I know this is my first post on your forum, and I am a guest here. But I hopefully can get some answers to a problem that has seemed to plague me since I started practicing in medicine. I am hoping that you will be honest enough to tell me why things have gotten to where they are. And by the way, my wife is an EM nurse. That is how we met.
I started in emergency medicine 10 years ago in NY. I spent 10 years prior in EMS, and also did a residency in EM for two years after graduating PA school. I have a fairly decent background. Right out of school, I worked in 4 EDs. One hospital in Brooklyn, on my first day, the charge nurse and two others came up to me and said "You are the new PA, let's get one thing straight, we have 4 year degrees, you have a 4 year degree, you are no better than us. You need labs drawn, x-rays put in, IV started, you do them yourself. It's bad enough we have to do them for the doctors, we are certainly not going to do them for you". They were called into the ED directors office the next day. They brought the union who threatened to have the whole hospital walk out if the director had anything to say to the nurses. Then at another hospital in NY, I had nurses tell me and the docs what procedure they would "allow us" to perform on our patients. They ripped up my prescriptions right in front of me and told me when they would not "allow me" to give out narcotics. In Virginia, large level 1 trauma center, they refused to do UAs on most patients. They didn't feel the test to be important. I had them tell me if my UA was so important, "are your legs broke, why can't you get it from the patient and walk it down to the lab?" They played passive aggressive for years, not giving my cardiac patients nitro or morphine for up to 2 hours consistently, answering "I heard you, put the chart in the rack and I will get to it when I get to it". Of course they refused to allow me access to the Pyxis to get the meds myself. I had them yell at me whe I wrote parameters for Cardazem for BP. They told me I was to assume ALL nurses know parameters and how dare I question their knowledge. They then told me they will question all of my orders for at least one year until I prove myself to them. That seemed to be a reoccurring theme in most ED.
I have war stories that I could go on for at least 10 pages. I have just touched the tip of the iceberg. So after almost 10 years of this and 10 emergency departments, I got to the point that I started to hate nurses in general, and thought that this is what I could expect for the rest of my career. Then of all places, I came to Las Vegas. I asked about the nurses here. I was told the same as all of my other hospitals (no one ever tells you how bad things really are as you would never take on a new position there if you knew). But to my surprise, it has been the best experience I have ever had. They are so nice, so professional. There are no power struggles. We all work together. What a difference when I get up every day to come to work.
So what gives? I have never seen a profession where so many are hateful, unprofessional, uncaring about their responsibilities (patients) and could care less about how little they are performing their jobs. This did not appear to be the minority in any of the places I had previously worked. Have I just had the bad luck to have picked 8 out of 10 of some of the worst places?
