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

[Giggity]

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.)

Life would be a lot easier if people would deal in what is said or done, not how they think someone is looking at them. I've said before here, and recently, that that might not be a nasty look - that might just be someone's face. Why judge on zero evidence?

[TealDragon]

Sorry for not being more clear in the OP.

They are coming in every half hour, which is 4-12 times per treatment. Each time they come in, they narrate what they're doing ("Hi, I'm Becky, I'm going to check your IV. I'm checking to make sure the line isn't tangled/there's no air/the fluid is moving through properly/etc" But the IV machine will beep loudly at the slightest provocation and doesn't really need to be checked this way). They ask how I'm doing, which I think is a fair question, as I can easily see that being required or a situation where a patient does not/can not otherwise inform them of a problem, and then they start asking chatty questions, like what I'm working on or what I'm reading or where my DF is (he stays with me on short days but I'm not going to ask anyone to stay for the long treatments) or about the weather, just inane small talk kind of stuff. Because of how often they come in, this really starts to get overwhelming.

As for the pills, they hand them to me at the beginning when I get hooked up and settled in. When they come on their first check they remind me that I need to take them and I tell them that my doctor has told me to take them at the end so I don't get sick and there should be a note in my chart. On the next check, they point out that I still haven't taken my pills and I say the same thing about the doctor and the note. By the third or fourth check, they ask me to please take the pills so they don't get in trouble (I find this worrisome that they have to almost beg patients to do something that will affect them negatively even against a doctor's orders to avoid getting in trouble) and after that they usually stop saying anything about it but will look at the cup of pills and back and me and look really worried or might say "Hmm". Given what happens before this, I don't think this is my "emotional baggage" but probably more a silent wish on their part that I would just take the pills. So yes, it is a slightly scolded feeling because it's very obvious that they want me to take them and I'm not going to do it and they don't like that. It is also aggravating to go through the same interaction multiple times.

But, as I said in post #22, I do have what I feel is a good plan for moving forward. While I appreciate your concern, I really don't feel as if I'm letting "emotional baggage" get in the way of my health or that I'm not being a good patient just because I had concerns about dealing with three specific student nurses. I have no problems with any other nurses and I am quite capable of advocating for myself and working with my healthcare team and interacting with people in a normal manner. The only things that I've said I'd feel bad about are if the student nurses were to be punished for something when they didn't really do anything wrong or if they were to find out that I requested not to have them and felt it was a personal thing.

[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.

  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.

I agree, she can request no students.  In fact, it seems like that's what she needs to do.  However, her wants do not override hospital safety policies (checks) without express orders from the Doctor.  So far the only notes on her chart are to allow her a snack and to take her pills later.   Also, they may just be forgetting call her by her first name.  If you see 40-50 patients a week through a treatment area, you forget which ones want to be addressed formally/casually.

[Jules1980]

Sorry for not being more clear in the OP.

They are coming in every half hour, which is 4-12 times per treatment. Each time they come in, they narrate what they're doing ("Hi, I'm Becky, I'm going to check your IV. I'm checking to make sure the line isn't tangled/there's no air/the fluid is moving through properly/etc" But the IV machine will beep loudly at the slightest provocation and doesn't really need to be checked this way). They ask how I'm doing, which I think is a fair question, as I can easily see that being required or a situation where a patient does not/can not otherwise inform them of a problem, and then they start asking chatty questions, like what I'm working on or what I'm reading or where my DF is (he stays with me on short days but I'm not going to ask anyone to stay for the long treatments) or about the weather, just inane small talk kind of stuff. Because of how often they come in, this really starts to get overwhelming.

As for the pills, they hand them to me at the beginning when I get hooked up and settled in. When they come on their first check they remind me that I need to take them and I tell them that my doctor has told me to take them at the end so I don't get sick and there should be a note in my chart. On the next check, they point out that I still haven't taken my pills and I say the same thing about the doctor and the note. By the third or fourth check, they ask me to please take the pills so they don't get in trouble (I find this worrisome that they have to almost beg patients to do something that will affect them negatively even against a doctor's orders to avoid getting in trouble) and after that they usually stop saying anything about it but will look at the cup of pills and back and me and look really worried or might say "Hmm". Given what happens before this, I don't think this is my "emotional baggage" but probably more a silent wish on their part that I would just take the pills. So yes, it is a slightly scolded feeling because it's very obvious that they want me to take them and I'm not going to do it and they don't like that. It is also aggravating to go through the same interaction multiple times.

But, as I said in post #22, I do have what I feel is a good plan for moving forward. While I appreciate your concern, I really don't feel as if I'm letting "emotional baggage" get in the way of my health or that I'm not being a good patient just because I had concerns about dealing with three specific student nurses. I have no problems with any other nurses and I am quite capable of advocating for myself and working with my healthcare team and interacting with people in a normal manner. The only things that I've said I'd feel bad about are if the student nurses were to be punished for something when they didn't really do anything wrong or if they were to find out that I requested not to have them and felt it was a personal thing.

