Pts abusing "cultural/religious" practices to manipulate RNs

[HvnSntRN]

This has been bugging me for a while.

A few weeks ago, we had a postpartum patient who is Jewish (Orthodox), which means that they won't do "work" on their Sabbath (sundown on Friday until sundown on Saturday). No problem. The nurse looking after her planned with her to check in every hour to see if she needed something.

I later found out that the patient sent the baby to the nursery to be bottle fed by the staff overnight, even though she was breastfeeding.

I also found out that not only did she do this on Friday-Saturday, but also Saturday-Sunday, and Sunday-Monday. She had a different RN working with her each shift and pulled the "no work on the Sabbath" routine, expecting that the nurse wouldn't be familiar with the differences between the Christian and Jewish observances of the Sabbath.

I guess I just have a hard time respecting people who misinform regarding their beliefs and cultural practices with the aim of getting what they want from other people. I mean, why not just say (like other people do) "I'm really tired from breastfeeding and I'd rather let you give the baby a bottle overnight", instead of trying to manipulate us with phony information about religious beliefs and practices? I'm pretty sure that Jewish people eat on the Sabbath; do they plan to not feed their babies on the Sabbath once they're discharged from the hospital? If that's the case, then we should be calling CPS, right?

I'm all for being culturally sensitive and respecting other peoples' belief systems. What I don't appreciate is when my colleagues get manipulated on that basis by people being deceptive about their beliefs and practices - it shows a distinct lack of respect for us and an abuse of our efforts at being culturally sensitive.

How do other RNs handle situations like this?

[cheshirecat]

Yes, in an ideal world mum would have said "please take baby for the night, I am exhausted". Maybe she felt guilty and thought she would be judged on this, i don't know. Life is hard, new motherhood is hard. Please give this new mum a break.

After I had my baby by c/s, she spent 3 nights in the nursery. Why? Because as a midwife with a husband in the military and family hundreds of miles away, I knew the next time I would get a decent nights sleep would probably be years away.

We do not know what support she will get at home.

[GardenDove]

---I agree, it's a little perturbing that folks here want to call CPS because this woman was trying to trick the nursing staff into taking her baby for the night. For some reason she felt like she couldn't be honest. I float to OB to help out and if someone wants to sleep here, we take the bassinet to the nurses station quite gladly.

---Wasn't it back in the old days that all babies were kept in the nursery? Women who wanted their babies at their sides had to fight for that right. I had my 6 children all homebirths so I would avoid dealing with domineering hospital staff. Maybe this woman didn't want to deal with it, so thought to use her religion as an excuse, thinking that the nursing staff wouldn't know too much about her religion.

[Yuliya3]

I loked up the calendar , this year September/ October 2006 :

Fri 22nd, Sat 23rd, Sun 24th - was Rosh Hashonah

Fri 30, Sat 31, Sun10/1, Mon 10/2 - was Shabbos followed by Yom Kippur

Fri 10/6, Sat 7th, Sun 8th - first days of Sukkos

Fri 10/13, Sat 14th, Sun 15th - last days of Sukkos/Simhas Torah,

so a week before Sukkos was Yom Kippur, maybe that's it?

[HvnSntRN]

Don't women already have a right to ask nursing staff to take their babies so they can rest? I wonder why the OP resents this, and why the mother felt she had to trick the nursing staff into taking the baby?

We are happy to have babies in the nursery at night to give moms a break. Nobody resents it - it's a service we will offer as long as we have a nursery to provide the service. As I said, what bothers me is the patient's resorting to "tricking" us by being deceptive about Shabbat practices, as if it gave some kind of "rank" to her request over other patients. All she had to do was say - like every other mom who wants baby to go to the nursery does - "I'm really exhausted, could you take the baby and do the feedings over night?"

Is it really such a crime to admit that you just want to sleep through the night, that you have to resort to fabricating stuff about religious practice? There's something dreadfully wrong when a belief system is perceived by a patient to be so oppressive that she can't be honest about her true physical feelings of exhaustion with people who are (a) not there to judge her and (b) are interested in her (and her baby's) physical and emotional well-being.

I think we have enough to do with our workload, without having to filter through dishonesty and manipulation from patients.

[HvnSntRN]

a week before Sukkos was Yom Kippur, maybe that's it?

Bingo. Thank you. I'd forgotten about Yom Kippur.

It all makes sense now.

[PANurseRN1]

Maybe she just wanted a break but was afraid to say so...there are a lot of breastfeeding zealots out there who would have jumped on her with all four feet for being so "selfish" as to ask for a break. She may have used Sabbath as an excuse because she thought people would be less judgemental.

She might have just been an overwhelmed Mom who was desperate for any excuse to get a break. It might not have occurred to her that there would be staff who would know about Jewish Sabbath observances.

[caroladybelle, BSN, RN]

Her thinking is convoluted. Don't women already have a right to ask nursing staff to take their babies so they can rest?

Actually, technically by the letter of law, an observant Jew cannot "ask" a Gentile to do "work" for him on Shabbos.

