what do nurses hate about doctors?

Mudwoman · Jul 21, 2008

One of the first questions I get from the Patient or Patient's family is "When is the doctor coming?" Then I say "I don't know". Then the doctor does come and to save time, he/she never goes into the room and talks with the patient, he/she just goes to the chart and makes some notes for 2 minutes and he/she is gone. Then I'm left to deal with the angry patient and their family and I'm the one that gets to deal with the bad rating on the Press Ganey survey and I'm the one that doesn't get a raise.

Patient has clearly taken a turn for the worse. I call the doctor, only he/she isn't on call-----Dr On-Call is. Dr On-Call informs me that she doesn't know anything about this patient, so she can't give me any orders and "NO" she isn't coming to the hospital to see this patient. Then I call the specialist that has been asked to consult on this patient. Guess what. This doctor is not on call either. He has his own Dr On-Call. This Dr On-Call doesn't know anything about this patient and is not going to give any new orders or come to see the patient. Fine, my next call is Rapid Response or Code Blue. Don't be on call for another Dr if you aren't willing to help the patient.

Patient is admitted for failure to thrive. This patient is in his 90's. Weighs 88 lbs. He is dying. So, I get an order for this patient to be OOB (out of bed) for all meals and to ambulate. Even had the DR come to the hospital on his lunch hour to make sure that I was trying to shove food in this man's mouth and had him up in a chair, and when he found that I had not, wrote me up. This man died at 2145 that night. My orders should have been comfort care only. This man was a DNR. Dr I-Keep-Them-Alive-Forever even wrote in his notes to discuss a feeding tube with the family. Be realistic. We ALL die at some point. Be humane.

All the elderly that are admitted with "confusion" aka dementia/alzheimers/sundowners. Family shows up for 30 minutes a day and we are left to corral this patient. Patient hits, bites, pulls out the IV and foley repeatedly as he/she tries to find their car keys to leave this prison. We are not allowed to use restraints, and the Docs don't want to "sedate" them. That might cause them to be more confused or mask something serious. NOTE that most hospitals don't provide sitters and most families are AWOL and don't have money for a sitter. With my patient load, I don't have time to deal with these patients. The hospital is not set up for these patients and there is a waiting list of 3 weeks for the in-patient unit for the senior citizens that are "confused". Help out would you! Ditto on the smokers that constantly leave the floor after they have gotten their pain med/drug fix.

Finally, just because I didn't go to medical school doesn't mean that I'm not smart. Thank goodness for you, or you would be like those Drs on Gray's Anatomy walking the patients in the hall or getting them a bed pan. I have a career just like you do. I also work for the hospital and I don't work for you, which in plain English means that I have rules I have to go by whether you write an order otherwise or not. Therefore, do not come and throw a temper tantrum yelling and screaming at me in front of the patient asking me if you need to take "your" patients to another hospital so that they get the care you expect. "Your" patient is also mine. I care just as much about good care as you do. The patient should NEVER, EVER know that we are not a team working together for their benefit. YOU need to know the rules of the hospital in which you are practicing. You don't like that I have 9 other patients with 9 other docs to also give "great" care for, then hire your own private duty nurses for your patient. Also, don't give orders that can't possibly done. What was this Dr screaming about? The orders were to keep the NG tube to suction at all times. Patient to have CT of abdomen with contrast and keep NG to suction during the proceedure. Resume all PO meds, but don't turn off suction. So, my hospital protocol is that the suction has to be turned off for 30 minutes for the meds and there was no portable suction machine anywhere in the hospital to accommodate the order for suction during the CT of the abdomen.

michaelarose · Jul 21, 2008

I did'nt undertake a 3 year degree to become "your nurse" Nursing is a profession, I am not your nurse.

Even if you are employed by a doctor, via his/her office in private practice, there are a lot of doctors that will not pay a nurse properly, sometimes its better to be employed by a medical facility.

narnia · Jul 21, 2008

Hi there!Without nurses,the doctors will have to go on duty and carry out their own orders and monitor their own patients.It would be best for doctors to be kind and appreciative of all the hardwork nurses put into their jobs.It would'nt hurt to say thank you each and everytime.

Music in My Heart · Jul 21, 2008

Here's an example from clinicals a couple weeks back.

We had a patient awaiting transfer. Physician had written and signed orders but not signed the transfer sheet. Patient cannot go without it. Period.

Nurse runs into the physician on another floor and says, "Hey, we need you to go up and sign the transfer form." His response? "No, I signed everything." Her reply, "No, I was just looking at it. You didn't sign that form." His reply, "Yes I did. I signed everything."

Summary: If a nurse tells you that you didn't sign something, believe him/her. You just look silly when you argue a point on which you're obviously and demonstrably wrong.

Music in My Heart · Jul 21, 2008

Here's another one:

A physician who, because of his/her personal religious faith, is reluctant to recommend palliative care in favor of "curative" care for a patient who's horribly uncomfortable and very obviously coming to the end.

Please make decisions based SOLELY on the best interests of your patient and not with regard to your religious beliefs... even if it is a Catholic hospital.

Cajun Nurse · Jul 21, 2008

My current pet peeve is practitioner orders specifically physician verbal orders. First if you are present write and authenticate your own order. If you are not present then make it a point to review the verbal order for accuracy and actual implementation. Then sign your orders. This is a patient safety issue. There is also the issue that the nurse took the verbal order in good faith. It is the physician's responsibility to follow through with the authentication to make the order a legal one.

Beary-nice · Jul 21, 2008

Things I dislike...

