The Culture of Nursing

kristiemiller1969 · Feb 12, 2014

That LPN's are not nurse's! I was an LPN for 20 years before I finally took my RN boards (being a RN was an achievement of mine since junior high). I can't tell you how many times either myself or other LPN's were told "I need to speak to a REAL nurse". Well what am I?? Also, this BS that LPN's can't do assessments. What do you think "data collection is"? Same thing, just worded differently. LPN's do the same job as a RN (sometimes better). There were times as a LPN in Florida, in a nursing home/rehab, when I was doing 5 admissions assessments, pass medications, do treatments, monthly summaries, insert an IV (if one was ordered) AND start the IV medication (we just couldn't add medications to the bag) and HAND CHART on 30 residents while the RN's on sub-acute with 15 resident's each were complaining about their workload (these were the ones who were last in and first out each shift). I LOVED every minute of it in that nursing home in Florida as an LPN and I wouldn't have traded a minute of it!!!!

Cuddleswithpuddles · Feb 12, 2014

Thank you! I actually left the hospital to only focus on graduate school. It felt like a Burger King drive thru where everyone could "Have it your way"

Yes, I am continuously flabbergasted by patients and families who are dumbfounded that they cannot have everything they wish for when they come to the hospital whether it be a perfectly pain-free state, a totally private room with a view, nothing invasive or icky (but keep me healthy!), great food to order etc. etc.

I also wish that nursing higher-ups would stand up for individual nurses who do draw the line and basically tell such patients and families that, no, what you are asking for is unreasonable. One can be perfectly respectful but be frank and honest. Some managers are under too much pressure from HCHAPS and the like to keep a united front. Squeaky wheel ends up getting the grease, whether it really needed it or not.

I was shocked, SHOCKED, when a manager of the new unit I transferred to actually defended me when a patient had an unfounded complaint about me being "too calm." Not really sure what the patient wanted out of me. Hysterics? Dramatic strobe lights? Passionate invocations for Jesus to HEAL, HEAL!? I don't know! But, basically, my manager talked to the family but took my side. This has not been my usual experience in the past so I was pleasantly surprised.

Ruby Vee, BSN · Feb 12, 2014

I would like to turn back the tide on the trend of nursing-as-customer-service.
Kindness, basic courtesy and attentiveness are to be expected, of course. But when nurses are graded on how well they rattle off customer service lines, are expected to see and care for patients based on standards to appease the public instead of on physiological needs, when nurses can be punished for daring to upset a patient or family with the truth... I call foul

Thank you. The customer service mentality has set patient care back a good bit.

1fastRN · Feb 12, 2014

Nurses who eat their young.... Ive actually only heard older nurses say this. As a young nurse this hasnt been the case. It is more so that ive had to "prove myself" to other nurses, docs, and techs. But that kinda goes with any job as a newcomer. But im not cocky either...so being humble probably helps.

And yes, the whole no food, no bathroom breaks, and working nonstop for 12+ hours thing isnt cool. I lost 25 lbs unintentionally (i wasnt overweight) in a couple months due to running around for a full shift and MAYBE getting 300calories in. Not to mention the lovely UTIs. Its not safe for patient care either since i can feel myself getting "fuzzy" bc i need to eat and have a few minutes to myself. One night i picked up my head after starting an IV and got tunnel vision.....almost fell over. Checked my BS for kicks and it was 33 (i have a hx of hypoglycemia). Definitely not ideal. Not trying to be a patient in my own ER!!!

And the nurses who forget what nursing is about...,burnt out or just cold. No empathy, walk into a room and dont even explain anything to the pt. Set up for an IV while barely giving the pt a heads up. Or the ones who let their CP pt sit there thinking their having a heart attack with no feedback on the ekg. Even techs who bust in the room, espose the pt, and start putting ekg leads on while barely saying a word....yeesh.

PHXRN1 · Feb 13, 2014

Yes I am continuously flabbergasted by patients and families who are dumbfounded that they cannot have everything they wish for when they come to the hospital whether it be a perfectly pain-free state, a totally private room with a view, nothing invasive or icky (but keep me healthy!), great food to order etc. etc. I also wish that nursing higher-ups would stand up for individual nurses who do draw the line and basically tell such patients and families that, no, what you are asking for is unreasonable. One can be perfectly respectful but be frank and honest. Some managers are under too much pressure from HCHAPS and the like to keep a united front. Squeaky wheel ends up getting the grease, whether it really needed it or not. I was shocked, SHOCKED, when a manager of the new unit I transferred to actually defended me when a patient had an unfounded complaint about me being "too calm." Not really sure what the patient wanted out of me. Hysterics? Dramatic strobe lights? Passionate invocations for Jesus to HEAL, HEAL!? I don't know! But, basically, my manager talked to the family but took my side. This has not been my usual experience in the past so I was pleasantly surprised.[/quote']
Jesus jumping Christ! I find it impossible to believe that any of you who spout off nonsense like this have actually read the HCAHPS questions.
Like it or not, a significant portion of what we do is service oriented. Getting the patient better and not being a jackass about it is the absolute bare minimum expectation of your role.
"Oh no, they're making me being really nice to my patient. Those *******s! If this madness doesn't stop, the next thing you know they're going to make us teach our patient about their discharge medications in a way that they can understand!"
If you can't pull your head out of your ass long enough to figure out how to verbally de-escalate a tough situation or set a reasonable expectation with the patient for their pain, find a new gig.
So to answer the original question in this thread, THIS... This is what I would change about our profession. Eliminating the abject ignorance surrounding the role of customer service in patient care.
/end rant

