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EDITOR’S VIEW

'It’s time to tell the public that nurses are not maids'

The implications of the health bill, and the public mauling-by-media the profession seems to endure on a regular basis are putting nursing under a fair bit of pressure.

But the thing keeping most of you awake at night is the fear that you cannot meet the expectations of patients and carers using your existing resources. In our exclusive survey last week more than half of you (55%) said this was your biggest concern.

Workforce cuts are piling the pressure on an already stretched profession, but the public’s expectations are adding to that stress.

Let’s not suggest that any patient or carer should ever tolerate the poor care we saw documented in last year’s Care Quality Commission and ombudsman reports. Drinks and food left out of reach and blatant disregard of dignity are totally unacceptable. But some patients are unrealistic about what a nurse’s role really is.

Nurses have told me that some patients use their call bell to get them to change the television channel, pour water or recline their beds – all reasonable requests, except the patients in question were extremely mobile and well enough to do these tasks themselves.

There will always be awkward patients and nurses are usually resilient at dealing with them. But the lack of appreciation for nurses, respect or understanding for the job they are being paid to do is leading to increased frustration – among nurses and patients.

Buoyed by the review website culture, where the customer is always right, some seem to believe a stay in hospital should be like a stay in a hotel. While of course feedback should be analysed to make healthcare improvements, patients need to realise that nurses are not maids. They must learn that nursing requires a broad range of skills – and unquestioning servitude is not in the job description.

Readers' comments (48)

  • michael stone

    'They must learn that nursing requires a broad range of skills – and unquestioning servitude is not in the job description.'

    How many patients do think 'unquestioning servitude' is in the job description ? As opposed to wishing to be treated as an ill person, rather than as a collection of clinical problems ?

    I don't know - has anybody got the evidence, in an 'evidence-based' sense, about how many patients do believe that nurses are 'room service' ?

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  • very little seems to be understood of the work of nurses and the wide range of skills required to do the job and all the health risks involved and there are many misperceptions. However, I also know very little of all the details of other jobs I have no experience of.

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  • In the States, the much of the public believes that you can't get a good CEO without throwing millions of dollars at them, but that nurses make too much money for what they do. Yes, I'd say we have an image problem.

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  • Alice P | 21-Feb-2012 12:50 pm
    from Anonymous | 21-Feb-2012 11:44 am

    It's strange that if people get poor nursing and medical care they may not fare so well yet they do not put great store by nursing, which reflects in attitudes towards them and how they are treated and paid.

    I have heard HCAs telling independent patients who expect to be served by them that they are not maids. Perhaps we should all be a bit firmer and make this perfectly clear.

    The way some patients wish to offer tips also seems to show a lack of understanding.

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  • Wow, tips? The only tips I hear about involved a lot of swearing and anatomically impossible instructions - usually given when they recieve £1.70 bus fare to get home from hospital instead of the generous taxi fare or train fare they hoped to get in cash! Either that or we are the visible target for their frustrations when they dont get the admission/scan/sick note they want. Doctors get the thanks, nurses often get the anger, it has been that way as long as I can remember but I also try and remember that it is only a small proportion of patients/public that do behave this way.

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  • "They must learn that nursing requires a broad range of skills – and unquestioning servitude is not in the job description."

    How are they going to learn this? Who is going to teach them? ...and how? Who is going to provide some effective suggestions and solutions?

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  • michael stone

    I have no doubt, at all, that nursing requires a broad range of skills. But I'm still unclear, if Jenni is quoting 'an evidence base' here ?

    Asking nurses 'Do you think a lot of patients treat you as if you were 'room service' ?' could elicit a 'yes', but at the same time perhaps asking patients 'Do you think a lot of nurses ignore your needs ?' might also elicit a yes.

    So, where is the evidence base for the assertion ? Is there one, or is this just based on a perception within nursing (I'm not saying that a lot of patients do not treat nurses as if they were 'maids' {I simply don't know} - I'm just saying, do we have the equivalent of 'a double blind methodology' here, or not ?).

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  • Little One

    I regularly find the attitude of patients is that I am there to do absolutely everything for them as they lie in bed 'getting better' and find myself telling patients that they will not 'get better' just by lying there, and whilst they have two good arms and legs they should use them.

    I don't think it comes across as rude, it is about making the patient aware that we are promoting their independence, not being nasty, and that if they truly need help they will receive it but that I am not prepared to bend to their every whim and hold the glass to their mouth as they drink because they are too lazy to do it themselves, and they think that is entirely what my job consists of.

