"Listening to nurses is key to being a good doctor"

[turnforthenurse, MSN, NP]

I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80′s, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Doctors will see you anywhere from 5 to 30 minutes a day, depending on how sick you are. And the rest is the nurses.

They're the ones making sure you get your pills and checking that your vital signs aren't dropping. They make sure you don't fall down and break something. If you start vomiting, doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They'll bring you a warm blanket. And clean disgusting things off you. Even if you're drunk. Or delirious. Or mean. And through all of this they try be friendly and positive. Even though you aren't their only sick patient.

I respect nurses. I learned early on that they're key to being a good doctor. You **** off the nursing staff, and you'll have a miserable career at that hospital. Respect and treat them well, and you'll never regret it. They're as important to being a good doctor as your medical degree. Maybe more.

If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they'll teach you. A good neurology nurse is often a better inpatient neurologist than some doctors I've met.

I remember a guy named Steve, who was an intern with me a long time ago. We were only a few months out of medical school, and as we were writing chart notes one morning a nurse came over and asked if he'd go listen to his patient's heart. With icy contempt, and not even looking up from the chart, he said "I don't have to listen to his heart, because I looked at his EKG." They ain't the same thing, dude. If he'd listened he might have noticed that the patient had developed a loud murmur in the last 24 hours.

When the attending caught it a few hours later, Steve got chewed out. If he'd taken the nurse's advice, and listened, he wouldn't have gotten reprimanded by the residency board.

Here's a quote from "Kill as Few Patients as Possible" by Oscar London, MD: "Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom."

Those doctors are also depriving themselves of friends. On a difficult day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn't make the day any less busy, but helps you absorb the punishment better.

What got me started on this?

While I was rounding this weekend, a grateful patient's family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said, "Oh, this kind is my favorite, it has cream filling."

And a patient in one of the rooms yelled, "Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!"

You say that to a waitress, and you'd likely get your kicked out of the restaurant.

You say that to a co-worker, and you'd be fired and/or sued for harassment.

You say that to a lady in a bar, and you'll likely get a black eye.

And what did the nurse do? In spite of the patient said, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way.

And I admire that.

Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.

Doctor Grumpy is a neurologist who blogs at Doctor Grumpy in the House.

http://www.kevinmd.com/blog/2010/06/listening-nurses-key-good-doctor.html

[Fiona59]

Reminds me of a surgeon, who I admire. He's been known to tell his residents "Listen to the senior nurses. They know more than you do at this stage of your career." He still listens to us.

[aboucherrn]

What a great article! Yesterday, at the end of my shift, a urologist was rounding on one of my patients, a particularly inappropriate and 'difficult' gentleman. The doc and patient got into an argument while I stood by. Afterwards, the doc pulled me aside and said "I can't handle him for five minutes, I don't know how you do it for 12 hours". I just smiled and told him I was used to it, that this was not an unusual type of patient in the med-surg world. He shook his head and said something along the line of "nurses are amazing". It was a difficult shift, but that small validation from the physician made my day.

[s1helipilot]

Well said, Truer words have not been spoken. I wish more Dr's were this smart.

[NO50FRANNY]

One of our most senior doctors popped his head through the curtain when myself and one other nurse were working up a new patient in resus the other day, he said "So, you guys have assessed the patient, made a diagnosis and started treatment havent' you?, continue on". Love it.

[merlee]

When I worked in Acute Dialysis, the chief of the unit told the new docs, the interns, the residents, the fellows, to listen to the nurses - the nurses know what they are doing. If they question something it is usually because they truly don't understand where you are coming from. Listen to the nurses!!

Docs who regularly do not listen to nurses or treat them poorly are usually unhappy miserable people.

[GitanoRN, BSN, MSN, RN]

Unquestionably, in my nursing career I have encountered half of those great doctors, and the other half with the God complex. Just several hours ago, we got a recent married couple, the husband was working with an electric saw and almost severed two of his fingers. Once the doctor stopped the bleeding and was almost finished he looked at me and said "You can suture the rest while I write some orders" then looked at the pt. and said "You're in great hands trust your nurse". Honestly, I felt totally validated just with those few words.

[Do-over, ASN, RN]

Dr Grumpy is one of my favorite bloggers. Also a favorite yak-herder.

[canoehead, BSN, RN]

He gives me a lift every day with his blog.

[Anisettes, BSN, RN]

I love me some Ibee Grumpy. He's one artisanal doc...

[CCRNDiva, BSN, RN]

This post made my day : ). I am fortunate that most of the docs I work with are like Dr. Grumpy. There is nothing better than being part of a good team that values the input of all.

[Guttercat, ASN, RN]

Love it!

One of the docs I work closely with, is wonderful. A total hoot, and a collaborator with the nursing team. Willing to teach to help us understand the why behind what he is asking us to do. He also takes our input seriously, and works hard to make our lives as easy as possible.

The other, not so much. We all dread days we're on-call with him. The sort of doc that exhibits random, childlike power plays, takes as little responsibility as possible for anything getting done and communicates almost zilch..."why are you calling me?" "What do you want me to do about it?"

Well now, how about you pull your Caste-system-cultured head out of your rectal orifice for starters? Kthxbye.