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Are nurses and doctors equal?

Nurses   (9,045 Views 67 Comments)
by SisterofMary SisterofMary (New Member) New Member

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Aunt Slappy has 2 years experience.

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There's always an exception to the rule ...but most nursing jobs do involve carrying out other people's orders. I don't find it offensive to be a little lower on the hierarchy than an MD. Very few people are at the top or the bottom of anything. Most of us fall somewhere in the middle.

Gawd thank you! I was rolling my eyes over here. Of course we know we are to question orders if necessary, but generally we implement a doctor's orders. We as nurses cannot give orders to doctors. That indicates inequality to me, and that's perfectly fine.

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1 Like; 2,996 Visitors; 150 Posts

You're only subordinate to those who are your managers/supervisors. For most nurses, this person will never be a doctor for them, but other nurses. It's hard to equate two very different careers that do not even have the same focus. Nurses could not do their jobs without physicians doing theirs and vice versa. You are neither equal to nor subordinate to physicians.

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1 Article; 2,361 Visitors; 51 Posts

You're only subordinate to those who are your managers/supervisors. For most nurses, this person will never be a doctor for them, but other nurses. It's hard to equate two very different careers that do not even have the same focus. Nurses could not do their jobs without physicians doing theirs and vice versa. You are neither equal to nor subordinate to physicians.

That's a good way of putting it and a different perspective.

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1 Article; 2,361 Visitors; 51 Posts

Thank you everyone for the conversation....I appreciate it. I've been a nurse for just shy 2 years. So I don't consider myself experienced just yet I jstarted in acute care recently which is a whole diff. animal from sub-acute. But where I work there aren't many nurse driven protocols so I didn't realize I would have to contact the physican so much. It begins to feel rather top heavy and after that conversation I was kinda like....am I subordinate to doctor's since I'm carrying out their orders? But as many people say it is two diff. roles with two different focuses.

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JBudd has 38 years experience as a MSN and works as a ED nurse, community college adjunct faculty.

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That's Animal Farm, actually.

You are so right!! I went back and edited it. sorry for misleading!

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FurBabyMom has 7 years experience as a BSN, RN and works as a Registered Nurse.

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But where I work there aren't many nurse driven protocols so I didn't realize I would have to contact the physican so much. It begins to feel rather top heavy and after that conversation I was kinda like....am I subordinate to doctor's since I'm carrying out their orders? But as many people say it is two diff. roles with two different focuses.

I worked in a hospital setting where nursing was not viewed the way it is where I work now. Like your situation, there were very few situations where we didn't have to call someone for permission for anything - there were no standing orders, no protocols, and you didn't really matter. In this place, nurses were not entitled to use a computer they were already using if a physician needed on (no, not in the MD workroom either - at our workspace).

Different roles with different focuses is a good way to think about it. Based on where I work now, I feel "collaborative" is a good way to describe it. We're lucky where I work, we have great relationships with our surgeons and anesthesiologists. Our surgeons are hilarious - some of the best ones correct people and say it is not their room, it is my (or another nurse's) room. They mean it too - and the good ones will tell you their view is segmented, so is anesthesia's, and I (or my coworkers) see the whole picture.

I have taught residents a great many things, and taught attendings a few things too. They've taught me more, but that is the nature of it.

I don't feel subordinate to most physicians. If they're good at their job and know what they're doing, there is no reason to make an issue over superiority. A few I know have a complex, and I wouldn't let them touch me or my family members even if I or we were dying.

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djh123 has 5 years experience and works as a RN at a transitional rehab facility.

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They're not equal in terms of education and pay. I view myself as a bit of a subordinate to doctors - and NP's - yet I also think they should treat us with respect. Many do, some don't.

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Many do, some don't.

True. I mean I guess it is okay to be a subordinate. I think I over estimated the role of the nurse as like I said in nursing school as much as we are the patient's advocate/first line of defense, it doesn't always feel that way in actuality.

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FurBabyMom has 7 years experience as a BSN, RN and works as a Registered Nurse.

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True. I mean I guess it is okay to be a subordinate. I think I over estimated the role of the nurse as like I said in nursing school as much as we are the patient's advocate/first line of defense, it doesn't always feel that way in actuality.

We very much are their advocate. I'm an OR nurse. Almost always my patients are unable to do anything for themselves while I/my coworkers/our team is caring for them. Different from many ICU patients in that we not only sedate them, but keep their family/friends from being with them. There is nobody else to ask questions or to ask what the patient would want. Nobody else brings up - this patients procedure is staged, they will be admitted the while time, they are a hard stick - should we take 10-15 minutes of set up time to put a central line in?

I personally have asked tons of questions, brought up tons of things - sometimes made the difference for my patients. I talk with the surgeons and anesthesiologists - have we considered ABC or XYZ, what about (insert issue/concern here), the imaging shows a LEFT sided (tumor/mass/lesion/Fx/whatever)...are we on the correct side? Do we have all of the things that are absolutely critical for our patient (essential supplies and implants), have we considered their allergies, have we considered their cultural or religious preferences (often for us it's non-acceptance of blood products which also limits some pharmacy options containing or made from derivatives of blood products, etc). Have we considered the worst case scenario (do we need to be on mass transfusion, do we need to be able to go on bypass or ECMO, are we set up to put in a trach if we have to, do we need to be prepared to code our patient)? Do we have a throughput plan for our patient (if things change during surgery suddenly we're scrambling for an ICU placement)? The patient is "behaving weirdly" - are the odd VSs related to mechanism of injury (my primary area of assignment is neuro), dehydration, other underlying medical issue, too close for comfort to early s/s of malignant hyperthermia?

