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Older Doctor doesn't think nurses should be in charge

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When I first started working on my unit, I had a physician tap me on the shoulder, then demand that I give up my chair to him. Because, “that’s how it should be.”

Thank god it was a joke, because the initial look on my face matched the words that were about to come out of my mouth ... words not quite meant to be stated in polite company.

Anyway ...

Luckily most docs understand that we work with them on my unit. We are not equals, per se. I carry out the orders, but I will damn well question them if I see a safety concern. And I should feel comfortable doing so.

Edited by pixierose

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I would say as 'justavolunteer' that there is a job ranking in the sense that RN's have to get a doctor's order for many things.  However, that does NOT mean that a physician is God & the nurse is a doormat.  Nurses rightfully raise concerns with the MD's about their patients at times.  The term is 'advocate' and a nurse is supposed to be one when necessary.  Fortunately, mostly what I see is teamwork.  Dr's & RN's work together for the betterment of patients.  I have only seen one time when a doctor was totally dismissive of an RN's concerns.  In that case, boy did he pick the wrong nurse.  She was respectful & still managed to shoot flame at him.  Myself, I can't imagine being disrespectful, especially to nurses.  They are some of the smartest people I know & I am deeply appreciative of them.

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22 hours ago, juan de la cruz said:

To me, "being in charge" needs further context. It sounds like this person described by the OP just feels that physicians should be de facto leaders in a totalitarian sense for anything by virtue of their degree which shouldn't be the case. Can a nurse be an executive? sure, there are nurses that have become CEO's but these are people who also have additional training in administration. They are no longer just wearing their nursing hat at that point. In the grand scheme of hospital hierarchy, the CEO, CNO, CFO, Chief of Medical Staff, Legal Counsel, etc are all important roles that are respected for their individual contributions to overall hospital operations. 

It is different, however, when we talk about our individual micro-team structure. In mine for instance, I would hope that we defer to the physician or other types of licensed providers in terms of decisions on medical management of patients, the nurse for their judgement on how the patient is responding to the treatment or whether the treatment is even implementable given the unit work flow/skillset, the pharmacist for whether the treatment has a higher risk of adverse effects, the social worker for understanding community and financial resources limiting patient recovery...you get the point. I'd say we all "lead" in our own respective specialty roles.

I agree with all of this. It is the specificity of these roles that make the collaboration so essential and good for patient outcomes, as proven in numerous studies. We all approach patient care through a different lens. When we can collegially and professionally share our observations and respect those as that of the content experts, the patient benefits. There is a hierarchal structure in the level of education, training and expertise. There is not a hierarchal structure of the physician being in charge no matter what and everyone else scurrying to do what he or she says.

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On 2/3/2019 at 9:57 AM, Sour Lemon said:

 It drives me crazy that everyone needs to be praised and told how equal they are


Does that mean I can abandon common sense and just blindly follow orders? No, of course not. I expect and appreciate the same use of common sense when delegating tasks to nursing assistants. That doesn't mean nursing assistants have the same level of education or responsibility that I do, though.

Your comments speak to an idea that's been rattling around in my head for a long time: Almost all healthcare professionals at all levels could use a refresher course in teamwork, leadership, and communication.  

"Equality" should be irrelevant on a team because we all have roles to play. One of my communication professors taught a great lesson on teamwork which began with the question, "What would happen on the field if everyone on the football team was a quarterback?" 

When someone play their role and plays it well, that's when they deserve praise. When everyone plays their role well, that's when everyone benefits.

I've worked with a couple of old-school docs who were just awful, and I've worked with a couple of old-school docs who were fantastic. Unfortunately cranky personalities show up everywhere all the time, and sometimes we have to work with them. I deal with it by trying to figure out what my role is within that relationship, and then play it well.

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There is and always will be a hierarchy in healthcare. This does not mean that people should disrespect each other, but the liability usually comes back to the physician hence why they are higher on the hierarchy. This is not a discussion of intrinsic human value but one of workplace roles. Physicians should not be condescending and be so aloof that they do not listen to input of nurses, and I also would not consider a physician to be a nurses "boss" (they have nurse-bosses for that). But the roles of physician and nurse are not equal since the role of a physician has more responsibility than the typical nursing staff.  But they are both important so respect should go both ways.

