No offense to you fellows out there! There are plenty of *wonderful* fellows out there, too!
amy

As a female physician who worked (hard) as an SICU nurse before going to medical school, I can identify with so much of what has been said. I agree completely that nurses are often mean, and I don't mean just to the housestaff physicians. I recall as a nursing student coming onto the floor for a day of clinical and hearing an older RN say to me "get a good look at all of this crap, ladies, so you know what you are getting into". What an awful thing to say to enthusiastic nursing students. I saw meanness in nursing professors to nursing students. Then after becoming a nurse and deciding to apply for med school, I received an occasional snide comment from a nursing colleague. I did not make my plans very known after that happened. I began to realize how much more I got along with men than women and had all my life, but had never clarified why. Now I know...women can be very catty.
The real eye-opener was when I became an intern. What a bunch in b*****s I was around. Yes, I do feel that nurses seemed to treat females doctors differently than male docs. I was also amazed how nurses would dump any job they could on unsuspecting interns/med students. Case in point: for years, it had been said in our teaching hospital that the job of drawing blood cultures for a fever work-up was the job of housestaff/med students. Do you know how often fevers occur on the AIDS unit??? I could be up all night doing just that. One night, a resident was bored in the desk area on a unit, but could not go to bed for some reason. He spent some time reading through the notebook on the shelf that described the nursing duties on that unit. Turns out that the hospital policy was for the nursing staff to draw those blood samples. Word quickly spread amongst the housestaff about the policy, including the page number and paragraph from the policy manual, and the nurses got quite a surprise when we would order cultures for fevers and let them know that they got to draw blood cultures on their 8 hr shift while I tried to grab a bit of sleep during a possible 36 hr day. I could go on with other stories of what nurses tried to pull on me that did not fly because of my experience as a nurse. As I entered my anesthesiology residency, I experienced even more crap from CRNA's.

PremedRN, I know where you are coming from...I have been there. You are bright and motivated and think everyone is as good a nurse as you are. But I am afraid that you might be in for quite a surprise when it is your turn as an intern to get the 3 AM phone call to renew an order for MOM that expires at 4 AM. My own mother, also an RN and God love her, told me that I was probably harder on the nurses because I know what they should and could do. I hope that when you are a physician,you are able to be more patient with the nurses than I have been.

Taurus,
I was hoping to get your perspective, as I remembered you were once a nurse from one of your previous posts. And thanks for the compliment.
I know that there are good and bad nurses, that's how it is in any job or position. I guess the message I was trying to give (maybe didnt do so) is that what some nurses have done to make them look like only "order doers" doesnt mean it must be the same for all nurses. Im sure there are and were legitimate calls, yet we arent hearing about those times. I understand the frustration one must feel when getting called for BS, I truly do. And I know it will happen to me as an intern/resident/doc. And maybe I will, like you, be less tolerable of those sort of things because I was a nurse at one time. I hope I will be able to keep myself contained and say something like, " You know, not trying to be mean to you, but most people would not have called me at 4am for an expiring MOM order, next time could you wait until I round?" or maybe I'll say, "Are you kidding me, you should have enough common sense not to call me for such an insignficant order!" I hope I would be nicer. We'll see.
I know nurses can be mean. I see it with some of the other nurses I work with when nursing students are on the floor, and following them. I witnessed a particular nurse, basically belittling the student nurse, and I did not like it at ALL! I decided later in the week to bring up the topic in front of that nurse of "why experienced nurses treat the nursing students like crap" I mentioned how I see it as those who do that feel inadequate, and insecure and trying to make themselves either look better, or feel better to fill that void. I also mentioned how it didnt make them look like anything but like jacka-ses. That nurse must have checked herself because she has gotten better. Again--you'll have that anywhere you go. I am starting to realize now, where the hostility comes from sometimes with the doctor-nurse relationship. I dont work at a teaching hospital, we never see interns or residents. Many people try to push their slack off on others who dont know it, better termed as gophers. Those people who mistreat people like that are lazy, and rotten. But not EVERYONE does it. It is not fair to make overgeneralizations--doesnt mean it doesnt happen.
And just as there are mean nurses there are mean doctors. The ones that no matter what you are calling for you are disrespected and treated like crap. Those that think you are their slaves, "Get me that chart" "Get me my labs", no pleases, no thankyous. The only ones who do that are those with personality issues. I do not stand for that, and never have. I will say and have said "The chart rack is right there......" the labs are posted in the computer." If I have time, and if I am asked, "Dana, could you grab me room 18's chart?" I will be glad to help. But if you disrespect me, I cant do anything for ya.
That's enough rattling for now.....

