A California hospital is starting a program that encourages nurses to speak up more regarding patient medical decisions. Is this a major problem? If so, what skills should such a program focus on?

I agree with oldnurse, but the problem isn't just with foreign-born nurses not being assertive - it's most nurses. This stems from not being included in a lot of the hospital leadership decisions. It's endemic, and I hope that more programs like these start up. We need them bad!!

A lot of experienced RNs around me from ex-professors to mentors keep asking the question "Do you want someone to speak for you?" Or "nurses must come together and speak loudly to make a difference for the profession. I never hear anyone respond by saying no that is stupid or no I don't want to get involved! However, I still don't hear anyone speaking up. RNs are the largest group of health care workers in the acute care setting. If we just said what we wanted in one big loud voice, I guarantee you we would get it.

Yes, we should speak up. But please let me play devils advocate. Do you want to be known as a troublemaker? Are you able to be unemployed for a undetermined amount of time? Would you be black-balled (not openly, of course) from trying to make a living in your chosen profession? If you wonder why so many questions are listed, take a realistic look at all the possible outcomes. Control is the real issue at hand. And those who have the control will not give it up easily.

Even though this is an older topic, it deserves MUCH attention, so I'll bump it back up. If you look up an old definition of "nursing," one meaning is to "suckle a pig," to "play wet-nurse." That ,in and of itself, sound pretty passive. In addition though the years, nurses were trained NOT to be assertive, to stand at attention when a doc entered the room, hands down at their sides or behind their backs. Similar to the military.

That "handmaiden to the doctor" started somewhere.

That's a submissive posture and for MANY years, that kind of training and attitude prevailed. It was a culture. Years of that culture and training is hard, but possible, to undo.

Before nursing school, unfortunately, many still have the idea that they take ORDERS from the doctor, and to an extent we do. However, we are independent thinkers and have our own practice laws, plans of care and diagnoses.

I think until it becomes common knowledge that nurses have ideas of their own and are respected for that, it is the place of nursing schools to fill this void, making assertiveness training part of their curriculum; not an elective, but part of coursework required for graduation.

Nurses need to know that they ARE part of the healthcare team, can work with physicians and they and other members of the healthcare team will then have a greater respect for us. I agree with cdnurse, when she says that ""There is a way to be assertive without appearing as a trouble maker." We can start by calling MDs physicians instead of 'doctors.' May be just semantics, but try it on for size.

In my mind, "doctor" conjures up a pedestal; physician conjures up a "healer." Isn't that what they really are intended to be. Certainly we don't want to further the pedestal "image."

teamRN

Being a physician I definitely believe nurses should speak up more. There's nothing more irritating that a nurse who disapproves of something the physician has done and instead of speaking with him/her about it, tells her supervisor! Then the physician has to find out about it later from someone else. Speak up nurses and please stop this behind-the-back stuff if you are guilty of doing this.