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  • michael stone

    'and find myself telling patients that they will not 'get better' just by lying there, and whilst they have two good arms and legs they should use them.'

    Little one, just to check something. So your hospital encourages patients who can walk, to walk around and do things for themselves, and to 'socialise with each other' if they wish to, etc ? I agree with what you say, but if you want patients to somehow 'be tied to their bed', that isn't true 'independence', is it ?

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  • Michael Stone:
    Your use of quotation marks baffles me, are these your random musings or those you have heard spoken by nurses? Do you do the little" " motion with the fingers when you talk?
    I'm a nurse, and was told that I was an arsehole by a patient because I wouldn't pull his blanket up over his feet when he was cold. He was cold after a walk outside for a fag...

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  • Little One

    michael stone | 22-Feb-2012 10:21 am

    If my patients can walk and talk they are encouraged to do so as long as they are safe. Be that getting up to have a shower, walking with the physios, or even walking up the corridor and getting a drink. As long as we are aware of where they are and what they are doing, and as long as they are not at risk of falling then they are encouraged to walk about the ward. If they want to socialise with each other then of course they can, they are in no way chained to their beds, they are however restricted in what they can do, as they are usually in hospital for a reason and not just for a holiday.

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  • tinkerbell

    Anonymous | 21-Feb-2012 1:47 pm

    this is my experience also. If i have a patient who wants waiting on hand and foot i usually say 'i am here to help you help yourself'. I would hate to de-skill and make someone totally dependent on me whilst a patient. I try to discourage the sick role wherever possible but will do anything i can to help someone who can't do something for themselves rather than won't. It is all about 'recovery' wherever possible. We help no one when we make them dependent on us. I think it would help if the more independent patient wasn't lying around on a bed if they don't need to be and were able to wear day clothes instead of hospital gowns to remove this image of them being 'ill' and promote an image of them 'getting better'. Wherever possible we should not be encouraging the 'sick role of a passive receipient of care' but someone who is jointly responsible for their well being and recovery.

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  • tinkerbell

    Anonymous | 21-Feb-2012 1:47 pm

    this is my experience also. If i have a patient who wants waiting on hand and foot i usually say 'i am here to help you help yourself'. I would hate to de-skill and make someone totally dependent on me whilst a patient. I try to discourage the sick role wherever possible but will do anything i can to help someone who can't do something for themselves rather than won't. It is all about 'recovery' wherever possible. We help no one when we make them dependent on us. I think it would help if the more independent patient wasn't lying around on a bed if they don't need to be and were able to wear day clothes instead of hospital gowns to remove this image of them being 'ill' and promote an image of them 'getting better'. Wherever possible we should not be encouraging the 'sick role of a passive receipient of care' but someone who is jointly responsible for their well being and recovery.

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  • when i worked in a home for the care of the elderly my concept was not to take away their independence but to let them do what they were able with my support and then help them with the rest. however, strict time constraints did not permit this and other staff did not agree with me. as a result they were seen, particularly by the relatives, as the better carers, and I was seen as the bad one despite more years of successful work experience and higher qualifications, and was very quickly out of a job on the grounds given by the administrative head of the home that I was not accepted by the team. This was after just over three months in the job. I found this a shame for the residents as some could have done more, no matter how little or how much, and in my view is poor nursing practice.

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  • tinkerbell

    atrocious. Isn't this discrimination?

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  • tinkerbell

    Anonymous | 23-Feb-2012 12:37 pm

    to you re above sorry forgot to copy/paste you.

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  • michael stone

    Little One | 23-Feb-2012 10:48 am

    This will probably be removed by the moderator, who has already removed my reply to redpaddys12. This is a REPLY, moderator !

    If you let patients do as you say, then I have no problem with nurses telling patients to be more independent, provided the patient is capable of doing things for him/herself. My only problem, is if your patients are getting confliciting 'advice/rules', or if patients who can't do things for themselves (for example, too ill to feed themself easily) are not being given any necessary help.

