Much needed help with communication?

TheCommuter, BSN, RN · Sep 20, 2006

I have the utmost respect for medical students because, after all, medicine is the most noble profession. It takes a motivated, immensely intelligent person to become a doctor. Being treated unkindly, however, is just not limited to medical students. As a student I was not treated respectably by a handful of the more experienced nurses and aides even though I felt I did absolutely nothing to deserve the deplorable treatment. I attempt to treat everyone kindly, regardless of the initials behind their names. Not all nurses are bitter.

Please continue to be an easy-going person, as this trait will do wonders throughout your career.

TheCommuter, BSN, RN · Sep 20, 2006

I get along well with the male nurses and all of the nursing students. The critical care nurses are great, but the general ward nurses and the ER nurses not so much (at my institution).

The general ward nurses (Med-Surg) and ER nurses tend to be the most overworked people in the entire hospital setting. They often deal with bad staffing ratios and are spread too thinly, which adds to the list of stressors. As a result, some of the ER and ward nurses you've encountered might be cranky due to being overworked, underpaid, and lacking resources or help. It often helps to place myself in the shoes of the other person to visualize their unique perspective of things. :)

anne74 · Sep 20, 2006

The general ward nurses (Med-Surg) and ER nurses tend to be the most overworked people in the entire hospital setting. They often deal with bad staffing ratios and are spread too thinly, which adds to the list of stressors. As a result, some of the ER and ward nurses you've encountered might be cranky due to being overworked, underpaid, and lacking resources or help. It often helps to place myself in the shoes of the other person to visualize their unique perspective of things. :)

Oh my God - you took the words right out of my mouth! The general ward nurses and ER nurses are under so much pressure to get things done QUICKLY. An ICU nurse has 1-2 patients, and has more time to work with med students/docs, etc. A student nurse doesn't have all the responsibilities that an RN has - so again, they have more time.

I work on a med/surg floor (and I'm transferring because I'm tired of being a waitress)- and I know a big source of stress is the constantly revolving door of patients - constant admits and discharges - and the nurse can't do anything until we get orders - often from med students. I've had many occasions were you're waiting for hours to get orders, meanwhile your pt is in pain and you can't do anything about it, etc.

Also, many med students/residents are new at making decisions, and often change their minds back and forth, which means double work for the nurse. Just the other day for one pt, an R1 wrote to DC a PCA & foley - then her attending came around, and reversed all the orders within hours - this was frustrating, since you're already so busy with at least 4 other patients - not to mention the patient didn't like getting a foley pulled and then have to go through the procedure all over again.

I'm always nice to med students and I sympathize with them - you guys have to deal with a lot of pressure. My advice is to keep doing what you're doing - be nice and respectful, and usually you'll get that in return. Already, it says a lot that you're reaching out to nurses to get their perspective. I applaud that! Also, thank the nurse - and listen to their input. Nurses spend the whole day with your patient, and are able to sense problems more easily than some docs who spend 5 minutes with the pt.

Lastly, many nurses are burned out, underrespected and overworked - and being in that type of environment for a long time will turn anyone into a bitter person.

Good luck!

TazziRN, RN · Sep 20, 2006

On the rare occasion we get an ER doc fresh out of residency, I get nervous. Most of them are arrogant, with an "I know all because I just finished school" mentality. Much like RN-itis that is suffered by new nursing grads. When nurses are overworked and then have to deal with med students with attitude, they tend to treat all med students/interns the same way until the students and interns prove themselves.

GatorRN · Sep 20, 2006

I enjoy working in the hospital however, and want to make it more enjoyable for myself and the nurses that I work with, so...
My questions are: 1.) is there a general feeling of animosity toward medical students, and if so, why? 2.) what can I do to improve the relationship with the nurses I work with without compromising my dignity (i.e. not kissing up)

I don't know if I would say that there is a "general feeling of animosity towards medical students. I have, however, seen situations over the yrs that may lead you to this conclusion. I, personally, get along great with most med students/residents. I treat them with respect and they in turn treat me with respect. Those that treat me with disrespect, well, they get the same back.

As Tazzi noted, a lot of med students/residents come off as arrogant, know it alls. Those that come off like that are transparent in their feelings that nurses are beneath them. They don't seem to understand that nurses are highly educated professionals with great knowledge of microbiology, anatomy and physiology, disease processes, S/Sx and general treatments of the same etc... We, as nurses, spend 8-12 hrs a day with the pts and are very familiar with their conditions, or any changes that may present. We know a lot more than some doctors give us credit for.

