I touched on this on another thread, but doing peer evaluations not too long ago, I came across a new question asking whether the nurse was too respectful or too friendly with the doctors. I don't recall the exact wording, unfortunately, but I took it to mean whether the nurse was able to act independently as an advocate for his/her patients. It gave me a bit to think about, because I do tend to have a lot of respect for doctors and will defer to their judgement if I don't feel strongly that they're wrong. It's not that I particularly want to be their buddy (although I generally do like most of them) but in a lot of cases I can understand their rationale, even when I don't entirely agree. Pain meds would be a prime example. I have let a doc slide on waiting for the day shift to reevaluate pain meds when I was already giving a lot, but the patient was still complaining of severe pain. (For what it's worth, and I know we aren't supposed to do this, I do firmly believe the patient was overstating her pain, but I also believe her actual pain was higher than acceptable, and in the case I'm thinking of, I wish I had advocated a little harder.)
So I'm curious to hear what others think about where to draw the line. I'm too old and too ugly to be interested in being anybody's handmaiden, but I don't want to be a jerk or exceed my scope of practice, either.
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
I don't think someone can be too respectful or too friendly. I personally like to think I am respectful and friendly to everyone I work with, not just the docs. I think everyone deserves respect as we are all the same . I am also questioning the wording that if the OP is insinuating "too friendly" with 'sucking up'???, or too respectful as in 'too intimidated' to speak up to question, suggest or disagree with an md while in doing so somehow causes one to be disrespectful??
As professionals we certaintly can disagree with one another and question someone''s orders without being disagreeable or disrespectful.
I think the doc would (and do) respect nurses that use their brains, questions orders or their rationale, suggest a different course, maybe see things from a different angle etc. I feel I have a very friendly relationship with the docs I work with and its mutual. I think a lot of that comes from the fact that I do question things, I think as pt advocates we need to, we have to in their best interests and for the sake of our license as well.
As the OP used pain meds for example, I would question why you would defer pain meds even if you feel the pt isn't where s/he should be? I would hope my nurse would help me out if I were that pt.
If I think a pt's pain level is still unacceptable, even if I have given ' a lot', I won't defer that at all. I never have a problem with that, I think that's a priority in my book. I will state the pt needs (rather than ask for ) something else, a bolus, a breakthru, whatever. I never have any problem with docs not giving additional pain meds, they are more than happy to comply.
I don't treat them any different from other staff. I've seen plenty of nurses who do though and quite frankly it makes me feel sick to see them fawning over these doctors while they are being arrogant to everyone.
The way I see it, in the OR we work alongside doctors but they are NOT in charge of us. They just come in, do their work, we provide what they want for the patient, but they don't manage how we run the theatre, they are not supervising our practice at all (we do that) and they are not our managers, we have nurse managers.
I don't think someone can be too respectful or too friendly. I personally like to think I am respectful and friendly to everyone I work with, not just the docs. I think everyone deserves respect as we are all the same . I am also questioning the wording that if the OP is insinuating "too friendly" with 'sucking up'???, or too respectful as in 'too intimidated' to speak up to question, suggest or disagree with an md while in doing so somehow causes one to be disrespectful??
As professionals we certaintly can disagree with one another and question someone''s orders without being disagreeable or disrespectful.
I think the doc would (and do) respect nurses that use their brains, questions orders or their rationale, suggest a different course, maybe see things from a different angle etc. I feel I have a very friendly relationship with the docs I work with and its mutual. I think a lot of that comes from the fact that I do question things, I think as pt advocates we need to, we have to in their best interests and for the sake of our license as well.
As the OP used pain meds for example, I would question why you would defer pain meds even if you feel the pt isn't where s/he should be? I would hope my nurse would help me out if I were that pt.
If I think a pt's pain level is still unacceptable, even if I have given ' a lot', I won't defer that at all. I never have a problem with that, I think that's a priority in my book. I will state the pt needs (rather than ask for ) something else, a bolus, a breakthru, whatever. I never have any problem with docs not giving additional pain meds, they are more than happy to comply.
Thanks for the input. I think the question (on the eval form) probably was phrased less awkwardly than I'm remembering it, although I do think it is possible to be too friendly. Personally, I'm not comfortable addressing a doctor by his/her first name in a professional setting, although I don't really object to those who do.
