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

linearthinker, DNP, RN · Apr 7, 2011

I had an instructor in nsg school who told us to give IM injections of abx for STIs with large bore needles to increase discomfort, b/c if they have a STI, they deserved it. Your perceptors attitude is not new, not uncommon. The best way to defeat it is to not be like her.

LeAnna, RN · Apr 7, 2011

You're going to hear "talk" all the time. We vent about our patients and that IS normal(being very careful of who is around and may be listening). However, if Nurse R is giving sub-standard and unprofessional care to those certain patients and/or she is looking up financial or personal information for hers or others' patients for any reason other that having to do with that patient's care, that is a serious HIPPA violation and in most facilities policies & procedures, would be grounds for immediate dismissal. It should be reported.

pedicurn, LPN, RN · Apr 7, 2011

Lay low? I'm not the "moral police?" Really? You've been an RN a year and you sound like her already. Yes, I can tell your world of thinking has changed already. You sound like your heart has started to harden already.
"Who cares what she says anyway?" --- gee, I don't know when she's violating HIPPA, giving substandard patient care (because low class patients don't "deserve" the same care as the private pay, full insurance patients) and running around the unit gossiping about patients LOUDLY where anyone and everyone (including other patients and family can hear).... call me a naive nursing student, but I do care. It's inappropriate on every level. It's shameful, it's embarassing. Change her? Nah. I'd like to see her fired truthfully. But at minimum I do want to make sure she is not around any more students. But that's not my decision. All I can do is stand up for what I know is right even if no one else -- staff, students or other instructors is willing to do it with me. I'll be able to sleep knowing I did the right thing.
But for you to say "who cares" and you've been an RN for only a year is really scarey. This crap is like high school. If you are in the cool group, you hang out, chat, gossip and talk nasty about the patients and their families. If you're a nerd, you don't play the gossip game. If nursing is THAT BAD, get out. Seriously.
I'm a nerd and proud of it. I've been over high school games for a long time. This is unprofessional behavior. I realize some of the nurses are barely above high school age, but discussing a patient's family, personal or social history is wrong and inappropriate -- unless it's DIRECTLY related to their illness and/or care plan.
It's not up to us as nurses to make moral judgements about our patients' life choices and then adjust our nursing care accordingly. Just as it would be inappropriate to give a patient different care because they are of another ethnic group, social group, whatever. Here's what I've picked up so far and it's VERY disturbing: :crying2:
1) Low class/trashy patient/poor life choices (no insurance or Medicaid): minimal care, ignore call lights, minimal pain meds (they are all fakers and whiners). Move FAR away from desk as possible.
2) Ethnic groups, illegals, weird religions, people with names you can't spell or pronounce, people with funny accents: minimal care, ignore call lights, minimal pain meds (they are all fakers and whiners). Again, put in no mans land and hope they give up.
3) Teen moms and their families: minimal care, ignore call lights, minimal pain meds (they are all fakers and whiners. Besides they deserve it (pain and suffering. It'll teach them a lesson. Maybe they won't come back so soon).
4) Elderly with multiple diagnoses, transfers from long-term care, obese (especially morbidly obese), needy, whiners:
minimal care, ignore call lights, minimal pain meds (they are all fakers and whiners).
5) Normal people (i.e.: regular middle or upper class people with good insurance, short-term admits that don't require much work like overnight admits -- but have good insurance): first class care, super polite, butt kissing, yes ma'am/no ma'am, yes sir/no sir, super pain control, SUPER care!!
The class system is alive and well in the USA. My eyes are wide open.

OK .... this sounds like she is allowing her personal views to affect her care. If you are sure she is ignoring call lights, depriving p'ts of pain meds - then report to your instructor.

Your instructor should then discuss with the facility. And hopefully she will be reprimanded and you be given a new preceptor.

Please note - this is not common. I have not worked with RNs like this. have always tried to work in good facilities and believe me this is not the norm ....far from it.

This is a good learning experience for you.

Best wishes

LeAnna, RN · Apr 7, 2011

OK .... this sounds like she isowing her personal views to affect her care. If you are sure she is ignoring call lights, depriving p'ts of pain meds - then report to your instructor.
Your instructor should then discuss with the facility. And hopefully she will be reprimanded and you be given a new preceptor.
Please note - this is not common. I have not worked with RNs like this. have always tried to work in good facilities and believe me this is not the norm ....far from it.
This is a good learning experience for you.
Best wishes

Just for clarification, I don't think Nurse R's behavior is "normal". She is obviously on the way end of extreme. I just think it's normal for nurses to discuss their frustrations (at the right place & time). And when I say frustrations I mean when someone is on the call light every 5 minutes, or when a patient is unjustifiably rude to you, etc. It is NOT normal to vent or gossip about someone's race, ethnicity, socio-economic background, etc, nor give crappy care to someone that she thinks doesn't deserve it.