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  • michael stone | 23-Feb-2012 3:00 pm

    for crying out loud Michael. Nurses are trained to assess patients and evaluate what they can and cannot do and where they need help, and care plans are made to assist in this so that care is consistent and continuous as no one nurse is with the patient longer than the duration of their shift. Nurses are also highly trained in psychology and interpersonal relations and are more than capable of evaluating what patient needs are and what they are able and unable to do. If t certain restrictions because of their illness or surgery are imposed these will be prescribed by the doctors and nurses also work closely with the physiotherapists. this is part of a nurse's job and part of the nursing care process.

    i can't help noticing the frequency with which you troll these sites wasting everybody's time and preventing some good discussions about important nursing issues where exchanges of other nurses is an important element in improving care although I have almost given up using these sites because of your constant remarks between other commentators and then projecting your trolling behaviour onto others.

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  • There is an attitude problem towards the NHS - that we nurses know too well - and as someone rightly says we are trained and can [usually] differentiate between those who need help and those who demand and treat nurses as servants. These patients, like bad nurses are not the majority however their attitudes have an impact on nurses behaviour. Too much emphasis has been put on patients rights without the balance of patient responsibility. When you look at the 'sick role' there is a balance between receiving care and doing all you can to get better - it is when patients forget this that they seem to nurses to treat them as handmaidens. Unfortunately repeated treatment like this can lead to jaded nurses who tell the wrong people to self care - and that is not what anyone wants. This by the way is based on anecdotal evidence - all nurses will have examples of when they are treated as servants and this is quite distinct from the people who loose all sense of self care when they become patients and just need to be informed that they are still allowed to do things for themselves without it being detrimental to their recovery.

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  • tinkerbell

    michael stone | 23-Feb-2012 3:00 pm

    I wouldn't tell someone without any legs to try and walk, we do assess our patients, observe, monitor and record regularly their strengths and needs.

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  • When people come into hospital they are scared, they are worried, they are frightened,
    They are not in control and hence their behaviour may well be different. Above all they may well be angry at not having control, of being ill - all sorts of things.
    That means they may not always behave in a rational manner and this may manifest itself in the way they act around nurses.
    Maybe we should all remember that next time a patient is rude or abrupt or barks orders at us? :)


    And I have NEVER had an independent patient ask me to do anything for them that they could do themselves.:)

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  • Liz Evans:

    You're lucky. I'm sick to death of the fetch me, carry me patients ( the majority of whom seem to be middle class)

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  • Tiger Girl

    Liz Evans | 23-Feb-2012 11:10 pm

    redpaddys12 | 23-Feb-2012 11:24 pm

    It seems to me, that people are very influenced by their own experiences - I don't think Michael Stone was suggesting that nurses are stupid, I think he was implying that perhaps some patients are unclear about what they are supposed to do without checking with staff, and that over-worked staff are hampered by this, then turn it into patients being awkward, as opposed to patients being a bit confused.

    But the baffling bit is how can Liz's experience be

    And I have NEVER had an independent patient ask me to do anything for them that they could do themselves.:)

    when redpaddys experience is

    I'm sick to death of the fetch me, carry me patients ( the majority of whom seem to be middle class)

    Is the middle class bit a clue - is redpaddys working in a posh hospital, and being demeaned as a peasant by The Officer Class ? Who knows !

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  • zena Jones | 24-Feb-2012 12:05 pm

    don't start discriminating. it seems to be a typical and very negative and damaging British pastime which does not enhance the image.

    nurses are there to nurse patients whatever the race, creed, origin, skin colour background, social class, disease category, street they live on or what ever else!

    those who can do things for themselves only need to be told politely and if nurses chose to grovel to them that is their own problem but should understand the basic principles of nursing care (or at least in earlier training) which is to assist and support those who cannot do this for themselves.

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  • tinkerbell

    i was a trolley dolly for a while in a private hospital and some of the paying private patients would ask if i could 'swing by' when i got a chance. I don't really think class enters into it though, had just as many other 'posh' folk who weren't like that. Did have to have a bit of a chuckle though when one of our clients/patients, a dentist asked me to attend his room to ask me why he was there,it was the early hours of the morning and i explained he was in for alcohol detox and for drunk driving and was awaiting his court case, and he replied 'wont be going to court as the masons have sorted that out and its all been squashed'. The next morning he informed another nurse that it was really nice of me to come by and explain why he was there but he didn't think it was necessary for me to wake him up and explain it all to him. He had forgotten that it was he that requested me. Never mind. must have just done it cos' i was bored.

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  • I worked briefly in a private clinic too. We weren't allowed to do any of the dressings following surgery. The surgeons did them all. Our wealthy and genteel clientèle were mainly Arabs who thought they could purchase our services. Once one tried to force a thick bundle of £ notes into my pocket - there must have been about 100. I was sorely tempted as a newly qualified staff nurse but I would probably have regretted it the rest of my life if I had accepted although I did wonder how other colleagues responded.

