I know that we, myself included, often ***** and moan about Management taking the sides of doctors, when it comes to conflict between us and them. I know we often feel that we rank pretty low on the hiearchy when it comes to whom to please. I'm taking some management courses in school, one of them being in management of Health care institutions. It opened my eyes a little bit to the other points of views out there. Basically we were discussting who the most important customer for any health care institution is. Who do you think it is?
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The Doctor! I know its hard to swallow, but without the Doctor there wouldn't be any other customers. The patient pays the bill, we take care of the patient, make sure they are happy, make sure they are taking care off. Make sure everything goes well. But it is the doctor who admitted the patient to the hospital in the first place. Most doctors in bigger areas have at least a couple of hospitals that they can admit to. If they know that a certain hospital staff will stand up to them and lasso them off the high horse they sit on, they will simply quit admitting to that hospital, and thereby cut of the funding. No patient, no money. At least thats whats being thought in my classes. I know that doesn't make the behaviors of a lot of doctos justified. They have no right to treat us the way some of them do. And it also doesn't mean we should take the abuse some of them dish out. But in the end the higher-ups gotta keep the doc's happy, or they'll quit aditting people there, or admitt less. I don't know if this theory is completely correct, or if I agree with most of it. It certainly doesn't give any justification to the way some of us are being treated by the doctors. But it does give an explanation about why upper management is often reluctant to take actions against docs.
Let me know what you think, I know there will be lots of negative responses to this. I hope they are not against me, I'm just presenting a viewpoint from another perspective. It just made me think for a little bit about why things are the way they are.
Physicians bring in patients (and money) to the hospital however nursing is the function of the hospital. This is what some physicians and administrators don't seem to grasp. The function of nursing is the reason the hospital exists so it would be in everyone's best interest if there is excellence in nursing. We've all seen the studies about patient outcomes related to nurse/patient ratio and nursing education.
I am in total agreement w/ your point. IMHO, today's nursing managers are not leaders, but simply individuals who are put in their position to implement a variety of policies and procedures that are fiscally advantageous for the institution and those in its upper levels of management. Physicians often are able to benefit montarily from policies which are detrimental to the nursing staff at the bedside, but most of all the patients. There are some great physicians and nurse managers out there, but they are few and far between. So many times, I see mid-level management supporting both nursing and medicine face-to-face and one-on-one, but when push comes to shove, medicine or administrative policies win out whether or not they are right in the end. As for upper management , nursing or otherwise, they are most often in a total disconnect w/ what happens at the bedside.
It is true that without the patient we wouldn't have jobs, I don't think that opinion should be carried too far. Making the patient happy should never compromise patient care
AMEN!!!
How often do patients refuse to do what is best for them and if we press the issue, we are in trouble? I've seen patients refuse their colonoscopy preps and then get upset with the nurse because the doctor couldn't see what he needed to see. I've seen patients refuse meds and then complain because they aren't getting any better. I've seen patients insist on getting solid food despite clear liquid diet orders and then scream and swear at the nurses when they throw up the pizza that their friends brought in.
Yes, the patient should be our top priority, but the patients also need to be a part of the team. We should alll be working toward a common goal, not working against each other.
We also need to show respect for our doctors. It may be old fashioned, but I will run and get a chart so the doctor doesn't have to go down the hall to do it. I'll also give them my chair, find them a pen, and get them a cup of coffee. I'll do the same for my coworkers...if they sit down to chart and can't find their pen, if I'm not doing anything, there is no reason I can't walk from one side of the desk to the other to get her one. It's a lot of the little extra things that put the icing on the cake...that make you a valuable part of the team and make a difference on annual evals (not that I'm a suck up or anything).
We also need to show respect for our doctors. It may be old fashioned, but I will run and get a chart so the doctor doesn't have to go down the hall to do it. I'll also give them my chair, find them a pen, and get them a cup of coffee. I'll do the same for my coworkers...if they sit down to chart and can't find their pen, if I'm not doing anything, there is no reason I can't walk from one side of the desk to the other to get her one. It's a lot of the little extra things that put the icing on the cake...that make you a valuable part of the team and make a difference on annual evals (not that I'm a suck up or anything).
I think that this is part of the problem. Nurses who still insist on giving up their chairs, etc. I realize that you are being nice, but part of the reason that doctors feel so entitled is in the treatment they receive/have received from nurses. (And I also realize that you do the same for your coworkers - but I can't help it, it makes me gag when I see a nurse give up their chair for a doc).
Hospitals with this out look over look the fact that they have power. Power to deny a physician the right to admit to thier facility. If a physician repeatedly misbehaves and is therefore denied hospital privileges he has a problem. Limiting privileges limits his paractice and income.
They call it privileges for a reason but some hospitals have lost sight of this.
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Sure he can take his business down the road to the next hosp. BUT the truth is with very rare exception physicians have privileges at multiple hospitals and without that today their practice suffers.
If hospitals clamped down and enforeced rules and regulations physicians would straighten up.
I own a business (not health care) if a "big spender" came in an began abusing my staff the way some physicians do I would be sued by my employees, the customer would likely be sued and I would be without a staff. Quite honestly from what I have seen of some physician behavior I would have to call law enforcement in my business. Without a staff I would loose my business.
Now think about this. I have seen docs be abusive at one hospital where they can get away with it. Then go across town to another hospital where they also have patients and treat the staff well because that hospital would not stand for thier nonsense. Docs do it because they can...... "
Agnus and everyone else,
you are so on the mark. at present i am reading a test book on nursing and malpractice risks:understanding the law. throughout this book i am acknowledging the reality of some doctors that give substandard care, whether it's in the form of orders and/or the casual dismissal of a pt's complaints; that we, as nurses are being held liable if we do not question or intervene on behalf of our pts. it's truly an eye-opening book. my point being, is that we all know there are too many doctors that are full of themselves, and expected to be treated accordingly. but with the number of escalating malpractice lawsuits, a hospital cannot afford to have doctors or nurses who might act less than competent. it's really an important message that nurses are being held just as accountable as doctors and if you have a facility with top notch, on the ball nurses that will question a doctors' orders or dare to report a doctor that may be rendering inferior care, then it's the nurses who shine (and rightly so) not the docs. and of course, the reverse is true too but mgmt. should not be blindly rubberstamping mds because they're mds. that's just plain senseless.
imenid37
1,804 Posts
I am in total agreement w/ your point. IMHO, today's nursing managers are not leaders, but simply individuals who are put in their position to implement a variety of policies and procedures that are fiscally advantageous for the institution and those in its upper levels of management. Physicians often are able to benefit montarily from policies which are detrimental to the nursing staff at the bedside, but most of all the patients. There are some great physicians and nurse managers out there, but they are few and far between. So many times, I see mid-level management supporting both nursing and medicine face-to-face and one-on-one, but when push comes to shove, medicine or administrative policies win out whether or not they are right in the end. As for upper management , nursing or otherwise, they are most often in a total disconnect w/ what happens at the bedside.