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

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by TexMex22 TexMex22 (New Member) New Member

TexMex22 has 30 years experience .

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You are reading page 4 of Preceptor bases care on moral judgements of patients. HELP!!!. If you want to start from the beginning Go to First Page.

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I have to chime in here because a similar situation happened to my group just this week.

There was a black mother who came to the ER of a differen hospital because her infant son had an episode of apnea during his sleep and she couldn't wake him up. He was transferred to out hospital and he was put under observation overnight. Apparently she was yelling and cussing in the ER and nobody wanted to deal with her. She was a Baby Phat wearing, bright colored extensions in th hair type of woman.

Anyway the night shift nurse went on and on during report about how horrible she was and to try to avoid her and her son was going home that day anyway and there was nothing wrong with him, so we were all scared to be assigned to her. During the day though, she was very talkative and and grateful to the student nurses. She was great wth her son and he was very healthy and happy (didn't cry, grabbed our hands, cooed and smiled at us). At post conference my instructor made it a point to tell us that the woman was probably given the brush off from everyone she encountered until we came. People might act out when they are vulnerable but you have to keep an open mind and not judge.

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hiddencatRN works as a Registered Nurse.

29,059 Visitors; 3,408 Posts

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.

I thought 'morality police' was pretty dismissive.

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8,722 Visitors; 696 Posts

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

Please have a reread of the posts .... the large majority of posters are not condoning the behaviour.

Saying you should 'tread lightly' or that you should differentiate between providing poor care and merely being judgemental ?

None of this is about agreement.

Rather than guns-a-blazing .... take a reflective moment and try to understand what the posters are saying.

We get that you are shocked (and rightly so too).

Many of us are just like you....we wholeheartedly agree this is very poor care. However the more experienced nurses are unlikely to be shocked and upset about this. They (in good facilities) will be disagreeing and reporting it. That's all.

Best wishes and choose your first jobs well

Edited by pedicurn

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53,662 Visitors; 5,978 Posts

The fact that you have to attack and immediately accuse someone who merely asks you to take a second look at the situation with a cooler head is very telling.

If it made you feel better to accuse me of being a terrible nurse, that really says more about you than it does about me.

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3,143 Visitors; 218 Posts

i'm just wondering if maybe she is charge or a leader and that's why she has information about other patients?

i think it's wrong if she's making harsh judgements obviously, but i think social factors are important to know in many situations.

for example, if you're dealing with someone who was in a car crash it might not change the medical aspect of care to know that they were driving drunk and killed another person. you could provide the same great care without being aware of those details - BUT it does help to know something like that so you can understand why a patient might be asking for medication every hour. is it physical pain or are they trying to be as sedated as possible bc of the emotional trauma? financial status can come into play in different situations also. is a patient anxious to be dishcharged because they really feel that they've recovered and can do fine at home with the support of a spouse, or are they anxious to be dishcarged because they have no insurance and they don't have anyone to keep their child if they stay another day? social factors can definitely impact medical decisions, but maybe you're right and she's just being nosey. maybe i'm thinking too much into it - i don't know. i know that i used to think a lot of the "details that shouldn't matter" shouldn't influence patient care, but in reality they do - and not always (in fact, not usually) in a bad way.

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TexMex22 has 30 years experience.

4,054 Visitors; 161 Posts

The fact that you have to attack and immediately accuse someone who merely asks you to take a second look at the situation with a cooler head is very telling.

If it made you feel better to accuse me of being a terrible nurse, that really says more about you than it does about me.

How and where did I accuse you of being a bad nurse? Maybe you are reading between the lines because you see some of your own behavior? But okay, seems this has turned into something else now. Expressing my views and venting my frustration feels threatening to you for some reason. You have bashed me more than once. Apparently standing up for what I feel is right is so threatening you need to continue to take shots at me; with cracks about "about what it says" about me. What does it say about you, the seasoned nurse with 25 years experience? Do you intervene when you see this happening, watch it and do nothing, or participate? What does it say about YOU? :eek:

Is this part of "nurses eat their young" thing I've heard about -- the hazing? That the old nurses break-in/break-down the new ones by treating them crappy, bashing them, picking on them, disrespecting them and trying to break them down --- instead of supporting, caring, mentoring and giving moral support? Maybe this is like The Code of Silence with cops? No matter what they do, everyone keeps their mouths shut and they take care of their own. I personally think that's part of the problem. If you look the other way, you are part of the problem; not part of the solution.

Ppl like you have made me even MORE sure of what I what I need to do and why. Thanks for that.