    The small rooms were always stuffed full of visitors. Once we had a dying woman whose stunningly very young and beautiful and very pregnant daughter in law slept on the floor of her room all night while the men folk went home to their beds. The young girl must have been in her early teens and the patient died in the night.

    Our patients often spiked a fever first day post op as when they came back from theatres their curious relatives pulled back their dressings to see what was underneath and we found them more than once palpating the wounds with several grubby looking fingers!

    A young Persian guy had surgery for a fractured tib and fib following a motor bike accident and had a full length plaster cast. On the big day when the consultant surgeon came to remove it we dutifully prepared a trolley with the giant plaster shears and all the other materials but when we entered the room behind the surgeon and his large entourage we found that the patient, on strict bed rest, had got hold of the instruments and removed the plaster himself! One of the times when you feel yourself going red and want to disappear under the carpet to escape the wrath of the surgeon (only carpets there were their minute prayer mats!). Surgeons seem to have far louder booming voices than the rest of the population.

    I never felt very servile there as I suppose the relatives were with the patients much of the day and nursing was different in the 1970s when patients stayed in bed for longer and nurses did more for them as it was all part of their care.

    One other story which is not so much to do with the article was that we had an African tribal chief who insisted in sleeping in his bed in all his colourful regalia, head dress and all. He had been prescribed post-op Omnopon and my senior colleague misread the drug chart and gave one ampoule instead of a half. It was very unclearly written and one ampoule did not seem unreasonable. If I remember rightly she had also queried it with her colleagues. The anaesthetist who wrote up the drug was summoned and was livid putting all the blame fairly and squarely on the nurse. The patient became confused during the night and at 6 am he was extremely aggressive with the night nurse and threw his glass urinal through the closed 6th floor closed window of his room onto a narrow alleyway where people were passing on their way to walk. Miraculously nobody was hurt.

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  • tinkerbell

    Joke of the week.

    I told a bad joke in a lift once, it was wrong on a lot of levels.

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  • Zena Jones
    Not all the middle classes are like that, but the private patient who finds themselves in an NHS bed is the worst of all!

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  • With love to my UK commrades.
    We are on massive walkouts over here in Melbourne to save what is the right of every nurse and patient

    http://youtu.be/Y0QHvHtwHMU

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  • Zena Jones
    Definately don't work in a 'posh' hospital, I'm in a large teaching hospital, that no-one from outside the area can spell or pronounce, in a city at the Irish Sea end of the M62 beginning with 'L', laa! There are a few posh areas around here, with plenty of people who are in BUPerrr, who relate a hospital spell with a fortnight in a hotel but with better room service. You are in an NHS hospital because you are ILL! I do not cook the food/ arrange what time it is bought to the ward/ deliver newspapers/ make tea for your friends and family ( unless you are dying or already dead)- all the things that I did whilst in a private hospital looking after rhinoplastys and breast implants. SICK=NHS. SPOILT=PRIVATE. Get sick in a private hospital-send for the professionals! 999 into a real hospital

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  • ll my comments seem to get removed. Does the truth hurt?

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  • tinkerbell

    Yvonne Bates | 25-Feb-2012 4:18 am

    thanks for the update Yvonne, think we will soon be following you at this rate. This so called government seems hell bent on destroying OUR NHS and decimating the nursing workforce and all public sector workers. Despite doctors/ nurses and most everyone telling them to halt they apparently in their infinite wisdom know better than us. The 'have nots' and the 'have yachts'. It seems we are all such a drain on 'their society'.

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  • As a patient myself following a C Section, I had to walk down the corridor to get my own breakfast, walk to the toilet, walk to the bathroom. Even though I had just come off a morphine drip and had a surgical wound I didn't dream of asking a midwife to a. fetch me breakfast, b. help me have a wash c. fetch me a commode. I was able to walk and did so.
    The midwifes were there to ensure that I received post op care (they washed me following the birth due to extreme blood loss), they administered analgesia, they offered to help me get up and out of bed, they dressed the wound, they helped me to breast feed when I couldn't even sit up. They did their job and did it well. I was starving hungry all the time, despite ordering larger portions of food but I didn't complain, I just ate biscuit and chocs between meals. I even cleaned the bath before using it!
    There are always going to be people who treat other people with lack of respect, whether they are nurses or not. It has little to do with expectations but more to do with a general lack of manners and respect in society today.

