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!!!

[SE_BSN_RN, 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.

That's why we should never cover the original label of solution.

[calivianya, 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.

Oh man, I wish all we'd had to do in undergraduate was cut pills in half. How about all of those IV drip rate calculations that needed the drip factor of the tubing? I have never used that ridiculousness in my life. All of the heparin calculations and insulin drip calculations, though, were actually useful.

I should have said pharmacy department instead of pharmacy, you're right. I don't know who is sending me those idiotic communications. I will agree with you that pharmacy school is more difficult than nursing school - I will not agree that those people who cannot answer simple questions when I call down to ask them a question are more educated than I am, and I am definitely not trusting pharmacy techs with on the job training and no formal education at all with my patients' lives. I had a roommate in college who worked as a pharmacy tech, and her only education was a high school diploma and some on the job med test she had to pass. I watched her party, party, party and then just cram the night before for that one test, and I never saw her look at the material again. I bet there are more stringent requirements for pharmacy techs now because the economy was awful, but I roomed with this girl for the 2007-2008 school year so it wasn't that long ago that there was no education required for pharmacy techs. I bet those people are actually handling the medications and tubing them to me more often than the real pharmacists are.

[BonnieBorcyk]

I think the respect people used to show doctors is completely different from the respect they show them now. Doctors ARE worthy of respect. I am a nurse, and I'm worthy of respect as well. My observations are that some nurses show respect to physicians and some don't. I am one who does. I also know what they go through, from medical school on up to one who's been practicing for 60+ years. Us nurses are constantly being taught not to stereotype. Well, isn't it stereotyping when you assume all doctors are deadbeats who sit around, forcing nurses to bring them coffee and bossing them around? I'm sorry, but physicians also deserve the same level of respect.

[Here.I.Stand, BSN, RN]

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

Actually, when I was working in an LTACH the dr. asked for my help to turn the pt so he could see the pt's sacral wound. :) We turned him and found the pt had been incontinent of stool. The dr. offered to help me clean him up. I gratefully accepted! I did ask "are you sure, do you have time?" not b/c I considered him too educated to clean poop (hey it doesn't take an RN license to clean poop either) but b/c it was nearly 1900 and while I was getting ready to report off to the noc RN, he STILL had a list of pts to see. If you've ever worked in an LTACH, you'll understand how complex these pts' courses are and why I'd consider that he still had a list of pts to see.

Yes, the idea of an RN referring every question to the MD is obnoxious. I've been asked by families when the multiple trauma pt's leg is going to be fixed, and I've told them that at this point it's not scheduled and that they could ask ortho in the a.m. when they round, but at this point the pt is having high ICPs and can't tolerate lying flat; and that the brain is of course a higher priority than the leg. I've been asked why a TBI pt is running a fever, "what kind of infection do they have?" I can't make a medical dx but I'll explain that we have sent blood, sputum, and urine cultures which the lab is running...right now the UA doesn't look like a UTI but the culture will tell us for sure...and then explain neurogenic fevers and that that is a possibility.

Now if a family asks "How effective is the surgery that they want to do?" I will refer them to the surgeon. Likewise if they ask about community resources I will refer them to the SW. If they ask about having a sage burning I'll refer them to the chaplain. I am a professional, but I'm not an expert in everything.

While I can't prescribe medical treatments, you BET we need to know that they're safe. When I interviewed for my first ICU job as a fairly new RN (a little over a year) the manager advised me, "We need someone who can critically think independently. Sometimes the RN needs to protect our pts from these residents." I have heard RNs on my unit, when their PT's ICP has been over 40 for half an hour, tell the resident "No, we're not going to turn their 2% from 30 ml/hr to 40 ml/hr and give it an hour. I'll do that, but he needs a dose of 23% also."

One story a nursing school instructor told still sticks with me. A baby had surgery, and the surgeon prescribed a morphine infusion at whatever dose it was. Anesthesia agreed to it. The pharmacist verified it and sent it to the floor. The RN administered it. The baby became overnarcotized and died. My instructor asked, "Guess who the only one to lose their job was? Yes, the nurse who gave it. She should have known that that was too much morphine for that size infant."

[sweetdreame, BSN, RN]

Actually, when I was working in an LTACH the dr. asked for my help to turn the pt so he could see the pt's sacral wound. :) We turned him and found the pt had been incontinent of stool. The dr. offered to help me clean him up. I gratefully accepted! I did ask "are you sure, do you have time?" not b/c I considered him too educated to clean poop (hey it doesn't take an RN license to clean poop either) but b/c it was nearly 1900 and while I was getting ready to report off to the noc RN, he STILL had a list of pts to see. If you've ever worked in an LTACH, you'll understand how complex these pts' courses are and why I'd consider that he still had a list of pts to see.

