Too respectful to doctors?

Nurses General Nursing

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I touched on this on another thread, but doing peer evaluations not too long ago, I came across a new question asking whether the nurse was too respectful or too friendly with the doctors. I don't recall the exact wording, unfortunately, but I took it to mean whether the nurse was able to act independently as an advocate for his/her patients. It gave me a bit to think about, because I do tend to have a lot of respect for doctors and will defer to their judgement if I don't feel strongly that they're wrong. It's not that I particularly want to be their buddy (although I generally do like most of them) but in a lot of cases I can understand their rationale, even when I don't entirely agree. Pain meds would be a prime example. I have let a doc slide on waiting for the day shift to reevaluate pain meds when I was already giving a lot, but the patient was still complaining of severe pain. (For what it's worth, and I know we aren't supposed to do this, I do firmly believe the patient was overstating her pain, but I also believe her actual pain was higher than acceptable, and in the case I'm thinking of, I wish I had advocated a little harder.)

So I'm curious to hear what others think about where to draw the line. I'm too old and too ugly to be interested in being anybody's handmaiden, but I don't want to be a jerk or exceed my scope of practice, either.

Any thoughts?

Batman24

1,975 Posts

I find this an odd question and one that isn't entirely appropriate as it could be interpreted in very different ways. I also see it leading to a lot of trouble amongst staff so I'd be curious too see how it goes as it's a new question.

The first thing that came to mind was that they were looking for who might be flirting or having a relationship with doctors and threw in the "too respectful" for comfort measures. I don't think any of us can been too respectful or too friendly to others whether they be doctors, nurses, aides, etc. I see it as a matter of courtesy and kindness. I will get a doctor, nurse, etc. a glass of water if I know they need it and are wiped out. I work in a very team oriented unit.

You seem to be taking it as to whether a nurse is deterring too much to a doctor. Some absolutely do. Thankfully most nurses I know take being a patient advocate very seriously and if they disagree with the doctor and feel harm will come to the patient will take it up the chain of command as they should. Deterring to a doctor at all times could potentially come with a high cost.

Some nurses are afraid of confrontation and calling doctors especially when new. I was. The environment should allow for some feedback on both ends done in a respectful and professional manner. Both sides learn from that and patients benefit the most.

xenonaut

98 Posts

Hi nursemike, I'm not a nurse yet, but I'm from a medical family (Dad- orthopaedic surgeon/ Mom- nurse) so I also have a lot of respect for doctors AND nurses. It's an interesting question that you pose, and I hope to read some good answers on it. Obviously it's a fine line that we (going to NS in Fall '09 so I'm feeling free to include myself :-) constantly walk. Personally, I feel that the answer probably lies on a spectrum -- case by case.

Ultimately, unless things are going really wrong, I guess I believe that the doctor is the one who iis in charge of the patient's care while nurses carry out the actual care itself. So, imho, deferring to a doctor unless he/she is blatantly wrong is not a bad thing. However, lines of discussion should always be open between patient-nurse-doctor.

xenonaut

98 Posts

Some nurses are afraid of confrontation and calling doctors especially when new. I was. The environment should allow for some feedback on both ends done in a respectful and professional manner. Both sides learn from that and patients benefit the most.

Well said.

leslie :-D

11,191 Posts

i can respect a doc when i respect their decisions.

if i feel any decision is r/t a cya, i become quite persistent.

leslie

nursemike, ASN, RN

1 Article; 2,362 Posts

Specializes in Rodeo Nursing (Neuro).
I find this an odd question and one that isn't entirely appropriate as it could be interpreted in very different ways. I also see it leading to a lot of trouble amongst staff so I'd be curious too see how it goes as it's a new question.

The first thing that came to mind was that they were looking for who might be flirting or having a relationship with doctors and threw in the "too respectful" for comfort measures. I don't think any of us can been too respectful or too friendly to others whether they be doctors, nurses, aides, etc. I see it as a matter of courtesy and kindness. I will get a doctor, nurse, etc. a glass of water if I know they need it and are wiped out. I work in a very team oriented unit.

You seem to be taking it as to whether a nurse is deterring too much to a doctor. Some absolutely do. Thankfully most nurses I know take being a patient advocate very seriously and if they disagree with the doctor and feel harm will come to the patient will take it up the chain of command as they should. Deterring to a doctor at all times could potentially come with a high cost.

Some nurses are afraid of confrontation and calling doctors especially when new. I was. The environment should allow for some feedback on both ends done in a respectful and professional manner. Both sides learn from that and patients benefit the most.

