Be less polite to me please! (update in #22)

[TealDragon]

BG: When I go to the hospital for my treatments, the basic procedure is that I am given a cup of pills and hooked up to an IV. The stuff going through the IV makes me rather dizzy and nauseous and taking the pills beforehand makes it even worse. After the time that I actually threw up, I quit taking the pills first and now take them at the end (my doctor suggested this). It doesn't matter if I eat before or after the treatment, what is in the IV will still make me feel bad. One of the nurses suggested a light snack, like plain popcorn and fruit juice, that I can eat while it's running. For many people, just having something small to munch on helps, and it helps me almost 100%, so this is what I do now (it is noted in my chart).

Most of the nurses have worked at this hospital or another one for a matter of years and are very experienced and are sometimes more lax in their standards. Not in anything that would endanger a patient, but in letting me snack on popcorn and juice even though there's an unwritten rule about eating or drinking anything but water in the treatment room (technically because there are IVs and blood draws, it's a biohazard, but the likelihood of it actually being an issue is quite low), and letting me take my pills after the IV finishes even though the medication instructions say they should be taken prior (also, my doctor made a note in my file that I take my pills afterwards on his recommendation, so this should override their concerns). I am also very friendly with them and laugh and joke and since I've seen them so much and gotten to know them, we are able to have interesting conversations about more than just the weather.

There are a few nurses who are new. They are all students. They are pleasant enough, and I certainly don't expect them to want to be super friendly with me if that is not their personality or if they don't like me or whatever. But they are extremely formal and overly polite, to the point where I am uncomfortable and considering requesting not having these people as my nurses. All of them refer to me as  Ms. Dragon, even though I tell them every single time to please call me Teal. We're all in our early/mid-20s, so the last name thing feels very awkward. Even my 5 year old barn kids don't call me Ms. Dragon! They also insist on checking on me every 30 minutes to ask if I need anything. I understand this may be the recommended protocol, but none of the non-student nurses do this, they understand that I am a very low-maintenance patient and all I need is to sit there and eat my snack and do work on my computer since it means a lot of time out of the office and I've done this enough to know what side effects to watch out for and if I do need anything, to press the call button and they all leave me alone and check on me about once every two hours. The student nurses come in every 30 minutes (treatments are 2-6 hours) and ask if I need anything. They don't ask any medical questions, but they stay there for about 5 or so minutes and check my IV (even though this isn't necessary) and remind me that I need to take my pills and ask me to please take my pills, and I explain that my doctor has told me to wait so I don't get sick, and they always seem awkward and put off by this. They seem like they want to tell me I have to take the pills right then but are just barely managing to hold their tongues, and I feel very scolded, even though I know I'm not actually doing anything wrong. They also always try to tell me I can't eat or drink, and I tell them that I need to or else I will get sick and this has been suggested and approved by other nurses and my doctor. They have the same uncomfortable/scolding-ish reaction. I'm not sure if they are required to do all of this, and if they are, I understand that I can't ask them not to, but since I know it's not medically necessary for me, I find it irritating. I am also very uncomfortable with them not calling me by my first name despite my asking. When they come in my room, I feel like I need to sit up straight and be on my best behavior and cross my ankles the proper way for a lady and all that. They are also all kind of shy I think, which isn't a flaw, I can be too, but it comes out very awkwardly with all of them and I'm just very uncomfortable around them.

Is there any polite way to tell them it's ok to loosen up a little with me and that I prefer being left alone when possible? Or, would it be unreasonable to request the more experienced nurses, and if so, how can I do that without making the student nurses uncomfortable (I am assuming they would find out about the request) or making them look bad? As I said, they are nice people and haven't actually done anything wrong, I wouldn't be un-requesting them because they're bad nurses, but just because I really prefer the other nurses. I'd hate for them to get in any trouble with their professors/bosses over it.

edit: for emphasis, since my post wasn't clear.

[Outdoor Girl]

I would talk to their supervisors.  Not to get them in trouble but so they can learn.  If they are student nurses, they need to know better how to interact with their patients.  The fact that they are students does explain why they are sticking exactly to the book but that isn't working for you, individually, and they need to learn when they can deviate from the strict letter of the law.

