Doctors vs. Nurses

Advanced Practice Columnist / Guide · Apr 14, 2015

How appalling. Actually, the rule about not having beverages or any other food items at work areas is an OSHA regulation that TJC (JCAHO) enforces. Nevertheless, nobody should be exempt from complying including the CEO.

I'm disappointed that those in nursing management at your institution are allowing physicians to be non-compliant. I also work at an academic medical center and the all our physicians from the top (attendings) all the way to the bottom (interns) know the rules and are not immune from being reprimanded by anyone (even by a housekeeper) when caught with a cup of coffee while rounding.

Workstations on wheels are another story. At our ICU, these are dedicated for use during rounds by the provider teams. Nurses have their own workstations (2 of them, one inside the room and another one right outside by the door). Pyxis stations also have an attached workstation. There is no reason why a nurse at our institution would even need to use a WOW. Maybe, the issue is that there is not enough workstations (wheeled or not) for nurses to use at your institution and that should be addressed by nursing management.

There's got to be some serious issues with nursing's voice in your institution. Academic medical centers should become champions of nursing excellence (as many are in fact affiliated with schools of nursing) and that includes recognition of nurses as professionals and colleagues in healthcare not as a subservient class of technicians.

RNperdiem, RN · Apr 14, 2015

I think it varies by hospital culture as well.

I never did understand the drinks thing. I do not understand the need for adults to walk around with drinks in their hands like toddlers and their sippy cups. Still, everyone should be held to the same standard.

dudette10, MSN, RN · Apr 14, 2015

I am so glad that there is a more collaborative, respectful environment between nurses and doctors where I work. I've seen attendings walk into the computer area completely filled with nurses and doctors, and he/she has never once expected a nurse to give up a seat. I have routinely walked into an isolation room to find an attending not gowned up, then when I hand over a gown and gloves, I get a "Thank you." I've even told the MD director of the telemetry department that he has to wash his hands in a Cdiff room, rather than gelling out, and I got a "Thank you." If I'm in a room during rounds, the doctors always ask to log me out before just taking over the computer.

The only issues I've ever had with disrespect were with a couple of surgical attendings. In one case, the surgeon had discharged a patient, but after reviewing labs, I knew the patient shouldn't be discharged. When I called him, he was copping attitude with me about my assessment findings (which were, admittedly, borderline by themselves), but when I got to the labs (assessment + labs = no discharge), he backed off considerably, cancelled the discharge, and ordered internal medicine to take over the patient.

What he didn't know was that he is my son's doctor, and you better believe I will tease him about our exchange when I am in the "mother of his patient" role!

Pangea Reunited, ASN, RN · Apr 14, 2015

I see it like this:

My unit is my "home". I'm there for 12+ hours at a time. The MDs stop by and I treat them like guests. If they need a computer, I let them use mine. If they need a chair, I let them sit down. I've never had someone "steal" a computer from me, but then, they would have no reason to...

As for not making a fuss about the drinks, that probably has to do with the fact that doctors make money for the hospital by opting to admit and treat patients there. As nurses, we simply cost money and have a much more direct employer/employee relationship. Our cup-of-coffee "sins" are also less transient and more noticeable as we're around for greater lengths of time. Is it right? Maybe not ...but it's a very small thing in the grand scheme of things.

Altra, BSN, RN · Apr 14, 2015

I'm sorry for your,experience, OP. I also work at a large teaching institution. When it's a day to throw out everyone's drinks ... everyone's drinks get thrown in the trash. A physician sitting idle in front of a workstation ... will be asked to move so that I can use the workstation.

JP drain contents spilled into an unlidded cup? I'd pay money to observe that *teachable moment*.

Birdy2 · Apr 14, 2015

So why are we not allowed to have drinks? I always carry a cup with a lid on my cart because I hardly ever have a chance to sit down in the break room during my shift. I have been told not to leave drinks around the nurses station because day shift doesn't like it, but never been told it's an actual rule everywhere. And all of night shift drinks and eats at the nurses station. We just clean up before shift change. At the place I work the doctors will most definitely sign u out or ask for a computer when you're using it. Another question, what about caps in the sharps container? I see people to this all the time, but I know we're not supposed to. I'm wondering why my hospital gets away with so much.

