What Docs Don't Understand About Nurses

[Music in My Heart]

One joy of working at a teaching hospital is the collegial relationships that I can form with our docs. A couple of days ago, I participated in a training exercise for some of our residents regarding interacting with patients and families after critical incidents and/or errors.

During this training, another nurse and I had the opportunity to share the nursing perspective and the docs were truly stunned at the revelations.

They were shocked to learn of the 'witch-hunt' and 'write-'em-up' behaviors that are so pervasive in nursing, the 'protect your license' mentality that so many of us feel so necessary, and our beliefs that our jobs and livelihoods often hang in the balance.

They really had no idea... and why would they? Except in the most egregious circumstances, docs do not lose their jobs nor their licenses. They do always consider being sued but they don't think of losing their ability to earn a living.

I shared with them my perceptions of the responses that I received after my own serious medication error and that the responses from the senior medical staff were much more supportive than that from the senior nursing staff.

I think it's so important that docs understand where nurses are coming from in the hopes of helping them to realize why we sometimes act the way that we do.

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What kinds of things do you wish that docs knew about the reality of being a nurse?

[TheCommuter, BSN, RN]

What kinds of things do you wish that docs knew about the reality of being a nurse?

It would be nice if physicians knew about the huge amount of accountability in nursing without any corresponding authority.

I have a vision and hope of putting together a lecture for the med students and residents to introduce them to real-world nursing.

[HouTx, BSN, MSN, EdD]

I once heard a lovely metaphor of the Dr-Nurse situation.... by a CV surgeon no less. He said that the hospital was a 747 filled with needy and demanding patients. Periodically, the pilot (physician) would venture outside the flight deck, take a quick look around and say "everybody all right?" then, without pausing to get responses, he would duck back behind the door. The nurses were the flight attendants... expected to meet everyone's needs while making do with just the resources on hand.

Occasionally, the pilots would be completely absent - expecting the nurses (flight attendants) to make sure that the autopilot was functioning correctly in addition to all their other duties and reassuring the passengers that everything is perfect and the (doctor) pilot is always available if needed.

The best scenario? The pilots had taken a breather, so they just relayed instructions to the flight attendants who had to step in and fly the plane and manage several emergency situations at the same time ... upon finally managing a very bumpy landing with all the passengers intact, the relaxed pilots strolled down the center isle, patted the flight attendants on the head and said "OK, we can take it from here" ... and proceeded to collect the full ticket price from each passenger.

It was a great opener for the activity - and paved the way for some frank discussions about issues needed to improve collaboration.

[meanmaryjean, DNP, RN]

Very enlightening discussion - thanks!

[LadyFree28, BSN, LPN, RN]

This post reminds me of a particular hospital that I did my rotations in as a nursing student, and how the doctors there wanted to have their educational format similar to nursing education; I think at this particular hospital there is a storied collegiality with them, to the point that when the nurses went on strike, there were doctors out there on the picket lines.

I think there will be a time in a much closer future that doctors will be able to be so closely collegial, the foolishness that pervades our profession will give a much push back; but then I may be dreaming about that, but I see hope from that particular hospital, anything is possible.

[tyvin, BSN, RN]

The "watch your back" mentality has been around since I've been in nursing, but it's only recently that this "fear of license loss" has entered IMO. When I first read the fear of the license loss was on this site a few years ago. I think it's the younger RNs (not age but amount of time being an RN). I don't know when it started, but it seems to be really prevalent amongst the newer nurses. It's like when someone thinks they're in trouble, my generation would think "I'm gong to be called in to the DONs office", or "I'm going to get written up", or whatever. With the new RNs it's "I'm going to lose my license!"

As far as the medical model and the nursing model of teaching, I know that many schools of thought have the docs model changing to encompass the whole instead of pieces. Moving more to treat the individual and the family as a whole.

[llg, PhD, RN]

Great topic for a thread. ...

I wish they knew what it was like to not be able to leave the unit, go to the bathroom, take a break, etc. -- to always have to stay with the patient, no matter what happens. When a code happens, or a procedure is done, a patient is given devastating news, etc., they get to walk away. The nurse has to stay with the patient, comfort them, and clean up the mess.

I once worked in a NICU with a very supportive Head Neonatologist. He came up with a great idea for all med students. Once each day, they had to buddy with a nurse and do the "cares" for a patient -- vital signs, diaper change, linen change, meds, bathe, feeding, etc. He had noticed that few doctors had a clue about what it was actually like to touch, turn, feed, etc. these tiny patients. How could a physician talk to parents about taking their baby home and caring for him/her if that doctor had never done anything remotely like that? He also wanted the students to appreciate the role and skills of the nursing staff.

So each shift, the med students would pick one of "their assigned babies" and make a plan with the nurse to help with one set of care activities -- and we got a "med student helper" for an hour. It was great fun! I think the med students learned a lot -- and it stimulated a lot of good discussion on the unit between the 2 disciplines.

My current hospital has played with "walk a mile in my shoes" between staff nurses and residents. A staff nurse shadows with a resident for several hours ... and then that resident shadows that same staff nurse for several hours on another day. Hopefully, each learns the joys and challenges of the other's roles.

[wooh, BSN, RN]

The fear of getting sued by physicians and the fear of losing a license/getting sued by nurses is way overblown by both.

[BostonFNP, APRN]

Interesting observation.

The irony is that during education the medical model is far more critical of its students while nursing protects them. Once practice begins it swaps; nurses try and weed out other nurses while physicians protect other physicians.

[TheCommuter, BSN, RN]

Once practice begins it swaps; nurses try and weed out other nurses while physicians protect other physicians.

You've brought up a salient point. I almost never hear of physicians who tell on other doctors, yet I do not have enough fingers and toes to count the number of nurses who have readily reported other nurses to management and/or the state board of nursing.

We even have posters on these forums who inquire about the best way to proceed with reporting their nurse coworkers without seeming to give a rat's behind about the manner in which the 'snitch culture' affects peoples' lives and livelihoods.

Don't get me wrong...some occurrences are egregious enough to be reported, but many other occurrences are too petty (in my opinion) to warrant a report.

[wooh, BSN, RN]

Interesting observation.

The irony is that during education the medical model is far more critical of its students while nursing protects them. Once practice begins it swaps; nurses try and weed out other nurses while physicians protect other physicians.

Of course, medicine protects their entry to only highly qualified applicants. Nursing lets in practically anyone. In theory, that means there should be fewer unqualified people that make it through to become physicians, while more unqualified people making it through to become nurses. So we've got more weeding out to do.