PACPhD

I work in a level 1 trauma center. I primarily work in ambulatory but also do some shifts in critical care, ob/gyn, medical, etc pods. I am not required to run anything by my SP. I tend to get some really sick people in ambulatory (bad triage system) and do my own central lines, LP, arthrocentesis, etc. I don't have to talk to the physician for anything if I chose not to. Even on the critical side, there are no requirements to run anything by my SP or any of the docs. But I do when I have a complicated case. And the reason? Look at a medical lawsuit against a midlevel and one of the biggest thing they will hang you with is "so let me understand this, you are not a doctor, you had this patient presenting with (fill in the blank) and the patient ended up going home and dying the following week and you didn't feel the need to run the case by someone with more medical knowledge and experience!" Yes, I know all of the arguments of how there are lots of bad doctors out there but the bottom line is we (PA/NP) are not doctors, and the public's perception of this is just that. They don't care that for 10 years you have done well in your practice.

I am sorry I was not able to reply for a couple of days. I had been working and didn't have a minute. Let me try to encompass everything said and asked from all of you. I am from NY and we do tend to "tell it like it is without sugar coating it". Just our style. To make myself very clear, I have so much respect for nurses, the ones I work with, many, and I mean many I have worked with in the past, and my wife, she is one of the best. What I was asking, and listen carefully as quite a number of you have missed this part, is how has the management of at least 6 or 7 of those hospital, as well as their co-workers allowed that kind of atmosphere to go on? They knew, they didn't just turn their backs, the condoned it. One hospital I worked in, an 80 y/o with a broken hip asked me for a bed pan. Not my patient, just happened to be put in the room. It was policy that a male did not undress a female and put a bed pan under them by themselves. I went to the desk of the main ED and asked the nurse if she coulld put a bed pan under the patient. She turned to me and said "Why do you go tell her to go piss on herself". I had to pick my jaw up from the floor. I had no idea how to respond. Not a problem because she turned and walked away and sat at the desk. I went back to the fast track and called the nursing administrator of the hospital. I told her exactly what the nurse had said to me, and her response was "well why can't you do it?". I asked her if she found it aceptable that her nurse spoke to me that way, she said, well, there is no reason you can't do it". It wans't even my patient, and she had no problem with the way her nurse spoke to me, and about the patient. So you wonder why I don't write nurses up? Partially because of that, partially because at the ED where they ripped up my scripts, a few nurses went to the director and made a complaint that my supervising physician told me not to give narcotics to a patient and I waited for his shift to end, told the patient "just wait until he is out of here and I will get you narcotics" and then asked the next doctor to come on for an ok for narcotics. First, I can order any narcotics I want, and I can't imagine what I would get out of telling that to a patient. The director and I had been close friends and he said "it's time for you to find another place. It's not you, it's them, and the next thing you are going to find is some viles of morphine in your locker". I was out of there in a heartbeat. As far as the docs backing me in the horrible ED in Virginia, about 90% of them (there were about 2 out of the 50 docs in my group to back me) said, I am sorry, I can't get on the nurses bad side. I have to work here and it is bad enough what they do to you, I can't work as a physician where the nurses are treating my like that". What does my wife think? She worked in Virginia with me. She knows the hell I went through there. She started out in the midwest and on her first job in oncology, a nurse asked her to give a medication. She was on the job for only 6 months. There ended up being a question on the physician actually giving the orders. The nurses in the unit denied ever telling my wife to give the medicastion. She was asked to leave. She happened to be blond, young, and cute, and that can sometimes be the kiss of death to a new grad (at least I have been told this by a few in the medical field). I wouldn't know, I don't think I am cute so I never had that problem. I am surprised that many of you have had similar situations. I am surprised that many of you have found some, and the emphesis is on SOME nurses as horrible as I have. I guess I had thought maybe it was just me. For those that have missed the post where I told you my perception of how I treat nurses, I have never had a formal complaint from a nurse in 10 years, and only one from a patient for not giving him a cast for his "sprain". If I thought myself better than the staff, then I would obviously have the same response at my current hospital. I hear at least once a shift when someone comes into the room "Oh, your working tonight, thank god, here's to a good night". Their words, not mine. I just want to thank you all for listening to me. No, I am not sitting here having a good laugh at your expenses as some of you think. Just wanted to vent, and get some feedback. Can't get that from the horses mouth on the PA forum....