1. Poor to illegible handwriting and then a tempertantrum when you ask for clarification.

2. Holier than thou attitude. (We are all human...get with the program)

3. Pt trying to or wanting to ask questions only to be brushed off or doc has one foot and both ears out the door. (Stop and listen to what your pt is saying or asking)

Those are some of my biggies. I agree with much of what other posters wrote.

Mudwoman · Jul 21, 2008

:yeah:

Docs need to remember that all nurses have friends and family and are sometimes patients themselves. I worked night shift for many years, so have developed the following rules:
Never refer a family member to a doc who yells at the nurses for waking them in the middle of the night with an emergency. It can delay care while the nurses do everything they can to avoid calling the doc.
Never refer a family member to a doc who is known to be abusive to the nurses.
Never refer a family member to a doc who does not listen to the nurses.
Never refer a family member to a doc whose handwriting is extremely illegible.
Never refer a family member to a doc who does not consult the appropriate specialists on a regular basis. (We have a couple of "cowboys" who play Nephrologist, Cardiologist, Infectious Disease docs, which means they have a hard time admitting when they are in too deep.)
Never refer a family member to a doc who doesn't know when to quit.
Never refer a family member to a doc whose partner fails any of the above tests and, to add insult to injury, fails to read the consulting docs' notes. (This one's courtesy of the smartoff partner of our former PCP, who told my DH that he'd "already lost 3/4 of his heart function" -- a statement that was completely untrue and he would've known it had he read the cardiologist's cath report -- a copy of which was given me by the cardiologist, so how hard could it have been for him to read the note?)

:yeah: :yeah: :yeah:

That would only leave 2-3 docs for patients in our town.

Here is another.....

Never refer a family member to a doctor who yells at a nurse and calls her stupid for an order, done by the primary physician on the case, that he disagrees with. Talk about passive-aggresive. This Dr expected me to call the primary and get the order changed. Hello! I told him to change the order himself if he didn't like it.

CO2emission · Jul 21, 2008

Do you guys have a government organisation that investigates and handles health care complaints? In some of the posts it seems there are cases for failure of duty of care. Do your managers advocate and mediate for you when you have a grievance against a doctor? You as nurses can change this so last century culture.

As you will probably have heard in the news, Dr Patel, former head of surgery at a large public hospital in Oz has been extradited back to Australia from the US (thanks) to stand trial on numerous charges of manslaughter and others related to a failure of duty of care.

This all came from a nurse manager who stood up for her patients, her colleagues and stared in the face of a hostile medical fraternity and complacent government.

Cajun Nurse · Jul 21, 2008

you have hit the nail on the head. the issue is nursing leadership. there is a huge difference between a leader and a manager. in the army nurse corp this behavior is not tolerated.

we have conditions of participation for hospitals in our federal regulations and now our joint commission has a standard related to disruptive behavior. the office of the inspector general and centers for medicare and medicaid are looking at this disruptive behavior as a quality of care issue. so there is shift towards lack of tolerance. i expect to changes in the not to distant future.

i have also noted that the abusive behavior is not uniformly applied. the stronger female and male nurses do not experience this. what we are actually dealing with are bullies. they have a tendency to be cowardly when they run into resistance. our colleague from down under has the approach. the nurse manager needs to put on the leader hat and standup for their staff. remember the old army slogan no gut no glory. it applies everywhere.

Hubby's girl · Jul 21, 2008

What they said---and, not speaking, like "hello".....we have an MD who will not speak to the nurses unless he is telling them something. This guy is known as "Mr. Personality"

ALSO some of the older docs still have the ego and superiority thing going on.:bowingpur

cdsga · Jul 22, 2008

I have always appreciated MD's who counsel with the nurses as peers rather than subordinates. Nurses get them out of alot of difficulties. I also appreciated MD's who truly have a good bedside manner with their patients and listen to what they are saying, what the nurses are seeing, and what the diagnostics are saying. Remember it is the art of medicine. God has a lot to do with the outcome, no matter how good a doctor or nurse you are. I respect doctors and I know how much education and sacrifice it takes to become an independent practioner, but doctors have a medical way of thinking and nurses have a more holistic approach. If those two disciplines can be balanced patient care can be enhanced. Many times an experienced nurse will pick up on fine nuances that only being at the bedside can produce.

The thing I dislike the most is demeaning behavior, and I always will remember a doctor who treated me or my peers in a rude disrepectful way. I won't let that go unnoticed and will confront a doctor or anyone who feels that they are justified in treating me in that way--especially in front of others. At that point, I will make sure they are exposed and demand an apology.

Nurses do need to learn the art of SBAR, which you speak concisely and leave the emotion out of the equation. Doctors like factual information that is delivered in an organized and understandible sequencing. That leads to respect and acknowledgement that the nurse has the ability to put together cause and effect outcomes, and knowledge based on scientific research. Intuition plays a part when nothing else will. The tenacity in which a nurse presents their case makes the doctor more aware that something is not right, and there may be hidden issues with the patient that have been undetected. A prudent doctor will take note and start assessing and diagnosing possible issues with the patient.

Thanking those that help you along your path is always a good thing. You did not get to where you are completely on your own. But I think that sometimes forget where they came from.

Nurses need to check bad behavior, and need to make sure that respect is expected whether right or wrong. "I appreciate your concern, but..." or "I appreciate this information, start...call me back when this is completed for a status report." or "I am on my way in...have this prepared for me, thank you"

I have always asked why I didn't become a doctor. For me, nursing is the ultimate, I would not want to become a doctor--care for the whole person, not just a disease process is what I am about.