The fact that you are asking for a nurses perspective says a lot about you and I, for one, appreciate that. You don't seem the arrogant type to me from your posting. As far as improving the relationship with the nurses you work with, treat them with respect, appreciate them for their knowledge/experience, thank them for what they do for your pts, treat them as a team member in the care of your pts, don't be afraid to ask them for their opinions, treat them as an intricate link in the the well being of your pts, give them credit where credit is due, and you will be surprised by the responses you recieve. None of these things would be construed as "kissing up," in my opinion. Good luck in medical school and your residency. :)

Trauma Columnist · Sep 20, 2006

I spent 10 years in a large teaching hospital level one trauma center where we had an ER residency program, med school, several nursing schools, etc. You get the picture.

Anyway - I'm pretty easygoing and soon realized that if I helped the students learn, it made caring for the patient much easier. I have been a nurse for awhile (read: I'm older than your mother - lol) and have never had any issues with med students. Like another poster said - I feel sorry for the students - you guys work many hours just for the experience of being in a hospital.

On the other hand, if a med student asks for assistance doing a procedure, then please know that we can help you to learn by providing a little coaching.

Please and thank-you sure go a long ways in my book. BTW thanks for asking.

RunnerRN, BSN, RN · Sep 20, 2006

I'm an ER nurse and I try to get along with all the students/residents. A few things that might help (at least, if you were at my hospital):

-Ask me my impression. When you come out of the room, be nice and compare your story with mine. A lot of people tell docs stuff they don't tell nurses, and vice versa.

-When I have a person who is dizzy with chest pain, and I'm working to put them on the monitor, get an IV in, and draw blood, don't get in my way. And don't tell the patient "You're probably just anxious." (True story last weekend....still steamed about that).

-Don't get upset with me when I go over your head. That CP patient needs intervention NOW, and you're doing to longest assessment EVER because you think he's just anxious.

-No flirting with me. Just because I don't wear my wedding ring doesn't mean I'm not married. And don't be overly familiar. I work with these people every day, they've earned the right to joke with me and speak more freely.

-My favorite med student ever would come out of the room, very nicely ask if I had a moment to talk (and not in the arrogant kind of way that implies "you'd better have a moment) and ask to read my chart. He said he learned a lot about the patient from reading my chart and talking with me, and didn't want to miss something.

-My personal thing....if the nurse asks if you want to order something (CXR, blood cxs, zofran) generally the answer is yes. I know as an M4 you can't really order stuff, but please dont' discount what I have to say. If I tell you I know this patient and he's only here for the Dilaudid, don't argue with me trying to make me push Dilaudid.

I think the fact that you're asking a community of nurses how to get along better is a good sign - you don't seem like an @ss!! Really though, just being nice and respectful and listening to me (again, don't try to push me to put an IV in a baby who has puked x 2 and is drooling all over herself) goes a long way.

Good luck!

santhony44, MSN, RN, NP · Sep 20, 2006

I'm an ER nurse and I try to get along with all the students/residents. A few things that might help (at least, if you were at my hospital):
-Ask me my impression. When you come out of the room, be nice and compare your story with mine. A lot of people tell docs stuff they don't tell nurses, and vice versa.
-When I have a person who is dizzy with chest pain, and I'm working to put them on the monitor, get an IV in, and draw blood, don't get in my way. And don't tell the patient "You're probably just anxious." (True story last weekend....still steamed about that).
-Don't get upset with me when I go over your head. That CP patient needs intervention NOW, and you're doing to longest assessment EVER because you think he's just anxious.
-No flirting with me. Just because I don't wear my wedding ring doesn't mean I'm not married. And don't be overly familiar. I work with these people every day, they've earned the right to joke with me and speak more freely.
-My favorite med student ever would come out of the room, very nicely ask if I had a moment to talk (and not in the arrogant kind of way that implies "you'd better have a moment) and ask to read my chart. He said he learned a lot about the patient from reading my chart and talking with me, and didn't want to miss something.
-My personal thing....if the nurse asks if you want to order something (CXR, blood cxs, zofran) generally the answer is yes. I know as an M4 you can't really order stuff, but please dont' discount what I have to say. If I tell you I know this patient and he's only here for the Dilaudid, don't argue with me trying to make me push Dilaudid.
I think the fact that you're asking a community of nurses how to get along better is a good sign - you don't seem like an @ss!! Really though, just being nice and respectful and listening to me (again, don't try to push me to put an IV in a baby who has puked x 2 and is drooling all over herself) goes a long way.
Good luck!