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  • Anonymous

    redpaddys, I am also (like Zena) puzzled by the statistical probabilities of this. If Liz's experience is as she described:-

    And I have NEVER had an independent patient ask me to do anything for them that they could do themselves.:)

    and many other nurses report they are regularly treated as if they were maids, I cannot fit those two things together ?!

    Unless the behaviour isn't very common, but is deeply remembered when it happens - so that you get the same sort of selection/reporting bias as occurs in 'it always rains when I put the washing out !'.

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  • I'm a bit dim but ... | 25-Feb-2012 2:10 pm

    Maybe it is an attitude problem just like all the 'too posh to wash' business!

    I have been in nursing for a very long time and always felt treated with respect like a nurse and never like a maid by my patients.

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  • Anon 2.44pm
    No attitude from me, but from patients. I can assure you that you are the ones in the minority. That doesn't mean though that I would ignore any requests, but ask the patient if they really need me to do that ( pass the remote control? fill glass up with water) If you can do it yourself, then do it yourself, if you can't I will, no problem.

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  • I've loved my job for over 30 years. My experience of patients? Brilliant, courageous, funny, vulnerable, scared, angry, rude, silly, smart, inspirational, infuriating, violent, nasty, kind.......I could go on.

    They are just people.We shouldn't demonise them, but we should not excuse all bad behaviour out of hand.

    Of course there are patients who treat nurses like maids! Just as there are patients who are almost embarrassingly grateful for the smallest thing. Swings and roundabouts really.

    Yvonne Bates | 25-Feb-2012 4:18 am

    Good to hear from you Yvonne. Keep up the good fight. Unfortunately, in this hemisphere....... there ain't no fight!

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  • tinkerbell

    Mags | 25-Feb-2012 10:44 pm

    well said, all of it. Hopefully the fight will come soon.

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  • tinkerbell

    top ten insult of the week.

    A couple of weeks ago one of our lovely HCW's was in a confined space changing a doubly incontinent, very vocally and abusive old gal who said to her as she was struggling to put on their shoes and socks

    'you're huffing and puffing like an old whore, you're too old for this job, you should retire'.

    When she came out and told us i said 'well she does have a point we are all getting on a bit, how's the other job going?.
    We have to remain lighthearted about it all as we are insulted on a daily basis.

    When one old lady loses her purse she says

    'when i found out which one of you bastards has stolen my purse i hope you die but not before a long, lingering illness in great pain'. Is she thinking of going into the greeting card industry?

    When a patient gives me a round house kick to the temple during hygiene needs that knocks me onto the bed and sends my glasses flying i take the opportunity to have a brief lie down and usually say 'i give up you win'.

    We are a jolly lot at work mostly and take it all in our stride, for after all we realise our patients are not well and under normal circumstances wouldn't behave this way.

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  • Anonymous

    tinkerbell | 26-Feb-2012 11:17 am

    Tink, I'm glad to see that you seem to have overcome your compulsion to tell old one-liners - it really wasn't a laughing matter !

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  • i am glad to see some humour in the NHS as I thought it was still run like the military as it used to be!

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  • I was shocked when I heard an HCA tell a patient in bed who had dropped something on the floor that she was not a maid. It wouldn't have troubled me or cost me anything just to pick it up for them.

    I amazed how patients are spoken to sometimes by staff. During training we were told that patients should be shown the same respect we would show guests in our own home. If patients are rude we should have enough professional training and experience in the psychological effects of illness, hospitalisation, social problems, anxiety and interpersonal relationships to realise it may be due to their current circumstances, and deal with it.

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  • tinkerbell

    Top 10 insulst of the week.

    When one of our lovely HCW's came out from doing a doubly incontinent patients hygiene needs in a confined space she told us that whilst putting on the patients socks and shoes and struggling around on the floor whilst patient was being non compliant she was told by the patient

    'You're huffing and puffing like an old whore, you're too old for this job, why don't you retire?'

    I said 'well she has got a point, we are all getting on a bit, how's the other job going?'

    When another old gal loses her purse and says 'I know one of you bastards has got it and I hope you die but not before a long, painful illness' I think she needs to get into the greeting card industry.

    When I get a round house kick to the temple whilst doing someones hygiene needs on their bed and my glasses go flying I take it as an opportunity for a brief lie down and say 'I give up, you win'.

    We are a jolly lot mostly at work and take it in our stride, realising that our patients are unwell and under normal circumstances would not behave this way.