allnurses Guide · Feb 13, 2014

Jesus jumping Christ! I find it impossible to believe that any of you who spout off nonsense like this have actually read the HCAHPS questions.
Like it or not, a significant portion of what we do is service oriented. Getting the patient better and not being a jackass about it is the absolute bare minimum expectation of your role.
"Oh no, they're making me being really nice to my patient. Those *******s! If this madness doesn't stop, the next thing you know they're going to make us teach our patient about their discharge medications in a way that they can understand!"
If you can't pull your head out of your ass long enough to figure out how to verbally de-escalate a tough situation or set a reasonable expectation with the patient for their pain, find a new gig.
So to answer the original question in this thread, THIS... This is what I would change about our profession. Eliminating the abject ignorance surrounding the role of customer service in patient care.
/end rant

That is interesting! I think you have a good point.

whichone'spink, BSN, RN · Feb 13, 2014

I want nurse managers to not wear business casual. I want them to wear scrubs. More so, I want them to get out of the office and get out on the floor.

Wile E Coyote, ASN, RN · Feb 13, 2014

Jesus jumping Christ! I find it impossible to believe that any of you who spout off nonsense like this have actually read the HCAHPS questions.
Like it or not, a significant portion of what we do is service oriented. Getting the patient better and not being a jackass about it is the absolute bare minimum expectation of your role.
"Oh no, they're making me being really nice to my patient. Those *******s! If this madness doesn't stop, the next thing you know they're going to make us teach our patient about their discharge medications in a way that they can understand!"
If you can't pull your head out of your ass long enough to figure out how to verbally de-escalate a tough situation or set a reasonable expectation with the patient for their pain, find a new gig.
So to answer the original question in this thread, THIS... This is what I would change about our profession. Eliminating the abject ignorance surrounding the role of customer service in patient care.
/end rant

You are making an interesting argument, but I think you picked the wrong post as a jumping off point. The OP's example of a complaint about being "too calm" is a polar opposite of your "complaining because they're making us be really nice to the patients".

Cuddleswithpuddles · Feb 13, 2014

To PHXRN1,

I think there is a happy medium between my rant and your post.

HCAHPS questions are actually very reasonable. They are all very worthy goals. Every month we get a breakdown of our hospital's scores in every specific question. These breakdowns allow us to see where we can improve on. My ICU was dinged on being very noisy at night and, yeah, that is totally valid.

Unfortunately, many of my past managers on many occasions have put scores, scores, scores! on a pedestal and have approached patient complaints as potential threats to said scores with little consideration for what really happened or if the complaints even have anything to do with HCAHPS' concerns.

I can understand their fears. It is a very real tendency of people who answer polls to skew their responses towards their overall impression. A patient or family who had a very bad experience is unlikely to give the hospital credit for the little things. Conversely, people who have had a fantastic experience are willing to overlook some faults.

I can see why managers want to smooth all patient-staff conflicts so that HCAHPS scores will be better. But I am still disappointed at the increasing number of unreasonable patient complaints that are given credence. Even after exhaustive patient teaching (whether it be on pain goals, non-pharmacological techniques for pain relief, their dietary restrictions etc.), different staffing, accommodations that they normally would not get, talks with higher ups, some people simply cannot be pleased. And the number of such people seems to be on the rise.

Here.I.Stand, BSN, RN · Feb 13, 2014

Oh I do!!! Sure if someone is coding I'll suck it up, and I don't typically take 15-minute breaks...just a lunch in an 8-hour shift. But I'm breastfeeding a baby, and if they ain't crumping, this mama's pumping! I also refuse to dehydrate, get hypoglycemic, or hold bodily waste.

I really don't care if my coworkers like it or "understand," (although I have to say this is not an issue w/ my current colleagues. They're fabulous!). Not my problem. Likewise I want them to take care of their basic needs, and will gladly watch their pt's.

In the past, if someone summoned me for my pt's routine nurse requests, I've responded "I'm at lunch, but Nurse A is covering my pts." Now I work nocs in an ICU so our surroundings are such that we know exactly who is on break, and only call each other if we have a question or of course if it's an emergency. Likewise, I have called the MD for issues that came up w/ their pt right after they left--stuff that was not immediately life-threatening but shouldn't wait 1/2 hour either.

Nurses should be able to take potty breaks and full meal periods without being pressured to cut the breaks short by management / coworkers.
Seriously, this is one of the few so-called 'professions' where educated women still run around with a full bladder and empty stomach for an entire shift. If don't respect our own bodies by meeting our basic needs for hydration and elimination, how do we expect others to respect us?