 

From prior experience the physicians who treat nurses like mud puppies are not good people to work with/good physicians. But the nurses who aim high and think they could run the place better and demand equality to physicians are just as wrong.

Edited by Spadeforce

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I have seen both problems. I have seen RNs (at the direction of the nurse manager)  boss physicians (and NPs) unfairly. And I have seen physicians (and one particular NP from a direct entry school) mistreat RNs. 

Some people truly don't  understand the difference between listening and obeying. Physicians should always listen to nursing staff, but that does not mean obey, necessarily. 

The doc has over a hundred patients. The nurse has far less. The nurse knows what's going on with her patient and is trained to report her concerns. A doc who is irritated by the data he gets just because it came from the nurse is failing to work in the best interest of the patient and also wasting time. 

But when nurses ask docs to do their bidding without taking the time to explain why or skip pass the assessment data (I need a haldol order vs. Patient is agitated and responding to internal stimuli, per history haldol has worked in the past) they are not respecting the liability that the doc is taking on and the doc's  role. 

And I agree with the previous poster that we ought to respect each other's expertise on the team. 

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Has anybody seen that scene from Scrubs where the nurse asks "Doug ordered 500,000 mg of morphine, I thought I'd check with you before I killed a man." -I think that scene right there explains it all.

But really, I view Doctors and Nurses as two separate disciplines. Sure, there was a time back in the olden days when nursing education wasn't as extensive. But these days, in my area its common to make recommendations to the doctors about what to do for the patient, since we are at the bedside and can actually see the pt.

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1 hour ago, FolksBtrippin said:

I have seen both problems. I have seen RNs (at the direction of the nurse manager)  boss physicians (and NPs) unfairly. And I have seen physicians (and one particular NP from a direct entry school) mistreat RNs. 

Some people truly don't  understand the difference between listening and obeying. Physicians should always listen to nursing staff, but that does not mean obey, necessarily. 

The doc has over a hundred patients. The nurse has far less. The nurse knows what's going on with her patient and is trained to report her concerns. A doc who is irritated by the data he gets just because it came from the nurse is failing to work in the best interest of the patient and also wasting time. 

But when nurses ask docs to do their bidding without taking the time to explain why or skip pass the assessment data (I need a haldol order vs. Patient is agitated and responding to internal stimuli, per history haldol has worked in the past) they are not respecting the liability that the doc is taking on and the doc's  role. 

And I agree with the previous poster that we ought to respect each other's expertise on the team. 

I want to revise this, because telling the doc you need haldol is not really a problem. 

There was other stuff that was really bad where I worked. From a bully nurse manager who ran over the docs. Just over the top stuff.

But I don't  feel like I can say it here.

Anyway, suffice it to say that there are nurse bullies, doctor bullies, social worker bullies, patient bullies. It takes confidence and skill to make your point without being dismissive or servile. And not everyone has it.

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The doctor did not have a good attitude. I was once interviewed by a unit secretary and it threw me for a loop because I thought, how will the person know what to ask, due to not having nursing experience. How will the person be able to fairly assess my capabilities? I went with the process though and was hired for the job. My point is as a nurse I have more experience on the patient side of things than a secretary. I am not sure if the doctor was thinking that, regardless she should have expressed it correctly and opened up to the change happening. I have also seen places pretty much be ran by CNA's or LPN's although there are RNs working in the place. In one of the places the CNA's were doing some illegal stuff. They would not listen to the nurse. Everyone has there part to play but it does need to be done right.

Edited by Workitinurfava

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I just tell them with a smile that they are not the boss of me. But I’ve been pretty lucky that most of the physicians I’ve worked with respect the relationship as a collaborative one. 

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How is asking a doctor to see a patient over a medication issue acting "above"  doctor?  It's recognizing the doctors expertise in medication ordering... sounds like the doctor didn't like being asked to do something... silly.

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I hope she knows that there are people who don't think women should be doctors. 

She needs to just stay in her lane, shut up and just be a doctor or retire.

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