I worked in a teaching hospital for a number of years also, and agree with all of the above. The smart med students/interns/residents (and attending physicians, for that matter) listen to the nurses. If the nurse says: "Wouldn't you like to_______" (fill in the blank here) then the answer almost always should be

"Yes, certainly!" The phrases "wouldn't you like to" and "don't you want to" should make alarm bells go off in your head. If you don't know why you should agree with the nurse, ask! He or she not only knows the patients better than you do, but also knows your residents and attendings better than you do. Those phrases are the sound of a nurse saving your behind!

I would add: don't act as if your patient is the only one the nurse is taking care of. That's definitely not the case, and on med-surg floors, the nurse probably has more to do than is reasonable.

Don't hold the chart for four hours and then come back three minutes after you finally let it go to ask if something has been done, or why it hasn't been. (This probably applies to the floor more than to the ER or ICU).

Above all, be polite and respectful. Many nurses today are old enough to be your mom or dad. Treat them that way. The younger ones also deserve respect. As do the CNAs, the unit clerks, the various techs, the housekeeping staff, etc etc.

I agree that you're on the right track. None of our advice will guarantee that every nurse will treat you well, there are difficult people in every profession, but the advice you've gotten here will go a long way toward making your life as a medical student easier. Thanks for asking, and good luck to you.

Columnist · Sep 20, 2006

I am not a nurse yet, but I know a lot about communication. One thing I would like to suggest is this: do not treat a nurse as a "subordinate." Treat him/her like a fellow team member, because that's what you are: a care-giving team. Just as the left guard is not subordinate to the quarterback, in terms of making a vital contribution to the squad, so nurses play on the same field as doctors. It takes ALL of the team to win a game. You may find taking this communication approach goes a long way toward improving relations with the others on your team (not only the nurses but techs, lab folks, etc.).

Like others, I applaud you for reaching out to solve this problem. I can tell you're going to make a great doc.

USNOUMED · Sep 20, 2006

Thanks for all of your replies. I believe that they are enough to gather a general consensus. I especially liked semisweetchicks analogy, since I can relate to team sports (I played college baseball and overseas for awhile), and santhony and NurseErica's posts were helpful. The Commuter, you'll always be special since you were the first to reply :-)

Well, let me tell you a little about my experiences so far. I fell in love with the ICU at the end of my 3rd year, likely b/c my attending and the ICU nurses were interested in my education and seemed to enjoy what they do. I geared the remainder of my rotations toward pulmonology/ICU boarding and even did a couple sub-I's to that affect. BUT, wouldn't you know it, just when I thought I had things figured out...Anesthesiology came along and whoomp, there it is (i'm a dork by the way). So, I'm on that path now. A major reason I switched is life-style. I hope to get married and have kids some day and teach history and coach baseball somewhere along the way. I love medicine but I also dig life outside of it.

So, I will be reading some of the other posts and any further replies to this one. I will let everyone know how your advice has helped (or not) since I am going back to the wards soon. Thanks again for your help, if there is anything I can ever do, let me know...I think my email is in this place somewhere!

traumamomtx · Sep 20, 2006

Well I think you found your answer from the nurses. I work in a Trauma I big city hospital on the trauma/medsurg floor. Needless, to say you know what kind of pts we get: GSW, MVC, MCC, Stabs, plus drug and alcohol withdrawal. We do get the occassional surgery pt. But we are carrying 7 of them at night and that is a lot of running and jumping. Last night had hallucinating pt, 4-pt restraints, pulled out Central line for 3 time since stay, foley, and biting, yelling, and shaking the bed so hard it is coming off the floor. Don't tell me "what do you want me to do?" Or "well I don't want to sedate them to much" this is said after 3 of ativan, 5 of morphine, 5 of haldol, and 10 of Geodon!!!!!! If that isn't going to know them out you need to go to the upper years and figure something out. I don't get paid enough to be beatup, biten, or injured because you don't want to come our of the doctor's sleeping room. We are extremely overloaded in ER and on the regular floors; walk in our shoes and you might understand.