Yes, the idea of an RN referring every question to the MD is obnoxious. I've been asked by families when the multiple trauma pt's leg is going to be fixed, and I've told them that at this point it's not scheduled and that they could ask ortho in the a.m. when they round, but at this point the pt is having high ICPs and can't tolerate lying flat; and that the brain is of course a higher priority than the leg. I've been asked why a TBI pt is running a fever, "what kind of infection do they have?" I can't make a medical dx but I'll explain that we have sent blood, sputum, and urine cultures which the lab is running...right now the UA doesn't look like a UTI but the culture will tell us for sure...and then explain neurogenic fevers and that that is a possibility.

Now if a family asks "How effective is the surgery that they want to do?" I will refer them to the surgeon. Likewise if they ask about community resources I will refer them to the SW. If they ask about having a sage burning I'll refer them to the chaplain. I am a professional, but I'm not an expert in everything.

While I can't prescribe medical treatments, you BET we need to know that they're safe. When I interviewed for my first ICU job as a fairly new RN (a little over a year) the manager advised me, "We need someone who can critically think independently. Sometimes the RN needs to protect our pts from these residents." I have heard RNs on my unit, when their PT's ICP has been over 40 for half an hour, tell the resident "No, we're not going to turn their 2% from 30 ml/hr to 40 ml/hr and give it an hour. I'll do that, but he needs a dose of 23% also."

One story a nursing school instructor told still sticks with me. A baby had surgery, and the surgeon prescribed a morphine infusion at whatever dose it was. Anesthesia agreed to it. The pharmacist verified it and sent it to the floor. The RN administered it. The baby became overnarcotized and died. My instructor asked, "Guess who the only one to lose their job was? Yes, the nurse who gave it. She should have known that that was too much morphine for that size infant."

Very, very well said. I really appreciate the personal examples. They really clarify and reinforce the points you made. You seem like an excellent nurse. Keep up the good work!

[systoly]

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

noncom

[iPink, BSN, RN]

No, I'm not a doctor. I'm much more...a nurse.

I'm a semi-new nurse (less than 3 years experience) and started off on a unit that didn't have residents. There were a few doctors there who wanted your input about the patient's care and they valued it. That experience forced me to study when I got home so my knowledge base was expanded.

[Brekka, ADN, RN]

While I do agree that nurses should be respected for their knowledge, and acknowledge their own achievements and abilities with a sort of professional pride, I don't necessarily agree that statements such as the one in the OP are subservient. I tend to say things along this line frequently, but I am **** proud of what I have accomplished and my role in the healthcare system. Statements such as "I don't want that much responsibility," or even "I'm just a nurse" should really be taken at face value only. What you heard may not be what was intended.

CNAs don't have the knowledge or training that nurses have. I've heard CNAs in my facility outright state frequently that they didn't want to go on to nursing school because they didn't want the responsibility that the nurses have. That doesn't mean they aren't knowledgable, capable, competent, caring professionals, or that they are in any way lacking intelligence. They simply, "don't want the responsibility."

The fact is, like CNAs to Nurses, Nurses do not have as much responsibility as doctors do. We do not have the training, knowledge, or experience that doctors do. We are knowledgeable and well trained in what we do, but we are not doctors, and should not be expected to be. There is increased responsibility with each step up the health care ladder, and that additional knowledge and responsibility should very well be acknowledged.

Pharmacist, doctor, nurse, CNA, social worker, etc... We all have different roles to play, different responsibilities, and are all very important in achieving the best patient care. Lose one and everything changes, and patients are put at risk. Some have more responsibility or knowledge than the others, but that doesn't make them any less important, and it shouldn't be looked down on to acknowledge the differences.

[jae_mc]

Oh man, I've been guilty of this mindset a few times, especially when I first started working at my department over a year ago. Luckily, I've been blessed to work with doctors who don't dare to look or talk down to their nurses and we all consider ourselves "family." In the time I've been as a nurse, I've learned that my attitude also determines my capabilities.

[chillnurse, BSN, RN, NP]

I am glad everybody is so humble on this forum.

[Here.I.Stand, BSN, RN]

Very, very well said. I really appreciate the personal examples. They really clarify and reinforce the points you made. You seem like an excellent nurse. Keep up the good work!

Aw, thank you!!! You made my week!!

[SingingBird]

My first thoughts after reading this: I love you. Second: I completely 100% agree with you!