Nurses knowing more than doctors

pugmum · Feb 6, 2006

My feeling (as other posters have put it) is not so much that nurses know 'more', but know 'different'...if we work collaboratively with the doctors, the patients benefit from what we both 'know'.

nursejohio, ASN, RN · Feb 6, 2006

I'm still fairly new to the game, and I'd never presume that I knew better than the MDs. With time and more experience, absolutely I will! Mind you, I'm not professing that I'll be an expert at everything. Nor am I saying that I'll know more about any patient than "doctors" in general. However, as a nurse in a teaching hospital, I know what it's like to have a new group of residents in house. The MD behind the name doesn't make an expert any more than RN behind mine makes me Florence Nightengale. New 1st years need, and at least the good ones, want advice and input from the seasoned nurses who can see the whole picture about the patient. Giving a 500 NS bolus to a POD #2 splenectomy with a pressure of 70/30 (down from 115/80) and taching along in the 150s (up from 90s) and wanting to wait 4 hours before trying anything else is one example. Oh, and did I mention she'd had NS running at 150/hr since PACU, and her Hgb was down 2 grams in 12 hours? It didn't seem to me or any of the nurses I'd asked for advice (since it was my very 1st day off orientation) that it was so much a volume issue....

I'm thinking this pretty much sums it up "You mean those same doctors who, over three years of residency, spend a total of three months in the MICU environment? Compared to your years of experience, spent working in the ICU since the time of the Crusades? You allowed them to tell you what to do, even though your experience told you that it might be wrong?"

Courtesy of http://www.icufaqs.org/BedsideEmergencies.doc

SmilingBluEyes · Feb 6, 2006

I think you are mixing up "knowing more" with developing the instincts that go with years of experience any nurse or dr has. It just seems to me, most dr/nurses develop a "6th sense" sort of thing when they have been "at it" for many years. If this is "knowing more", I might buy that, but this intuition is NOT limited to nursing. I see it in doctors, RTs and other professionals, at work in their specialties. It's like they can "sniff" out things the less experienced cannot.

I remember a visiting social worker who alerted me (an inexperienced new nurse) to a problem my patient was having with her magnesium sulfate therapy (she had been stable on it for 3 days). She said, "she looked wrong somehow". SHE WAS RIGHT----the gal was becoming toxic and suddenly. Just one illustration of someone who is awake at the wheel and can "sniff" trouble---someone who is not even a nurse, but knew patients.....

We nurses may just seem at times to " know more" because we just may tap into it (the 6th sense) more often. After all, we are the ones at the bedside most often and we know our patients well after a while.....

Jay-Jay, RN · Feb 6, 2006

I work in home health. We do a LOT of wound care, and are constantly learning and taking inservices to improve our knowledge. Most GP's know beans about wound care. I had a post-quadruple bypass patient with a very nasty infection in her chest incision that needed packing. It was 5:30 on a Friday evening, and I had her GP on the line (try to reach her surgeon at that time of day?? HAH! Dream on...) Anyway, the GP was doing his best to give me wound care orders. Finally, he stopped and said to me, "You obviously know much more about this than I do. What should I write?"

Then there was the GP who ordered 20 mg. of morphine sulfate an HOUR for a patient who was dying, and had a respiratory rate of only 9. I asked the family how much morphine she had been getting, and it was one 15 mg. tablet of MS-Contin q. 12 h. (and no breakthrough prescribed)!! Thank goodness I have enough experience in palliative care to know the difference between a drug dose that's going to relieve pain, and one that's going to push the patient over the edge!!

What REALLY burns me are the docs who STILL use Hygeol, Betadine, and hydrogen peroxide for wound packings, and refuse to change...some of 'em are even specialists in plastics/dermatology/internal medicine. I am very glad to see 2 local hospitals whose wound care used to be pretty hit-and-miss now have wound clinics which use the latest treatments. (It now means patients who used to be seen in their homes now travel to the hospital for dressing changes, which I'm NOT too happy with, nor are they...)