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

[atirial]

If these student nurses can't be bothered/allowed to  even follow the dr's orders  - it would be the last time they treated me.  My comfort during a serious procedure is paramount - not their  careers...that's not the patient's job to worry about.  And honestly I would not be too happy with being addressed in a manner which I did not want to be addressed.

I agree completely. Also reporting student nurses for failing to follow a patient's notes, and endangering a patient as a result, may damage their career but puts the blame squarely where it belongs.  (Said as someone who once had to ask a nurse three times whether she'd read my notes, then buzz for a doctor when she carried on anyway. The nurse was removed and I haven't seen her again).

[ClaireC79]

That said if the doctors orders put a patient in danger and the nurse follows those orders she'll still get into trouble for it and potentially lose her license - standing in coroners court saying 'the doctor told me to do it' isn't going to work as a defense

[snowdragon]

That said if the doctors orders put a patient in danger and the nurse follows those orders she'll still get into trouble for it and potentially lose her license - standing in coroners court saying 'the doctor told me to do it' isn't going to work as a defense

  Which is why these nurses should not be working with this patient and the patient needs not to worry about what is best for the student nurses. The nurses are not trained as dr's they have less experience and no authority to over ride what the dr says to do. If they can't handle or don't want to listen to the dr's orders the patient should not have to suffer for it.
  We've had nurses chime in on this thread - none of them said what the dr is ordering is dangerous. Even if it was the student nurse's responsibility is to go to their superior and have her take it up with the dr/dr's superior, NOT to over ride things in the chart on their own. If I were the OP I would not allow anymore student nurses to treat me. Heck, I am not even undergoing any significant issues and I won't let student nurses or dr's in residency or "rotation" training treat me...it's the patients right to have the people they want treating them and if that impacts someone's career, it's not the patient who needs to worry about it.

[happygrrl]

Maybe I just missed it, but what exactly did the student nurse do that endangered the patient? The only issue I see is that they asked (repeatedly, unfortunately), if the patient wanted their meds during tx, not after. Did I misunderstnd someting? J/C.

[Sharnita]

Maybe I just missed it, but what exactly did the student nurse do that endangered the patient? The only issue I see is that they asked (repeatedly, unfortunately), if the patient wanted their meds during tx, not after. Did I misunderstnd someting? J/C.

Called her by her more formal name (not a threat), checked on her more often than she would like (not a threat), the food thing seems like a problem because of OP's tendency to get sick but is following protocols.

I think that a problem is that when a nurse/doctor doesn't follow follow protocols, even when the patients are OK with it - in fact even when they wish it, the hospital or insurance company can still dump them as being too dangerous because they are the type to go rogue.

[Auntie Mame]

I am seeing both sides of this issue now.  On one hand, we have a patient who deserves to have a comfortable, safe environment to heal.  On the other hand we have student nurses who have to follow certain rules or they lose their livelihood.  It's a catch 22 and not ideal for anyone.

Perhaps a compromise.  Less student nurses on the end of the hospital, and you overlooking some of things they have to do. 

Talk to your primary care provider and see if a solution can be found.

[TealDragon]

As a 3 month old RN, I can understand your aggravation, but let me see if I can explain this from the student nurse' perspective.

OMMV, but at my college, we.were.told.to.follow.specific.patient.protocol. These were set by the college/facility, and were completely non-negotible. Completely. Failure to follow them could you dismissed from the program. They weren't kidding. They applied to any level student at any clinical facility. Period. Alll of our clinical classes were limited to 10 students and on RN instructor. Unlike other school, we didn't go the night before and be assigned our patient. We got them the morning we got to the hospital, and no one, including the intructor, was intimately familiar with the patient. Or the staff. So, we would meet, get our assignments, read the chart (as much as we could), and off we go for the day.

