"Send my girl down here now"...(Please.....)

[Jason-ACNP]

I was writing a progress note today on a cardiac step-down unit when my concentration was shattered by a booming voice coming through the patient-call system. An 60 y/o gentleman (for lack of a better word)exclamied, "Send my girl down here nawh! (southern slang for "now"). The nurse at the nurses' station, who was working overtime to cover a shortage of nurses, looked puzzled. She replied, "Sir, I was not aware that you had a daughter. Anyway, she isn't here just now". He shouted back, "Don't be a dumbass! I ain't talkin' bout my daughter! Send me that damn nurse!" Now before I go any further, I should explain that this patient was alert and oriented, and could ambulate easily on his own. He could easily feed himself, (although he was NPO) and could walk to the bathroom without difficulty

He was scheduled for a cardiac cath later that day. So what did he want so desperately? He wanted the nurse to hand him a damn magazine that was sitting in a chair five feet from his bed. I couldn't help but intervene, and I'm sure I'll catch criticism for this. I walked down to his room and without introducing myself, I said, "Lets get something straight! This person is a highly respected RN within this hospital, and she is not AND WILL not be addressed as your girl! It is clear that she is of no relation to you! Secondly, THIS IS NOT A FIVE STAR HOTEL! You can and will ambulate on your own!! That means that when you have to go to the bathroom, get a magazine, or scratch yourself, YOU WILL BE THE ONE WHO DOES IT AT THIS POINT IN THE GAME! These nurses are not your handmaiden, and they are NOT at your beck and call. Each nurse cares for 12 patients with very little assitance, and every patient on this floor is in far worse shape than you are! Am I absolutey clear?!

Now before I catch hell for that, let me say this. I know that the concepts of "compassion", "going the extra mile" and "giving that patient an extra five minutes even though your feet are aching and your back is about to break" are all very sweet and are inherent traits of the "genuine" nurse. But lets be realistic. I worked as a critical care nurse in several states (as a traveler) before I pursued an advanced degree. Thus, while it may seem that patients like this are the exception, I know that they are rapidly becoming the rule. Although being a hospitalized patient is not fun, there is absolutely no excuse for patients or families to treat nurses with disrespect. The "turn the other cheek" rule is crap. Verbal abuse and condescending attitudes towards nurses have become worse every year for the past several years. Regardless of the nursing shortage or other factors, there is no excuse for this. In fact, the nursing shortage should generate more respect for these nurses. However, I feel that the general public perceives staff nurses (and particuarly floor nurses) as handmaidens and mindless recorders of blood pressures. This mentality is unfounded and very unfortunate. Maybe I'm crazy, (and if you read this far, let me know if I'm wrong), but I think that part of the problem is a image problem of nursing that stems from the media. Medical shows such as E.R. and Gideon's Crossing have become the rage over the years. Particuarly "E.R.". How many times has that show ever portrayed the nursing profession in a positive light? I honestly can't remember one show. I do remember shows that illustrate nurses as being jealous of physicians, and a show that illustrated nurses as "gossip queens". Numerous shows have shown the general public as being "authoritarian" and certainly condescending, but not one time have I seen one of these nurse actors make a stand. Does a movie such as "Meet the Parents" do much for the promotion of nursing? Please..The bottom line is this. The public, (in general) associates nursing with bed pans, bed baths, and "fetching some water". While these are all a part of nursing, other aspects include critical thinking and excellent skills. Yet, rarely, if ever, is this noticed. One more thing. I know that there are numerous patients (and families) that appreciate the care that you provide, as well they should. But this type of patient (and family) is a malignant tumor that continues to grow with time. If you read this far, thanks. If I'm way off base, don't be afraid to let me know.

[Mijourney]

Hi. Good topic, and many good responses. Like previous posters wrote and Jason acknowledged, it's difficult to tell what state of mind this person was in when he demanded his "girl." I would be curious to know, even if it does not matter, the social history of this man.

Jason, I think taking a firm attitude is important when you witness disrespect. It's great to see that you made a decision to stand up for your coworker. You also make a great point about the expectation of patients when they are receiving care from a nurse.

It's high time that we nurses stood up for ourselves and not continue to overly pander to our patients and make them dependent or establish codependent relationships with them. We know that hospital administrators in their quest for more profits will not give the green light to nurses to demand respect from the public or other staff. Therefore, we have to take the initiative ourselves.

One way I approach incidents like this is to simply tell the patient(or family for that matter) that references to the staff by other than their given name won't be tolerated. That this patient's doctor ordered his activity level which gives him the freedom to get his magazine himself, and he is encouraged to take advantage of that.

I feel for you and the other staff once the cath has been done. Years ago, a patient would be on bedrest postcath for a day or so and then it was decreased to eight hours. Since I'm no longer in the hospital, I don't know what it is now.

