Never understood nursing

[PACPhD]

I know this is my first post on your forum, and I am a guest here. But I hopefully can get some answers to a problem that has seemed to plague me since I started practicing in medicine. I am hoping that you will be honest enough to tell me why things have gotten to where they are. And by the way, my wife is an EM nurse. That is how we met.

I started in emergency medicine 10 years ago in NY. I spent 10 years prior in EMS, and also did a residency in EM for two years after graduating PA school. I have a fairly decent background. Right out of school, I worked in 4 EDs. One hospital in Brooklyn, on my first day, the charge nurse and two others came up to me and said "You are the new PA, let's get one thing straight, we have 4 year degrees, you have a 4 year degree, you are no better than us. You need labs drawn, x-rays put in, IV started, you do them yourself. It's bad enough we have to do them for the doctors, we are certainly not going to do them for you". They were called into the ED directors office the next day. They brought the union who threatened to have the whole hospital walk out if the director had anything to say to the nurses. Then at another hospital in NY, I had nurses tell me and the docs what procedure they would "allow us" to perform on our patients. They ripped up my prescriptions right in front of me and told me when they would not "allow me" to give out narcotics. In Virginia, large level 1 trauma center, they refused to do UAs on most patients. They didn't feel the test to be important. I had them tell me if my UA was so important, "are your legs broke, why can't you get it from the patient and walk it down to the lab?" They played passive aggressive for years, not giving my cardiac patients nitro or morphine for up to 2 hours consistently, answering "I heard you, put the chart in the rack and I will get to it when I get to it". Of course they refused to allow me access to the Pyxis to get the meds myself. I had them yell at me whe I wrote parameters for Cardazem for BP. They told me I was to assume ALL nurses know parameters and how dare I question their knowledge. They then told me they will question all of my orders for at least one year until I prove myself to them. That seemed to be a reoccurring theme in most ED.

I have war stories that I could go on for at least 10 pages. I have just touched the tip of the iceberg. So after almost 10 years of this and 10 emergency departments, I got to the point that I started to hate nurses in general, and thought that this is what I could expect for the rest of my career. Then of all places, I came to Las Vegas. I asked about the nurses here. I was told the same as all of my other hospitals (no one ever tells you how bad things really are as you would never take on a new position there if you knew). But to my surprise, it has been the best experience I have ever had. They are so nice, so professional. There are no power struggles. We all work together. What a difference when I get up every day to come to work.

So what gives? I have never seen a profession where so many are hateful, unprofessional, uncaring about their responsibilities (patients) and could care less about how little they are performing their jobs. This did not appear to be the minority in any of the places I had previously worked. Have I just had the bad luck to have picked 8 out of 10 of some of the worst places?

[PACPhD]

My apologies for not responding sooner. I work the night shift and just turned myself around and am squinting in the daylight. Where do I start. First, I want to thank many of you for your support. I guess I should try to clarify some of your concerns. First I am not a troll. I honestly want to gain a better insite into those I work closest with in my daily (or should I say nightly) life. I guess you have to understand I work closer with and am with nurses for more hours than my wife. I am truely happy with the current nursing staff, even the "bad apples" are decent to work with. So now some details. 10 hospitals - no, I do not change my jobs as often as my underware.

I started out from school with 4 jobs at the same time. All Per Diem. I wanted the experience. Then moved a few times. THe last place in Virginia I was at for 4 years. It was a horrible working environment. I loved the patient population, the doctors were the best, but (here we go...) the nursing staff was, on an average, where I got the terms "unprofessional, uncaring, etc". This was not directed towards me in general, although as a PA I got a tad bit more cr*p than the docs. There was one nursing supervisor, she was above the charge nurse, who seemed to care about what was going on. I went to her and told her that one nurse refused to place an IV in a patient because she said the patient was a drug seeker and she was not going to take the "risk of a needlestick putting an IV in someone who she didn't feel deserved it". The drug seeker was 26, pregnant, and had sever abdominal pain. The supervisor took her aside and told her in no uncertain terms how inappropriate her behavior was and that she follows a written order or leaves. She spoke to two more nurses in the next week on my behalf for similar unprofessional behavior. The following week, I went to her with again something one of the nurseds refused to do and she said "I am sorry, but apparently the nurses went over my head and told the management I was diciplining them and management told me if I attempt to correct their behavior that my position will be terminated. She left a month later. By the way, the COO of the hospital, the director of the emergency department and every supervisor in between was an RN. There were no positions of supervision in the hospaital that I knew of that didn't have an RN in place.

