What Docs Don't Understand About Nurses

Nurses Relations

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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?

Specializes in Adult Internal Medicine.
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.

Absolutely.

Specializes in None yet..
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.

I wish this insightful and compassionate doc could be cloned and seeded throughout the health care system.

That said, words are not enough. The change has gotta come

Specializes in None yet..
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.

Does nursing truly let in "practically anyone?"

:unsure: All through doing my prereqs and testing and etc. I thought I was making my way through qualification screens. Was this a delusion?

Does nursing truly let in "practically anyone?"

:unsure: All through doing my prereqs and testing and etc. I thought I was making my way through qualification screens. Was this a delusion?

How many people do the prereqs for med school and the MCAT and have brilliant qualifications and don't make it in?

How many of those could sleepwalk through nursing school prereqs?

How many people do prereqs for for nursing school and the TEAS and have, well, qualifications, and don't make it in?

How many of those could sleepwalk through med school prereqs?

As idiotic as most of the posters on student doctor dot net are, you don't see them needing help with basic algebra.

Nursing school isn't that hard to get into. Yes, you need good grades. It's probably tougher than some other bachelor's degrees. Definitely tougher than other technical or associates degrees. But in the grand scheme of things, it's not THAT selective.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Does nursing truly let in "practically anyone?"

:unsure: All through doing my prereqs and testing and etc. I thought I was making my way through qualification screens. Was this a delusion?

Yes, nursing lets in pretty much anyone. Don't forget that there are many programs that operate on a waiting list. Meet the minimum requirements, and wait long enough and you will get a shot at nursing school. The standards can be pretty low too in some places.

I was approached by a for profit nursing school as a possible preceptor for their students. With the particular school it appeared to me that if a student could find a way to pay the extraordinary tuition then they got in.

I agree to an extent. Although, there are many physicians who graduated from schools overseas because they couldn't get in to an American school. Doesn't make them any better or worse, in my opinion. I see crappy nurses come from all schools, not just for profit ones. In the end, it boils down to the person.

Specializes in ER.

At the school I went to, nursing program entry was based on points. So, if you got As in the required prereqs (A&P I and II, Micro) your points were as high as someone who spent 2 more years and lots of $$$ getting Cs in zoology, chemistry, biology, astronomy (any science with a lab).

NO, getting straight As or straight Cs doesn't make you a good or bad nurse. There were many I knew that failed out one time and had to come back, and are now fine nurses.

Where I work, in the ER, I have found that the ER-only docs are much better at understanding the plight of the nurse, whereas the office and ER docs do not. Office docs are used to nurses having everything ready for them before they get there, all nice and neat. ER docs understand you have more than one pt at a time and may get hung up, and will actually do something themselves (strep swabs, get their own suture kits).

ALL of them, though, generally expect you to have the "obvious orders" put in for them before they even see the pt, i.e., abd pain, you get CBC, CMP, amylase, lipase, maybe KUB, UA/hcG, etc. Injuries, put in the XR. Heck, they expect CTs in for stroke sx, falls w/head impacts. Yes, it makes sense, but it is also illegal. So, I don't think when you are caring for multiple pts and didn't get every single thing in, you should be yelled at, as it is THEIR responsibility and out of our scope.

I wish our hosp would have our docs follow us.

Specializes in Adult Internal Medicine.
I agree to an extent. Although, there are many physicians who graduated from schools overseas because they couldn't get in to an American school. Doesn't make them any better or worse, in my opinion. I see crappy nurses come from all schools, not just for profit ones. In the end, it boils down to the person.

They also have to pass a standardized set of board exams and match and complete a residency in this country.

I have heard from several people that I wouldn't want to have the responsibility of a doctor, not to mention the heavy student debt. I have more responsibility now as a nurse. I am caring for the whole person and often their families. A doctor is only responsible for the medical aspect. Frankly I would rather be responsible for one piece of a puzzle than the whole one. And get paid more for it. Let the nurses do the grunt work.

Specializes in PACU, presurgical testing.

Fear of losing one's license was drummed into us in nursing school (graduated in 2011). In today's litigious society, I think it's more likely that nurses will get sued, get fired, lose their license, etc., for a variety of issues than it might have been some years ago.

Also, someone pointed out that nurses are more likely than physicians to rat each other out. I know that many hospitals have a policy that if a nurse is aware of someone else doing something wrong and doesn't report it, he or she is culpable as well. I do spend a lot of my day worrying about these kinds of issues in addition to worrying about the patients themselves (not that my colleagues are doing something wrong, but all this other stuff is always in the back of my mind!).

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Fear of losing one's license was drummed into us in nursing school (graduated in 2011). In today's litigious society, I think it's more likely that nurses will get sued, get fired, lose their license, etc., for a variety of issues than it might have been some years ago.

Also, someone pointed out that nurses are more likely than physicians to rat each other out. I know that many hospitals have a policy that if a nurse is aware of someone else doing something wrong and doesn't report it, he or she is culpable as well. I do spend a lot of my day worrying about these kinds of issues in addition to worrying about the patients themselves (not that my colleagues are doing something wrong, but all this other stuff is always in the back of my mind!).

You are wasting your energy worrying about losing your license. In the 18 years I have been in nursing I have only seen nurses lose their license for the most obvious of things like:

Steal drugs

Being high or drunk at work AND causing harm to a patient

Sexually abusing a patient

Physically abusing a patient

Specializes in orthopedic/trauma, Informatics, diabetes.

I work in a teaching hospital and we just went through "new resident July" They learn very quickly how to listen and use the nurse as an ally/teacher/mentor. The ones that don't listen to us or, heaven forbid, ignore our pages/requests. We are not afraid to go to the fellows or attendings to get what we need. Those first year residents become very grateful when you have held the Lovenox for the pt that is going to surgery that they forgot to d/c. The good ones maintain a good working relationship with their nurses, some don't and that is too bad. Sad thing is that once we get them trained-they leave.

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