[ClariceS]

I sometimes wish I was able to react like that to abusive patients but would most likely loose my job if it were found out. I have many times wanted to ask the patient or family if they think their behavior actually makes us want to come to the room faster. I have told patients I do not need to listen to what they are saying and that none of my nurses need to come into their room unless they can be in control of their outbursts. I am at least able to get support to do that. In this age of customer service though it seems that we are told (by those who never enter patient rooms) that the customer is always right, even if they are yelling at us. That is pushed so hard that it is extremely disheartening and I know that it has led to at least 2 of my nurses leaving - the profession. It does seem that it has gotten worse over the last couple years also. No answer as to why. I unofficially applaud you Jason (I'm even nervous on the bb!).

[momangel29]

I work in a long term care facility with a subacute unit as an LPN.I was helping the CNA's pass out dinner trays and I set a tray down in the room and opened everything up for the residentwhen the daughter,who was there to feed her mom shouted,"Come back over here girl and tell me what is on this tray!" It was puree and I really had no idea what it was but I made it up because I didn't want to have to go back in there and deal with her!

[Stargazer]

Sign me up for the list of people supporting Jason. Yes, this man may have been fearful or feeling out of control, but as far as I'm concerned, you're never too old or crotchety to learn that you can catch more flies with honey than vinegar. Yes, it's generally a bad idea to treat the people most directly responsible for your comfort and well-being--i.e., the nurses--with contempt and disrespect. Go figure.

I had to do this once with an ICU pt. He was an ex-career military guy and from what I could tell after 12 hours of caring for him, pretty much a misogynistic control freak with a REALLY bum ticker, not to mention bad kidneys and some other problems. I walked into his room at start of shift to find his Foley stretched dangerously tight, one of his IV's about to fall out, and a continuous run of really scary dysrhythmias on the monitor. He started demanding a phone and some other things which weren't my first concern, and when I told him so, he pointed his finger at me and started "lecturing" me about how he was paying X amount of $$ for this room and he demanded "service", etc. etc.

I sat down and explained to him that he was there because he was critically ill, and I was there because he was critically ill. I explained that I was not the maid, or his waitress, and he was going to have to trust my professional judgement, education and experience that his IV, foley and rhythm were more urgent than his telephone call, although I would be happy to get him a phone after I sorted out the more pressing problems. He sulked and pouted and gave me the silent treatment the rest of the evening, but he seemed to get the point and quit complaining about the "service". People like this get away with crap because everyone's always let them.

I had another pt like this--a "problem pt." that several floors refused to take care of because he would throw meal trays, scream at staff (ANY staff, including docs) and just generally throw a tantrum when things didn't go his way. His wife would simper, "Oh, well, he's always been like this," which made me want to snarl, "Gee, thanks for enabling his dysfunctional behavior for the past 35 years, Cookie!" Maybe if someone had let him know, just once, that *grown-ups* don't behave this way, he would've knocked it off. Anyhoo. The day nurse reported that when they brought him back from CT, he decided while rolling down the hall that his pillow needed to be fluffed. Like, now. The nurse told him she'd do it when they got to his room (about 60 feet away). Apparently that wasn't soon enough, because he started pounding the siderails with his fists, screaming, "Fluff my pillow, you bitches, FLUFF MY PILLOW!!" at the top of his lungs. She said she was laughing so hard by that point she was doubled over and could hardly push the bed.

I think the lesson is, sometimes jerks get sick too, and all the therapeutic communication in the world will not make a lick o' difference with some of them.

[This message has been edited by Stargazer (edited April 23, 2001).]

[-jt]

Originally posted by Jason-ACNP:

"Lets get something straight! This person is a highly respected RN within this hospital, and she is not AND WILL not be addressed as your girl! It is clear that she is of no relation to you! Secondly, THIS IS NOT A FIVE STAR HOTEL! You can and will ambulate on your own!! That means that when you have to go to the bathroom, get a magazine, or scratch yourself, YOU WILL BE THE ONE WHO DOES IT AT THIS POINT IN THE GAME! These nurses are not your handmaiden, and they are NOT at your beck and call. Each nurse cares for 12 patients with very little assitance, and every patient on this floor is in far worse shape than you are! Am I absolutey clear?!

Now before I catch hell for that, let me say this. [Q]

You wont catch any hell from me. You took the words right out of my mouth! Theres a time & a place when they just need to be said. I havent been fired yet for similar exchanges & insisting on being treated as a professional & with the respect that my position deserves. Id love to hear administration try to explain firing you for stopping a pt from abusing an RN. What is of concern is that the RN didnt do it for herself & someone else had to speak up for her. But congrats for doing it so well & for showing the rest of them how.

[-jt]

Originally posted by Joanm:

Did anyone see Jay Leno last night? One of his "jokes" was that he had seen on CNN that there was a nursing shortage. And we can't do without nurses, because without nurses there would be no more Media movies.

hes done that more than once. Last yr he was bombarded with letters from nurses for another degrading "joke". Even THAT turned into a joke & he has merely increased his nurse "jokes" after that instead of knocking it off. On the other hand, around the same time, David Letterman featured his MDs AS WELL AS his nurses on his show & said that without nurses, he would be dead.