I do have to say, about the introducing themselves and narrating what they are doing, you don't have to answer.  They probably have to narrate exactly what they are doing by law.  State law where I am says that you must ask every patient's name and clearly explain the procedure before doing anything to the patient to make sure you have the right patient.  Most nurses I know don't really expect you to respond to anything but the 'Are you Mrs. Dragon?' and "Are you doing okay?' questions.  Esspecially if you are a regular patient.  Most of them are on autopilot when they explain the procedures anyway.  Especially after the 10th time. 

[TealDragon]

Good to know.

And to be clear, I am not absolutely not expecting them to change/ignore hospital or school policies. In giving them another couple of chances, as I intend to do, I will either ignore the simple preferences or see if there can be a compromise (Stick their heads in and get a thumbs up to check on me, let them know I'm going to continue to focus on my book or work because breaking focus creates difficulty sometimes and they can talk to themselves in the background, wearing headphones to indicate that I'm not up for chatting, etc. Nothing that asks them to break the rules.).

[Judah]

As for the pills, they hand them to me at the beginning when I get hooked up and settled in. (*)When they come on their first check they remind me that I need to take them and I tell them that my doctor has told me to take them at the end so I don't get sick and there should be a note in my chart.(**) On the next check, they point out that I still haven't taken my pills and I say the same thing about the doctor and the note. By the third or fourth check, they ask me to please take the pills so they don't get in trouble (I find this worrisome that they have to almost beg patients to do something that will affect them negatively even against a doctor's orders to avoid getting in trouble) and after that they usually stop saying anything about it but will look at the cup of pills and back and me and look really worried or might say "Hmm". Given what happens before this, I don't think this is my "emotional baggage" but probably more a silent wish on their part that I would just take the pills. So yes, it is a slightly scolded feeling because it's very obvious that they want me to take them and I'm not going to do it and they don't like that. It is also aggravating to go through the same interaction multiple times.

The pill thing would really bother me.  * At this point I would be very clear. As they hand me the  pills, I would say, "The doctor has made a note in my chart. He wants me to take the pills after the treatment."

 **The second time I would simply ask, "Have you familiarized yourself with my chart yet? I won't be going against my doctors orders." And I would repeat that every subsequent time they said anything about the pills.

[Onyx_TKD]

As for the pills, they hand them to me at the beginning when I get hooked up and settled in. When they come on their first check they remind me that I need to take them and I tell them that my doctor has told me to take them at the end so I don't get sick and there should be a note in my chart. On the next check, they point out that I still haven't taken my pills and I say the same thing about the doctor and the note. By the third or fourth check, they ask me to please take the pills so they don't get in trouble (I find this worrisome that they have to almost beg patients to do something that will affect them negatively even against a doctor's orders to avoid getting in trouble) and after that they usually stop saying anything about it but will look at the cup of pills and back and me and look really worried or might say "Hmm". Given what happens before this, I don't think this is my "emotional baggage" but probably more a silent wish on their part that I would just take the pills. So yes, it is a slightly scolded feeling because it's very obvious that they want me to take them and I'm not going to do it and they don't like that. It is also aggravating to go through the same interaction multiple times.

The bolded sounds like there's a huge problem with either the policies or the way the students are trained. They're seriously asking a patient to do something that will make her ill, which her goes against the doctor's formally noted orders, because they're afraid they'll get in trouble? If they think they'll get in trouble for following the doctor's orders written in the chart (or more accurately, for allowing the patient to follow her doctor's orders), then surely the proper course of action is to find someone who can treat the patient properly without getting in trouble rather than trying to change the patient's treatment and talk her into do something she knows will make her physically ill?  That is horrifying. If it's the actual policy of the hospital that students will get in trouble for following the doctors' instructions on the chart (rather than getting in trouble for trying to change the patient's treatment plan without checking with anyone, which seems by far the greater offense), then what the heck were the policy-makers thinking?! If it's the students' misunderstanding of policy, then I think they need to seriously revamp how they teach the policies.

[ClaireC79]

There is (at least in the UK I'm sure there is in the US too) a code for them to put onto the drug chart to say patient declined/refused - all they need to do is write that code on then write the time it is taken next to it*

(*is it possible that it causes an issue because the drugs are at the bedside and have the potential to be taken by someone else/lost (I know it's not likely because the OP is there and conscious) - if that is their concern I wonder if not accepting the drug when issued would help - ie when they pass it to you first, you don't take it and get them to give it to you when the time is right for it to be taken.  Medication left 'lying around' even in the patient's eyeline would get me into trouble)

[happygrrl]

OP, I just read your post # 47, and I am truly embarrassed. It's the meds thing that is getting to me the most because there is no excuse for that. I can **maybe** understand the first time it's asked (should have read your chart better), but after that? Nope. (And quite frankly, the chatting would get on my nerves after a while too.) The safety checks are just that. State law/facility regs require them. (I do them once an hour, all night, every night--I've gotten good at creeping into a room; I can even hook up an IV and not wake someone. )

If you're interested, a typical clinical day (boiled down for brevity) would go something like this: conference room with instructor where she assigns the patient(s) (we had 3 at the max), then to the floor/nurses station to get morning report, then to the patient's room to do quick rounds/introductions, then a conference with the staff nurse where we would usually get the fine details of our patients (non-medical things about the patient (family members in attendance, patient preferences (!!), likes/dislikes)), and then we were off. At that point we should know at least something about the patient, and then I would read as much of the chart as I could. Then off  to the meds, treatments, etc.....  Then end of shift, post-conference with intructor, and home.