One of the things we were taught was to call the patient by Title. Lastname. Even if we were told by the patient to call them by their first name. I had to explain several times that due to my program requirements, I had to call them Mr. Doe, and that I wasn't trying to be deliberately rude by ignoring their requests. (Honestly, you could be expelled from the program for this; not that it was life or death, obviously, but it had to do with following orders---kinda like making a bed in the Army. Make sense?) We were also told that ***we*** needed to follow all facility protocol, even if the staff wasn't. So, just becasue the staff RN didn't check on the patient every hour, we needed to. No, wait---we had to. For example, if
I hung blood, I had to stay in the patient's room for 15 minutes to monitor for any reactions. No exceptions, no excuses.

Now that I'm experienced (haha!), I do have the freedom to call you Mary, if that's what you perfer. I can just stick my head in the room and take a peek to see if you're OK. If the dr has odered your meds to be given XXX, then yep, that's what you're gonna get. But not as a student nurse. We could not.

My heart felt suggestion from a not-to-long-ago- student nurse; request that they aren't assigned to you. I think it would make your treatment better for you, and quite frankly, it would probably take some stress off of them. (We had to answer to our intructors for any infractions, and I'd hate to see them get in trouble only because they were following non-negotible orders and protecting their student position. Students were kicked out for seemingly inane actions--none that endangered the patients lives, but yet they failed to follow protocol. Again, kinda like the Army. )

Thank you for this perspective, it was very interesting and informative. It also helps me feel less guilty about requesting not to have them. I wouldn't want for them to find out and think it's because I think they're awful or something. I also think maybe I will mention this to the woman who is the director of nursing at the hospital/university. Maybe she can't do anything, but I just think it's terrible that one of these kids could be kicked out for following a direction from a senior nurse about something that's best for the patient just because it doesn't follow protocol.

That is exactly what I expected.  I think it would be kinder to ask not to have a student then to put them between a rock and a hard place.

I'm not sure why you think I'd want to do something like that? I said quite clearly in my last post "...even if they can't stop following the rules, maybe there's some sort of compromise, like quietly sticking their head in the door and I can give a thumbs up or something if all is well. If after a couple of tries, it's still not working out, I'll go ahead and request no student nurses."

I just want to point out that if you complain about the student nurses for following floor protocol and mention that the veteran nurses are not following the same policies, you may get the veteran nurses in trouble.  I'm a nurse and on my floor, the nurses got in trouble after a patient complained about the student nurses checking on him every hour.  Our manager decided that if he was only complaining about the student nurses, it meant the we (the floor nurses) were not doing our jobs and not doing our hourly rounds.  We were marked off on our evaluations and we all got less points, which resulted in much smaller raises.  Just something to think about.

I think if you have talked directly to the student nurses and there is no change, you should request no student nurses.

Thanks, I hadn't considered this. I will make sure when I mention this that my complaints are focused on the changeable issues or protocol in general and not the individuals.

That said if the doctors orders put a patient in danger and the nurse follows those orders she'll still get into trouble for it and potentially lose her license - standing in coroners court saying 'the doctor told me to do it' isn't going to work as a defense

I'm at an excellent hospital and I am very confident in my doctors' expertise that they would not endanger me in such a silly way. Also, I don't think that we should take this into the territory of debating how a lawsuit would play out. I don't really want to get the thread closed over it, and given the nuances of such a complicated hypothetical case, I don't think there would be any way to really accurately debate that anyway.

Maybe I just missed it, but what exactly did the student nurse do that endangered the patient? The only issue I see is that they asked (repeatedly, unfortunately), if the patient wanted their meds during tx, not after. Did I misunderstnd someting? J/C.

Called her by her more formal name (not a threat), checked on her more often than she would like (not a threat), the food thing seems like a problem because of OP's tendency to get sick but is following protocols.

I think that a problem is that when a nurse/doctor doesn't follow follow protocols, even when the patients are OK with it - in fact even when they wish it, the hospital or insurance company can still dump them as being too dangerous because they are the type to go rogue.