The pain med question comes up from time to time. My home services, neuro/neurosurg, can be pretty stingy with pain meds, and it makes some sense. You need to know whether a mental status change is neurological and not drug induced. We often have orders to give no narcs after 0400 until rounds are completed--in which case, I try to make sure any pain is well-addressed by 0359.
The patient I was thinking of in my post, though, was ortho, s/p knee replacement. I was giving her everything that was ordered, which might have killed some patients. She had been taking po opioids over a long period, so she was pretty tolerant. Her reported pain was way out of proportion to what one might expect from such a surgery (I'm not an ortho nurse, but I worked with ortho pts in my previous position.) She said herself that she just wanted to be "knocked out."
In retrospect, I think I should have "gone up the ladder" until someone at least came and saw her. But I think I recall there was some reason she couldn't take NSAIDs, so Toradol wouldn't have been appropriate. So, more opioids?
I'm told that during the week, the docs were mad because we hadn't gotten her OOB. When I was on, she wouldn't let us pull her Foley because she thought using the bedpan would hurt too much. On the whole, I have to say it wasn't one of my most shining moments as a nurse, but other than calling the next doctor on the chain of command, I'm still not sure what could have been done. And, hypothetically, if you get to the attending and he won't order anything else, what then?
A week or two later, I had a post-op transfer, ortho again (God help me!) with orders for Demerol. She had already had it in recovery. I gave it as ordered, nearly peeing myself in anxiety, and every other nurse on my unit was, like, "Demerol? Really? Oh dear!" Me, too. But it worked.
A week or two later, I had a post-op transfer, ortho again (God help me!) with orders for Demerol. She had already had it in recovery. I gave it as ordered, nearly peeing myself in anxiety, and every other nurse on my unit was, like, "Demerol? Really? Oh dear!" Me, too. But it worked.
This part of your post made me chuckle.
A number of years ago, I had emergency abdominal surgery. I vividly remember waking up in PACU in excruciating pain. I was given 2 doses of morphine to no avail, followed by 2 doses of fentanyl to no avail, at which point the anesthesiologist washed his hands of me. Fortunately, the surgeon was still there, and he ordered demerol in 12.5 mg increments until pain was relieved. After 37.5 mg, I was finally reasonably comfortable and able to breathe.
Since then, I have had 2 other experiences (both orthopedic) in which liberal doses of morphine did absolutely nothing for pain. I guess I am just an odd duck who responds to pain meds differently than 99% of the population. I know that demerol has fallen from favor due to its safety profile, but for my sake, I hope it remains available and that I don't get labeled a drug seeker for asking for it the next time I mess up my knee.
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
nursemike, I get the neuro thing, but if someone is on longstanding opioids preop and then has surgery,if the docs can't manage them, they should be followed by acute pain service,many times people being treated for chronic pain don't present as typical in reference to the standard pain scale, they may look fine and rate their pain as an 8 or 9 since they are used to living @ 5 or 6 , they probably are very tolerant, but should still get as much as they need for pain management. I certaintly understand pts that get tons where it would put a horse out, that's why they should be followed by the pain service, ideally preop, just my experience...
Yeah, a pain consult was definitely in order. Wish we had them on nights. (Fortunately, nobody ever has pain on nights???) Ideally, I guess all of that should have been handled before I ever got there, but since it wasn't, I think I probably should have gone over the resident's head. I don't think I could have made it any clearer that her pain was not controlled.
I think that hesitation to go up the ladder might have been "too respectful," or maybe just too sympathetic to the doctor's situation.
I wish I could hope not to encounter a similar situation, again, but I don't guess that's realistic. So I'll have to try to apply the lessons learned when I do.
The nice thing about neuro/neurosurg is that, except for back surgeries, they usually aren't too painful. Trouble is, some stroke patients have bad backs, or hip fractures, or other pain not related to the admission.
A fairly typical order set for our services may include 0.2mg Diluadid IV, Q4H and 1-or-2 Percocet, po, Q4H. Just lately, instead of alternating, so that they get something Q2H, I've been trying giving the Dilaudid and Percs together, especially at QHS. It seems like it works quicker and holds longer.
In what might be a bit of irony, considering this thread, I recently got recognized on our unit for doing a good job of patient satisfaction. No cash, but still, it's nice. Awhile back, I had my first patient write in and mention me by name for the work I had done. She called me "The Morphine Man," and made a little song to "The Muffin Man." Oh, yes, that's just how I want to be remembered...