You are the experienced 25-year nurse though. I'm just the student. I can live with my choice. Oh and thanks for your support. :redpinkhe

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TexMex22 has 30 years experience.

4,054 Visitors; 161 Posts

i'm just wondering if maybe she is charge or a leader and that's why she has information about other patients?

i think it's wrong if she's making harsh judgements obviously, but i think social factors are important to know in many situations.

for example, if you're dealing with someone who was in a car crash it might not change the medical aspect of care to know that they were driving drunk and killed another person. you could provide the same great care without being aware of those details - BUT it does help to know something like that so you can understand why a patient might be asking for medication every hour. is it physical pain or are they trying to be as sedated as possible bc of the emotional trauma? financial status can come into play in different situations also. is a patient anxious to be dishcharged because they really feel that they've recovered and can do fine at home with the support of a spouse, or are they anxious to be dishcarged because they have no insurance and they don't have anyone to keep their child if they stay another day? social factors can definitely impact medical decisions, but maybe you're right and she's just being nosey. maybe i'm thinking too much into it - i don't know. i know that i used to think a lot of the "details that shouldn't matter" shouldn't influence patient care, but in reality they do - and not always (in fact, not usually) in a bad way.

You are kind to think of it in that way. However, none of it (that I saw or heard) had anything to do with patient care in that way. When I said "social" factors I meant strictly separating what was considered trash and low lives, welfare cases, teen moms, illegal immigrants and less than stellar citizens (in her opinion) from the higher class patients.

Under normal circumstances the situations you stated make total sense. None of these were the case. The ones I saw and heard were all strictly nasty gossip just for the fun of it and just because the nurse has certain moral and racial biases, and was happy to share them with others. Oh and by the way, apparently certain ppl in these groups don't need/deserve pain medication the way other patients do (because it will teach them a lesson) and if you ignore them maybe they will shut the h*ll up and go home. Or at least just be quiet and leave you alone during your shift.

Yes, a lovely learning environment for nursing students. A nuturing, caring environment for patients and their families. Makes you feel warm and cuddly like you want to help people get better! And I did. Because I wanted to help them escape from this unit as quickly as possible.

Oh and she wasn't a charge or a leader. Just a staff nurse. She looked up other patient information because she was nosy and wanted to gossip. That simple.

Discussing this and thinking about it has worn me out emotionally. So I'm going to block the responses for a while. I hope you all understand. Thanks. :)

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GHGoonette works as a PACU RN.

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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

Note to Pedicurn; I'm not quoting your post in order to attack you :) but I think we need to consider the lines I've highlighted.

Firstly, even though Texmex is "only a student", this should not hinder him/her from patient advocacy. Her preceptor's attitude indicates that this RN is teaching students exactly how not to advocate for the patient, and regardless of the student's status, such conduct must be reported to the appropriate person. From that point of view, Texmex is indeed the "morality police" here; would anyone here be prepared to lie low and not report a case of child or elder abuse if they saw it? Someone has to advocate, and it seems no-one working with this RN is prepared to do it.

The second line I highlighted touches on a very sad issue. "Young" or "new" nurses losing their shine and becoming cynical "old" nurses. I know nursing is stressful, I know it often chews us up and spits us out and leaves us feeling as if we have nothing left to give, but how can we allow ourselves to forget that our patients are human, with human failings? At what point does a nurse lose her empathy? Where does the dedication go?

Texmex, please never lose your passion; you will undoubtedly ruffle many feathers in your future career, but once you have learned to balance knowledge with wisdom and dedication with tact I am sure you will be a asset to the profession.

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ShayRN has 18 years experience and works as a Hospice nurse.

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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. :eek:

Who is left for her to take care of? Yeesh. While I do think the nurse sounds like a rasist. What I really think is that she is lazy. She doesn't want to take care of anyone that will cause actual work for her.

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8,722 Visitors; 696 Posts

Note to Pedicurn; I'm not quoting your post in order to attack you :) but I think we need to consider the lines I've highlighted.

Firstly, even though Texmex is "only a student", this should not hinder him/her from patient advocacy. Her preceptor's attitude indicates that this RN is teaching students exactly how not to advocate for the patient, and regardless of the student's status, such conduct must be reported to the appropriate person. From that point of view, Texmex is indeed the "morality police" here; would anyone here be prepared to lie low and not report a case of child or elder abuse if they saw it? Someone has to advocate, and it seems no-one working with this RN is prepared to do it.

