Earlier on in the year I had an orthopaedic inpatients placement and often had trouble negotiating with the nursing staff when I wanted to treat a patient. On one particular occasion, I was meant to be seeing an elderly woman who had undergone a THR the day before. I had already checked the Xray to make sure that the joint was properly aligned, her haemaglobin levels were within normal limits and the doctors orders were for her to be WBAT today. I ran all this past my supervisor and she agreed to go ahead and get her up and standing if my objective examination deemed it appropriate.
However, when I went into the room a nurse approached me immediately saying 'she can't have physio today'. I was a little taken aback, and asked her why this was. The nurse then said that the patient had been very anxious and she had only just calmed her down and got her to sleep. I was unsure how to deal with the forcefulness of her statements and decided to ask my supervisors opinion.
When I told my supervisor of the situation and explained which nurse had been so quick to shut down my attempts at treatment she told me that this particular nurse was known for being a little pushy and thinking she knew what was best for the patients. She suggested I go back in a little while when the nurse wasn't there and see how much examination I could get done. I felt somewhat strange about what I felt was going behind the nurses back but I took her advice anyway. The patient woke up again and was calm, giving appropriate answers to questions. As she was slightly dizzy when SOEB, she only sat in that position for a short amount of time doing deep breathing. The nurse didn't come in while I was treating the patient and was probably not aware that I did unless she read the notes the next day.
I have been in similar situations since then, and have learnt from this occasion that while it is sometimes difficult to stand up to other professionals (especially when they have been working there for many years and are very confident of their own opinions) it is important to make your case (within reason). It is not really up to the nurses to decide whether or not you can treat your patient even though some of them will try to tell you. Obviously it's important to take any information they can provide about the patient on board, but as long as there are no safety issues and it is cleared with the doctors, it is really down to you whether or not the patient is fit for treatment.
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I’m also familiar with this clash! In fact, it was just this afternoon when I went to assess a patient’s mobility that the nurse adamantly informed me that the patient could not walk. As I had read the patient’s earlier notes, I knew this patient could ambulate and the patient progressed to show me how she could independently ambulate across the room. I think as long as you have checked safety parameters for the patient, it’s important to learn to be confident and trust our own abilities, whilst still respecting the other health professionals. I’m hoping this will become easier with practice!
I agree, assertiveness is very important when dealing with other health professionals. I'm in ICU at the moment and there are multiple health professionals wanting to see the same patient in the morning. Unless you make it clear to the nurse that you need to see that patient in the morning you may never be able to assess or treat the patient. It will definately take experience to become more confident.
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