Yes, I am making this all up. I don't understand what possible rationale I could have for this. If I wanted to do some nurse bashing this would not be the place to do it. I would go where none of you could defend yourselves. And that is not what I am looking to do. I just wanted to start some dialogue on a very touch subject, and that there is a very concentrated group of nurses in a particular area who seem to have run amuch with their profession and have given it a bad name, at least to anyone who has had the misfortune of working in those hositals. I was just giving my story, I guess for some, and I hate to use the word, validation that this goes on.

It was a hospital in Bay Shore, Long Island where two of the nurses loved to tell the director and anyone else who would listen that line. My fiance at the time was an ER attending physician. She told me one of the nurses played passive agressive with her during a code and said "sorry, I don't know how to work the paddles, you will have to come over here to do it your self". The attending was livid and demanded the ED director do something because this was typical of some of the staff. He said "she has a file over an inch thick with complaints and every time we go after her, the union backs her. We don't bother anymore. Then there was Brooklyn. That is where the charge nurse and the two others let me and the director know when and from whom they would take orders. And I do know that doctors usually have no say over the hiring and firing of nurses, although in one place they had some say. Regardless, the nurses seemed to take pleasure in saying that. As far as the nurses who's mission statement was to make my life a miserable hell, their problem stemmed from the previous group had lost it's contract and we were all new. They didn't know any of us and didn't really seem to want to get to know us. They liked the old group and decided to do what ever it took to make us quit. It wasn't a PA issue. That was the hospital where they ripped up my prescriptions and refused the LP kit. Another interesting story, they would insist that any patient who was given a narcotic could not be D/C for 2 hours. They of course would try to talk everyone out of taking the medication by threatening that the could not leave for "another 2 hours if you take this medication". I was told it was hosptial policy. I asked for the policy many times. It took about a month before the hosital nursing administrator came to the ED. She asked for "that doctor who keeps insisting on the narcotics policy". I told her it was me. She shoved the book at me and said "here, now maybe you'll believe the nurses". She was quite pissed. I read the paragraph and it said "2 hours or until the physician (or PA) feels it appropriate. I pointed this out to her and advised her that according to the policy, I could allow the patients to be D/C when I felt appropriate. She grabbed the book from me, and yelled, "that is not how we follow the policy here" and stormed away. Go figure.

You know, in Mississippi, in the 60's, when an Afro American had a problem with the way he was treated, it was always his own fault. I am trying to be polite here. I am a guest in your neighborhood. Basically you are telling me I am lying. You have no idea what I have gone through for years because of the abuse I had to take from some of those nurses. I spent 11 years in school learning my profession. My main concern at all times was my patient. What an eye opener it was to see what was more important to some of the staff I worked with. I was amazed. I litterally went to work with a knot in my stomach and dreading the next 12 hours. Stress? You have no idea. The medicine part (and I worked in acute areas of the ED) was easy compared to the everyday BS. Everything I have told you was dead on, with no artistic license taken. I used to come home and tell my wife the stories, day after day. And I could go on for probably 10 pages of incidents, and the ones listed here are not the worst, they are just random incidents that poped into my head. And no, the nurse had two front teeth, it was not uncommon on eastern Long Island NY for the locals to say "aint". Certain statements have stuck in my mind for years, and I was so taken back by that one, that I haven't forgotten how she said it. Balls in your court.

As far as the union issue goes, probably 50/50. I have actually had union nurses tell the physicians on numerous occasions "I'm union, what are you going to do, fire me?" Here is my take on the hospitals. I think 6 in NY - 3 were horrible for all of the non nursing staff. This is not something that I sat in my corner of the ED and thought they were just acting that way to me. All of the staff talked about how uncomfortable it was to work there, and the main reason was the nursing staff. Many left. The other 3 were just not a nice atmosphere to work in because of the nursing staff. I actually had a few of the nurses in one ED tell me they were going to "make my life as miserable as possible until I quit". I lasted 6 months and quit. Then I worked in Milwaukee. Better. No real complaints there, but still not what I thought a cohesive group. Way better than anything in NY.Then N. Virginia. Horrible place. Then Las Vegas. Ahhh paradise. You know it's funny, about the worst patient population I have had to deal with. Drugs, homeless, scammers, (county hospital), but I enjoy going to work. The atmosphere is just so different. And the nursing staff has made it that way. So why haven't I written up any of the nurses? Made formal complaints to the nursing boards? Not the way it's done in my world. I don't write up my co-workers.