My other hospitals? At the one where they would rip up my perscriptions, an ER director from a neighbor hospital came over to help out and cover a shift for our director. He had a very sick 2 month old. He called for a transfer and asked the nurse for an LP kit. She said "you aint doin that to the baby". He looked at me and back at her in astonishment and said, "where are the LP kits", She said "maybe you didn't hear me but I said you are not doing that to the baby. You can wait until the transport team gets here and they can do it". He found a kit himself and did what he had to do.

If I had a few hours, I could go on and on. Here is my point. If I ever spoke to a nurse as thay have done to me for years on end, I would be in my director's office explaining why I should be allowed to keep my job. The second time I would not have a job. How have we gotten to the point that power, laziness, "getting back at the providers for all of the years they asked you to get them coffeee and you had to stand when they came into your area" is an acceptable excuse for way they have treated me and my coworkers? That is what I am looking for an explanation of.

And yes, I do belong to a similar PA forum, but this is where the nurses are. And to those of you who feel comfortable thinking that, well, look at the common denominator, Let me tell you about my work habits. I clean up after myself on all my procedures. I am the only provider who has a pyxis number so when the nurse is busy I can get my own meds. I say please when asking for anything. We laugh at work. I ask everyone how their families are. I go out with nurses and their families. And I thank them every single day at the end of the shift for all of their hard work. The have told me I am one of the best clinitian's they have worked with. I do try.

What is an OP?

[Drysolong]

My apologies for not responding sooner. I work the night shift and just turned myself around and am squinting in the daylight. Where do I start. First, I want to thank many of you for your support. I guess I should try to clarify some of your concerns.

What is an OP?

OP = Original Poster

[JustLynn2U]

I seriously hope that isn't "normal". Does it happen? I'm sure. I've been on the family of the patient end of the stick and though I wasn't a nurse, I wasn't stupid. I understood they felt the were overworked, understaffed, etc. but some of it played out to laziness. Fortunately, we had some fabulous nurses as well. THAT is the nurse I plan to be. I'm a team player, if a colleague needs a hand, I've got it. I can't say I won't disagree with something a doctor may do, I've seen a lot of crappy doctors, but there are ways to handle things without compromising patient care. Maybe I sound a little too enthusiastic with no experience but I consider myself an optimist and will do whatever I can to be a great nurse!

[TazziRN, RN]

If this stuff really did happen (ripping up Rx's, refusing to start lines, refusing LP's), those nurses need to be reported to their BON's. Deciding that someone does not need an Rx or tx is practicing medicine without a license.

[Empress]

I understand where the OP is coming from, and I also understand why his approach is raising hackles. It doesn't mean what he is trying to convey is less important, just needs some polishing.

I've worked in healthcare for 6 years off and on, multiple different settings and states. I admire the work nurses do, and I think I would love to be a nurse, but what is holding me back is the experiences I have had as well. Not "why is or isn't s/he doing this or that?" I understand that there is more to patient care then I would see as a tech And being low on the totem pole I haven't had too much trouble with nurses, I do my job and I am left alone. But I have seen a lot of unprofessional behavior, especially in group dynamics. Gossip, backbiting, rudeness, etc. Not just to other nurses, but to doctors, PAs, PTs, paramedics, RRTs, etc. It's shown here on this site, too. It's not professional, and it's a turn off to be a nurse.

[JazzyRN]

I seriously don't think this behavior is the norm at all. Too bad your bad experiences have caused you to form a stereotypes about nurses. Ive had good and bad experiences with PAs as well, but I wouldnt dare classify PAs as a whole, I just take it individual by individual. My suggestion to you is to choose the ERs you work in more carefully and not put up with crude, unprofessional behavior by reporting it to the correct authorities. I also feel there are 2 sides to every story. So being that this behavior isnt the norm and you have ONLY had negative experiences with nurses, there may be a problem with you and how interact with these nurses. If everyone is reacting badly to you, is it everyone being wrong and crazy is every nurse in the country mean,rude and unprofessional or could YOU possibly be creating part of the problem?

[Works2xs]

For the OP...

Without asking you to recount 10 years of experiences, I would like to ask a couple of questions regarding your search for further understanding...

It appears as though that the worst of your experiences occurred at 2 facilities. Having upper management give the sort of order to the nurse manager that they gave seems highly unusual, as well as understandably infuriating. Your post seems to imply that this level of hostility was the norm. Was that really the case in all 10 locations? Or did these 2 hospitals taint further the possible lower level irritations found at the other places?

Some workplaces are just crappy for all concerned, regardless of position. Were any of the 10 places in that category? Was it possible that a generally bad work environment for all was seen in a more personal light, based on the bad personal experiences you may have had elsewhere?