MsPebbles · Apr 15, 2015

I'm sorry for your,experience, OP. I also work at a large teaching institution. When it's a day to throw out everyone's drinks ... everyone's drinks get thrown in the trash. A physician sitting idle in front of a workstation ... will be asked to move so that I can use the workstation.
JP drain contents spilled into an unlidded cup? I'd pay money to observe that *teachable moment*.

And I'd pay to see someone ask a physician move to use a computer! Especially the countless med students who hog every single one at the nurses stations, including the ones used by the charge nurse and secretary! As a nursing student, we are told that we must always relinquish our computers if staff needs them, and to try to not use the ones at the nurses stations. After all, we are "guests." It's apparent the med students at my facility are not encouraged to have the same courtesy.

Ruby Vee, BSN · Apr 15, 2015

And I'd pay to see someone ask a physician move to use a computer! Especially the countless med students who hog every single one at the nurses stations, including the ones used by the charge nurse and secretary! As a nursing student, we are told that we must always relinquish our computers if staff needs them, and to try to not use the ones at the nurses stations. After all, we are "guests." It's apparent the med students at my facility are not encouraged to have the same courtesy.

As a nursing student, you are a guest -- I'm very happy to hear that you're told to relinquish a computer if staff needs it. Medical students, pharmacy students, RT students and PT students are no less "guests" and also expected to relinquish computers if staff needs them. As a charge nurse, I'd be speaking to those medical students and pointing out the designated workstations for providers. If they didn't immediately take the hint, I'd be speaking to their supervisors.

Things may be different when you're staff.

JPINFV · Apr 16, 2015

I'm still just a Tech, but the disparity between what doctors can do and get away with and what staff do (namely nurses) has been bothering me since I first entered the hospital setting.

I think one of the things that is missing is the difference between the working conditions and employment style of nurses and physicians. As a resident, I can have up to 10 patients (total of 20 for the entire team) spread out among between any of the med/surg or tele units (3 floors, 3 units per floor). If I'm really unlucky, it might include an ICU downgrade that hasn't made its way out of the ICU (so 2 more units on seprate floor, so 10 patients between 11 units on 4 different floors). That's a far cry from having all of my patients on the same unit like a nurse has (and while less patents, nursing duties requires more time per patient. I can follow up labs and write orders from any computer in the hospital or even at home, the same can't be said for med passes or assisting with ADLs).

So, do I often have a bottle of soda or water that I take with me on units? Sure, however I don't have a lounge that I can duck into for a few minutes like the nursing staff does. It doesn't help if I have a bottle of water in a lounge 2 floors away. That's a big deal when I've had days where I'm running 12+ hours straight without a chance to see a bathroom or the cafeteria.

In regards to bad physicians (and there are bad ____ in every field), the simple fact is that the nurse manager isn't my manager. If it's a heads up ("hey, you could have handled it better"), then the reality is that the nurse should be the one bring it up and not them hiding behind their manager. If it's something serious or repetitive enough to require formal discipline, then it should go to the nurse manager, who then goes to the department chair or chief medical officer (or, as a resident, my attending, or for med students, the attending or resident for that team and at this level no need for the nurse manager). Similarly, I wouldn't expect a nurse to accept a formal reprimand from a physician. The proper chain of command would be for the attending to go to the nurse manager.

This ignores that often problems can be taken care of directly as there can easily be a miscommunication regarding the medical plan and/or nursing assessment/concerns that shouldn't be disciplinary in nature.

The other thing to realize is that often physicians aren't hospital employees. They're either independent contractors or employees of medical groups that contract directly with the hospital. This further skews things in regards to the nursing chain of command compared to the medical chain of command in regards to management and oversight.

In regards to computers and students, at least at my hospital, it really depends on the service the student is on. Again, there's a huge difference between a medical student and ____ students. Medical students are a part of the medical team for a month often keeping the same hours. When I was a medical student, I could easily be in the hospital for 60+hours a week. Surgery? I clocked over 80 hours one week and 13 days straight (M-F with 30 hour call starting Saturday morning). My progress notes where cosigned by the attending and stood as the official progress note for the medical team. How often are nursing students writing directly into the chart? How often are nursing students in house for 80 hours a week? How often are nursing students assigned to the same nurse for a month at a time?