The potentially threatening things would be eating during treatment because it's a room with IVs and multiple patients behind curtains and therefore the potential for bodily fluids to come into contact with the food/drink, although since they are so on top of it when it comes to making sure bodily fluids don't get anywhere they shouldn't, very thorough in cleaning up if they do, thoroughly clean the beds/"rooms" between each patient, and since I know better than to eat while there is any blood or medicine actually out and I'm very careful when eating there, the risk is minimized. However it is, as far as I have been told, not a rule, but very very very strongly recommended. The other potentially threatening thing would be their insistence that I take my pills at the beginning, even though that makes me sick. The food was ordered by a senior nurse and approved by my doctor, and the pills at the end was ordered by my doctor, and there are notes in my chart about these things, so by ignoring/pushing against them, they are directly disobeying a doctor's orders to the detriment of the patient, and putting me in the middle of it.

The rest are simply my preferences, however I included them in my first post because I wasn't sure how to handle them, as they are the true matters of etiquette here. However, since we don't actually know what the exact rules for the RNs are at the hospital and they seem to be very competent and safe and responsible in every other way, I think it would be best not to assume that they are all breaking the rules all the time and on the verge of going rogue.

[ClaireC79]

I was not referring to this particular case, it was the 'nurses take their orders from the doctors' and implying if the doctor had said one thing the nurse(s) had to do it

[Jules1980]

Honestly, it is not the OP's responsibility to conform to the student nurses protocols - it's her responsibility to follow the protocols that her Dr has set up and approved for her. I believe that Nurse take their orders for patient care from the Dr's, even if they are experienced.
 If these student nurses can't be bothered/allowed to  even follow the dr's orders  - it would be the last time they treated me.  My comfort during a serious procedure is paramount - not their  careers...that's not the patient's job to worry about.  And honestly I would not be too happy with being addressed in a manner which I did not want to be addressed.
  If they have to be in the room, I don't have to be chatty with them, I don't have to do with them at all and I would go on with reading or crafting or sleeping - if they continued to talk or ask questions after I told them to be quite - again I would be requesting they never return. If it reflects badly on them - it should.
  The nurses evaluations student or not are not the patient's issues to worry about. and it's wrong to lay that on the shoulder's of another person.

Yes, they should be following the dr's protocol about the pills and the snack, but everything else is just something to let go of.  They have to refer to you as Mrs. Lastname.  In school they are told that you are the patient, not their friend, not their honey, darling, or dear, just Mrs. Last name.  It is a way of showing respect and even though you've asked to be called by your first name, they may not feel they can.  After all, if their supervisor heard them call you  Firstname and didn't know you'd requested it, or forgotten that you had, they get a bad review.  Its the same with checks.  WHen I worked on the surgery floor, it was standard procedure to get vital signs every 2-4- or 6 hours depending on how far our from surgery you were and to open the door and just physically check on patients every 2 hours.  Even at night.  And the only way around this was to have the patient sign a form saying that they didn't want checks but every X hours or only when they called and post it on the door.  No sign on the door, you went in regardless.  This was just to make sure no one had tried to get and fallen, but their treatment area may have a similar rule for some reason. 

[gmatoy]

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 like the suggests given here. I think they would work and will remember some of the things you've suggested in my, much less invasive, medical procedures.

[Deetee]

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.

For these, I suggest you look at the nurse and say very clearly. "I know you have been taught that these pills are given before treatment. Now would you please look at my chart and read what the doctor has ordered about my pills"....(WAIT for them to read it )......."I will be taking my pills after my treatment is fully complete. If you have any concerns about that please bring that up with the doctor who has prescribed my treatment, not myself"

I think I didn't read carefully enough or didn't really understand before, but it sounds like these student nurses are not just hovering and following orders, they are actually making mistakes. From my understanding (nurses please correct me if I am wrong), there is a default protocol for medicines (in this case "take pills first") but this is entirely overridden by the doctor's orders on the chart ("take pills after"). So they are not just annoying, they are dangerous.

The idea that they are hovering and badgering you to go against doctor's orders is not just annoying, it's incredibly poor patient care.

Please bring this up with someone.

[O'Dell]

From the OP:  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 think you've gotten a lot of good advice on how to handle the student nurse situation already. I just wanted to address this bit.

