As a patient family member (who is also a nurse), I recently encountered an interesting situation. The nurse corrected the assumption she was the doctor by saying "Oh I'm not the doctor, I don't want that much responsibility"! Attitudes such as this one perpetuate the subservient mentality of many nurses today. We MUST start acting like the educated, experienced, capable professionals we are!
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!!!
One reason I love my job (private duty nursing) is I have parameters to work with, there is no doctor there to report to, I know my clients medical diagnosis and know how to treat it and how to educate them. My clients think I'm the smartest person in the world..... until things go downhill and I send them to the ER.
Sorry, but I'm not taking credit for fixing your heart failure. ( I may have noticed the signs and symptoms and sent you for help, but I didn't stop it)
I don't think respect is tied to education all the tine. I have worked with quite a few disrespectful MD's(and nurses) and there are MD's (and nurses) I have no respect for.
Me...I am very happy being a nurse. I have been a nurse for 35 years. I love critical care and emergency medicine...I have done trauma flight. I have NO DESIRE to be the MD. Could I have been a MD? Yup. I got accepted to Vet school.
I don't want an office. I don't want rounds. I don't want insurance billing. I toyed with CRNA a while back but I met my hubby and wanted my children more.
Am I respected...yup! When patients have asked why didn't I become a MD I tell them I am perfectly happy as a nurse.
I am perfectly happy being apart of the collaborative team. I have no inferiority issues...I don't want to be a MD.
This.
There are far more nurses, including myself, in my career journey that are smart, competent, and far more comfortable being a nurse-because that's WHAT we want to do.
I scratch my head for the nurses that are trying to clamor for "respect", or is it some sort of glory??? Guess they can nil answer that personally.
I've always been respected for my knowledge, the way I investigate and find out what is abnormal for pts that are considered "abnormal", rather, complex and know when to intervene as well as escalate it. THAT alone is empowering.
I have NEVER been treated as a handmaiden, nor will expect to be, and that's because I respect and *gasp* ENJOY what I do.
1. Patient's family members should NOT be translating even if he or she is a medical professional.
Why? Sharing knowledge within the community is not acting outside our scope of practice. I am not giving medical advice, just helping the decision makers understand their options. In fact, both the hospitalist and surgeon specifically asked for me to attend family meetings for that reason. Every member of the patient care team expressed their thanks for me being there to help. I don't suddenly loose my knowledge when I clock out. There is no reason I can't educate regarding what I know and refer the family to the physician for other questions or further clarification.
That wasn't at all the point. I always correct patients. I want the profession to get credit for the amazing care I provide. It was the "I couldn't handle that much responsibility" comment afterward.
[quote=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.
The fact that the physician or the facility are more likely to be sued is one part of the higher Liability Insurance. Physicians are independent contractors, nurses are not.
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.
Of course there is not a thing wrong with the nurse referring the family members to the doctor when he or she doesn't know an answer to a question. Again, not the issue here. Nurses should have some working knowledge of the medications they give, the medical diagnoses of the patients they treat, and the general care plan for the patient. However, the nurse should know SOMETHING and should feel comfortable discussing (at least) nursing-related concerns with the family. The point is know what you know...and what you don't. But at least...KNOW SOMETHING!
I think you have a lot of good ideas, and maybe you just misunderstood the situation presented in my post. But make no mistake, there is nothing wrong with nurses providing education to patients. That is one of the cornerstones of the profession. Nurses have more time with patients and should feel comfortable functioning in the role of educator.
Not too long ago, another nurse from my department and I went up to the Cardiac Surgery ICU of our hospital to learn more about Pulmonary Artery catheters and how they work/what parameters they monitor. The nurse who explained how PA catheters worked had as much knowledge about (and understanding of) the subject as any competent CSICU attending would. We asked him how he knew so much about the subject: he said that not only had he read about advanced hemodynamics and heart failure on his own time, he had also learned about it in his MSN classes.
This interaction, as well as my prior experience, convinced me of a few things: 1) That nurses who take the time to understand the pathophysiology of disease- and who actively contribute in rounds- command a lot more respect from physicians. Nurses also command more respect from physicians in the long term when they consistently advocate for their patients and clearly articulate the logic behind their requests. 2) That physicians would think of nurses more as colleagues rather than subordinates if: a) Most bedside nurses were MSN prepared- with a curriculum that focused more on clinical science than nursing theory and research; and b) If there were more men in nursing. Some may strongly disagree with the latter point, but let's face it- nursing still has a significant gender imbalance compared to medicine. Historically, nurses- as part of a female-dominated profession- have been socialized to be subordinate and altruistic- to "hope and hint" as one attending physician so accurately put it. I think some of that mindset is changing, as many a nursing professor in my class encouraged us to be patient advocates and to "rock the boat a little." However, I feel as though many nurses still go into their first jobs with the mindset that they can't be too direct if they disagree with physicians or if they feel as though their patients are at risk because of something the physician is doing. That, and sexism still persists in how girls and women are socialized- all too often they are still socialized to be more submissive, pleasant and passive. This is something we as a society stilll need to change.
Not too long ago, another nurse from my department and I went up to the Cardiac Surgery ICU of our hospital to learn more about Pulmonary Artery catheters and how they work/what parameters they monitor. The nurse who explained how PA catheters worked had as much knowledge about (and understanding of) the subject as any competent CSICU attending would. We asked him how he knew so much about the subject: he said that not only had he read about advanced hemodynamics and heart failure on his own time, he had also learned about it in his MSN classes.
