Malicious "pimping" in nursing / nurse practitioner school?

[RomaniGypsy]

I have been investigating both advanced practice nursing and medical training, and I get a bad feeling about medical training. I've mentioned attitude problems I've caught from doctors and medical students before, but now it's time to address one specific topic.

They say that in medical school, "pimping" is a common thing. Apparently there are two main types, each of which begins with a medical practitioner who is serving in the capacity of an instructor firing off a series of questions at a student or resident. The "beneficial" type is where the questions are legitimately related to something the student or resident should know because he/she will need to use it in practice, and if the student / resident gets to the point of saying "I don't know", the instructor will tell the student to look it up and perhaps do a brief presentation on it the next day they're together.

For the record, I consider this entirely acceptable. I teach (though not in a school) and I do the same thing to my students sometimes.

The second type is "malicious", where the point of the questioning is to humiliate and embarrass the student. As I've read, the questioning may or may not deal with relevant topics, but in either case when the student / resident reaches that "I don't know" point, the instructor will mock the person in front of his/her peers for not having that knowledge.

What makes it worse is that they seem to think that this is acceptable practice and that people should not rise up to stop it. (I suggested that they could rise up en masse to stop it if they wanted to, and some of them mocked me for that!!) Personally, I see no benefit in the mocking / humiliation / whatever you'd call it, because all that does is bring people down with no counterbalancing benefit.

So my question is: In nursing education, considering all levels from LPN up to DNP, how prevalent is the "malicious" form of "pimping"? And, if it happens at all, what is the likelihood of retaliation against someone who either returns fire at that moment (so as to save face if nothing else) or reports the abuse to the administration of the school or facility?

[Oldmahubbard]

Nursing should not be referred to as "the medical field" until the APRN level. It is healthcare.

[RomaniGypsy]

Down in Texas we call it "BULLYING" but regardless it is the same and being in nursing over 30 yrs I've seen it at all levels. This one thing I know.

The person who does this type of thing has some major issues in life that has made them so insecure that the only way they can make themselves feel better is by belittling others. When I catch it I will tell them I am sorry they feel so bad abt themselves and that usually stops it. I once worked with an RN (LVN here) who thought she was all that and a bag of chips, and constantly ran LVN's down. When the day came the LVN fired her it was quite a shock to her system. LOL To me we all have different titles and sometimes different roles but from Housekeeping on up we can only do our jobs by teamwork, there isn't ANYONE better than anyone else.

One of these days I'll figure out the multi-quote on this.

I'm glad to have gotten so many responses to this thread. Truth be told, I'm trying to get a feel for the culture of nursing in addition to the answers I've sought, and I think I've gotten some good insight here... at least, as good as insight could be without firsthand experience.

I'm also a believer that nobody is better than anyone else and I tell people that all the time. As a musician, I get lots of comments about how awesome and talented I am... what I've found to be rather sad is that these people don't recognize that they, too, are awesome and talented in some way(s). I always say "well, we're all good at something, aren't we?", and too often they say "I'm not good at anything". One or two questions later, I can always find something at which they are / were good, at which I've never been any good (even if that's only because I've never tried). Really, we're all good at something, our excrement is similarly malodorous, we were all born as helpless babies and we'll all die eventually, and nobody should consider himself / herself better than anyone else.

I find it amusing, if somewhat perplexing, that the LVN you referenced was able to fire the RN. One would think an RN would outrank an LVN, but I wouldn't doubt that it's possible for an LVN to be in an administrative position such that he/she would have the authority to fire an RN.

As for nursing shouldn't be referred to as "the medical field" until the APRN level, I was hoping to get some insight into this problem at the APRN level.

What I've gathered so far is that in nursing education, bullying happens rarely, but generally is not tolerated, meaning that bullies are likely not to be long for their jobs. If I'm wrong, do correct me. I find this to be a delightful contrast to what I have read about doctors, from articles as well as from people who have posted to forums. The feeling I get is that doctors consider it sacrosanct, as though to say that it's a way to separate the wheat from the chaff and numb people to the realities of working as a doctor. At one point I thought, "this sounds a lot like what they do in the military; breaking down young recruits so as to build them back up the way they think those people need to be in order to succeed in the military". Long have I known that that's why I would never make it in the military; I simply wouldn't tolerate that and I would be discharged for "failure to adapt to military life". The same fate would likely await me if I tried to become a doctor, unless I lucked into a school and residency where this didn't happen.

I'm sure that nurses and doctors alike get tired of trying to explain the difference between being a medical doctor and being an advanced-practice nurse to people like me, but I have found that the best I can do is get a consensus of opinions. This requires many opinions. It's sort of like the MD vs. DO debate; some people say there's no difference, some say there is a difference. All I can do is put all of the opinions together, weighing them based upon the authority of the people who present them, and come to my own conclusions.