TexMex22 · Apr 7, 2011

Your instructor needs to know. As an instructor, I would never want my students paired with this "nurse," and I use the term lightly. Our thoughts are our own, but when it translates into inferior care, HIPAA violations and gossip, this is a problem. When someone feels this strongly, patients DO pick up on it. This is abusive behavior, not only to the patients, but to all bystanders who must listen to her spew hatred. The fact that she is digging in charts of patients not under her care shows that she is willing to cross lines of propriety.

Your right -- the patients absolutely pick up on it. :crying2: The families do too of course. Several families have asked for "new nurses." She even poisons the techs working on her team by telling them nasty things about the patients she doesn't like. Mind you, she doesn't know these people --- she forms these opinions strictly on last names, skin color, social status, being a teen mom, etc. If a patient is BRAND NEW, just admitted, you can hardly blame the nurse's nasty attitude on the patient and family.

I'm suprised at how many posts are justifying this inappropriate behavior. :eek: :down:

pedicurn, LPN, RN · Apr 7, 2011

Your right -- the patients absolutely pick up on it. The families do too of course. Several families have asked for "new nurses." She even poisons the techs working on her team by telling them nasty things about the patients she doesn't like. Mind you, she doesn't know these people --- she forms these opinions strictly on last names, skin color, social status, being a teen mom, etc. If a patient is BRAND NEW, just admitted, you can hardly blame the nurse's nasty attitude on the patient and family.
I'm suprised at how many posts are justifying this inappropriate behavior.

I don't think most people are justifying the behaviour.

I think you are not making the important distinction between allowing a judgemental attitude affect nursing care and having a judgemental attitude. However neither are desirable. But nevertheless there is an important point there.

We have already mentioned how it is quite acceptable to note how certain lifestyle and personal attributes can adversely affect p't progress toward optimal health. It's all about how it is expressed. It is not judgemental for a nurse to say that p't X is not receiving enough support from family to change dietary behaviour because the family/societal group have normalised a high-fat/ highly processed / no fresh vegetable/junk diet. Or it's going to be very difficult to have p't C stop smoking as most of her friends and family have not absorbed any public health education message over the last 20 yrs. Or p't A will likely keep picking up STIs because he continues to choose sexual partners who have them. Or how the children of p't Y will likely continue to receive a substandard diet because parents choose to place higher priority on gambling and buying alcohol and cigarettes.

There is nothing wrong with pointing out how certain social behaviour /norms/values and ethnicity/education/intelligence/class have negatively or positively impacted on health.

But there is everything wrong with expressing these in a judgemental fashion ....and even more wrong with withholding quality nursing care because of it

allnurses Guide · Apr 7, 2011

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.

emphasis in red - mine.

while i understand some of the posts about being able to vent about our patients - it does drive me crazy to have the nurse during report go over all this kind of judgmental crap. just give me the basics and depending on which end of the shift it is, let me get out of report and start my day or go home.

there are nurses who meander all over the place during report - there are many threads here on an about that particular issue.

as to basing your care of the patient on the issues noted in the op's post - that is wrong.

we are patient advocates -regardless of how they live their lives.

on the first day of nursing school our assignment was to identify our own biases - and write about it. then remember to never base our care on a patient on how we feel about our bias.

yes, talk with your clinical instructor. don't lie low.

i'm proud of you for being appalled at this behavior.

i've seen a few circumstances of it but for the most part the nurses i work with are true patient advocates.