Did you speak to other PA's in these facilities? Were they treated in a similar manner across the board? How about on different shifts? Sometimes, when you see something occurring in your immediate environment, it's easy to project that across the whole. I'd imagine that when a new person comes on board, you generally get funneled to the least favorable shift. If you are changing jobs every few years, it may be that you just got the short straw at each location.

Then there's the phenomenon of taking extra notice of something once you've experienced it. Sort of like when you purchase a new car. Suddenly, it seems they're all over the road when before, you hardly saw them. Were you just noticing those that acted poorly in an otherwise normal distribution of people with bad attitudes?

Finally, there's the 10% phenomenon. Like the ol' saw says, it only takes 10% of a group to act badly to make the entire population look bad. Since these bad experiences tend to focus your attention in one direction, did you inadvertently miss those who were either normally courteous or even above average on the "nice" scale?

I don't mean to imply that your experiences didn't occur or weren't understandably upsetting. Like any field of human experience, it gets a little dangerous to paint a group with such a broad brush. Yes, undoubtedly, there are crappy people in nursing, as there are in any profession. Similarly, there are great people. Perhaps, there's just a matter of focus involved here.

[oONurseSharkOo]

were most of the hospitals you worked at union? if so i think therin lies your answer

[begalli]

The above statement about unions is a statement that uses just as broad a stroke with that paintbrush as the OP has been accused of using in his statements about nurses.

[oONurseSharkOo]

all im saying is this may explain the contrast he's experiencing between him past experiences and las vegas. Here in arizona there are no unions and i have never seen a nurse act in such a way torward a PA. i think some nurses (and certainly not all) that work union may feel they have the leway to step out of bounds like that and from the op's stament he said the nurses threatened to take action with thier union if the doctors amde a fuss about it. I'm not making a generalization ther are horrible nurses everywhere and likewise their are acceptional nurses everywhere but again ive traveled and done strike relief assignments to union hospitals and have heard many similar stories from tecs and lpns that i have never heard in a non union hospital.

[SkateBetty]

Has anyone noticed that the TITLE of the thread is "Never understood nursing?" I think if the intent was to gain a better understanding, there would have been a different/longer title.

"Help me understand nursing" or "Never understood nursing...am I missing something?"

Semantics, I know. But, it didn't start off productively.

When I first read the title I thought it was going to be a question of the role and purpose of the nurse. "Never understood nurses" seems fitting!

OP - I think I would take your post more seriously if the situations were less...unlikely. Ripping up prescriptions would get any nurse I know fired in a second. Rude verbal exchanges with any co-worker would get someone written up where I am. Are you sure these stories aren't salted and peppered a little to make them more interesting? Take your pregnant ER patient as an example. "One nurse refused to place an IV in a patient because she said the patient was a drug seeker and she was not going to take the "risk of a needlestick putting an IV in someone who she didn't feel deserved it". I don't know a single nurse ridiculously stupid enough to open her pie-hole and say a patient doesn't deserve drugs she is seeking, and refuse to even start the IV. Every ER nurse knows this gal will probably get fluids at the least. And what about the nurse who says 'aint? "He called for a transfer and asked the nurse for an LP kit. She said "you aint doin that to the baby"." Let me guess, her two front teeth were missing too, right? It's the way you describe the situation that puts me back a step, and the raw ridiculousness of the situations that seem hard to belive. A nurse refuses to get an LP kit for a doctor? She'd be escorted to her locker and her badge confiscated. Do you see where I'm coming from? Your situations seem too colorful for me to take seriously. Last post for me on this thread.

[PACPhD]

As far as the union issue goes, probably 50/50. I have actually had union nurses tell the physicians on numerous occasions "I'm union, what are you going to do, fire me?"

Here is my take on the hospitals. I think 6 in NY - 3 were horrible for all of the non nursing staff. This is not something that I sat in my corner of the ED and thought they were just acting that way to me. All of the staff talked about how uncomfortable it was to work there, and the main reason was the nursing staff. Many left. The other 3 were just not a nice atmosphere to work in because of the nursing staff. I actually had a few of the nurses in one ED tell me they were going to "make my life as miserable as possible until I quit". I lasted 6 months and quit. Then I worked in Milwaukee. Better. No real complaints there, but still not what I thought a cohesive group. Way better than anything in NY.Then N. Virginia. Horrible place. Then Las Vegas. Ahhh paradise. You know it's funny, about the worst patient population I have had to deal with. Drugs, homeless, scammers, (county hospital), but I enjoy going to work. The atmosphere is just so different. And the nursing staff has made it that way.

So why haven't I written up any of the nurses? Made formal complaints to the nursing boards? Not the way it's done in my world. I don't write up my co-workers.