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?

[SkateBetty]

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.

OK, so it wasn't my last post.

I don't mean written up by you, I mean by the charge nurse or nursing supervisor.

[PACPhD]

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.

You know, in Mississippi, in the 60's, when an Afro American had a problem with the way he was treated, it was always his own fault.

I am trying to be polite here. I am a guest in your neighborhood. Basically you are telling me I am lying. You have no idea what I have gone through for years because of the abuse I had to take from some of those nurses. I spent 11 years in school learning my profession. My main concern at all times was my patient. What an eye opener it was to see what was more important to some of the staff I worked with. I was amazed. I litterally went to work with a knot in my stomach and dreading the next 12 hours. Stress? You have no idea. The medicine part (and I worked in acute areas of the ED) was easy compared to the everyday BS.

Everything I have told you was dead on, with no artistic license taken. I used to come home and tell my wife the stories, day after day. And I could go on for probably 10 pages of incidents, and the ones listed here are not the worst, they are just random incidents that poped into my head. And no, the nurse had two front teeth, it was not uncommon on eastern Long Island NY for the locals to say "aint". Certain statements have stuck in my mind for years, and I was so taken back by that one, that I haven't forgotten how she said it.

Balls in your court.

[begalli]

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 nurses 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.

Digging under the surface here, it sounds like you are a bit surprised that nurses actually have so much decision making power in the running of hospitals? Unlike the television shows ER and Grey's Anatomy where it is portrayed over and over that the doctors or some medical management are in direct charge of nursing, nursing is it's own self-governing professional body with just as much input as to how things run as the medical side is. Yea, nurses are COO's. Nursing is autonomous and collaborates with other disciplines for a common outcome - which should be, but is not always - delivering safe, cost-effective patient care (this is quite simplified).

Although you are stating that some nurses flat out refused to carry out orders, it is not at all unusual for an RN to vociferously question orders from anyone. We do have the knowledge and experience to know what might be better for a particular situation. It is against our professional code of ethics to not speak up when we feel a situation warrants.

Like the title of your thread, I think you really don't understand nursing. The behaviors of some who you've encountered are absolutely unacceptable, but I think you also need to accept that nurses are part of your team. Just because they may question orders does not mean they are steeping out of line or out of their scope.

Gotta cut this short - gotta go.

This is about recognition and respect. Have you talked about this with your RN wife? I'd be curious to know what she thinks.

[LeahJet, ASN, RN]

You know, maybe it's a regional thing. Add that with the 'protection' of the union.......and maybe that is why it is hard for some of the rest of us to understand.

I am not trying to insult you or call you untruthful.... but as someone else said.... the scenarios you describe are almost inconceivable. I could not imagine a nurse ripping up an RX or refusing to do routine procedures. At the most, I have seen a doctor questioned but diplomatically.

Maybe we could hear from some nurses in NYC or (was it virginia?). They may be able to shed some light and put the rest of us in the know.

For the record, of all the ER's I have worked, Albuquerque was the BEST. I loved my co-workers and it was fun to go to work. Maybe it's the west!

[JazzyRN]

I must admit I tend to agree with SkateBetty, these stories do seem quite unbelievable.

Like I stated earlier there are two sides to every story. For a FEW nurses to tell you that "they were gonna make your life as miserable as possible until you quit." This leads me to believe you were doing something to make these nurses dislike you. Or are we to believe that this what all these nasty nurses in this hospital tell all PAs and MDs? Im not saying that if that was the statement made, that it was appropriate and professional, but Im very certain that a statement that strong wasnt unprovoked. Please do tell the WHOLE story of what led up to that statement being made to you by a FEW nurses.

Now this statement by the OP:

"I have actually had union nurses tell the physicians on numerous occasions "I'm union, what are you going to do, fire me?"

It just doesnt make sense or ring true to me as something a nurse would say, let alone MANY nurses on NUMEROUS occasions. Nursing is a distinct and different profession from medicine. I dont know of any doctor that can fire a nurse in the hospital setting. They dont have control over hiring and firing of nurses. Thats were nursing administration comes in. All nurses realize that, so I have a hard time believing that a number of nurses would make a statement such as this over and over again implying that the doctor had some authority over them keeping their job, union or not. Please respond.