I have always observed (if possible), the habits of the patient and adjust behavior accordingly. Or they ask "where is the light switch located" (hint)and I automatically change the setting. I always bring fresh water several times a shift or preferred kosher compliant beverage. I round regularly to help unplug the pump or make sure that the tubings are long enough for bathroom trips. I ask "May I provide for you a pain pill" rather than "Do you need a pain pill". I look up the time of Sunrise/sunset and put it on the patient board. I put the shades up, and set up a chair shortly before sunrise and note to staff to (if possible and safe) to not disturb the patient for VS/assessment for 60-90 minutes after sunrise. I accompany (or have accompanied) observant visitiors from the floor to the door of the hospital so that they do not have to push elevator buttons. I try to make sure that they have a portable frig, if possible, for food from home. I give their benedryl in tablet form rather than capsule (gelatin "skin") if available.

[JeanettePNP, MSN, RN, NP]

Not all Jews believe in Heaven and Hell, some are even atheists and if you understand that you are doing better than I. And I am Jewish. A Jew can be a Buddhist, a Hindu, or whatever other religion and still be accepted as a Jew. The only thing a Jew can never be and still be accepted by fellow Jews is a Jew for Jesus, a Christian. Of course, there have always been some Jews who followed Jesus and there are lots of Hebrew Christians, Jewish believers in Jesus today.

Not to sidetrack the thread into a discussion of the finer points of Jewish theology, but that's not technically correct. A Jew who "apostizes" (I'm sure that's spelled wrong) by adopting another religion, be it Buddhism, Hindu, Christianity or whatever, might have to immerse in a Mikvah (ritual bath) in order to be accepted back into the Jewish fold, but they're considered Jewish all along, and a child born to Jewish parents, even if they practice another religion, is considered Jewish and is welcome back anytime without having to undergo conversion.

[tntrn, ASN, RN]

Maybe her issue is not with feeding her baby but with breastfeeding and in order to avoid flack from family, staff, friends, that's how she was dealing with it. Not something CPS needs to be called for, but maybe a little heart to heart from a caring and open minded (when it comes to breast of bottle feeding) staff member might sort it out. I think that would the first thing I'd investigate. Does she or does she not really want to breastfeed? If not, then move on to how do you plan to feed your newborn who will need you every day, not just on the non-Sabbath days.

[HvnSntRN]

Actually, technically by the letter of law, an observant Jew cannot "ask" a Gentile to do "work" for him on Shabbos.

I have always observed (if possible), the habits of the patient and adjust behavior accordingly. Or they ask "where is the light switch located" (hint)and I automatically change the setting. I always bring fresh water several times a shift or preferred kosher compliant beverage. I round regularly to help unplug the pump or make sure that the tubings are long enough for bathroom trips. I ask "May I provide for you a pain pill" rather than "Do you need a pain pill". I look up the time of Sunrise/sunset and put it on the patient board. I put the shades up, and set up a chair shortly before sunrise and note to staff to (if possible and safe) to not disturb the patient for VS/assessment for 60-90 minutes after sunrise. I accompany (or have accompanied) observant visitiors from the floor to the door of the hospital so that they do not have to push elevator buttons. I try to make sure that they have a portable frig, if possible, for food from home. I give their benedryl in tablet form rather than capsule (gelatin "skin") if available.

These are the kinds of things I was talking about regarding understanding all the subtle nuances of various religious practices. Without being educated on the matter, I would never know that there is a correct and incorrect way to ask a simple question of an observant Orthodox Jew, or to accompany them to the elevator to push the buttons - they seemed quite content to use the stairway instead.

Thank you for the information.

[GardenDove]

I still am not seeing what's so bad about what this pt did. Maybe she is a very sensitive soul with limited ability to articulate her needs openly. I doubt if it had anything to do with her religious beliefs because I'm sure there are some Orthodox Jews who are assertive and able to be more straight forward. For some reason this woman was not, its probably her personality.

The fact of the matter is that the mother didn't ask anything unreasonable, that wasn't a normal part of the job of the nurse. We are there to serve these peoples needs. They are not manipulating us by having us do that. For some reason this woman didn't feel comfortable enough to make a simple request. She happened to use a fairly transparent ploy to get her needs met. So what? I always try to go along with pts and let them save face.

Before my husband died, I had a little trick I used to do to get out of things. I would say "Oh, I'll have to check with my husband". Or when they'd call me to work extra I'd say "Oh, my husband wouldn't like it" It worked great. Sometimes I still will use it for things like saying "Oh, my husband wouldn't have liked me to do that". Ha Ha, I was hardly an oppressed wife, but it was a nifty trick!

[tntrn, ASN, RN]

I'm sorry but I don't think walking a patient's visitors to the elevator and pushing the button for them is a part of my job. Especially in my unit where we have to go beyond the locked doors to get to the elevator. And why should I have to know this also?

I pride myself in being very tolerant, but there's a limit to what we are supposed to know about all the many differences. And again, if I, as a Protestant, were to be hospitalized in a predominantly (fill in the blank) area, would they be busting their bums to honor each and every one of my religious beliefs, not to mention already knowing about them? Seriously doubt it.