Doctors vs. Nurses

[MsPebbles]

I work in a large teaching hospital that is affiliated with a med school, which means residents and med students account for a large number of those we share our work spaces with daily. Up until recently, my unit had a designated area at each station for staff drinks. As long as they were named, dated, lidded, and remained in the designated area, it was okay to have them there. It is a very large unit and some stations are far from the break room.

A few weeks ago, JCAHO visited and determined this was was not permitted as it poses a risk to staff safety. This I understand...in fact, I had always known this but was informed that JCAHO approved our designated areas the last time they came.

Now, although staff are forbidden from having drinks outside of the break room, physicians are exempt from this (per management), and often do their rounds with beverage in hand. Yesterday I nearly spilled JP fluid into an open coffee cup on a sink ledge left by a doctor while he was talking to the patient in that room.

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. Drinks are one thing. I've witnessed doctors take a WOW computer from a nurse while she was logged in about to pass meds as her back was turned. The response to the RNs who ask management to inform doctors not to run off with WOWs during their crucial times: "Find another WOW." The response to doctors who complain: "We will order more dedicated physician computers." Then there are patients who complain about nurses claiming they were unavailable, were not attentive, did not provide quality care, etc., and you better believe those nurses will get reprimanded. Yet a doctor rounds for a few minutes, never smiles, doesn't address patients' concerns appropriately, and acts self-entitled and he is viewed upon gloriously by patients and management alike. As professionals, shouldn't we all be held to the same standards across the board?

Maybe I'm just naive, but I thought that the notion that nurses are beneath doctors and are not entitled to the same level of respect was a thing of the past. I guess I can understand how society has a doctor vs. nurse mentality, but why can't it stop being perpetuated from within the healthcare setting?

[klone, MSN, RN]

This is still AllNURSES, right? How did we get a bunch of physicians arguing amongst each other?

[Ruby Vee, BSN]

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.

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.

Yesterday, I walked onto the unit to get report on my patient, and there were two people on the nurse-designated computer outside the patient room. There were two open (no lids) containers of steaming hot coffee perched right next to the keyboard and the paper chart. There was a physician-designated WOW right behind them, close enough that it was touching the back of the nurse-designated chair they were sitting on. And yes, they were a physician and a medical student. Interesting thing is, the work room full of computers that we'd designated for providers was a mere six feet away, directly across the hall and empty. No reason for drinks, open or otherwise, to be endangering my work station or that patient's paper records from an outside hospital. No reason for them to be at the nursing workstation on the nursing computer or in the nurse's chair. They were just being oblivious. And when the person I was taking over the patient from tried to gently educate them on shift handover, they were rude and dismissive.

The charge computer is for charge nurses, the secretary's computer is for the secretary. If we have to wait for a med student to finish what he's doing and get out of our way every time we need to look something up, it significantly slows the work process. That can be a patient safety issue. It's definitely an issue when the surgeon wants to know something and I can't tell him because there's a medical student on MY computer!

[JPINFV]

Yesterday, I walked onto the unit to get report on my patient, and there were two people on the nurse-designated computer outside the patient room. There were two open (no lids) containers of steaming hot coffee perched right next to the keyboard and the paper chart. There was a physician-designated WOW right behind them, close enough that it was touching the back of the nurse-designated chair they were sitting on. And yes, they were a physician and a medical student. Interesting thing is, the work room full of computers that we'd designated for providers was a mere six feet away, directly across the hall and empty. No reason for drinks, open or otherwise, to be endangering my work station or that patient's paper records from an outside hospital. No reason for them to be at the nursing workstation on the nursing computer or in the nurse's chair. They were just being oblivious. And when the person I was taking over the patient from tried to gently educate them on shift handover, they were rude and dismissive.

...and if your hospital has enough computers for such niceties, then yes, the physician should have been using the physician designated computers. Similarly, I recognized that medicine, like every field, does have a-holes in it.

The charge computer is for charge nurses, the secretary's computer is for the secretary. If we have to wait for a med student to finish what he's doing and get out of our way every time we need to look something up, it significantly slows the work process. That can be a patient safety issue. It's definitely an issue when the surgeon wants to know something and I can't tell him because there's a medical student on MY computer!

...and it's a patient safety issue when a team is rounding and no one can get updated labs because a medical student was asked to get them instead of sending a resident or attending and there's a distinct lack of computers available on the unit.

[Corey Narry, MSN, RN, NP]

Not knowing how the OP's hospital is set-up, it's really hard to tease out the issues other than the reality of the OP's preception of lack of respect towards nursing in her workplace which is a valid point based on her post. What drew me to this conversation is the fact that the OP stated that the institution is an "academic medical center", yet it sounds so atypical from what I experience where I work.