I remember one nurse when my Mom was dying.  Mom was naseous and a friend of hers who was a doctor in the hospital ordered Gravol injections, which the nurse on duty at the time administered and charted.  As did every other nurse after her.  But the doctor hadn't specifically written his order in the chart and this one nurse refused to give her Gravol in a shot and would only give Mom pills, which she promptly threw up.  She was a newer nurse and was sticking to the rule book but it put my Mom in more distress than she needed to be.  She died that night.  She was going to go soon but I'm not sure that the whole Gravol debacle didn't hasten it a little.

[WillyNilly]

Level with them.  They are people.  Just tell them what you've told us.  That there's a note in your file from the Dr about your pills and that the eatting was suggested by a senior nurse.  Talk to them and react to them the way you want to be spoken to and treated.  If you get all straight-backed, formal, best behavior on them it can become a behavior loop, where they see you reacting formally so they step up the formal.

But the name thing... that I'd let go.  They might have a universal method of addressing people and if they are finding most people prefer last names, thats going to simply be their default.

[Auntie Mame]

So the complaint is that these young nurses who are trying to find their footing are too polite and professional, and that they follow the procedure?

[dharmaexpress]

I think, and I may be remembering incorrectly, that even at a teaching hospital, you can request no students.  Don't know if you'd want to do that, but I think it's fine if they're making your treatments harder rather than easier.

I think it's also fine to talk to them or the charge nurse and tell them all you've said here - if it were me in their shoes, I'd want to know.  Good opportunity to work on the bedside manner - especially with addressing you as you've requested.  As for what they are required to ask you about re: charted instructions, if you see the same nurse or two for each session, I'd tell them your situation at the beginning and then be politely but firmly dismissive about it if they bring it up again.  Basically, you are noncompliant (that's just the medical term) with the pills before rather than after, and that's your right.  You get to manage your own care at that level, and it's validated right in your chart.

Although I agree that you could be extremely patient, instructive, and accommodating to these new nurses, I think your comfort is more important if you are ill or undergoing medical treatments for any reason - you're not there specifically to train and interact with them, that's not your responsibility.  It would be great to see them give patient-centered care, not policy-dictated-hovering especially against your expressed wishes.

Edited for sense: I needed to make some. 

[CakeBeret]

I would ask a head nurse to note in your chart that you must be addressed as Teal, please leave you alone during treatments, and that they must abide by the doctor's recommendation for taking your pills afterwards.

Since these are new nurses, they are trying to err on the side of caution and cover all their bases. It might also help to tell new nurses, "I'm a regular here and I really just need to relax, so please take a look at the notes in my chart."

[Deetee]

As the nurses are trying to follow the actual procedure, it's really hard to fault them though I can see how it's annoying.

I would (if possible) talk to the student nurse at the beginning of the shift. It would be best if a head nurse could be there as well. Be friendly and mention that you have been doing this a while. Let them know that you will be taking your pills at the end of the treatment as is noted in your chart by doctor's orders (give them a chance to double check your chart). Let them know you will be having your snack during as it keeps down the naseau as was suggested by the nurses and works very well. Let them know you find this treatment easiest if you are not disturbed from your work as it provides an excellent distraction and you will call them if you need anything. Let them know not to disturb you when they check on you (I don't think that you can ask them not to check on you every half hour, but you can ask that that be a brief visit) as you enjoy some uninterupted time to work. Let them know they can call you Teal. Ask them to pass on your preferences to any other nurses who may be looking after you.

Ask if they have any questions.

The nurses sound like they really, really want to do a good job so let them. You just need to let them know what a good job looks like.

[johelenc1]

They are just doing their jobs.  And as students they are overly cautious and don't want to mess up.

I like the idea of having your preferences noted in your chart.  That will give the students permission to break protocol.  Without some kind of permission, if I was a student nurse, I would keep doing what I was supposed to do.

[Onyx_TKD]

So the complaint is that these young nurses who are trying to find their footing are too polite and professional, and that they follow the procedure?

