I'm not the doctor!

[sweetdreame]

Recently my husband's grandmother was a patient in the ICU. I am frequently used as the medical translator in the family, this time wasn't any different. I had the opportunity to make a couple of observations I would like to share with you.

Before I continue, let me tell you a little about myself. I have worked in many areas of the hospital. L&D (as and OB tech), Ortho/Neuron MedSurg, ER, Trauma ICU, CVICU (all as an RN). I recently started graduate school in hopes of gaining more autonomy and advancing my education. I LOVE being a nurse. I love the way it blends science and compassion. I am PROUD to be a nurse. Except for one thing.....

I have always had a problem with the societal perception of nurses. I love the show Grey's Anatomy (despite its medical inaccuracies), but can't help noticing that there are no nurses in major roles. I see nurses as a whole represented as coffee-fetching secretaries. My family even says to me "I know you're not the doctor, but what do you think about this....?".

This perception, of course, does not jive with the fact that many nurses have a Bachelor's or Master's Degree in Science, multiple additional certifications, years of experience, and have saved multiple patients from incompetent physicians.

This week, while observing the nurse caring for my family member, I realized a MAJOR part of the problem with the way nurses are perceived. My confused family member mistakenly called the nurse DOCTOR. The nurse replied...

"Oh, I'm not the doctor I couldn't handle that much responsibility".

EXCUSE ME?! Throughout our visit, she repeatedly dodged conversations, referred the family to the doctor with any questions, and generally made me feel ashamed about our profession. I realized that I have encountered that same attitude so many times in my fellow nurses. But WHY?? I once heard a nurse tell a physician who offered to help her clean a patient...

"Oh I'm sure you have more important things to do! This isn't your job."

This is just as much the physician's patient as yours, and if the job needs to be done for the good of the patient, why would you assume this meek, butt wiping maid position to the ALMIGHTY DOCTOR??

Let me start out by saying that I know all nurses are not created equally, but I think this is a mindset bred into many nurses from the beginning of our education. Instead of thinking "I am an educated, experienced caregiver who is more than capable of answering your questions. I shoulder a TON of responsibility every day I come to work." We are taught this...

"The doctor is GOD. The doctor is KING. You are JUST THE NURSE."

This thought is reaffirmed every time we allow a colleague's ideas to be dismissed by a rude attending, or when we don't speak up in family conferences, or when we say things like "Oh I'm not the doctor, that's too much responsibility". This inaccurate perception of the "pecking order" is not only offensive, but unsafe. This mindset is what makes you second guess yourself before calling that mean physician to report a critical value, or bring up an important concern. NO MORE!!!

I'm calling all nurses to WAKE UP!

Empower yourselves through education and experiences. Realize that you are not the secretary, the butt wiper, or the maid. You are smart, you are important, you are educated! Quit it with the subservient attitude and be the powerful PROFESSIONALS you should be. We are separate professionals, MDs are not your boss, they are your colleagues. Quit demeaning our own profession with your engrained lowly mindsets.

OK, rant over... feel free to comment, tell me what you think!!!

[chillnurse, BSN, RN, NP]

medicine and nursing are both challenging professions. But the amount of knowledge required to practice medicine is much much greater than to practice nursing. I am not saying nursing is easy, but too many nurses have the attitude that they could do everything the doc can. So 3 years of RN school equates to 4 years of med school and 3 years of residency? No, it does not. I worked as a nurse on many different units prior to becoming an np. even being an NP requires much more knowledge than a staff nurse. It is just ocmmon sense. I am sure there are very smart nurses out there and not so smart nps and mds, but overall, the doctor WILL know more. If you refute this you are just plain wrong and have not done both.

[chillnurse, BSN, RN, NP]

I think the big misconception is that all smart people to go medical school and advanced practice, which is also false. The big gap in knowledge comes from the continual pounding of our knowledge base that we take on a daily basis. When forced to use knowledge more often, we will become more competitent. I am sure if any of the RNs on this forum took the pounding we take as providers for several years, they would be just as comp. at the job of a provider. One's career molds their intelectual ability. Hence why I can't spell without spell check.

[dudette10, MSN, RN]

Nurses have a huge amount of responsibility. Of course we have many reasons we didn't go to medical school, but less responsibility should not be on that list. Even if you think the physician is legally responsible, you have a moral and professional obligation to ensure that every action taken by the physician is in the patient's best interest as the patient's advocate. The "I don't want that much responsibility" response makes nurses look lazy and uneducated. We aren't.

Um, what? It's a damn good reason for not becoming an MD in the context the poster you replied to used it. You changed the meaning of the phrase in your reply.

I'm a nurse, I love my job most days, and I'm not insecure in my role. I have no desire to be a provider because it IS too much responsibility. Just because I believe that does NOT mean that I fail to fulfill my role as a nurse. Frankly, I don't follow your logic.

