Friday, April 27, 2007

Say the word and be like me.

It's so fine; it's sunshine. It's the word "no."

A meditation on saying "no."

I had one of Those patients today. You know the sort; they come in with poorly defined abdominal pain that stays poorly defined and resists all efforts to diagnose it. The only thing that calms the pain is a patient-controlled pain pump with X number of milligrams every Y minutes (determined by the patient) with a Z bolus of A milligrams every B minutes.

You know the sort.

This one wanted to go smoke. Then she wanted to go to the gift shop. Then she wanted just to walk around outside. I told her she could do none of those things; that leaving the floor with that much narcotic was not allowed.

So she put an aide on the spot by asking *him* to take her out to smoke.

Which I called her on. Then she called the aide a liar, which I called her on. Then it became a huge joke, which I did not find funny.

The last straw, for That patient, was when I told her that, regardless of what she *wanted* to eat, she'd be getting a particular diet. Period. No argument.

Whereupon she, being an old hand at this hospital business, called the Big Boss and poured out her tale of woe. Oh, the cruel nurse! Oh, the inhumanity!

Immediate Boss dealt with it and came back with this ultimatum: either give up That patient and offer a "half-assed apology" or offer a "half-assed apology" (and I'm quoting, here) and go on for the rest of the shift.

I said "no."

As in, No, I will not apologize to the patient who will not follow the rules. As in, I was not rude or condescending or nasty; I simply stated how things would be. As in, No, That patient won't get an apology, and further, *you* get to handle her for the next four hours.

As in, No, I will not be abused in the name of customer service.

Because, you see, my job is not customer service. My job is to provide the safest and most therapeutic environment possible for my patients. If that means that they don't get to smoke their usual two packs a day while they're being evaluated for a duodenal perforation, so be it. I'm happy to offer nicotine replacement; it's their loss if they refuse.

My job is also to protect the people who have less power than me. If you call my aide a liar while trying to get him to do something he knows he can't, I'll call you on it. And if you continue to screw around, I will not tire of telling you "no."

The surgeon, thank God, is on my side.

The other nurses I work with are shocked. And admiring, that I had the huevos to say "no" to something that we'd all normally go along with in order to keep the peace.

I've had enough of saying "yes." It's time we, as a profession, got rid of this imagine of being pushovers who only want to please. I'm sure the first twenty-dozen nurses who refused to stand when the doctors entered the station got hell, as did the first twenty-dozen who refused to carry the MDs charts for them during rounds.

I'll take hell for saying "no." I've already defined my job; my bosses' job is to make sure I can do *my* job safely and without untoward interference.

I have the feeling I'll hear about this once Biggest Boss Of All gets back from vacation. In the meantime, I'll savor the feeling of "no."


Anonymous said...

It's funny how they teach you to "take care of yourself" when you are in nursing school, and then you find out they don't really want you to take care of yourself. They want you to say yes, yes, yes to unreasonable demands. So, No, I won't do another hospice admission in
BFE after I've already worked all day. No, I won't go eval two patients at the hospital at 7:00pm. No, I won't get up at 2:00 am to admit a patient. We have on call for all that. Yes, I know they are overworked. Hire some more people. I've had it!

Anonymous said...

Good for you, Jo. The nurses who follow in your footsteps will thank you for it...Thank you.

Anonymous said...

i stand to applaud you! the sooner we stop taking crap from anyone, we will all be healthier!

things got really screwy when all the big bosses took the disney seminars. now we are all supposed to act like minnie and mickey while goofy runs the show.

GingerJar said...

How about a pt on 24 hr strict bedred following AICD placement, w/r groin perclose who hopped the rail 1 hour into the 4 hours flat and no bending leg (he said no one would bring him a urinal, but it was hanging on the bedrail 3 inches from his hand", who informed me he didn't need any pain meds as he had brought his own and taken all he wanted...unless I had some IV *good stuff*...oh and wifey came by to load into a WHEELCHAIR (4 hours into the 24 hour...what part of strick bedrest don't you understand) to take him to *smoke* (pot???crack???speed???) He was going 90 to nothing about having a job fair to go to at 6 am the next am....he hadnb't worked in 2 years...but had to be out now...tonight...who ever heard of 24 bedrest for a AICD...(his first one) ....

He was 50 years old. Totally floored when I put him back in the bed, commandered the wheelchair and told the wife to either pull out the sleep bed or leave...he was not going off the floor and he was staying in bed.

The other nurses told me..."you can't do that"

the patient...."yes" "you're the boss...until 7 in the morning...them I'm outta here.

" shift will be over, take it up with the doc and the next gal".
*service with a big smile*

Anonymous said...

Good for you - and I was fired while the Big Big Boss was on vacation - for sticking up for workers with no power and for (gasp) complaining to HR about someone in power who abused it - and who happened to be my Boss. Gone in two weeks.

Be careful out there - your nurse firends DO NOT have your back. Regardless of what they say and do to your face.