This interaction, as well as my prior experience, convinced me of a few things: 1) That nurses who take the time to understand the pathophysiology of disease- and who actively contribute in rounds- command a lot more respect from physicians. Nurses also command more respect from physicians in the long term when they consistently advocate for their patients and clearly articulate the logic behind their requests.
This I agree with.
2) That physicians would think of nurses more as colleagues rather than subordinates if: a) Most bedside nurses were MSN prepared- with a curriculum that focused more on clinical science than nursing theory and research; and b) If there were more men in nursing. Some may strongly disagree with the latter point, but let's face it- nursing still has a significant gender imbalance compared to medicine. Historically, nurses- as part of a female-dominated profession- have been socialized to be subordinate and altruistic- to "hope and hint" as one attending physician so accurately put it. I think some of that mindset is changing, as many a nursing professor in my class encouraged us to be patient advocates and to "rock the boat a little." However, I feel as though many nurses still go into their first jobs with the mindset that they can't be too direct if they disagree with physicians or if they feel as though their patients are at risk because of something the physician is doing. That, and sexism still persists in how girls and women are socialized- all too often they are still socialized to be more submissive, pleasant and passive. This is something we as a society stilll need to change.
This part- and here's why:
You can understand Pathophysiology by doing self study as well as working with the patient; I've learned this way when I was an LPN; the "ah-ha" moment in how I dictate my practice was based on I was intervening for my patient with a particular condition, and even the doctors had no idea what to do.
I started digging in the pt's chart, googled it, and found out it's pathology from a EBP article; I had the tools to help reduce my pt's symptoms. I printed it out, and I found out that an I service was conducted based on my findings.
I didn't need a MSN THEN to know how to assess and investigate.
Now, as far as sex...being a double X and lacking a Y chromosome has not prevented me from commanding respect from even the most off the wall doctors; ...confidence, self-respect and commanding respect have served me just fine; perhaps it was because I was raised to be objective and observant (despite my upbringing of an all-nothing absolute approach, and other issues that are too long to post-I'll say it was not as conducive...) and ran away with it; sometimes it worked, sometimes it didn't, but I learned not to back down, but use my life lessons in a positive way to shape a confident person that strives for competence; that comes with having a self-awareness that can be fine tuned for self-benefit, and anyone-shall I say, everyone can learn how to do that.
I see something a little different as a student and just as a patient having had interactions with doctors and nurses. I see a lot of times patients and their families complaining about the doctors and how they seem very uncaring and callous. The nurses are revered more for caring and taking the time to communicate. Then, there are those that complain about the nurses not doing the little things they think they should be doing (which is more a symptom of teamwork and facility problems and not shortcomings of the RN). Now that I see how doctors talk to patients and now that I know what a patient means to a doctor as opposed to what a nurse's patients mean to that nurse, my perspective has become more all-encompasing.
Yes, doctors are callous toward their patients at times but I think it's more a "busy-ness" problem and a "I have no idea who this person is outside of their Dx and medical Hx" issue. Nurses need to know more about the patient because we typically have fewer patients than a doctor's typical workload and are concerned about the patient as a whole and not just based on their medical Dx. As far as interactions between the nurse and the doctor, it seems that doctors are concerned with one thing and nurses are concerned about the other thing. If these interactions are harmonious and composed of excellent communication, then this is to the benefit of the patient. I can't really see how a nurse kowtowing to a doctor facilitates this. I know that nurses are responsible for a lot but we have a lot of teaching authority and therapeutic communication that may be more than sufficient for typical patient/family informational needs. I can't really conceive of, at this point in my education, to ever bow to a doctor. He/she does his/her thing, I do mine. We collaborate. It's all good.
I work for multiple doctors and they are all different. I agree with a few of the comments. Nurses are professionals just as Physicians are. We each develop respect for some and do not respect others in the Medical profession. I have had to question orders before and have refused to give a medication when I knew the dosage ordered was not correct. I work under my own licenses. So I am guarded when I work with some Physicians. When I am asked questions by patients that the Physician needs to answer, I will tell them I will let the Physician know that they have questions. I would never say I am just the " Nurse" as I worked hard to become a Nurse and am Proud to be in the Nursing Profession. Good luck to anyone considering the Nursing Profession. It is rewarding as well as heartbreaking at times.
:mad:We, as nurses, are highly educated professionals who should demand respect. Now physicians are hiring medical assistants to work with them and even give meds which they are not trained to do. They can't deal with the consequences of allergic reactions or adverse reactions from meds. If we as nurses don't recognize and value the power we hold, how can we expect others to respect and value our work?
and here's why:.thumb.gif.9c97ffa9443a5f22ff38e1eac832292c.gif){kind=avatar}
NightNurseRN13
353 Posts
One reason I love my job (private duty nursing) is I have parameters to work with, there is no doctor there to report to, I know my clients medical diagnosis and know how to treat it and how to educate them. My clients think I'm the smartest person in the world..... until things go downhill and I send them to the ER.
Sorry, but I'm not taking credit for fixing your heart failure. ( I may have noticed the signs and symptoms and sent you for help, but I didn't stop it)