Similarly, if the team is rounding, often it's the medical student who is grabbing a computer to update labs if labs weren't done by the time the residents and students were "pre-rounding." This doesn't justify anyone being a jerk or kicking someone off of a computer, but if the only open computer is the charge nurse computer (which, in my observation, is often the least used computer), then it's more than justifiable for the med student to log on for a couple of minutes to see if labs are back yet.

This doesn't, of course, given license to physicians and medical students to be a-holes. However often times the complaints on how medical staff is treated different from nursing staff (and other hospital employees) fails to take into account the stark contrast between how each side does their work and is employed.

tobra99 · Apr 19, 2015

I think one of the things that is missing is the difference between the working conditions and employment style of nurses and physicians. As a resident, I can have up to 10 patients (total of 20 for the entire team) spread out among between any of the med/surg or tele units (3 floors, 3 units per floor). If I'm really unlucky, it might include an ICU downgrade that hasn't made its way out of the ICU (so 2 more units on seprate floor, so 10 patients between 11 units on 4 different floors). That's a far cry from having all of my patients on the same unit like a nurse has (and while less patents, nursing duties requires more time per patient. I can follow up labs and write orders from any computer in the hospital or even at home, the same can't be said for med passes or assisting with ADLs).
So, do I often have a bottle of soda or water that I take with me on units? Sure, however I don't have a lounge that I can duck into for a few minutes like the nursing staff does. It doesn't help if I have a bottle of water in a lounge 2 floors away. That's a big deal when I've had days where I'm running 12+ hours straight without a chance to see a bathroom or the cafeteria.
In regards to bad physicians (and there are bad ____ in every field), the simple fact is that the nurse manager isn't my manager. If it's a heads up ("hey, you could have handled it better"), then the reality is that the nurse should be the one bring it up and not them hiding behind their manager. If it's something serious or repetitive enough to require formal discipline, then it should go to the nurse manager, who then goes to the department chair or chief medical officer (or, as a resident, my attending, or for med students, the attending or resident for that team and at this level no need for the nurse manager). Similarly, I wouldn't expect a nurse to accept a formal reprimand from a physician. The proper chain of command would be for the attending to go to the nurse manager.
This ignores that often problems can be taken care of directly as there can easily be a miscommunication regarding the medical plan and/or nursing assessment/concerns that shouldn't be disciplinary in nature.
The other thing to realize is that often physicians aren't hospital employees. They're either independent contractors or employees of medical groups that contract directly with the hospital. This further skews things in regards to the nursing chain of command compared to the medical chain of command in regards to management and oversight.
In regards to computers and students, at least at my hospital, it really depends on the service the student is on. Again, there's a huge difference between a medical student and ____ students. Medical students are a part of the medical team for a month often keeping the same hours. When I was a medical student, I could easily be in the hospital for 60+hours a week. Surgery? I clocked over 80 hours one week and 13 days straight (M-F with 30 hour call starting Saturday morning). My progress notes where cosigned by the attending and stood as the official progress note for the medical team. How often are nursing students writing directly into the chart? How often are nursing students in house for 80 hours a week? How often are nursing students assigned to the same nurse for a month at a time?
Similarly, if the team is rounding, often it's the medical student who is grabbing a computer to update labs if labs weren't done by the time the residents and students were "pre-rounding." This doesn't justify anyone being a jerk or kicking someone off of a computer, but if the only open computer is the charge nurse computer (which, in my observation, is often the least used computer), then it's more than justifiable for the med student to log on for a couple of minutes to see if labs are back yet.
This doesn't, of course, given license to physicians and medical students to be a-holes. However often times the complaints on how medical staff is treated different from nursing staff (and other hospital employees) fails to take into account the stark contrast between how each side does their work and is employed.

Just because your lounge is 2 floor away and you have patients on multiple floors doesn't mean the beverage policy should not be applied to physicians, if the policy was put in place for a patient safety issue.

Moreover, I do not think the medical student is any more part of the physician team than a nursing student is part of the nursing team. Your 80 hours a week during the surgery rotation is part of your medical education, and if during your education you also help out by getting labs, then that is great but it doesn't entitle the medical student any rights to a computer more than any other staff. Conversely, if a nurse, charge or otherwise, prevents someone else from using "nursing designated" computers, I consider that an impediment to patient care.