It seems to be like you have your own issues that are complicating this situation. If I read you right, they aren't *saying* anything to you. They aren't badgering or scolding you. They remain silent or "bite their tongues" as you put it. So what are they actually doing? I'm guessing they maybe frown or look troubled? They could just be mulling it over and wondering how to work that into their methods or to ask questions of their instructors or mentors later.

That you take silence as "scolding" or "badgering" is likely due to your own emotional baggage. It doesn't sound like they are having an etiquette or work fail here. Whatever you decide to do about the student nurses, I think you need to cultivate more of an attitude of being an equal partner in your health care. That goes for all the nurses, student or otherwise, and doctors and techs, etc. That means you might have to brush off odd or negative reactions on their part or step up and advocate for yourself if needed. It sounds like you do advocate for yourself but then feel bad, when you have no reason to.

[snowdragon]

Honestly, it is not the OP's responsibility to conform to the student nurses protocols - it's her responsibility to follow the protocols that her Dr has set up and approved for her. I believe that Nurse take their orders for patient care from the Dr's, even if they are experienced.
 If these student nurses can't be bothered/allowed to  even follow the dr's orders  - it would be the last time they treated me.  My comfort during a serious procedure is paramount - not their  careers...that's not the patient's job to worry about.  And honestly I would not be too happy with being addressed in a manner which I did not want to be addressed.
  If they have to be in the room, I don't have to be chatty with them, I don't have to do with them at all and I would go on with reading or crafting or sleeping - if they continued to talk or ask questions after I told them to be quite - again I would be requesting they never return. If it reflects badly on them - it should.
  The nurses evaluations student or not are not the patient's issues to worry about. and it's wrong to lay that on the shoulder's of another person.

Yes, they should be following the dr's protocol about the pills and the snack, but everything else is just something to let go of.  They have to refer to you as Mrs. Lastname.  In school they are told that you are the patient, not their friend, not their honey, darling, or dear, just Mrs. Last name.  It is a way of showing respect and even though you've asked to be called by your first name, they may not feel they can.  After all, if their supervisor heard them call you  Firstname and didn't know you'd requested it, or forgotten that you had, they get a bad review.  Its the same with checks.  WHen I worked on the surgery floor, it was standard procedure to get vital signs every 2-4- or 6 hours depending on how far our from surgery you were and to open the door and just physically check on patients every 2 hours.  Even at night.  And the only way around this was to have the patient sign a form saying that they didn't want checks but every X hours or only when they called and post it on the door.  No sign on the door, you went in regardless.  This was just to make sure no one had tried to get and fallen, but their treatment area may have a similar rule for some reason.

  This is why the OP should be absolutely free to request no students. She needs to be comfortable at this time, not getting "respect" that smacks of disrespect to her or anything else. If the student nurse has to do something that the OP does not want or like - away with the student nurse. The student nurse's "need" does not out weigh the OP's. And frankly I would stop answering them if the refused to call me as I told them I wanted to be called.   If the want to check IV's, scold or talk about whatever, they can do it on their time, not mine, I'd put headphones on and ignore anyone who I did not wish to deal with. And I would not worry about how my not wanting any student nurses would affect anyone of them.  I don't believe that if someone says no student anyone - that it can be held against one student or anyother.

[Onyx_TKD]

From the OP:  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 think you've gotten a lot of good advice on how to handle the student nurse situation already. I just wanted to address this bit.

It seems to be like you have your own issues that are complicating this situation. If I read you right, they aren't *saying* anything to you. They aren't badgering or scolding you. They remain silent or "bite their tongues" as you put it. So what are they actually doing? I'm guessing they maybe frown or look troubled? They could just be mulling it over and wondering how to work that into their methods or to ask questions of their instructors or mentors later.

That you take silence as "scolding" or "badgering" is likely due to your own emotional baggage. It doesn't sound like they are having an etiquette or work fail here. Whatever you decide to do about the student nurses, I think you need to cultivate more of an attitude of being an equal partner in your health care. That goes for all the nurses, student or otherwise, and doctors and techs, etc. That means you might have to brush off odd or negative reactions on their part or step up and advocate for yourself if needed. It sounds like you do advocate for yourself but then feel bad, when you have no reason to.