When I was a floor (stepdown) nurse, I did a LOT of translating for patients and families. I would be there while surgeons explained a diagnosis, and then help them process it. Answer the questions I could, and start a list of questions to ask when the provider rounded again for things I couldn't answer (prognosis, very specific questions related to treatment).

While different, I was the advocate for those floor/stepdown patients too. The patient that was NOT ready to leave ICU? We watched them as closely as possible, caught a complication, sent them back to ICU. Angered a surgeon (how dare we call with a major status change), rapid responsed the patient because the surgeon didn't allow us to get the imaging the patient clearly needed, packed the patient up and took them for the imaging. Transferred them to a more appropriate level of care. It doesn't have to be this stark - it can be looking at the medications you're scheduled to give, looking at the patient's vital signs and determining whether to give the meds or hold them, or call for clarification (insert labs in place of VS, etc). It could be asking for a more comprehensive plan to address a patient's pain...like a consult to the pain service.

Some of the planning and throughput things we do are also examples of advocating for our patients. Working to get a plan for continued OT or PT either in a SNF, inpatient rehab or on an outpatient basis? Yep, that counts. Helping make arrangements for patients to learn to manage insulin administration? Teaching them to be able to do the best they can independently or as a family? A form of advocacy.

Being the patient's advocate doesn't necessarily mean calling the shots. You will learn how to talk to providers and collaborate with them. You learn what questions to ask, how to phrase them, who you have to talk to in a way that makes them think your request is their idea, how to handle coworkers, when to ask for a different intervention/revise the plan, when to pull the "policy card".

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theRPN2b works as a RPN.

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YES we are all equal,no one discipline is "above" another.No MD is "higher/more important" than a nurse just like no nurse is "higher/more important" than a CNA. Even though we have diferent roles and different levels of knowledge,we ALL work together and make a contribution to patients' outcomes.

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amzyRN works as a RN-Emergency Services.

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Every person should be respectful in all of their interactions in my opinion. I do not see myself as a subordinate to anyone. As a nurse, my role is different though. The MD or NP directs patient care, writes orders seeks assistance in treatments. As the nurse, my role is to assist and support while making sure what I am doing makes sense for the patient. I don't just blindly follow orders and if something doesn't seem right I say so and have refused to follow if it is not in the patients best interest, or have requested clarification. I make suggestions, like in the SBAR (situation, background, assessment RECOMMENDATIONs). I have caught important things that doctors have overlooked.

CNAs, techs, scribes, are all members of a team. People who disrespect anyone because they view them as subordinate is not acting professionally and this should be brought to their attention. With that in mind, the job we do as health care workers in what ever our roles is very stresful and sometimes people don't behave as they should, being flexible and forgiving and giving poeple the benefit of the doubt is also necessarily, as long as it doesn't happen regularly that someone behaves badly or disrespectful.

If there is a pattern of rude and disrespectful and disruptive behavior by any team member, this really sould be addressed.

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Ashley_SF has 4 years experience and works as a Registered Nurse.

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I feel like this question as been abused over time but I think in nursing school I was taught to respect my position and the importance of nursing care in patient's outcomes. Although I respect the doctor tremendously, should I consider myself an equal? Or a subordinate? I feel like it matters in terms of nurse to patient interaction. I do have patients who value my logic and thought processes but also who think I am the doctor's lackey. I think to be a nurse you have to have humility and for one's ego to be set aside because our decisions do require medical supervision. And I don't have problems being humble.

I still consider myself a new-ish nurse with a lot to learn about nursing. I consider myself competent with a commitment to learning. I am still working on confidence building.

Thoughts?

So, I've been thinking about this post all day. After speaking with my SO and doing a little research I have some observations..

Subordinate: placed in or belonging to a lower order or rank.

of less importance; secondary.

subject to or under the authority of a superior.

Equal: as great as; the same as

like or alike in quantity, degree, value, etc.; of the same rank, ability, merit, etc.:

evenly proportioned or balanced:

If we look at the definitions of the words "equal" and "subordinate" we can argue both that nurses are equal/not subordinate and that they are unequal/subordinate to physicians. But, I contend, these adjectives need to be removed from the conversation concerning the relationship between the nurse and the physician.

The following quote from the American Journal of Nursing illustrates the importance of a team approach to healthcare and the detrimental effects of our choice of language, "doctor's orders", on the development of a more complimentary relationship between nurses and physicians:

"The term physician's orders has outlived its appropriateness. Nurses have an ethical duty to be members of collaborative teams. Communication, consultation, and interdisciplinary cooperation are the benchmarks for quality outcomes. Other professionals communicate without issuing orders to each other-by continuing to use this phrase, nurses support a linguistic and symbolic discounting of their autonomous and accountable practice."

See full article here: Physician Orders : AJN The American Journal of Nursing

I'll finish with this quote from Brian Secemsky, MD: "The greatest challenge and the ultimate goal is to create a friendly and personal environment where nurses and doctors are able to question each other's decision-making without fearing an angry or defensive response. Even the greatest nurses and best-trained physicians make mistakes. In order to mitigate these potential medical errors, nurses and doctors must obtain a level of communication where it is okay to question a medical decision or provide productive feedback on any aspect of patient care."

Full article here: Doctors and Nurses: A Relationship in the Works | HuffPost

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