I'm a first-year student, and we had an interesting question on a test the other day. It asked what was an example of teaching that a nurse can do. One answer (exact wording changed to protect the innocent) was "Your BP is 120/80, which is within normal range". This answer was wrong, as I learned, because calling a BP "normal" was not something a nurse can do. I was told "nurses don't make judgments". Which got me rather down, as I wonder if I'm walking into a profession that is really so tightly restricted.
I can understand why the answer was incorrect. If I read into it and realize there was no information given as to the patient's previously measured BP, 120/80 might indeed not be "normal" for them. And there's always the nightmare looming over my student head that if I say something positive about someone's status and two minutes later they crash and die, it'll be me everyone's pointing fingers at.
I get answers like this, but then on another question asking about a nurse's duty, the correct answer was "to gather and interpret data". Somewhat contradictory. Then I go to my community health rotations and watch a nurse (not a practitioner) help a patient interpret their high AC1 level and some other labs. At LTC rotation, the nurses I observed seemed to be making plenty of judgments as to whether something was abnormal with their patients.
So I'm just curious to hear from working nurses, because as a student I don't feel like I've grasped where the line is yet -- do you feel you make judgments? And where do you feel is the border between the kind of judgments a nurse can make (if any), and where it crosses into medical calls that you can't make? Is it only correct when you're repeating what a doctor has said?
I think what your instructor is trying to instill is the proper TERMINOLOGY.
For example: You walk into a patient's room and he says "Get the **** out!" and throws his urinal at you.
If you state: Pt very rude and abusive to this RN. Demanded RN leave the room.
You are judging that the patient is rude and abusive.
You have to document objectively by only stating fact: RN entered room. Pt states "Get the **** out" and threw urinal at this RN.
"Normal" is subjective. If I say "bleeding is normal" for my post partum patient, what does that mean? How much bleeding is "normal" to you? To me?
She is probably just trying to have you focus on charting OBJECTIVELY instead of subjectively. Words like "Well, good, normal, poorly, easy" are subjective and should never be used in charting.
Was the instructor also trying to say that nurses don't make "medical diagnoses?" If so, then the instructor was right. Staff nurses don't make medical diagnoses. However, they do make all kinds of judgments of a different nature all the time.
Also, is this in an LPN program or RN program? In many (most?) states, LPN's are limited in their ability to make nursing diagnoses as well and cannot do the official "patient assessment" part of a plan of care. The LPN's gather data, but the RN has to sign off on the official nursing diagnoses. If you are in an LPN program, that might have been part of what the instructor was trying to teach.
Thanks for the guidance, everyone. A lot of what everyone's saying makes sense (and thank you ukstudent -- it helped immensely to think of it that way). Separating out 'normal' as a subjective judgment versus objective ones does help put everything in perspective.
Nursel56: The right answer was (exact wording changed, ahem) "I'm using my stethoscope to listen for bruits". As it was explained to us, this is correct as the nurse is giving facts, not judgment.
Words like "Well, good, normal, poorly, easy" are subjective
If this is the reason that one was wrong, that makes sense. It's probably not a good idea for a nurse to appear to be proclaiming resolutely that there are no problems with the blood pressure.
Still, it's not as clear as it could be. Students should know what is generally considered "normal parameters" (based on evidence of course), but this question doesn't test that knowledge. A student could get this question right even if they didn't remember much about blood pressure. In fact, a student might think that blood pressure is too low or too high and that's why they didn't choose that answer.
And how much more confusing if the instructor explained that that answer was wrong because "nurses don't make judgements" and that that comment is essentially diagnosing the patient, akin to telling a patient they have hypertension with one high blood pressure reading. How easy for a student to interpret that to mean as a nurse, you're not supposed to say or think anything except "the blood pressure is XYZ" and nothing else!
Additional comment: Saying "Your BP is 120/80, which is within normal range" is not the same as saying "Your BP is 120/80 which means your blood pressure is right where it should be."
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If this is the first time you've seen this patient and the patient doesn't look to be in any distress, an adult of average height and weight, and this is the blood pressure reading you get, as a nurse you should take into account that the reading was within normal parameters, shouldn't you? "most recent BP within normal parameters" would inform your continued assessment. However, if the blood pressure was crazy high, even if the patient seems okay, you'd want to address it immediately.
I'm a first-year student, and we had an interesting question on a test the other day. It asked what was an example of teaching that a nurse can do.
One answer (exact wording changed to protect the innocent) was"Your BP is 120/80, which is within normal range". This answer was wrong, as I learned, because calling a BP "normal" was not something a nurse can do. I was told "nurses don't make judgments". Which got me rather down, as I wonder if I'm walking into a profession that is really so tightly restricted.
I can understand why the answer was incorrect. If I read into it and realize there was no information given as to the patient's previously measured BP, 120/80 might indeed not be "normal" for them.
The right answer was (exact wording changed, ahem) "I'm using my stethoscope to listen for bruits". As it was explained to us, this is correct as the nurse is giving facts, not judgment.
After reading your second post with the right answer included, I concur with your professor. The question asked you to decipher which action showed TEACHING. If I had to choose between the two, the choice regarding bruits is actual the choice where the nurse is TEACHING. In the other choice, there was no teaching. The nurse was simply stating the bp was normal. In nursing school I was taught that under 120/80 was normal. 120-130 systolic and 80-90 diastolic could mean pre-hypertension so this patient's bp is actually more borderline for prehypertension.
When I answer nursing questions and I'm not sure, I reread the question and ask myself: Does this question want an assessment or an action? This question wanted an action. The first answer was an assessment.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Nursel56: The right answer was (exact wording changed, ahem) "I'm using my stethoscope to listen for bruits". As it was explained to us, this is correct as the nurse is giving facts, not judgment.
Thank you for replying! I can see what they were getting at now, too. Most patients would probably ask you "a bru-what?" so that would lead into patient education. I don't think there is a blanket rule that we not tell someone what normal values are in general, though. Best wishes to you as you navigate your way through the world of multiple choice test questions! :)
The question asked you to decipher which action showed TEACHING.
Good point about what exactly is the question asking about! That's always something to watch out for on tests.
Still, isn't it educational to tell someone that 120/80 is in normal range? Whereas the stethoscope answer sounds more like an explanation (what is the nursing doing?) and the answer is using medical jargon that likely makes no sense to a patient. I'd imagine immediately crossing that answer out as a teaching example for that reason!
jjjoy -- that's exactly the thing that got me! I was wondering why on earth I'd be flooding the patient with words like 'bruits' when I didn't seem to have a reason to (hadn't even listened yet!).
Your other comment made so much sense! I haven't yet figured out how to quote the exact lines in replies yet...I think need a teaching moment, myself.
obnursesherri -- Ahhh interesting way to put it with asking for assessment, thank you.
nursel56 -- Some days it feels like a maze you're navigating, except instead of NSEW on your compass, you've got ABCD
d'cm
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I think you will find that the "nursing judgement" you use the most is the filter between brain and mouth.