The second line I highlighted touches on a very sad issue. "Young" or "new" nurses losing their shine and becoming cynical "old" nurses. I know nursing is stressful, I know it often chews us up and spits us out and leaves us feeling as if we have nothing left to give, but how can we allow ourselves to forget that our patients are human, with human failings? At what point does a nurse lose her empathy? Where does the dedication go?

Texmex, please never lose your passion; you will undoubtedly ruffle many feathers in your future career, but once you have learned to balance knowledge with wisdom and dedication with tact I am sure you will be a asset to the profession.

Yes ...however I am most definitely not condoning the judgemental nurses behaviour.

What was post was about was suggesting the OP broaden her perception of the issue.

The large majority of experienced nurses I work with are great advocates. We haven't turned into old dried up cynics - nor have we lost our passion because we don't fly off the handle in the face of p't injustice. We objectively and methodically gather the full picture /reflect /discuss with peers and take action. That kind of judgemental behaviour is not tolerated at my facility.

Nothing much fazes us anymore. We are able to see the problem with this and take action. We've still got our passion and our empathy - however we have grown up and choose not to feel the anger /outrage at every injustice.

That would be the quick way to burnout.

It is better if the OP learns to choose which events she/he is going to feel angry/upset about as she/he will need to learn how to take care of own emotional health as a nurse.

And to keep it in perspective - there were many posters stating this poor behaviour would not be tolerated in their facilities.

I think posters are annoyed at being painted with a very broad brush by the OP. It would have been better if the OP had taken more care reading the replies and reflected a little.

And I think I also mentioned the OP should report to her instructor .... also mentioned the OP needs to be sure that p't care is actually being affected.

This can be a big ask for a student. Get this wrong ... then no employment opportunity at that facility on graduation. And may even be black-listed at sister facilities? I'm not saying this should stop you reporting - I'm saying just be smart and gather the whole picture before taking action. What if the OP lives in a rural area/small town? This facility may be the only employer around.

However the OP might not want to work at that facility - when I said it had likely being going on for years, I meant this was indicative of poor culture. That would be a sign that she/he might want to look out for.

The world is not perfect. Reporting the issue /being a good role model /raising awareness .... that's about all the OP, and any other nurse, can do.

This has been a good learning experience for the OP

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8,722 Visitors; 696 Posts

Is this part of "nurses eat their young" thing I've heard about -- the hazing? That the old nurses break-in/break-down the new ones by treating them crappy, bashing them, picking on them, disrespecting them and trying to break them down --- instead of supporting, caring, mentoring and giving moral support? Maybe this is like The Code of Silence with cops? No matter what they do, everyone keeps their mouths shut and they take care of their own. I personally think that's part of the problem. If you look the other way, you are part of the problem; not part of the solution.

Ppl like you have made me even MORE sure of what I what I need to do and why. Thanks for that.

You are the experienced 25-year nurse though. I'm just the student. I can live with my choice. Oh and thanks for your support. :redpinkhe

Just a *gentle* reminder.

Before anyone accuses anyone else of bullying they need to be sure they have objective information of such behaviour.

Just receiving a response one didn't like, or a curt reply .....or even an outright rude interaction .... doesn't mean an older nurse has 'eaten' the newer nurse.

One needs to take a moment and reflect before leaping to that. Misread the situation and get it wrong - then it's slander.

In my facility we have had some new grads leaping to that conclusion anytime they are part of an interaction they didn't like.

Mostly (as I work in a very good facility with mostly great culture) the new grad has misread the situation.

These days we are treating our new nurses as fully fledged adults and supervisors do take action when the new nurse gets it wrong.

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4,412 Visitors; 142 Posts

Wow, I am completely on your side. Your response to my post, and to several other posts leads me to believe or ASSUME, if you will that you have already made up your mind about people with very little information to back up your opinions.

NOTHING in your original post actually pointed to any neglectful care on NURSE R's part, and other than reading other patient's charts, all you stated was that she talked negatively about ppl.

My point was, and is, that you don't really know what it's like "in the real nursing world, YET." That is not a slight, it's just reality. I am not disagreeing with you, you are right to feel the way you feel. I just know that you have to pick your battles, especially in school. You asked for opinions, and I gave you one that I feel was the best one that would benefit YOU. Furthermore, this will not be the first or the last "crappy, mean, judgemental" nurse, or any other human that you will ever meet.

I think you are really looking for a fight, and all I was looking to do was point you in a good direction because I HAVE BEEN THERE...not to belittle you.

I still wish you the best of luck, and would love to hear from you after you have been working for a year.:nurse:

"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. :o

"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. :mad:"

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