet or burdens that we carry around with us. Nobody is perfect regardless of what they may think. For that reason even the judgemental folks that we encounter at work have the right to be as messed up as they want to be so long as it doesn't effect coworkers or patients.

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Tread lightly. I respect your need to speak up about the injustice you are seeing. Consider who you confide in, however. You don't know if the person you report her to is her best friend, married to her 3rd cousin, or dating her brother if you know what I mean. Nursing networking is no different than any other network...sometimes bad behavior is overlooked by who you know. I'm glad you recognize her behavior as despicable. Is she taking care of her patients, whether she thinks they are good or bad? I don't mean is she nice, etc, I mean is she meeting their care needs, pain relief, hygiene, etc? If she is treating them within standard, I might be tempted to lay low and let her dig her own grave. If her behavior is as blatant as you say, no doubt someone has already taken notice of it or will soon. The preferable thing would be for a peer or superior of hers to recognize the behavior and report it. Sometimes nursing students can be viewed as being overly zealous in their perception of "abuses" and you risk not being taken seriously. However, If she is denying the "bad" patients appropriate and timely care, you have an obligation to seek out a trusted nursing instructor in your school. Good luck on your decision and please be reassured that, while we all have prejudices and biases, I would say the vast majority of peers do not act in this manner.

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Please bear with me while I try to explain my dilemma.

I'm an RN student, doing rotations in a large hospital. I've rotated off and on a med/surg unit over the past few weeks. There is a nurse (Nurse R) on the unit that has been assigned as a preceptor (of sorts) for the students while we are there.

Here's my "issue." Nurse R seems a bit psychotic. During report she makes comments (judgements really) about the patients social situations. Some of the remarks are based on ethnicity, some are about class, stupidity, being sleezy, being an annoying patient... you get the idea.

She is projecting an attitude of that care (or lack of) is based on if SHE thinks the patient is deserving. Poor patients that make bad choices in life, lower class people, needy elderly, obese, minorities, certain ethnic groups are put into her category of "bad" patients. Bad patients don't deserve the same level of care as good patients. She even goes so far as to look up history (including social work reports, financial information, etc.) on patients she is not assigned to take care of "just in case." She gossips in a way that is mind boggling. I've actually had to just get up and leave the area. I feel sick to my stomach sometimes when she starts a rant about a patient.

Am I naive? Is this normal? I heard the other nurses doing it to a minor degree, but nothing anything near this level. Maybe the everyone does it, maybe I just don't hear them. This nurse talks badly about patients in front of other nurses in the med room, the break room, at the desk -- EVERYWHERE!!! I am mortified. I want to crawl under a rock.

I guess what I'm trying to say is ... what do I do .. as a student when my preceptor seems borderline psychotic and is behaving in morally and ethically inappropriate way? Talk to someone at my school? Talk to someone at the hospital? Write up an anonymous comment and send it to HR a few weeks from now. Oh and she's not new. She's been a nurse at this facility for 10+ years. Please don't tell me this is the reality of nursing in a big hospital. I'll just quit now. :mad:

She makes judgements about features of a p't lifestyle which are inhibiting progress toward a healthier existence?

Or ... she allows her judgements to influence nursing care?

Huge and important distinction.

Experienced nurses and doctors can often manage the two quite well.

(Though it would appear here the nurse is being judgemental ....rather than making appropriate judgement. She sounds very inappropriate)

I work with several highly experienced RNs and doctors who might state that a particular p't doesn't make progress in their health journey because the p't refuses to change behaviour.

However there is an acceptable way of saying that without attracting the wrath of the morality police.

There is an appropriate way of describing how a p'ts lack of education / intelligence / class can inhibit the p't from achieving optimal health.

Anyway, as a student I would tread very lightly here and probably not mention it at all ...unless you see p'ts care being adversely influenced. Don't forget you are not an employee and also not the nursing morality policewoman here. Better to think about how you would approach this issue later when you encounter it as an RN. This experience is a good learning experience about how not to do it and what kind of nursing culture you need to avoid when you go job hunting. She did not start doing this yesterday - likely been doing it for years

Edited by pedicurn

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Five&Two Will Do has 3 years experience and works as a RN MICU.

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She makes judgements about features of a p't lifestyle which are inhibiting progress toward a healthier existence?

Or ... she allows her judgements to influence nursing care?

Huge and important distinction.

Experienced nurses and doctors can often manage the two quite well.

(Though it would appear here the nurse is being judgemental ....rather than making appropriate judgement. She sounds very inappropriate)

I work with several highly experienced RNs and doctors who might state that a particular p't doesn't make progress in their health journey because the p't refuses to change behaviour.

However there is an acceptable way of saying that without attracting the wrath of the morality police.

There is an appropriate way of describing how a p'ts lack of education / intelligence / class can inhibit the p't from achieving optimal health.

Anyway, as a student I would tread very lightly here and probably not mention it at all ...unless you see p'ts care being adversely influenced. Don't forget you are not an employee and also not the nursing morality policewoman here. Better to think about how you would approach this issue later when you encounter it as an RN. This experience is a good learning experience about how not to do it and what kind of nursing culture you need to avoid when you go job hunting. She did not start doing this yesterday - likely been doing it for years

Very good points that you have made. Trying to teach patients that a healthier lifestyle would keep them out of the hospital is certainly a part of our job. I would be wrong if I did not encourage the detoxing etoh patient that they should perhaps try AA or some othe rtype of treatment. We should always teach and empower ourpatients to take control of their own health as much as that is possible. Giving lesser priority or taking longer to answer call lights or give pain meds to a patient because we don't agree with their life choices is not an option. That kinda judgement would be terrible.

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TexMex22 has 30 years experience.

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Whispera:

Sorry I didn't mean she was literally psychotic. I need to watch my language. I haven't even done my psych rotations yet. I'm sorry I offended you. I'm overwhelmed and exhausted by this mess. I've got to get some rest. I can't even think straight at this point.

To everyone else that replied. Thanks. I appreciate all of your advise.

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I agree with a lot of these posts- you need to take this up with your clinical instructor first to prevent this nurse as a future preceptor to nursing students. To answer your question on if this is the reality of nurses in big hospitals, the answer is no. Unfortunately, there are plenty of negative, not-in-the-patient's-best-interest, and HIPPA violating nurses. I sometimes think this behavior goes along with some kind of void and unsatisfying life they are trying to fill and feel better about.--

However, we are definitely are not all like this. Every profession has these horrible disgruntled, mean spirited people but it's up to you whether you will tolerate working with it. If you do, do it professionally and within the chain of command.

So sorry you've had to deal with this!!! You need to be focused on patients, meds, physiology, etc,... but this may be a good learning experience for you!

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Having said that, she is morally and ethically totally inappropriate. Most nurses would be sickened by her attitude and open patient-slamming. What do the other nurses do when she's doing this? Do they go along with her? Do they walk away?

As a student, you have to be careful, at least somewhat, because to a certain extent your future is in the staff members' hands. If I was working with her, as an equal peer, I'd probably say something like, "Wow, that's just so inappropriate" to her and walk away. If she did it again, I'd talk to the manager. If the manager did nothing, I'd go to the DON. Right now you should talk to the person at your school who is overseeing your experience. Perhaps she can intervene.

Edited by TheCommuter
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