The complaint is that the young nurses' strict adherence to protocols (both etiquette and medical) is causing them to make their patient uncomfortable and interfering with her ability to manage her own condition as recommended by her doctor and by more experienced nurses.

If this is the fault of strict rules requiring them to pressure her to take her pills at a time it will make her ill, to address her by title and surname (despite her preferences), etc., then whoever makes and enforces those rules needs to be made aware of how they are negatively affecting patients. If the problem is that the young nurses are (understandably) interpreting guidelines as hard-and-fast rules or not understanding what circumstances override the normal protocols (e.g. the doctor's recommendation overrides normal pill-taking protocol and the patient's preference overrides normal manner-of-address protocol), then whoever trains them needs to be made aware of how this is negatively affecting patients.

The young nurses aren't necessarily doing anything wrong, but somewhere between the setting of the standard protocols and their implementation by the young nurses, something in the system is causing problems for the OP's treatment. Only the people who know the system can tell what is necessary to solve this--it could be that the young nurses require more training, it could be that the OP's accommodations need to noted down officially, it could be that rules need to change, etc. However, the fact that they are currently ignoring the doctor's recommendation noted in the OP's chart suggests to me that someone above the young nurses needs to be made aware of the problem if it's going to change.

[Sharnita]

I am actually wondering if the rules have changed - to the stricter rules being followed by the younger nurses.  Maybe the older nurses, being used to a time when those weren't the rules are a bit more lax while the younger ones have just been trained int the rules and the reasons behind them and they understand what they are supposed to do and why.

[TealDragon]

As the nurses are trying to follow the actual procedure, it's really hard to fault them though I can see how it's annoying.

I would (if possible) talk to the student nurse at the beginning of the shift. It would be best if a head nurse could be there as well. Be friendly and mention that you have been doing this a while. Let them know that you will be taking your pills at the end of the treatment as is noted in your chart by doctor's orders (give them a chance to double check your chart). Let them know you will be having your snack during as it keeps down the naseau as was suggested by the nurses and works very well. Let them know you find this treatment easiest if you are not disturbed from your work as it provides an excellent distraction and you will call them if you need anything. Let them know not to disturb you when they check on you (I don't think that you can ask them not to check on you every half hour, but you can ask that that be a brief visit) as you enjoy some uninterupted time to work. Let them know they can call you Teal. Ask them to pass on your preferences to any other nurses who may be looking after you.

Ask if they have any questions.

The nurses sound like they really, really want to do a good job so let them. You just need to let them know what a good job looks like.

I'm sure in a couple of years they will be excellent nurses. They all seem very caring and interested in learning. I like this approach though. When they start everything, if I have a student nurse, one of the actual nurses always introduces them, so that would be a good time to make sure that things are clarified.

They are just doing their jobs.  And as students they are overly cautious and don't want to mess up.

I like the idea of having your preferences noted in your chart.  That will give the students permission to break protocol.  Without some kind of permission, if I was a student nurse, I would keep doing what I was supposed to do.

I know, and I don't fault them for that, if those are the rules they have to follow then the problem lies with whoever made those standards as they were clearly disconnected from the actual patients and how to balance the patient needs with the new nurses gaining knowledge. Unfortunately there are already notes in my chart about the food and drink and the pills and the student nurses are either not reading my chart or are so stuck on following what some book says that they are disregarding it, even though the notes came from my doctor and a senior nurse.

I am actually wondering if the rules have changed - to the stricter rules being followed by the younger nurses.  Maybe the older nurses, being used to a time when those weren't the rules are a bit more lax while the younger ones have just been trained int the rules and the reasons behind them and they understand what they are supposed to do and why.

I had this thought as well, but then decided it didn't quite seem to fit. The non-student nurses are not necessarily that much older, and it seems strange that there would be such drastic changes when I know some of them must have only graduated within the last few years. And the ways that the non-student nurses are different are more related to confidence and what seems to be experience. Like knowing the trick about eating popcorn and just being able to tell how hands-on they need to be with a patient without them having to spell it out. They just all seem to have the same sort of confidence while the students seem to have the same lack of confidence. Plus I just can't imagine that if the rules actually have changed so drastically, that not one single nurse (there are a ton of nurses in the department of the hospital) has been retrained or is implementing any of the new rules.

