To Judge or Not to Judge -- That is the question.

One of the fundamentals of nursing is to not pass judgment -- use your assessment skills, not judgment, to view your patient.  This is taught in every class, for every age across the lifespan, no matter whether your patient has cancer or schizophrenia.  It is drilled into our brains.  So why doesn't it stick?  Too often, I see nurses who use hasty judgment with their patients instead of assessing them.  I certainly don't mean to say that it's always that simple.  Sometime the signs directing us toward hasty judgment are like the neon glow of Las Vegas with arrows blinking and bright colors flashing.  It's not always easy to turn away from them and conduct a non-biased assessment.

In my Public and Community Health Nursing (PHCN) class we are currently focusing on the concept of upstream medical care.  The analogy is that if you are standing on the bank of a river and you see a person float by, your natural instinct is to jump in and save them (with rescuscitation if needed).  The question is if you continue to stand there and more and more people come floating by in distress and need of rescuing -- do you just continue to rescue and rescuscitate them or do you walk upstream to determine why they are falling into the river in the first place?  The rescuer at the bottom of the river, standing on the bank, is part of a downstream solution.
Similarly, hospitals are downstream solutions to people who are sick.  The upstream solution is related to why the people are getting sick in the first place and acting to prevent illness and promote wellness (health).   Now that those definitions are clear, I can't help but conclude that judgment prevents both downstream and upstream interventions.  If we judge the flailing human in the river and hastily determine that they fell into the river because they were not smart enough to avoid it then we may jump to the conclusion that they do not deserve to be rescued -- OR -- if we walk upstream and determine that the people who are standing too close to the edge of the river are not smart enough or good enough to be advised to step back, to prevent their slip into the water, and we just allow them to fall in and float downstream.  In my opinion, judgment can never lead to a therapeutic intervention or a favorable outcome, and nursing is all about therapeutic interventions (helping) and favorable outcomes (healing).  So what's to be done?  Do we pass out life preservers upstream or build a damn??

In the ER yesterday I saw too much passing of judgement by one particular nurse -- she was not my preceptor and for that I am thankful!  It really frustrated me!!!!!  My PCHN class has me really trying to focus upstream.  There were two patients, in particular, that were chronic ER "visitors" who had been labelled as "drug seeking".  Now, I do not doubt that there are patients who are drug seeking.  They usually come in and tell you that they are allergic to all NSAIDS (Advil, Motrin, Aleve, Toradol) and some even go as far as to tell you they are allergic to Morphine, in which case they are seeking the "really good stuff".   I would be lying to myself and to others if I denied that drug seekers exist.  My question is -- why are they drug seeking.  Are they depressed, are they struggling with mental illness, are they being abused, are they living a life of desperation.  How do we get upstream to figure out why they are drug users????  If we were able to identify the reason for their drug use -- then maybe we could stop them from using our health care system this way.  As I watched this particular nurse roll her eyes at the announcement
 of two patients' arrival -- I found myself feeling frustrated at her hasty
judgment.  Granted, I am not an ER nurse, I do not see these patients
 time after time, but I still wish I could have hand in taking a look upstream to figure out why they enjoy visiting the ER so much!   And today, eye rolling is considered lateral violence in the work place.
 If a nurse rolls her eyes at another nurse it is a punishable crime!  Too bad this is not the case in my house, as I have a tween daughter whose eyes roll more than they look straight ahead! LOL!  But I digress. . .

I found it very difficult to watch this nurse roll her eyes and pass judgement.  Being a nurse requires vigilance.  So a chronic ER "visitor" returns for the fourth time this week and they are quickly judged and labelled a "drug seeker".   Well, drug seekers tend to be rather unhealthy individuals.  If our hasty judgement leads to our lack of vigilance and that patient has a heart attack or a stroke  -- we're gonna miss the signs and that might result in a patient's death.  The words "First do no harm" always run through my head.  Nurses should be helpers, no matter the situation.  Drug seekers are drug users and if they don't need help I'm not sure who does!

Hospital nursing certainly does have a downstream position -- we take care of the people who are sick (those flailing in the river) but we can still rescue those floating by, or better yet, talk to the people upstream and figure out why everyone is falling in!   And remember. . .

Nurses should never define themselves by judging others.