Thanks Andrea! I am a current RN and almost done with my prereqs!
Thanks Mya for giving your perspective as doc-there are good and bad nurses.
Dont let those bad apples spoil the whole barrell!
Mackayla---try to keep your sanity through those annoying calls! Just know, the nurse beside the nurse calling is rolling his or her eyes thinking what the HELL?! too!

OH, in my other post, I am not meaning to construe that nurses dont care to assess their patients, they have to, or else they wouldnt know their patients may be going into CHF, etc.

I can tell ya this, I had a patient one day, in the am heard just a few bibasilar crackes, by afternoon whe was full of fluid (rales throughout), I called the doc and told him she sounds like she'd in CHF, and he disgarded my assessment and said he thought she had bronchitis. I didnt agree, but he's the doc and I dont have as much training and experience as he, what more could I do? I cant order lasix, etc. I got off work an hour later, told the nurse picking up my patient that I notified the doc, and that patient died that very evening. So I do think what I do involves some thinking. I'll give you another one, had a patient who was in with a horrific decub, she kept vomitting bile, I made her NPO per nursing order, she kept vomitting, it was bile, I listend to her abd, no apparent bowel sounds, lady was large-abd still appeared to be much larger than the day before--called doc, I thought she need a stat KUB,NGT or something for an ileus, doc thought differently. I told nurse picking up my team, two days later I come in, she has an NG, doc that was on call was notified at some time, ordered a stat KUB---guess what?-----Ileus. So yes, we do or I do critically think. Is this not critcal thinking?

I think that there needs to be a clarification/ distinction between RNs, LVNs, MAs, Nurses aides

I personally see the nurses (usu RNs& LVNs) as my assistant and help. They know a lot! I was not above asking them what they would normally do in certain situations when I was a new intern & knew nothing!

I think they get treated as "inferiors" and this may be why there is some "hostility?" (maybe too harsh a word?)

Even though I am the MD on a team I am never afraid to ask a nurse for help with a question I may not remember, or a dose I might not be sure of ( will look up of course- but they can be very helpful)

I have worked closely with LVNs & RNs and my experience has always been great. I don't talk down to them or act condescending towards them. I appreciate their respect & I also respect them for their training.

Right now if someone coded in front of me- I'd look at the nurse & say "help!"

I think if nurses are treated with respect they too in return treat you with reapect

Thanks DrMOO. Yes that is part of it too, the being treated as inferior, as a nurse, we are on the top of the ladder as far as patient care services goes, we dont work for the doctors (at the hospital)--I mention that because lots of people think otherwise. I had a patient's family member one time complain to me about her previous nurse and told me she told the doctor on that nurse. "Huhhhhh?"
A lot of nurses (most, with the exception of me) dont want to become docs, not that they couldnt be, they just arent willing to sacrifice and spend gruelling years in school just to have a higher degree, make more money and never have time to enjoy the extra money. It is all a personal choice. Doesnt make them inferior.
They want to care for patients without those added extras.
And DEFINATELY if you respect nurses, they will respect you back!
Thanks for your comment.
Lets hear some more!!!!

I have to agree with drmoo. One of the most useful long-term skills you can learn as a medical student and resident is to get along with and work with nurses. If you treat them like crap, they WILL call you in the middle of the night for a suppository order. If you respect them, they will be immensely helpful to you! Yes, it's our job to tell them what to do, but they each spend 8-12 hours with the patient and it's their job to tell us what's going on the 23 hours and 45 minutes we're NOT with the patient. Without that information, we'll do a crappy job taking care of people.

When you get out in practice, depending on your specialty, you will probably not be sleeping at the hospital. Your ability to work with the nurses often means the difference between staying in bed or dragging your butt to the hospital at 3am (maybe with the temp. at -20)and still doing the right thing for the patient.

I work in a teeny hospital but the nurses are spectacular. They don't always know exactly what's right for the patient. They sometimes call for things they wish they didn't have to because of protocols. Some are better than others and you have to work with them to learn who's who. I've learned to listen to their concerns, clarify with questions of my own, but bottom-line to LISTEN to them. If they're worried, I get my butt in there. If they're not, it can usually be handled over the phone. Don't listen to them, and you're bound to end up killing someone.