By the way, conroenurse, I may at some point ask you about the potential for nurses / nurse practitioners to travel and do disaster response nursing. With you being so close to Houston, I imagine that the hurricane response from last year required an emergency infusion of nurses, doctors, and mid-level providers from outside the region.

[Horseshoe, BSN, RN]

I find it amusing, if somewhat perplexing, that the LVN you referenced was able to fire the RN. One would think an RN would outrank an LVN, but I wouldn't doubt that it's possible for an LVN to be in an administrative position such that he/she would have the authority to fire an RN.

It may depend. The Texas BON position statements make it clear that a LVN may not supervise the nursing practice of a RN. But I can imagine that certain administrative oversight could be possible, depending. Not sure about the situation described above. If the LVN was supervising the RN's clinical practice, the LVN would be in violation of the Texas Nurse Practice Act.

It is not appropriate and is beyond the scope of practice for a LVN to supervise the nursing practice of a RN. However, in certain settings, i.e.: nursing homes, LVNs may expand their scope of practice through experience, skill and continuing education to include supervising the practice of other LVNs, under the oversight of a RN or another appropriate clinical supervisor.

Bad Request

I don't know why the above link reads "Bad Request," but it does work.

[debrasimons]

The term is accurate in medical school. My daughter finished medical school and that is what she called it much to my surprise. As far as nursing school perhaps it's called the nursing instructors eat their young but at the same time I know that if one complains there is retaliation often in those programs. I'm sure other people can give examples. I remember an appalling situation at the VA hospital where we did our psychiatric nursing training and when I made a complaint about the treatment and Facilities I was told by one of the nursing school directors that because of my complaint we could lose our school privileges for that facility and then that would affect the nursing schools credentials and Licensing. I was point-blank threatened on that particular occasion because I had complained. Not to do with being questioned or pimped but something similar. Complaints are best done anonymously in that type of program

[kclady]

It didn't ever happen to me in nursing school and I never saw it happen to any other students. However, I have seen older nurses do what you're describing to younger, new nurses while they were giving report I've also seen nurses try to humiliate new hires, in front of patients and staff, because the newbie didn't know something or forgot something.

[Silver_Rik, ASN, RN]

I haven't really seen it at all in lecture, and very limited in clinicals. I've only seen it aimed at students who are clearly unprepared and not taking the experience seriously, and then just enough to get their attention.

Personally, I would like to see more Socratic inquiry used in nursing education, classroom and clinical. But it doesn't have to be done in a cruel way.

[Horseshoe, BSN, RN]

I haven't really seen it at all in lecture, and very limited in clinicals. I've only seen it aimed at students who are clearly unprepared and not taking the experience seriously, and then just enough to get their attention.

Personally, I would like to see more Socratic inquiry used in nursing education, classroom and clinical. But it doesn't have to be done in a cruel way.

It's pretty brutal in law school, as I mentioned earlier, but not cruel, and not aimed at torturing certain individuals while sparing others. Some teachers have a bowl with the names of students in it, and just draw them at intervals during class. But the penalty for being unprepared can be tough. D told me that when one young man admitted he hadn't read the case in question, he was told to leave immediately (and was "memo-ed," meaning he had to write a paper on the case before the next class resumed, on top of preparing for new discussion). Another stammered, and while not admitting he hadn't read the case, made it clear he had not. The professor said, "clearly you know nothing-come back when you do."

The incentive is very strong to come to class prepared.

[lovetoos]

After reading a lot of the comments here, many of you are very lucky. When I was doing my medic rounds I had a ton of resistance from the nursing staff and some doctors. I had to explain what exactly paramedics do and their scope of practice. To ED nurses and doctors. Perhaps it was just the culture of this particular teaching hospital, who were already inundated with nurses and residents to teach to.

That being said I also spent a lot of time observing the hospital culture during clinical rounds, hence why it took me so long to go in to nursing. This behavior described was absolutely done, more so by the doctors. I would have termed it bullying. A few times I watched the teaching staff put a resident in tears. She was gorgeous, smart as hell and there was a lot of jealousy towards her. After being the object of work place harassment and bullying myself, I couldn't stay silent. I happened to know one of the residents who bullied her. And you bet your bottom I took her to task on her behavior towards another resident and another woman. So for everyone out there that sees this... it falls under the if you see something, say something. We need to stand up for one another. Nursing staff eating their young and doctors pimping will only stop if we all stand up for one another.