[begalli]

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.

I can absilutely see a nurse judging a patient and coming to the conclusion that an IVDA doesn't deserve pain meds. Absolutely wrong, but I can see it happening.

I might, maaaaaybe try sticking the patient once that's it - and I wouldn't even try that hard. I can see refusing to stick an IVDA for an PIV. The reason would be because it's futile and I would fight tooth and nail over this. The patient needs a central line due to the fact that their veins are shot, literally.

[jb2u, ASN, RN]

Well I have worked MANY jobs...Army, diesel mechanic, car sales, shipping receiving clerk, retail manager, warehouse manager, medical assistant, sorter, transporter, unit clerk, cardiac monitor tech, cna, and courier. In every job I've heard people complain and be unhappy with their job or other depts. I've always talked to everybody. Janitors do not feel respected by management. House keeping in the hospital does not feel respected by the Nurses/MD's, etc. My point is I treat everyone as an equal because WE ALL ARE. When I was a warehouse manager, I always would go to the employee breakroom where the other warehouse employees ate, while the other managers ate in the office with other managers. I had everyones respect because I treated them as equal (because we are). My point being people normally respond based on how they "feel" that they are treated/respected. I'm sure that you have had some bad experiences and I'm glad to know that you are now happy at your current hospital.

That being said, let me help you understand nurses and nursing. It is a truly giving profession. It is not one of financial excess, admiration by the public, private parking, private dining rooms, parent-in-laws lighting up when they find out your a nurse, and general respect for your hard earned education. It is a job where Nurses provide the most intimate of care, one in which even a lot of families will refuse to provide. It is one in which they may think that that iv drug user, prisoner, etc...may not "deserve" such care..BUT they provide it anyway!!! They get verbally and physically abused by pts, pts' family, and yes, some times MD/PA's. They, however, still provide that much needed intimate care. They struggle to provide outstanding, professional care while at the same time trying to battle shortages that cause unsafe conditions for their patients and leave little time for the very thing that drew them to nursing...PROVIDING INTIMATE CARE! To sit and talk with a patient, to hold the hand of a family member of a dying pt., to clean the pt that can no longer clean him/herself, to help a pt regain that which can be regained, and to help the pt deal with that which can not, to let the pt that feels all alone know that "I am here for YOU." They do all of this because they are truly caring individuals. They do not get paid near what they are worth. They by all means are intelligent and capable of persuing a medical degree, but that is NOT where their hearts are. They want to be a NURSE. Nursing begins with caring. Nursing is about caring. And Nurses are human. Sometimes the lack of respect, long hours, short staff, and other headaches get to them, but they always come back because deep down that person that cares so much is still in them. They just get frustrated because they know that the business of medicine many times gets in the way of their ability to provide the care that they so much want to give! That is what Nursing and Nurses are all about.

I thank all of the Nurses out there for giving your all inspite of the many, MANY obstacles that you all face everyday. I thank you for caring enough to go into a profession, not for the glory, but because you want to care for the patient as a whole.

Sincerely,

Jay

[leslie :-D]

i don't think nurses are all angels of mercy: that would be 1 end of the spectrum.

the other end of the spectrum: beastly, problematic, defiant, disrespectful power-mongers- obviously this too, is an extreme.

and that's why i struggle with this thread.

the problems the op has encountered with nsg, seems to pull to the other exteme in the aforementioned spectrum.

we all know there are some beasts out there, that work as nurses.

but to encounter so many?

it's just not credible.

i would be interested in knowing what all these other nurses had to say about this pa- how did he come across? what was their impression?

there are 2 sides here.

we are only hearing one.

but i am glad to hear that he has found a place of employment where he feels welcomed.

leslie

[SkateBetty]

I might, maaaaaybe try sticking the patient once that's it - and I wouldn't even try that hard. I can see refusing to stick an IVDA for an PIV. The reason would be because it's futile and I would fight tooth and nail over this. The patient needs a central line due to the fact that their veins are shot, literally.