With all of that being said, even if the staff nurse forgot to tell me something like...I don't know...the OP does work during the treatment, you telling them up front **should** be a heads up to them not to keep talking to you. Heck, we were told to talk to our patients (and I still do as much as I can), but if the patient didn't want to, then I'll would be quiet unless absolutely necessary.

Maybe I'm just whatever, but if I saw you eating, I would ask the staff nurse why, but it wouldn't cross my mind to ask you. (I'd figure there was a reason that I just didn't understand.)   

[JenJay]

There is (at least in the UK I'm sure there is in the US too) a code for them to put onto the drug chart to say patient declined/refused - all they need to do is write that code on then write the time it is taken next to it*

I'd be furious if they did that because here in the US it could give your medical insurance provider grounds to refuse to cover you. She is following her doctor's orders.

I'd explain the first time and then say something like "I'm concerned that you keep advising me to go against my doctor's instructions. Have you read my chart?"

[Bast]

TealDragon, with your latest update, had a bit of an aha moment.

You've got your pills sitting right next to you.  I, and all the other student nurses that I know, are trained to never, ever leave medication at a patient's bedside.  Doesn't matter what the medication is, we're taught to watch the patient take the medication, and if they don't, then we either dump it in the sharps container (if it's opened), or put it back in the med room (unopened) and mark in the chart that the patient didn't take this med for whatever reason.  We can and do get in trouble if it's found out that we've left medication at a patient's bedside.  Two options there.  One, ask the staff nurse if you can be given the meds at the end of your treatment, or two, tell the student "Yes, I know that I have pills sitting right here.  But I've been told by my doctor to take them after I'm done with my treatment, please go look at the orders in my chart."

When they start in with the small talk, don't be afraid to look at them and tell them that you're sorry, but you're busy and don't have time to chat.

[JoyinVirginia]

Teal Dragon, hope your treatments are going well except for this little blip with the students. I have a simple idea which I think will help. Just write out on a note card or a piece of paper, ” TEAL DRAGON ROUTINE”. List what you put in your OP. 
1.  Start iv. 2. Eat snack to avoid side effects (see Dr. Smith orders in chart). 3. Take pills when infusion committed (see Dr Smith orders in chart).
Note: I often work on computer while receiving treatment. Please limit interruptions if I an working. Thank you!
Yrs, they should know what is in your chart. They may not have time to read everything, the pill schedule may be printed out by computer, etc. better for you to have your preferences noted. Like bringing a birth plan to the hospital, or carrying around a list of medications and allergies in your purse.

[suzieQ]

Can you just put the pills out of their line of sight? that's what I would do in your position if I could be sure I would remember to take them after the treatment. (of course, I couldn't be sure of that, so even though I'd want to do it, I wouldn't.)

I think just requesting not to have students would be easiest on everyone involved. You are dealing with enough as it is, you don't need the additional aggravation.

[RubyCat]

As others have said, the biggest part of the problem is that these are student nurses.  I've only been a nurse for >3 years so I can still remember how nervous I was about following every rule to the letter.  If you continue to allow them to care for you, I would insist that they go read the orders in your chart.  It is actually a good lesson for them to realize that not every treatment is carried out without changes.  That should keep them from hovering over you, waiting for you to take your pills.  Though I know it is sometimes done, it is against the rules and I never leave a room until I've seen a patient take all of the pills given unless it is something like a tums.  That being said, they shouldn't give pills to you until the correct time for you. 

More and more hospitals are insisting on what they call hourly rounding and also something called "AIDET," which stands for Acknowledge (the patient), Introduce (yourself), Duration (of treatment), Explain (what you're doing), and Thank you.  I'm told that studies show that most patients like this system and it leads to increased patient satisfaction scores for the hospital.  However, when I was hospitalized last spring, I appreciated the staff poking their head in the door to check on me occasionally, but I would've lost my mind if they had to run through their script every time, and yes, it often is scripted.  Unfortunately, the student nurses either don't have a feel yet for when to speak up and explain what's going on and when to leave the patient in peace, or their program simply will not allow them to use their own judgement.

If you feel that the problem lies with the students, I would not hesitate to request that you not be cared for by them.  I agree with the others, that they won't mind.  While I was always very grateful to those patients who allowed me to care for them, I would've felt terrible if I thought they patient would rather not have a student and the hospital or instructor somehow assigned them one anyway.