[RomaniGypsy]

It's pretty brutal in law school, as I mentioned earlier, but not cruel, and not aimed at torturing certain individuals while sparing others. Some teachers have a bowl with the names of students in it, and just draw them at intervals during class. But the penalty for being unprepared can be tough. D told me that when one young man admitted he hadn't read the case in question, he was told to leave immediately (and was "memo-ed," meaning he had to write a paper on the case before the next class resumed, on top of preparing for new discussion). Another stammered, and while not admitting he hadn't read the case, made it clear he had not. The professor said, "clearly you know nothing-come back when you do."

The incentive is very strong to come to class prepared.

I think that those reactions were a bit too harsh, but it seems to me that when you're talking about "reading the case", it was probably some form of homework assignment where the law students had to read this case or a bunch of cases that included this one, and the students who couldn't answer the questions were unable to answer the questions because they had committed the elementary-school sin of failure to do their homework. That seems a pretty stupid thing to do, in freaking law school... or, for that matter, nursing school, medical school, etc.

[RomaniGypsy]

After reading a lot of the comments here, many of you are very lucky. When I was doing my medic rounds I had a ton of resistance from the nursing staff and some doctors. I had to explain what exactly paramedics do and their scope of practice. To ED nurses and doctors. Perhaps it was just the culture of this particular teaching hospital, who were already inundated with nurses and residents to teach to.

That being said I also spent a lot of time observing the hospital culture during clinical rounds, hence why it took me so long to go in to nursing. This behavior described was absolutely done, more so by the doctors. I would have termed it bullying. A few times I watched the teaching staff put a resident in tears. She was gorgeous, smart as hell and there was a lot of jealousy towards her. After being the object of work place harassment and bullying myself, I couldn't stay silent. I happened to know one of the residents who bullied her. And you bet your bottom I took her to task on her behavior towards another resident and another woman. So for everyone out there that sees this... it falls under the if you see something, say something. We need to stand up for one another. Nursing staff eating their young and doctors pimping will only stop if we all stand up for one another.

I do agree. The question becomes - how much is that "standing up" tolerated in nursing? When I brought this up in the doctor forum, I was told that anyone who does such a thing would "watch their career die a martyr's death". The more I read about it, it seems that standing up against it, at least in MD / DO education, is taboo because it can result in getting bad grades for clinicals (which can torpedo your career).

I read all kinds of articles about how this needs to be resisted, and how the culture of medicine must change (this includes nursing, though to nowhere near as great an extent as in the world of doctors) for the better of all healthcare personnel and their patients. I've also been reading that female medical students are having a rough time to an extent because their increasing numbers are causing them to be emboldened to change the culture of medicine to something more human (the article said "like nursing") and they are experiencing pushback from the "old guard", as it were, most of whom are male and many of whom were educated in the "good old days" when medical education was harder and residents worked 100+ hours per week.

If nursing is more human, that's great, and it's a better fit for me. It does seem like it is, from the responses I've gotten here. I do wonder if that has something to do with how over 90% of nurses are female... if so, great. Maybe this is in the same ballpark as the reason why I've always had a much easier time being friends with females than males.

[Horseshoe, BSN, RN]

I think that those reactions were a bit too harsh, but it seems to me that when you're talking about "reading the case", it was probably some form of homework assignment where the law students had to read this case or a bunch of cases that included this one, and the students who couldn't answer the questions were unable to answer the questions because they had committed the elementary-school sin of failure to do their homework. That seems a pretty stupid thing to do, in freaking law school... or, for that matter, nursing school, medical school, etc.

I don't even necessarily believe it was too harsh.

Today was the first day of their litigation path, a series of classes on court performance which lasts 2/3 of their last year and is considered the most rigorous and excruciatingly stressful time period of the whole law school experience. My D was called to the front today, the first one of the school year, and stood in front of the entire class while she was questioned (she said "grilled") for an entire hour on the assigned cases. She said she got home and immediately ran to the toilet, where she had diarrhea and cried simultaneously from the stress, lol. Now she is psyching herself out - "I think the prof will assume we all believe I'm done after that, but will he want to make an example of me by calling on me again next class?!?!"

All I can say is I'm glad I'm not in law school. Being asked a series of tough questions at clinical is NOTHING compared to this.

[Whull1, BSN, DNP, RN, APRN, NP]

As a nurse in a DNP program, I have yet to see this. In my ADN program, we had one instructor that hated students and would do this. I worked in a teaching hospital where one MD was notorious for doing this to residents. Especially, when it came to patient status changes, current medications and interventions. It was awkward, however it's hard to save a resident, especially when a resident comes in thinking they know the patient yet never asked for an update on the patient prior to rounds. Or when you have to constantly correct the resident during team rounds.