What could you possibly be talking about? The question of the IV is not technical in nature but has to do with which medicines may be given once it's placed.

[PACPhD]

I must admit I tend to agree with SkateBetty, these stories do seem quite unbelievable.

Like I stated earlier there are two sides to every story. For a FEW nurses to tell you that "they were gonna make your life as miserable as possible until you quit." This leads me to believe you were doing something to make these nurses dislike you. Or are we to believe that this what all these nasty nurses in this hospital tell all PAs and MDs? Im not saying that if that was the statement made, that it was appropriate and professional, but Im very certain that a statement that strong wasnt unprovoked. Please do tell the WHOLE story of what led up to that statement being made to you by a FEW nurses.

Now this statement by the OP:

"I have actually had union nurses tell the physicians on numerous occasions "I'm union, what are you going to do, fire me?"

It just doesnt make sense or ring true to me as something a nurse would say, let alone MANY nurses on NUMEROUS occasions. Nursing is a distinct and different profession from medicine. I dont know of any doctor that can fire a nurse in the hospital setting. They dont have control over hiring and firing of nurses. Thats were nursing administration comes in. All nurses realize that, so I have a hard time believing that a number of nurses would make a statement such as this over and over again implying that the doctor had some authority over them keeping their job, union or not. Please respond.

It was a hospital in Bay Shore, Long Island where two of the nurses loved to tell the director and anyone else who would listen that line. My fiance at the time was an ER attending physician. She told me one of the nurses played passive agressive with her during a code and said "sorry, I don't know how to work the paddles, you will have to come over here to do it your self". The attending was livid and demanded the ED director do something because this was typical of some of the staff. He said "she has a file over an inch thick with complaints and every time we go after her, the union backs her. We don't bother anymore. Then there was Brooklyn. That is where the charge nurse and the two others let me and the director know when and from whom they would take orders.

And I do know that doctors usually have no say over the hiring and firing of nurses, although in one place they had some say. Regardless, the nurses seemed to take pleasure in saying that.

As far as the nurses who's mission statement was to make my life a miserable hell, their problem stemmed from the previous group had lost it's contract and we were all new. They didn't know any of us and didn't really seem to want to get to know us. They liked the old group and decided to do what ever it took to make us quit. It wasn't a PA issue. That was the hospital where they ripped up my prescriptions and refused the LP kit. Another interesting story, they would insist that any patient who was given a narcotic could not be D/C for 2 hours. They of course would try to talk everyone out of taking the medication by threatening that the could not leave for "another 2 hours if you take this medication". I was told it was hosptial policy. I asked for the policy many times. It took about a month before the hosital nursing administrator came to the ED. She asked for "that doctor who keeps insisting on the narcotics policy". I told her it was me. She shoved the book at me and said "here, now maybe you'll believe the nurses". She was quite pissed. I read the paragraph and it said "2 hours or until the physician (or PA) feels it appropriate. I pointed this out to her and advised her that according to the policy, I could allow the patients to be D/C when I felt appropriate. She grabbed the book from me, and yelled, "that is not how we follow the policy here" and stormed away. Go figure.

[ortess1971]

Sorry, I agree with the people who smell a troll.....

[SmilingBluEyes]

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

Union shop where I work and TRUST ME; we would NEVER Get away with these types of bad behaviors and doctors and APNs have a LOT of say over who stays or goes, in many cases---esp in extreme ones like these. Their input is MORE than valued by our admin. With proper paper trails and documentation, it's not hard to fire a nurse where I work. But this is the KEY: PROPER PAPER TRAILING AND DOCUMENTATION. Without these, it's hard to make a case, and rightfully so! I hate to see anyone "railroaded" out of a job by unfair mgt/admin practices.

This is such a common assumption w/union shops; no nurses can be fired. SO NOT TRUE.

I wish we could stick to facts and stop w/generalizations here. It would add so much more to the conversation and working out resolutions to conflicts. This is as true here at these boards as it is in real life.