My apologies for not responding sooner. I work the night shift and just turned myself around and am squinting in the daylight. Where do I start. First, I want to thank many of you for your support. I guess I should try to clarify some of your concerns. First I am not a troll. I honestly want to gain a better insite into those I work closest with in my daily (or should I say nightly) life. I guess you have to understand I work closer with and am with nurses for more hours than my wife. I am truely happy with the current nursing staff, even the "bad apples" are decent to work with. So now some details. 10 hospitals - no, I do not change my jobs as often as my underware. I started out from school with 4 jobs at the same time. All Per Diem. I wanted the experience. Then moved a few times. THe last place in Virginia I was at for 4 years. It was a horrible working environment. I loved the patient population, the doctors were the best, but (here we go...) the nursing staff was, on an average, where I got the terms "unprofessional, uncaring, etc". This was not directed towards me in general, although as a PA I got a tad bit more cr*p than the docs. There was one nursing supervisor, she was above the charge nurse, who seemed to care about what was going on. I went to her and told her that one nurse refused to place an IV in a patient because she said the patient was a drug seeker and she was not going to take the "risk of a needlestick putting an IV in someone who she didn't feel deserved it". The drug seeker was 26, pregnant, and had sever abdominal pain. The supervisor took her aside and told her in no uncertain terms how inappropriate her behavior was and that she follows a written order or leaves. She spoke to two more nurses in the next week on my behalf for similar unprofessional behavior. The following week, I went to her with again something one of the nurseds refused to do and she said "I am sorry, but apparently the nurses went over my head and told the management I was diciplining them and management told me if I attempt to correct their behavior that my position will be terminated. She left a month later. By the way, the COO of the hospital, the director of the emergency department and every supervisor in between was an RN. There were no positions of supervision in the hospaital that I knew of that didn't have an RN in place. My other hospitals? At the one where they would rip up my perscriptions, an ER director from a neighbor hospital came over to help out and cover a shift for our director. He had a very sick 2 month old. He called for a transfer and asked the nurse for an LP kit. She said "you aint doin that to the baby". He looked at me and back at her in astonishment and said, "where are the LP kits", She said "maybe you didn't hear me but I said you are not doing that to the baby. You can wait until the transport team gets here and they can do it". He found a kit himself and did what he had to do. If I had a few hours, I could go on and on. Here is my point. If I ever spoke to a nurse as thay have done to me for years on end, I would be in my director's office explaining why I should be allowed to keep my job. The second time I would not have a job. How have we gotten to the point that power, laziness, "getting back at the providers for all of the years they asked you to get them coffeee and you had to stand when they came into your area" is an acceptable excuse for way they have treated me and my coworkers? That is what I am looking for an explanation of. And yes, I do belong to a similar PA forum, but this is where the nurses are. And to those of you who feel comfortable thinking that, well, look at the common denominator, Let me tell you about my work habits. I clean up after myself on all my procedures. I am the only provider who has a pyxis number so when the nurse is busy I can get my own meds. I say please when asking for anything. We laugh at work. I ask everyone how their families are. I go out with nurses and their families. And I thank them every single day at the end of the shift for all of their hard work. The have told me I am one of the best clinitian's they have worked with. I do try. What is an OP?

If you don't mind a response from a (emergency medicine) PA on the subject. I was also in the EMS world for 10 years. There is an old joke: What is the difference between god and a paramedic? God doesn't think he is a paramedic. When I take a report in the ED from EMS (of course not all, just a few of the idiots) I occasionally get the look when I question them of "Oh look, the doctor thinks he has a clue about anything we do out in the field". Of course I then throw at them that I was in EMS for 10 years, sat on MAC committees, ran QC/QI for years for ambulance coprs, was a chief, etc. That usually shuts them up. If it ever happens to you again, I would do exactly what you did, and get your medical director to call and specifically state that the particular EMT/Medic is never to enter your establishment again. That usually makes your point better than anything. Sorry you had to encounter that idiot. And for the record, oxygen is basically never withheld when needed. That is why there are Ambu bags : )

No, not a troll. May have been prior to this job I now have. You will just have to take my word for it but it was not a personal issue with me. The other clinicians in each plase also felt like they couldn't believe how everyone, not just me as a PA was treated. Sorry for jumping right in head first on my first post and not trying to attack anyone. Just been so miserable in my past places that I wondered why it went on.

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?