steph

OCNRN63, RN · Apr 7, 2011

Lay low? I'm not the "moral police?" Really? You've been an RN a year and you sound like her already. Yes, I can tell your world of thinking has changed already. You sound like your heart has started to harden already.
"Who cares what she says anyway?" --- gee, I don't know when she's violating HIPPA, giving substandard patient care (because low class patients don't "deserve" the same care as the private pay, full insurance patients) and running around the unit gossiping about patients LOUDLY where anyone and everyone (including other patients and family can hear).... call me a naive nursing student, but I do care. It's inappropriate on every level. It's shameful, it's embarassing. Change her? Nah. I'd like to see her fired truthfully. But at minimum I do want to make sure she is not around any more students. But that's not my decision. All I can do is stand up for what I know is right even if no one else -- staff, students or other instructors is willing to do it with me. I'll be able to sleep knowing I did the right thing.
But for you to say "who cares" and you've been an RN for only a year is really scarey. This crap is like high school. If you are in the cool group, you hang out, chat, gossip and talk nasty about the patients and their families. If you're a nerd, you don't play the gossip game. If nursing is THAT BAD, get out. Seriously.
I'm a nerd and proud of it. I've been over high school games for a long time. This is unprofessional behavior. I realize some of the nurses are barely above high school age, but discussing a patient's family, personal or social history is wrong and inappropriate -- unless it's DIRECTLY related to their illness and/or care plan.
It's not up to us as nurses to make moral judgements about our patients' life choices and then adjust our nursing care accordingly. Just as it would be inappropriate to give a patient different care because they are of another ethnic group, social group, whatever. Here's what I've picked up so far and it's VERY disturbing: :crying2:
1) Low class/trashy patient/poor life choices (no insurance or Medicaid): minimal care, ignore call lights, minimal pain meds (they are all fakers and whiners). Move FAR away from desk as possible.
2) Ethnic groups, illegals, weird religions, people with names you can't spell or pronounce, people with funny accents: minimal care, ignore call lights, minimal pain meds (they are all fakers and whiners). Again, put in no mans land and hope they give up.
3) Teen moms and their families: minimal care, ignore call lights, minimal pain meds (they are all fakers and whiners. Besides they deserve it (pain and suffering. It'll teach them a lesson. Maybe they won't come back so soon).
4) Elderly with multiple diagnoses, transfers from long-term care, obese (especially morbidly obese), needy, whiners:
minimal care, ignore call lights, minimal pain meds (they are all fakers and whiners).
5) Normal people (i.e.: regular middle or upper class people with good insurance, short-term admits that don't require much work like overnight admits -- but have good insurance): first class care, super polite, butt kissing, yes ma'am/no ma'am, yes sir/no sir, super pain control, SUPER care!!
The class system is alive and well in the USA. My eyes are wide open.

I think you need to take your concerns to your instructor and let him/her handle the situation from there.

In all honesty, I thought your blistering response to the person who replied to you was completely unwarranted. I did not get the sense from her post that she was laissez faire about this sort of situation. I think you need to take some time to step back from this and ask yourself why you become so emotional when discussing this. Hint: You've tipped your hand with the high school reference.

allnurses Guide · Apr 7, 2011

I thought the response was passionate - not blistering.

She's tired - she's frustrated - she's confused about why this kind of behavior is being tolerated.

This is a place to vent - so I think people should feel free to vent.

(This isn't report by the way - I don't need to leave for home or go take care of my patients).

steph

OCNRN63, RN · Apr 8, 2011

Blistering is telling the person who responded to her that after one year she sounds as hard as the nurse she's complaining about. Telling her she sounds like the girls in a clique at school she didn't like. Telling her she needs to get out of nursing.

TexMex22 · Apr 8, 2011

I think you need to take your concerns to your instructor and let him/her handle the situation from there.
In all honesty, I thought your blistering response to the person who replied to you was completely unwarranted. I did not get the sense from her post that she was laissez faire about this sort of situation. I think you need to take some time to step back from this and ask yourself why you become so emotional when discussing this. Hint: You've tipped your hand with the high school reference.

Seriously? If you can't figure out why I'm so emotional about this you have become part of the problem. You obviously didn't read the posts if you still don't get it. But it's obvious some people just don't -- and never will.

Go back and read some of the comments -- they were basically telling me to "shut up and color." What ever happened to moral courage and ethics?

As for your high school crack it only goes to show your limited thought processes. You don't know if I'm a returning nurse getting more education, an RN going through a refresher course, an LPN getting an RN, there are almost too many options to cover. Maybe I'm a 60-year-old widow returning after being out of nursing -- you don't know, do you? And even if I was a young nurse, so what? Would that automatically make me stupid or a bad person for caring and having some ethics?

Here's an article about moral courage in healthcare some people will find interesting.

http://www.medscape.com/viewarticle/737894?src=top10

TexMex22 · Apr 8, 2011

I thought the response was passionate - not blistering.
She's tired - she's frustrated - she's confused about why this kind of behavior is being tolerated.
This is a place to vent - so I think people should feel free to vent.
(This isn't report by the way - I don't need to leave for home or go take care of my patients).
steph

Thanks for the support, Steph. You've hit the nail on the head! :yeah: