I'm not the doctor!

[sweetdreame]

Recently my husband's grandmother was a patient in the ICU. I am frequently used as the medical translator in the family, this time wasn't any different. I had the opportunity to make a couple of observations I would like to share with you.

Before I continue, let me tell you a little about myself. I have worked in many areas of the hospital. L&D (as and OB tech), Ortho/Neuron MedSurg, ER, Trauma ICU, CVICU (all as an RN). I recently started graduate school in hopes of gaining more autonomy and advancing my education. I LOVE being a nurse. I love the way it blends science and compassion. I am PROUD to be a nurse. Except for one thing.....

I have always had a problem with the societal perception of nurses. I love the show Grey's Anatomy (despite its medical inaccuracies), but can't help noticing that there are no nurses in major roles. I see nurses as a whole represented as coffee-fetching secretaries. My family even says to me "I know you're not the doctor, but what do you think about this....?".

This perception, of course, does not jive with the fact that many nurses have a Bachelor's or Master's Degree in Science, multiple additional certifications, years of experience, and have saved multiple patients from incompetent physicians.

This week, while observing the nurse caring for my family member, I realized a MAJOR part of the problem with the way nurses are perceived. My confused family member mistakenly called the nurse DOCTOR. The nurse replied...

"Oh, I'm not the doctor I couldn't handle that much responsibility".

EXCUSE ME?! Throughout our visit, she repeatedly dodged conversations, referred the family to the doctor with any questions, and generally made me feel ashamed about our profession. I realized that I have encountered that same attitude so many times in my fellow nurses. But WHY?? I once heard a nurse tell a physician who offered to help her clean a patient...

"Oh I'm sure you have more important things to do! This isn't your job."

This is just as much the physician's patient as yours, and if the job needs to be done for the good of the patient, why would you assume this meek, butt wiping maid position to the ALMIGHTY DOCTOR??

Let me start out by saying that I know all nurses are not created equally, but I think this is a mindset bred into many nurses from the beginning of our education. Instead of thinking "I am an educated, experienced caregiver who is more than capable of answering your questions. I shoulder a TON of responsibility every day I come to work." We are taught this...

"The doctor is GOD. The doctor is KING. You are JUST THE NURSE."

This thought is reaffirmed every time we allow a colleague's ideas to be dismissed by a rude attending, or when we don't speak up in family conferences, or when we say things like "Oh I'm not the doctor, that's too much responsibility". This inaccurate perception of the "pecking order" is not only offensive, but unsafe. This mindset is what makes you second guess yourself before calling that mean physician to report a critical value, or bring up an important concern. NO MORE!!!

I'm calling all nurses to WAKE UP!

Empower yourselves through education and experiences. Realize that you are not the secretary, the butt wiper, or the maid. You are smart, you are important, you are educated! Quit it with the subservient attitude and be the powerful PROFESSIONALS you should be. We are separate professionals, MDs are not your boss, they are your colleagues. Quit demeaning our own profession with your engrained lowly mindsets.

OK, rant over... feel free to comment, tell me what you think!!!

[OCNRN63, RN]

My standard reply when addressed as "doctor" is: "i'm not the doctor, i'm your nurse, i work for a living".

Why the need to denigrate another member of the health team? Doctors work very hard, too.

[calivianya, BSN, RN]

We have a pharmacist for that

Whoa, really? Jeez, are these the same pharmacists that that send a communication through the computer for you to clarify why a patient takes colace at home? Or what the indication for PRN simethicone is? You really trust those people with your patients' lives? I don't think I'd trust them with house plants. Just saying. I get that it's just protocol that makes them send that communication about what the PRN meds are for, but when you are talking about an acid reducer, a gas medicine, or a stool softener, you'd think they'd be able to put the medication into the system without calling for clarification.

[OhioCCRN, MSN, NP]

SCARY POST re: trusting the pharmacist. clearly you have been away from the bedside too long....

[explorereb96, ADN, BSN]

Well, sometimes we HAVE to just trust the pharmacist. There are premixed IV's and such that are labeled. All we can do is verify a label. But reading and rereading a label a hundred times can not really tell you for 100 percent sure if thats exactly what is within that IV bag that came up from pharmacy premixed.

[chillnurse, BSN, RN, NP]

What is with all this nursing hate vs doctors and pharmacists. clearly some people are feeling inferior and want to peck at other professionals. Our staff pharmacist is very intelligent and I am sure knows more about medicines than I do or these nurses pecking at pharmacists do.

I am pretty sure the math in pharmacy school is more difficult than the simple nursing calculations of cutting pills in half we had to do in undergraduate.

[sweetdreame, BSN, RN]

What is with all this nursing hate vs doctors and pharmacists. clearly some people are feeling inferior and want to peck at other professionals. Our staff pharmacist is very intelligent and I am sure knows more about medicines than I do or these nurses pecking at pharmacists do.

I am pretty sure the math in pharmacy school is more difficult than the simple nursing calculations of cutting pills in half we had to do in undergraduate.

I don't intend to continue going back and forth, because clearly we have very different professional philosophies, and it doesn't appear you are reading my responses anyway. I see that you have been a nurse for one year. I am glad that during that time you have developed a trusting relationship within the interdisciplinary team. That is very important. I certainly hope that you don't think we are jaded just because we have seen things that have altered our viewpoints.

