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 Specializes in L/D, newborn, GYN, LTC, Dialysis.
I have seen many "A-student-look-good-on-paper" nurses graduate and go on to be lousy nurses. Oftentimes, programs choose people based on how they look on paper; fine, but to let these people who are disingenous and would throw their mom under the bus, rather than own up to mistakes or misteps, I have seen WAY too many of these in the last few years. I can smell them a mile away and I feel more unease working with them than I do most physicians. I work with a couple such nurses now. Nursing school standards of entry SEEM difficult, but honestly, way too many get by and come out barely able to function and lie through their teeth d/t "fear of liability" if they DO mess up...... That is unfortunate.
Specializes in NICU, PICU, Transport, L&D, Hospice.
My nursing program let anyone in but only about 10% actually graduated the full program. All of the graduates passed the NCLEX first attempt.
I just spoke with an RN yesterday who just changed jobs when the Medical Director of the large multi-disciplinary clinic she worked for stated that;
1) The nursing staff should be supervised by his best MA,
2) the nursing staff didn't require nursing leadership within the organization,
3) because the nurses worked under his license anyway.
She said that the changes were made, the MA was promoted, and 3 RNs submitted resignations stating that they DO NOT work under the license of the physician and they will not submit to professional evaluations conducted by a non licensed health care worker who know NOTHING about nursing.
All through doing my prereqs and testing and etc. I thought I was making my way through qualification screens. Was this a delusion?
Yes... sort of. Your particular school may have been very discriminating in its admission standards -- and only graduated top-notch nurses. But there are lots of schools with very low standards and that will admit just about anyone with a high school diploma -- as long as they agree to pay enough money.
I just spoke with an RN yesterday who just changed jobs when the Medical Director of the large multi-disciplinary clinic she worked for stated that;
1) The nursing staff should be supervised by his best MA,
2) the nursing staff didn't require nursing leadership within the organization,
3) because the nurses worked under his license anyway.
OH. MY. WORD. I am pretty much screaming in my head right now. This is ridiculous that anyone who works with nurses would believe these things to be true!!!! I can't even imagine. So glad the nurses were able to leave and hopefully find a better place to work. Jeesh!!!
The fear of getting sued by physicians and the fear of losing a license/getting sued by nurses is way overblown by both.
Yes! Fear does not always equal reality. It's akin to people being afrai of riding airplanes and in reality, it's the safest form of transport. I remember a discussion here where people were looking up reasons why nurses lost their license on the BON website. They were all really grave errors, not having a narc count off x1 or forgetting to sign out the 7am Protonix before leaving at 7:30.
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.
We are expected to do all that, because they trust our judgement; but it isn't illegal at my hospital, we have protocols in place for certain complaints, identified as early as the initial triage. They are in the computer as Nurse Initiated Protocols, signed off on by the medical director, agreed to by the entire ED medical group. All we have to do is enter the "c/o abd pain", or "chest pain" protocol, and it all pops up.
I went for a job interview with a group of interviewers from the new facility, and they asked what I thought would be best about my new job, and just joking around, I said, "No double shifts 4 times a week and weekends off--I have worked every weekend for the last 10 years!" The two doctors looked at each other and then at me and asked if I was kidding. The four nurses looked at each other and said, "You know, we do that here, too, right?" The doctors literally had no idea that the nurses in this facility worked like that, and they were horrified :)
Yes... sort of. Your particular school may have been very discriminating in its admission standards -- and only graduated top-notch nurses. But there are lots of schools with very low standards and that will admit just about anyone with a high school diploma -- as long as they agree to pay enough money.
There are also a number of community colleges with abysmally low entry requirements... and they're very inexpensive.
There are several around here whose minimum entry requirements include a 2.5 GPA and they admit by wait-lists or lotteries... just not very discriminating.
I was gonna say, I'm in Canada and it's extremely difficult to get into nursing school here. My school told me there were 1000+ applicants for around 100 spots and you need a 90% average in prereqs as well as an admission essay to be considered.
Specializes in NICU, PICU, PCVICU and peds oncology.
Our unit and a couple others at our hospital have a semi-annual contest called Nurse for a Day. All the attending physicians have a donation box and every dollar placed in the donation box is a vote for that physician to be crowned as Nurse for a Day. It came about as the result of a significant exodus of experienced nurses from one of the ICUs whose exit interviews all had a common denominator - disrespectful treatment by the attendings. The thought is that if the "winner" of the contest spends a day walking in a nurse's shoes, they may change the way they treat the nurses. So far we haven't seen evidence of that phenomenon on our unit. Of course, they're given a jammy assignment and the attending on service that day tends to go very easy on the "team". For example, the attending isn't going to appear at the patient's bedside in the last half hour of the shift and write a whole page of new orders. Nor is it likely that the patient orders will include things like pan-cultures and initiation of three or four new antibiotics. And it's just as unlikely that there'll be an order to discontinue all the sedation and analgesia for an intubated patient... all big favourites of we nurses. I've never been at work on the day of the big event, so I have no idea exactly how much of the patient care is actually provided by the physician although I suspect it's minimal at best.
Specializes in Emergency/Trauma/Critical Care Nursing.
Our unit and a couple others at our hospital have a semi-annual contest called Nurse for a Day. All the attending physicians have a donation box and every dollar placed in the donation box is a vote for that physician to be crowned as Nurse for a Day. It came about as the result of a significant exodus of experienced nurses from one of the ICUs whose exit interviews all had a common denominator - disrespectful treatment by the attendings. The thought is that if the "winner" of the contest spends a day walking in a nurse's shoes, they may change the way they treat the nurses. So far we haven't seen evidence of that phenomenon on our unit. Of course, they're given a jammy assignment and the attending on service that day tends to go very easy on the "team". For example, the attending isn't going to appear at the patient's bedside in the last half hour of the shift and write a whole page of new orders. Nor is it likely that the patient orders will include things like pan-cultures and initiation of three or four new antibiotics. And it's just as unlikely that there'll be an order to discontinue all the sedation and analgesia for an intubated patient... all big favourites of we nurses. I've never been at work on the day of the big event, so I have no idea exactly how much of the patient care is actually provided by the physician although I suspect it's minimal at best.
Although I'm sorry it hasn't quite worked, I LOVE this idea!!
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SmilingBluEyes
20,964 Posts
I have seen many "A-student-look-good-on-paper" nurses graduate and go on to be lousy nurses. Oftentimes, programs choose people based on how they look on paper; fine, but to let these people who are disingenous and would throw their mom under the bus, rather than own up to mistakes or misteps, I have seen WAY too many of these in the last few years. I can smell them a mile away and I feel more unease working with them than I do most physicians. I work with a couple such nurses now. Nursing school standards of entry SEEM difficult, but honestly, way too many get by and come out barely able to function and lie through their teeth d/t "fear of liability" if they DO mess up...... That is unfortunate.