I am an ICU Nurse Practitioner at an academic medical center on the West Coast (Top Medical School + Top Residency programs). While we have big names in our physician and surgeon faculty roster (who do bring revenue for sure), they are all part of the same closed medical group. I also feel that as an institution, the value of interdisciplinary collaboration and mutual respect between disciplines are well realized here. There are exceptions for sure, but certainly not the norm. I feel that it has something to do with the fact that though the medical school is well recognized, the schools of nursing, pharmacy, and others bring just as much prestige to the institution's name.

I would say that we rarely if ever have an issue with sneaky, prohibited beverage-carrying issue among physicians and nurses here. There are designated areas on the units where all employees (regardless of profession) can leave covered beverages with a name label on it. There are ice and water dispensers on all the units accessible to anyone - I could easily excuse myself, grab a cup of water and toss the empty cup on the trash bin, then return to rounds. BTW, they are not styrofoam cups and are actually biodegradable so I'm not killing the environment.

The struggle for workstations can be hectic early in the morning as every member of the provider teams (residents, interns, sub-interns/med students, NP's, NP students) try to log in to pre-round on patients. However, there are enough designated provider workstations in the units, so when I say "struggle", it's really finding that comfortable spot close to your patient's room so you won't have to walk far to see the patient you're reading about. Needing to Look up labs at a pinch? come on, you have an iPad or iPhone right? well Epic has apps available on those devices so go look it up that way. We may be spoiled here.

[APRN., DNP, RN, APRN, NP]

To the poster who implied the CEO thinks he is the money making machine of the hospital: Last time I checked, the patients came to the hospital for NURSING care.

[tobra99]

To the poster who implied the CEO thinks he is the money making machine of the hospital: Last time I checked, the patients came to the hospital for NURSING care.

Yes, the patient comes to the hospital for both nursing care as well as for the inpatient delivery of physician expertise/surgery.

However, as a paid employee of the hospital, you deliver the "product" that the hospital is selling to its patients, and therefore the nurses are an expense they hospital must pay in order to deliver their product. If the hospital does not like your performance or if you do not comply with its policies, they can simply replace you with someone else who does.

However, physicians, unless they are hospital employees, bring the patients to the hospital to which the hospital can sell its "product" (nursing care, facilities, OR equipment). Therefore, the nurses are not directly generating revenue for the hospital, even though they are providing a vital service that cannot be provided in an outpatient setting. They indirectly bring business to the hospital by providing quality nursing care, which improves the reputation of the hospital, making patients and physicians want to come there.

Since physicians bear the role of direct primary revenue generators of the hospital, and the hospital administration/CEO knows the physician often times has a choice in which hospital to send their patients to, the administration will often do what it takes to keep the physicians happy, in order to maintain the flow of patients and revenue.

I believe this is the basis for the preferential treatment of physicians at some hospitals. I would think this would less likely be the case at academic institutions or hospitals that employ their physicians. Therefore, I am a little surprised the OP notices this differential treatment at an academic center, unless it's a hospital affiliated with an academic center to which an academic group provides services where hospital needs the services more than the physicians need that hospital.

[klone, MSN, RN]

To the poster who implied the CEO thinks he is the money making machine of the hospital: Last time I checked, the patients came to the hospital for NURSING care.

Sure, but we do not make the hospital money. Nor do individual nurses draw patients to a particular practice or facility, the way individual physicians do.

[Libby1987]

There were no Starbucks or water bottles when I worked acute care. We grabbed a cup and filled it from the sink.

I will sometimes carry chocolate covered espresso beans, caffeine rush without the BR trips.

The computer problem.. we used to fight over charts, it was actually a fairly contentious issue back then.

[APRN., DNP, RN, APRN, NP]

We will be making the hospital money when we are able to get reimbursements up for not causing UTI's, and VAP's, and CAUTI's, and having high Press Ganey scores returned.

That's where healthcare is headed. Just because the nurses are rolled into the bed now, doesn't mean it's going to stay that way.

Look out, because it IS coming.

[APRN., DNP, RN, APRN, NP]

"Value Based Healthcare"

[klone, MSN, RN]

We won't be making the hospital money. We will just be ensuring that they get their full reimbursement. That's not making them money; that's just not costing them extra.

[CASTLEGATES]

People go to hospitals because they need nurses. Nurses are revenue producers, not just costs. When a patient is admitted, it is for nursing care. Labs and tests can be scheduled in, or outpatient, but it's the nursing care that gets them back to health. I keep hearing that physicians are revenue producers, nurses are costs (seems kinda ridiculous). We work as a team to get patients out of the door, and retain some income for their stay. Physicians will check outpatient to see how they are, and if they need 24/7 nurses again, they'll readmit them and we start again.