You are oh so right, DrHeidi. You have a very realistic perspective and thanks for adding your insight.
Nurses dont always know what is exactly going on, nor are they supposed to---nurses are supposed to monitor and know when things are going on to alert the docs, and through experience, boy does one get better at it.

I think often times, it is the new nurses who call for the insignificant things, like calling for an order for a headache because the tylenol was written for a fever. I assume that nurse is going straight by the book--that nurse needs to be given time, and when that nurse gets her head bit off, she'll think twice. It will happen.
Sometimes nurses are put on the spot by patients. A patient may not complain of constipation all day and suddenly at night, even past 10pm, they will demand you to call the doc for an order. We have to answer to the patients, and furthermore, our patient care administrators when we get complained on for not meeting the patient's needs. So sometimes nurses call with their arm twisted behind their backs, figuratively speaking. If a patient has a headache that developed late in the night, and wants the nurse to call for a pain med, does the nurse say, "Im sorry, your doctor will get pissed at me for calling him or her this late, it is not like you are going to die, youll have to suffer?" How is that making the doc look? If I dont call and dont give a reason, how does that make me look?
I really never knew that doctors could have such a wrong idea of what nurses really do. I am glad I started this thread.

No, you don't say "the doc will get pissed at me for calling" with regards to the tylenol order. You realize (as a critically thinking RN) that tylenol has multiple indications, and if it's been deemed "safe" by the doctor (i.e. and order written in the chart for tylenol prn pain) you can certainly give it for a headache. A tech or lower level medical assistant may not know this. But at my hospital only RNs call the doctor, therefore this "ignorance" isn't an excuse.

As a nurse there are ways to avoid calling the physician and appeasing the patient using your own critical thinking skills. Just like I don't prescribe narcotics simply because the patient requests them, the RN doesn't have to call the MD for bullsh*t just because the patient requests it.

I agree with drHeidi. No need to be so fired up, my intentions here are create a better understanding of each the docs and nurses perceptions of one another and thru this have better rapport.
myimd,
When I first mentioned the not ordering tylenol for pain situation, I was not trying to correlate the latter situation with it. The latter situation I talked about was assuming there were no orders of pain at all. That as why I put them in seperate paragraphs from one another. I think you misunderstood my points.
In the first situation, it is not that the nurse doesnt know the indications of tylenol, it is that it was written with a specified use. By law, if a doc writes for a med with a specified use, we are to give it only for that use. My point was that newer nurses are more than likely to go straight by the book intially and call for things like that. I would give it, regardless, even though I am technically stepping out of bounds. And believe it or not there are some docs with certain personalities who may say "Why did you give tylenol for a HA, when I specifically wrote for fever only?" and maybe there was a reason for this, I dont know off hand......but maybe he or she wanted to know if the patient experienced pain because it could be significant for one of the diagnosis in the differential....I guess the day I give tylenol for pain again eventhough it was ordered for only fever and the doc doesnt like what I did, I will know.
If you are getting called for BS, then write for tylenol prn pain,fever. I think when I am a doc and when I admitt someone, if I dont want to be notified for a fever, or mild pain, or consipation, as long as it is not contraindicated, I will routinely order tylenl for pain and fever and MOM.----Oh and ambien 5mg HS prn insomnia---that is a common complaint that a doc may get called for a night.
In regards to your sarcasm with the crtical thinking. As a whole, it doesnt matter to me if you dont think I have to critcally think as a nurse despite trying to show you the light of things, I am still helping to save lives, and have helped prevent the loss of lives time after time which has to involve some type of thinking.

Ooooooh, myimda:
Usually when the patient DEMANDS you to call the doc it is because that warm prune juice, walking around, and sitting on the toilet didnt work. You may not know this, but from what I observe from the most of the other nurses, you guys are called when all else has failed.
As for the headache, there really isnt a way to get around that without an order.
Do I need to make the patient suffer, or feed the patinet lines, to make a doc not look bad for not wanting to be disturbed with the patient's problems? No, the doc will be called. If one doesnt want to be called late at night even for the nonthreatening thinds one should reconsider their profession as a doc, or order things routinely.

While we're on the subject, what about nurse practitioners? Becaue they are able to prescribe meds and have more autonomy than RNs, how are they percieved by doctors? How do nurses feel about them? What is their role exactly?
Court