[Julian]

In my experience, treatments like the OP is undergoing have certain protocols or policies in place. 

As an example, back when I was a student nurse (around when the dinosaurs roamed) blood transfusions required full observations every 10 minutes for the whole duration, plus a certain time period afterwards.  Student nurses were taught these protocols, and were expected to follow them to the letter.  They were also expected to treat their patients in a certain manner, such as how they're addressed.  Medication charts were another very black and white area - medications to be administered prior to x event were administered then, not after. 

Importantly, student nurses themselves are monitored, not only by the experienced nurses in their particular area, but by educators / mentors / preceptors that are more specialised educators.  Failure to abide by protocols can result in disciplinary actions at that stage of their training.

More experienced nurses know, particularly after working in a specialised area long enough, when variations can and should be substituted.  It should be documented in the patient's record when these substitutions are permitted, particularly if recommended by the treating physician.  They also have had time to develop a 'bedside manner' that puts patients at ease, rather than on edge, and the experience to judge how much informality a patient prefers.  In the case of experienced patients, these nurses understand that the patients understand the treatment, and can, to a point, trust you to self-monitor, so that you will alert them to problems rather than have them hovering around watching.

OP, as suggested, you can probably request that no students be allocated to your care.  Alternatively, having an experienced patient can be a valuable learning experience for a student nurse.  Do you feel comfortable enough to talk to them about your treatment?  How it affects you?  About anything not related to your treatment?  Sometimes all it takes is a little chat with a patient for a student to start to relax a bit, to see you less as 'patient' and more as 'person'.  Once that barrier is crossed, it may be easier for the student to relax the formality somewhat.

Of course, if you don't feel comfortable with that, you're not obliged to.

[Corrina]

I would talk to their supervisors.  Not to get them in trouble but so they can learn.  If they are student nurses, they need to know better how to interact with their patients.  The fact that they are students does explain why they are sticking exactly to the book but that isn't working for you, individually, and they need to learn when they can deviate from the strict letter of the law.

I remember one nurse when my Mom was dying.  Mom was naseous and a friend of hers who was a doctor in the hospital ordered Gravol injections, which the nurse on duty at the time administered and charted.  As did every other nurse after her.  But the doctor hadn't specifically written his order in the chart and this one nurse refused to give her Gravol in a shot and would only give Mom pills, which she promptly threw up.  She was a newer nurse and was sticking to the rule book but it put my Mom in more distress than she needed to be.  She died that night.  She was going to go soon but I'm not sure that the whole Gravol debacle didn't hasten it a little.

Looks like the other nurses made a huge med error then. In order to give a med, you need to have an order in the chart, and it looks like these nurses didn't have one. A quick phone call to the doctor on call would have remedied this, but as an rn myself, of there's no order and you give a medication the wrong route, you are risking losing your license. The new nurse should have called the md for a telephone order.

[Bijou]

It appears to me that the problem is that none of the preferences you have and which have been allowed by  your doctor and the more experienced nurses has been charted so that the student nurses can read in your medical chart that you are to be called Teal, are allowed snacks, that you take your pills after the treatment and that you can dictate how often they will check on you, or something like 'check on patient every two hours instead of every half hour'.

Personally, I think it is asking too much to expect  new nurses to make allowances that are part of the stated procedure, are not in the chart and are out of their realm of authority.

I would ask for other than student nurses, if I felt as you do about it (and I do understand why you feel that way).

[hyzenthlay]

Importantly, student nurses themselves are monitored, not only by the experienced nurses in their particular area, but by educators / mentors / preceptors that are more specialised educators.  Failure to abide by protocols can result in disciplinary actions at that stage of their training.

POD POD POD

You may not like how the student nurses act, but their careers may be on the line here. I would just learn to tolerate their over-helpfullness and formality, and add a note to the chart about taking the medication after treatment.