[chillnurse, BSN, RN, NP]

after reading the phrase "make sure every action taken by the physician is good for the patient" I have come to the conclusion that the OP has probably been cussed out continually for questioning sound orders. Lol

[chillnurse, BSN, RN, NP]

If every physician order was executed by the nurse without question, some nurse would have given 50mg of IV (that is, not PO) hydralazine to a hypertensive patient and likely killed them or stroked them out because the physician "thought it was 1:1." Or they might even have given 6mg adenoside to a symptomatically bradycardic patient, instead of 1mg atropine since the young doc must have mixed the two "a drugs" up. The MD mistakes we catch are huge, and great harm could result if it wasn't for the "second set of eyes" that are nurses.

Yes I do believe physicians and nurses should have ongoing professional and respectful conversation for the good of the patient. I also wish I got more credit for the knowledge that I have (although I do acknowledge the greater knowledge of physicians). However, I do not want the responsibility (and with it, accountability) of a physician. At least not as long as I'm being paid or respected as little as I am as a nurse.

We have a pharmacist for that

[RNperdiem, RN]

When a patient or family starts asking questions about their medical plan of care "what are the chances of recurrence of this tumor", I will refer them to the doctors.

If the patient has questions about things nursing related, I can answer questions about the use of the incentive spirometer, the importance of early mobility, things to know about pain control.

[Nurse SMS, MSN, RN]

The doctor's role is to investigate, diagnose and treat the disease itself. The nurse's role is to help the patient live within all of the above and ensure the patient is both safe and monitored.

Totally different roles. Both extremely important to the patient. I can be valued for what I do without having to go into competition with the MDs, PAs and NPs. I just don't need the chip on my shoulder. Each needs the other and there is nothing wrong with saying " your doctor will be better able to answer that than I".

[sweetdreame, BSN, RN]

The OP has an excellent working relationship with many amazing physicians. I also don't hesitate to question an intern...or an experienced attending for that matter if I don't think the order is for the best of the patient.

You certainly misinterpreted my quote. What I said is the job of every nurse.

Additionally, I have never been cussed out by a physician. That is unprofessional and inflammatory behavior and would NOT be tolerated. How are we supposed to have Collegiate Interactive Teams (see "Why Hospitals Should Fly" by John Nance) if we allow such behavior?

[sweetdreame, BSN, RN]

We have a pharmacist for that

OMG. I cannot even explain how uncomfortable your comment makes me. Google "the swiss cheese model" related to patient safety. The bottom line of that theory is that we are all human and prone to error (you could also read "To Err is Human") and must have multiple double checks in a high-risk industry such as health care. We can't just assume someone else will take care of it and move on. That is how adverse events happen.

[HappyWife77, BSN, RN]

It's best to KNOW what you KNOW....then simply find out for them if necessary things you don't know or that they need to see the doc for....or what we need to contact them for. We're hands on and once the doctor knows the nurses, They will usually take in to consideration our suggestions anyways.

Doctors are human just like us.

[sweetdreame, BSN, RN]

medicine and nursing are both challenging professions. But the amount of knowledge required to practice medicine is much much greater than to practice nursing. I am not saying nursing is easy, but too many nurses have the attitude that they could do everything the doc can. So 3 years of RN school equates to 4 years of med school and 3 years of residency? No, it does not. I worked as a nurse on many different units prior to becoming an np. even being an NP requires much more knowledge than a staff nurse. It is just common sense. I am sure there are very smart nurses out there and not so smart nps and mds, but overall, the doctor WILL know more. If you refute this you are just plain wrong and have not done both.

I certainly didn't mean to imply that the education MDs have is somehow not significant. My point is that we are all important integral parts of the care team, just as the pharmacist, the RT, etc. Often, the primary nurse does (and should) know a lot about his or her specific patients. A good physician can rely on a good RN to fill him in on many issues he might not be aware of since he has 20+ patients!

Additionally, I will make the argument that an experienced ICU nurse has as much working knowledge to treat patients as a first or second year resident. The nurse may not be able to describe each metabolic pathway, or the physiopharmacology of each drug, but certainly knows what the appropriate treatment is MOST of the time. I don't want you to think that I don't respect physicians or consider them a very important part of the team. I just don't want nurses thinking that their knowledge and experience are not worthwhile and important as well.

Thanks for your comment.

[TorresFNP2b]

I have worked with both respectful physicians and rude, condescending, arrogant physicians, and I have to say that how each treats and interacts with us nurses does impact the level of pride I feel in our profession. Mutual professional respect is key. Unfortunately though there are still many docs and patients who will always see nurses as "less than" so we have to try not to see ourselves that way.