    When one of our lovely old ladies during hygiene needs tells me 'you're effing ugly' I say 'please you can insult me as much as you like but don't mention my looks as that upsets me'. After all the hygiene needs are sorted she will say 'thanks old fruit' and we're all friends again. Lovely

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  • tinkerbell

    what's happening why is it posting twice?

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  • tinkerbell

    oh i see i edited it, put in a few spelling mistakes for flavour, thought it didn't go the first time as was stuck in cyberspace, redid it and oh never mind. Going for a lie down.

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  • I have a simple way to bridge the gap. By saying the words. "Is there anything else I can get for you?" when I walk away from patients and to inform them about what I will be doing before I return after I settle them in does the trick.

    I say I will be headed to lunch, but before I go "Can I get you anything? There will be some one else keeping an eye and feel free to call the nurse when you need us." They never ever call or treat me like a maid.

    I have said the "We are having an emergency on the unit right now, I saw you called the nurse, what can I do for you?" The patient almost always says, it's not that important, please do whatever you were doing.

    Also, the patients that are truly overly demanding I have a way with saying, you are in the hospital and if you want to get home sooner you need to try to do some of these things yourself. I will help you adjust the bed, but next time you give it a try, if you can't get it to do what you want since it is awfully hard to operate, call me and I will help you. I have never gotten another call to adjust a bed. Or the can I have more water, when you just brought two full cups because they are lonely. I just bring them more with a smile. It seems as though some patients need a roomie to talk to when the nurses are busy. But I always respectfully inform them what I am doing. I am never surfing the internet or call my friends when my patient may need a simple conversation with a human to feel at ease. We are all human.

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  • Ummm...I maybe completely wrong for saying this but....I am going to say it. I am a Nurse, I am a medical professional who assesses you, monitors your heart rythm, gives you meds, educate you and your family on disease process, etc..etc. Not bring you water, warm your toliet seat(yes I got that request). I know I am going to get back lash for this. But my sisters our skills, technology, and our input into the patient care is different than it was back in the days of florence nightingale. Why is it so hard for us to say....I am a medical professional,a student, i can shock people , give iv meds, md's listen and take into consideration my part of the patient care. How can we allow or even have it insinuated to allow people to still see us as "the maid" for those needs the tech or pca needs to be called. Which is why our profession at times is so frustrating to us and that we feel we are not respected. OUR ROLE has changed and it is not how fast I bring you a glass of water. Would a MD allow a manager to bring him into the office because a patient stated it took him 15 minutes to bring him a snack. We have not made our patients, hospital administrators know how we have evolved. This is our profession and we are in charge of it.

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  • I think some people may have (intentionally?) misunderstood the issue here. Neglecting a patient who is clearly in need of assistance is not the opposite of being a maid. In fact, the true definition of a maid would probably prove more glamorous than a nurse job as I am sure they are not expected to deal with bodily fluids!
    The issue here is the attitude towards the nurses role. I personally do not think it is reasonable to send a nurse to the shops, or ask your nurse to make you a cup of tea half way through their medicine round. If I seem unkind here, I could remind you that most hospitals have around 6 tea rounds per day. We are also pretty damn busy most for most of the day and genuinely do not have time to acquiesce to every finger clicking demand. Quite often, the time required to provide basic care for those who need it is taken up by these demands.
    We do not necessarily have more to do than doctors, physios etc, but they are not expected to take on the extra role of servant. I'm sure they would not have time.
    Many patients will order nurses around, show no regard for the true nature of our job and the many, many things we are doing to keep them alive, comfortable, informed and supported. They will rarely bother with niceties such as "please" and "thank you" .
    Of course most people are not aware of this as this attitude is reserved entirely for nurses- any nurse who has ever spent time with a patient, out of uniform, will notice the staggering difference in the language and attitude of the patient.
    Unfortunately, our biggest battle is with ourselves, i.e. other nurses. We operate in a climate In which we cannot say no to a patient, whatever the demand. An example of this is a recent patient who was accompanied by 2 prison guards- this in itself carries no implications as any patients may (and indeed do) behave this was- pressed his call bell at 3am. On entering the room, he said "coffee, 2 sugars and if it's not strong enough you're going straight back to do it again" he then turned, smirking to his guards and said "can she get you anything?" They, at least had the decency to decline and looked extremely uncomfortable by the situation. Of course I got his coffee, refusal would have led to disciplinary action. I believe this is wrong- does anyone else?

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