However, just because we want more respect absolutely does not mean we HATE anyone. If you wish to reread my response to you implying I get cussed out by physicians, it may shed some light. Additionally, implying that everyone is human is not "pecking" at each other. As I have said previously, we have to create multiple layers of safeguards to protect from inevitable human error. It has nothing to do with how hard our math classes were. It has to do with the fact that even the best and the brightest make errors and we have to work as a team to ensure that those errors never make it to a patient.

I hope you will consider reviewing the sources I mentioned in my previous posts. They are really interesting and shed a lot of light regarding shared responsibility, communication, quality within healthcare, and a culture of safety.

"To Err is Human" I believe is free online through the Institute of Medicine.

"Why Hospitals Should Fly" by John Nance (If you would like I will mail you my personal copy. Just PM me your address).

[TU RN, DNP, CRNA]

Whoa, really? Jeez, are these the same pharmacists that that send a communication through the computer for you to clarify why a patient takes colace at home? Or what the indication for PRN simethicone is? You really trust those people with your patients' lives? I don't think I'd trust them with house plants. Just saying. I get that it's just protocol that makes them send that communication about what the PRN meds are for, but when you are talking about an acid reducer, a gas medicine, or a stool softener, you'd think they'd be able to put the medication into the system without calling for clarification.

I find that oftentimes when I ask to speak to a pharmacist about a medication, they have to pause before giving me an answer. Almost like they're looking my question up in some database. Not to undermine the importance of pharmacists to the healthcare team or say that I expect them to know everything there is to know about every drug at all times... but I could've googled the damn med myself dude and for much less than what they're paying you!

[ProgressiveActivist, BSN, RN]

The guy's writing is totally irreverent. He was just being facetious.

Sorry if you can't relate.

[ThePrincessBride, MSN, RN, NP]

So I have a few problems with the OP's post:

1. Patient's family members should NOT be translating even if he or she is a medical professional.

2. I've always been told that people should correct patients and family members regarding credentials. For example, I've had patients call me "nurse" all the time, and I gently remind them that I am the aide. There is a major difference between doctors and nurses, so it is not wrong or subservient for the nurse to correct the patient/family member about his or her title.

3. Doctors DO have more responsibility and liability on their hands than nurses, hence why they have ridiculously high malpractice insurance. Doctors also diagnose and from the doctor's diagnoses, the nurse builds his or her own care/treatment plan. The nurse collaborates with the doctor on how best to meet the needs of the patient, but make no mistake; if something goes horribly wrong (and we're not talking about a med error committed by the nurse), the doctor (and facility) will be the one sued (most likely), not the nurse.

I thought about going to medical school, but to me, being a doctor is a ton more responsibility than my anxiety can handle and unlike nurses, doctors just can't clock out and go home, many are oftentimes on call 24/7. Now, that isn't to say nurses don't have a ton of responsibility...they do! Nurses are the coordinators of care, advocates and protectors for the patient. I half-joke that nurses prevent the doctors from killing their patients, but there is more than a bit a truth to that statement.

4. There is nothing wrong with the nurse referring the patient/family member to the doctor if the nurse does not know the answer to the questions at hand. That isn't to say that the doctor is "almighty" but that he or she may be more knowledgeable about a certain aspect of the patient's diagnoses and treatment plan.

5. A physician...offering to help clean up a patient? Am I seeing unicorns?

I think most people realize that doctors are not gods or kings (though judging from some of the attendings' and residents' attitudes, one would think differently). The best doctors are those who realize that they are NOT perfect and that nurses are educated professionals who, more often than not, cover their orifices and can make a doctor's day a living hell or very pleasant. My NP clinical instructors have told me that the attending will trust the seasoned nurse or the nurse practitioner before the resident (and rightly so).

I've talked to plenty of seasoned nurses, and even they have told me that times have changed. When they were young and green, they were taught to give up their seats to the doctor and never question the doctor's orders. Now? These same seasoned nurses will NOT give up their seat for the doctor and have no problem calling out these young residents on their orders and judgment, and I applaud them for that.

[Nurse SMS, MSN, RN]

5. A physician...offering to help clean up a patient? Am I seeing unicorns?

ROFL!! I had a similar thought!

[SE_BSN_RN, BSN]

We have a pharmacist for that

It doesn't and shouldn't stop at the pharmacist. What if they overlook the same mistake and you trust THEIR judgment?

[SE_BSN_RN, BSN]

What is with all this nursing hate vs doctors and pharmacists. clearly some people are feeling inferior and want to peck at other professionals. Our staff pharmacist is very intelligent and I am sure knows more about medicines than I do or these nurses pecking at pharmacists do.

I am pretty sure the math in pharmacy school is more difficult than the simple nursing calculations of cutting pills in half we had to do in undergraduate.

Of course. But they are human, and make mistakes. Do you not call and question if a med looks different? Do you call if you have a cloudy IV solution? Or, do you blindly trust the pharmacist to not make a mistake, and know, out of the goodness of their heart, they would not put the blame on YOU should something accidentally happen to the pt? What if the dose is wrong, and it went totally over pharmacists head, and you caught it? Would you not say something?

This is where critical thinking comes in. After only a year as a nurse, you are not yet adept at critically thinking. I have almost 9 years of experience, and I still question the pharmacy if I am unsure. Docs, too. And, usually, they have no problem explaining their decision. That's how we learn.