In the end it comes down to the greed of the original poster's hospital CEO. Hospital administrations realize that physicians are providing the expertise that brings in the patients, and (especially in private practice), physicians have the choice of which hospital they want to send their patients to in order to deliver that expertise.

Last year, I realized I brought in millions in revenue to a hospital from my surgical volume as a surgeon, and I cost the hospital only the equipment I ask them to buy for me. There is no other worker at that hospital that brings in anything close to that amount except other surgeons. I can easily take my patients to the hospital down the street and make them millions of dollars richer instead.

That realization alone by the CEO is what gets physicians the best parking spots, the upscale attending lounges, and the ability to drink beverages on rounds. The business and greed of healthcare is unfortunately what turns an ideal healthcare working environment where everyone is held to the same standards for the patient's sake, into one that bends over backwards for those that can most line the CEO's pockets.

JPINFV · Apr 19, 2015

Just because your lounge is 2 floor away and you have patients on multiple floors doesn't mean the beverage policy should not be applied to physicians, if the policy was put in place for a patient safety issue.

As stated, it's an OSHA issue.

Moreover, I do not think the medical student is any more part of the physician team than a nursing student is part of the nursing team. Your 80 hours a week during the surgery rotation is part of your medical education, and if during your education you also help out by getting labs, then that is great but it doesn't entitle the medical student any rights to a computer more than any other staff. Conversely, if a nurse, charge or otherwise, prevents someone else from using "nursing designated" computers, I consider that an impediment to patient care.

I fail to follow the logic that a student grabbing labs for a team actively rounding on the floor at that instant is any different than a resident grabbing labs for a team actively rounding at that moment. I agree that the student, when acting as a part of the entire medical team, has no more right than any other staff member. However, I will also put forth that they have no less right either when the team is actively rounding on the floor. The conversation was regarding a student vacating for a nurse (direct quote, "As a nursing student, we are told that we must always relinquish our computers if staff needs them, and to try to not use the ones at the nurses stations. After all, we are "guests." It's apparent the med students at my facility are not encouraged to have the same courtesy."). It's absurd for me to think of a med student being kicked off of a computer when the entire team is on the floor because it's a med student, but not if it's a resident. I also think the same way regarding nursing students. I don't kick nursing students off computers if I need a computer. There's generally a computer available at one of the three stations (our units are triangle in shape with 2 small 1-2 computer stations at the other points) because I've got 2 good legs and need the exercise anyways.

There also aren't any "nursing designated" computers at my hospital any more than there are "physician designated" computers with the exception of the charge nurse computer, which is a sign taped over it (and I try not to camp out on those computers, but sometimes it's any port in a storm). The lack of computers is a recognized problem since the hospital wasn't designed as a teaching hospital, but now has over 100 residents in various programs, thus causing a well known computer shortage (I actively try not to need a computer at 7am because of the sheer number of physicians and nurses needing computers for pre-rounds and sign out respectively). Now if we want to be specific, the hospital does encourage bedside charting for nurses with the in-room computers, but even I recognize that as a stupid idea for numerous reasons, including the lack of efficiency when constantly logging in and out.

In the end it comes down to the greed of the original poster's hospital CEO. Hospital administrations realize that physicians are providing the expertise that brings in the patients, and (especially in private practice), physicians have the choice of which hospital they want to send their patients to in order to deliver that expertise.
Last year, I realized I brought in millions in revenue to a hospital from my surgical volume as a surgeon, and I cost the hospital only the equipment I ask them to buy for me. There is no other worker at that hospital that brings in anything close to that amount except other surgeons. I can easily take my patients to the hospital down the street and make them millions of dollars richer instead.
That realization alone by the CEO is what gets physicians the best parking spots, the upscale attending lounges, and the ability to drink beverages on rounds. The business and greed of healthcare is unfortunately what turns an ideal healthcare working environment where everyone is held to the same standards for the patient's sake, into one that bends over backwards for those that can most line the CEO's pockets.

The funny thing is that I'm at a county hospital. Heck, we don't have an attending lounge. We have a resident lounge that's normally infested with med students from the slower services (not IM or gen surg). No one is coming here because of "Dr. So and So."