So, on my little poster, I had to give my "secret" to patient satisfaction. I couldn't resist putting, "Morphine." But I didn't quite have the nerve to leave it at that. In fact, probably one of the best things I did with the lady in my OP was just sitting in her room for ten minutes and listening to her complain that "they" (we) weren't doing enough for her pain. I'm not saying that was adequate, but it did seem to make her feel a little better.
Why shouldn't we develop good relationships with doctors? I find being on friendly terms helps keep communication channels open, and makes me more comfortable in calling doctors, conversing with them, and bringing up issues.
We humans are multi-dimensional social beings, and it's a natural part of being in a human community to be friendly and take an interest in those we work with. It makes our work for a common cause easier.
I would also like to add that I believe the MD to environmental services staff should all be treated respectfully. I would like to think I would treat the CEO of the hospital down to the transport staff with the same amount of respect. I firmly believe that you have to give respect to get respect.
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
I guess my pts are spoiled, they routinely get Dilaudid 0.1-0.2 mg q6 minutes via PCA and if they aren't post op and need IV narcs they get 1-2 mg q2 hrs (dilaudid for opioid naive pts) God I hope I never need back surgery!! :sstrs: Bless you, I think I would find it very frustrating to work where the MD's weren't up to speed with current pain management
I guess my pts are spoiled, they routinely get Dilaudid 0.1-0.2 mg q6 minutes via PCA and if they aren't post op and need IV narcs they get 1-2 mg q2 hrs (dilaudid for opioid naive pts) God I hope I never need back surgery!! :sstrs: Bless you, I think I would find it very frustrating to work where the MD's weren't up to speed with current pain management
Thank you. Yes, it certainly can be. I guess the amazing part is that it very often isn't a problem. But it does seem like it is a problem rather more often than it ought to be. On more than one occassion, I've felt like all I was accomplishing was making sure that someday when a patient decides to sue over inadequate pain relief, they feel that I've done all I could. (All the more reason to document thoroughly.)
Why shouldn't we develop good relationships with doctors? I find being on friendly terms helps keep communication channels open, and makes me more comfortable in calling doctors, conversing with them, and bringing up issues.
We humans are multi-dimensional social beings, and it's a natural part of being in a human community to be friendly and take an interest in those we work with. It makes our work for a common cause easier.
I don't even hesitate to agree that a cordial, collegial relationship is desireable. There are even doctors I'd say I feel more than cordial toward.
When I was very new, my former future fiancee was a neurologist I didn't mind calling even when I was scared to call doctors, because she never made you feel stupid, even when you were. Alas, she moved on to bigger and better things before I got around to discussing the future fiancee thing with her, but I'm sure she new I appreciated her. And I did learn my lesson: I've told my current future fiancee that I was considering her for the future fiancee position.
But, yeah, the docs I like best are easiest to talk to, and often the most ready to explain what's going on with a test or procedure. I've tended to think I like them because because they're easy to communicate with, but I guess I hadn't fully considered that they may be easier to communicate with because I like them. Typically, I don't find myself getting into debates with these doctors, but then I don't really get into debates with many of them. I report what I see, offer suggestions if I have them, and am usually satisfied with the response.
Future fiancees aside, do you think it's possible to be too chummy?
GrumpyRN63, ADN, RN
833 Posts
I don't think someone can be too respectful or too friendly. I personally like to think I am respectful and friendly to everyone I work with, not just the docs. I think everyone deserves respect as we are all the same . I am also questioning the wording that if the OP is insinuating "too friendly" with 'sucking up'???, or too respectful as in 'too intimidated' to speak up to question, suggest or disagree with an md while in doing so somehow causes one to be disrespectful??
As professionals we certaintly can disagree with one another and question someone''s orders without being disagreeable or disrespectful.
I think the doc would (and do) respect nurses that use their brains, questions orders or their rationale, suggest a different course, maybe see things from a different angle etc. I feel I have a very friendly relationship with the docs I work with and its mutual. I think a lot of that comes from the fact that I do question things, I think as pt advocates we need to, we have to in their best interests and for the sake of our license as well.
As the OP used pain meds for example, I would question why you would defer pain meds even if you feel the pt isn't where s/he should be? I would hope my nurse would help me out if I were that pt.
If I think a pt's pain level is still unacceptable, even if I have given ' a lot', I won't defer that at all. I never have a problem with that, I think that's a priority in my book. I will state the pt needs (rather than ask for ) something else, a bolus, a breakthru, whatever. I never have any problem with docs not giving additional pain meds, they are more than happy to comply.