The OP said that the student nurses come to check on her every 30 minutes during a 2-6 hour treatment (i.e., they see her 4-12 times per treatment). The part you quoted was her description of what they do during these checks. The OP did not explicitly say whether this question-and-answer happens during every check, but it sounded to me like they are "reminding" her to take her pills every time*, and having to be reminded every time that her doctor's orders written in her chart are to take the pills after treatment. If this is the case, then IMO they are definitely badgering her and is totally inappropriate. Even if they only ask once per check-in, that means they're "reminding" her to violate her doctor's orders 4-12 times per treatment. This strikes me as a very serious concern--the OP is confident in her knowledge of her own treatment plan and assertive in following it despite their comments, but what if she wasn't? The students' position as medical caregivers puts them in a position of authority, despite their inexperience. If they repeatedly instruct a patient to ignore their doctor's orders, someday they're going to get a patient who obeys their instructions because they assume the "nurse" knows better than they do (I know they're still students, not nurses yet, but I'm talking about they may be viewed by the patient). When that happens, I sincerely hope that nausea is the worst consequence.

*It's possible the OP meant they prompt her to take her pills at the beginning of the treatment or during the first check, which seems more reasonable (although I wonder why they haven't checked the chart and seen the doctor's orders for themselves already), but the phrasing of the OP suggested to me that the questioning was repeated multiple times during the same treatment and part of the reason the frequent checks were so annoying to her.

[O'Dell]

From the OP:  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 think you've gotten a lot of good advice on how to handle the student nurse situation already. I just wanted to address this bit.

It seems to be like you have your own issues that are complicating this situation. If I read you right, they aren't *saying* anything to you. They aren't badgering or scolding you. They remain silent or "bite their tongues" as you put it. So what are they actually doing? I'm guessing they maybe frown or look troubled? They could just be mulling it over and wondering how to work that into their methods or to ask questions of their instructors or mentors later.

That you take silence as "scolding" or "badgering" is likely due to your own emotional baggage. It doesn't sound like they are having an etiquette or work fail here. Whatever you decide to do about the student nurses, I think you need to cultivate more of an attitude of being an equal partner in your health care. That goes for all the nurses, student or otherwise, and doctors and techs, etc. That means you might have to brush off odd or negative reactions on their part or step up and advocate for yourself if needed. It sounds like you do advocate for yourself but then feel bad, when you have no reason to.

The OP said that the student nurses come to check on her every 30 minutes during a 2-6 hour treatment (i.e., they see her 4-12 times per treatment). The part you quoted was her description of what they do during these checks. The OP did not explicitly say whether this question-and-answer happens during every check, but it sounded to me like they are "reminding" her to take her pills every time*, and having to be reminded every time that her doctor's orders written in her chart are to take the pills after treatment. If this is the case, then IMO they are definitely badgering her and is totally inappropriate. Even if they only ask once per check-in, that means they're "reminding" her to violate her doctor's orders 4-12 times per treatment. This strikes me as a very serious concern--the OP is confident in her knowledge of her own treatment plan and assertive in following it despite their comments, but what if she wasn't? The students' position as medical caregivers puts them in a position of authority, despite their inexperience. If they repeatedly instruct a patient to ignore their doctor's orders, someday they're going to get a patient who obeys their instructions because they assume the "nurse" knows better than they do (I know they're still students, not nurses yet, but I'm talking about they may be viewed by the patient). When that happens, I sincerely hope that nausea is the worst consequence.

*It's possible the OP meant they prompt her to take her pills at the beginning of the treatment or during the first check, which seems more reasonable (although I wonder why they haven't checked the chart and seen the doctor's orders for themselves already), but the phrasing of the OP suggested to me that the questioning was repeated multiple times during the same treatment and part of the reason the frequent checks were so annoying to her.

I read it as once during the session. Maybe the OP can clarify. My comment still stands as far as feeling scolded due to a facial expression. Maybe if every student nurse is pursing her/his lips and a more condescending type look, but I find that doubtful that they are all doing it every time. (I'm not sure how to describe that look...it's not one I run into often.)