I was taken aback, myself, but I actually thought it was a pretty good question. It was probably worded a good bit better than my paraphrasing, and may also have questioned whether the nurse wasn't respectful enough. Part of the reason I didn't dwell on it, at the time, was that the nurses I was reviewing had no problem in that area--or any other, for that matter. The reviews are anonymous, but I feel really lucky that I usually get to do the best nurses on our unit. Makes it a lot easier.

nursemike, ASN, RN

1 Article; 2,362 Posts

Specializes in Rodeo Nursing (Neuro).
i can respect a doc when i respect their decisions.

if i feel any decision is r/t a cya, i become quite persistent.

leslie

I can picture that. (And I mean that respectfully.)

RN1982

3,362 Posts

Specializes in ICU/Critical Care.

I resepect doctors because heck, I would not want to work the hours that they work during residency and get paged at home. However that does not mean the I submit to any type of rude behavior by a doctor. If they want my respect, they must respect me. I respect them even more if they ask what opinion I have regarding patients that we are caring for.

Jolie, BSN

6,375 Posts

Specializes in Maternal - Child Health.

I agree that it's a strangely worded question. IT seems to imply that a nurse who questions a physician's order is being disrespectful. Not so.

It is possible to disagree and question a physician's order (or plan of care, etc.) without being disrespectful. If I engage in a professional conversation with a doc, yet still disagree with his/her judgement/order/plan, I will calmly and politely let him know that I'm going to pursue my questions up the chain of command. Nothing disrespectful about that. Frankly, I think that is more respectful than going behind his back to his superior or the nursing supervisor.

I agree that patients are best served when we discuss our differences of opinion openly with the medical staff.

lpnflorida

1,304 Posts

Specializes in psych. rehab nursing, float pool.

I am not afraid to advocate for my patient, no matter what it might be. I do present my concerns to any doctor respectfully. I back it up with what I have observed in the patient, giving examples of their pain scales if that is the issue and what I have tried in additon to medications which are already ordered such as diversion, repositioning, using ice, etc.

It is then up to them what they do with the information. That is their job, as I have done mine.

PiPhi2004

299 Posts

Specializes in Trauma ICU, Surgical ICU, Medical ICU.

I feel that people can be respectful to MDs while questioning their opinion. Usually if I question an order, I will say "Just to clarify this order, you want xyz done...were you aware of the patients current condition, labs are this, the patient has had this done today, etc etc etc" or I will say, "Is there a reason we can't do abc instead of xyz, please help me understand where you are coming from." Many times they will listen to my judgement and sometimes they weren't aware of the patients condition before writing the order, going off something said in morning rounds. If I find the MD is really out of line, I have a charge nurse step in and either help me understand the reasoning for the intervention or have them talk to the MD if they find the order seems to be an issue. I never say "I want to do it THIS WAY!" I just state my opinion in a tactful, respectful, manner. I believe you should always question something you feel is not right and should never just take orders blindly. I have only been an RN 1 year and if I had done this I would've probably lost my license already...I learned quick that you have to stand up and advocate for your patients but you don't have to scream about it like an idiot.

I would also like to add that I believe the MD to environmental services staff should all be treated respectfully. I would like to think I would treat the CEO of the hospital down to the transport staff with the same amount of respect. I firmly believe that you have to give respect to get respect.

Nurse2Doc2008

22 Posts

Hey all, I was part of the discussion in the prior thread...here's what I said there:

That's an interesting question...and interesting choice of adjectives! Too respectful or too friendly....as in those two things were two extremes? Like you can't be both respectful and friendly? Or that they were the same end of the spectrum, as in being both too friendly and too respectful? I feel like either way it's kind of problematic, since it seems to imply that to disagree is either unfriendly or disrepectful (or both).

Disagreeing is another interesting point...I feel sometimes I can't win on this issue (and I'd imagine you'd feel the same). For example, sometimes when I ask the nurse what s/he thinks about a situation, or what s/he usually does in a similar situations, most of the time, they tell me what they think and what's usually done, and I usualy do what they think. Of course I think about it first and make sure it makes sense to me, but most of the time, they're right and it's what I should be doing. However, sometimes when I ask what they think we should do, I'm answered with a snappy, "I don't know, YOU'RE the doctor!"

And the reverse is sometimes true, too, albeit less often...sometimes the nurse will call and want to do one thing, and I really disagree with it for one reason or another, so we talk about it, and usually, the nurse is like, "oh yea, that makes sense, was thinking about that differently," or whatever. (Believe me, I almost never do something the nurse doesn't agree with after discussing it, unless I am really, really, really sure I am right and have discussed it with my senior, and even then, I continue to try to explain WHY we're doing it that way.) But sometimes, I go to start explaining why I'm thinking we should do something, and mid-sentence, I get cut off and the nurse says, "do what you want, I don't know I'm just a NURSE," as if they're mad if you don't agree.

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