PremedRN: And I certainly do not mean to imply that all nurses are b*****s. There are good nurses that are nice, good nurses that are mean, and so on with all the various combinations possible. I just remember being so shocked at what would be thrown my way in the dead of night. I worked night shift in the SICU, but I do think that I understood that everyone else in the world would want to sleep. It is so hard to work for 18-20 hrs non-stop and try to squeak in a bit of sleep when a non-emergent call comes through. It would seem that the night nurse was unaware of our chronic, severe sleep deprivation. Think about this: we would have rounds at 7 AM about the same time the nurses came in for work. They go home at 3 pm, I'm still working. They see their family, eat dinner, shop, have sex, have an argument and go to bed. I'm still working. They come in the next morning at 7 AM and I am still working (often never saw the bed). They go home at 3 pm and guess what? I'm still working!!! I might go home around 7 pm. I had to go off the birth control pill because I could not keep my days straight. The nurses are unaware of how long a day we have...it's two of theirs.
I do not recall getting the stupid (there...I said it) phone calls during the day, but must have...it's just that at night is a different ball game and it stands out so much more. Residency is so grueling.

I never blew up at a nurse, but my irritation showed on occasion. Most of the time, I was able to remain civil. Two times stand out. I received a phone call at 1AM about a new fever, oredered a fever work-up, got the med student to go draw the blood cultures and went back to sleep. When the same nurse called me at 4 AM with the same fever on the same patient, I was highly irritated. We had already addressed this new problem, but to her, she was following orders that read "Call MD for Temp > 101.5 F". I could not get her to understand that we had already dealt with the problem and why couldn't she just give the man some Tylenol that was previously ordered. No critical thinking!

Another time revolved a pt that I, as an intern, diagnosed and saved. Three days after I got him through the night of mild septic shock (since my resident had decided that he was DNR and would not be transferred to the ICU), I was approached by an excellent RN who suggested that it was time to get this elderly, slightly demented gentleman out of bed. I agreed and ordered "OOB BID". The next day, another nurse marched up to me and said that she was not able to get him OOB because of his central line. She was unaware of my nursing history. I looked at her in shock and stated that that was not acceptable, it was ordered, period. She stood her ground, saying that if he was OOB, he would pull out his central line (huh???). When I explained that as an ICU nurse, I got patients who were intubated and with Swan Ganz lines out of bed and was certainly versed in the judicious use of wrist restraints, she stomped down the hall to get the pt OOB. A short time later, I checked on the man, who was OOB, but (swear to GOD) his central line tubing was draped down to the chair and was in his restrained hands. The nurse walked in at that time, and I could tell by the look on her face that she had put that line deliberately. She was caught. I calmly moved the line and told her that if we did not want the line pulled by the patient, maybe we should not put it in his hands. I should have written that up, not because it was stupid, but because I believe that she meant to get back at me at the patient's expense.

I will state unequivically, that in private practice, I do not see near the amount of "power struggle" stuff that I saw in the training hospital setting. Things seem to run so much more smoothly. Of course, as an anesthesiologist, I do not get as many of the night phone calls; the ones I do entail actually getting out of bed and going in, as oppossed to my FP friend who goes in far less often, but gets more calls. She expresses some of the same frustration. Enough venting for now.

I feel your pain!! :yes: . Too much controversy and too many people "challenging" my position, jeopardizes the entire team. The nurse is not the teamleader, no matter how bad she wants to be. That's not a judgement on character, it's not a belittlement, it's what is. Sometimes, in an effort to appease everyone (and make them feel nice and important), we lose site of the facts.

Again, fuel for debate.

Fortunately this relationship improves as time passes. It's difficult to be "friends" with the nurses as an intern. Both the RN and the MD are trying to be in control. The intern is now a "doctor" and needs to gain confidence, and learn to "hold her own." The (usually) older more experienced nurse knows a bit more (usually) about actual clinical practice, and doesn't hesitate to display this fact.

As physicians become more experienced, they are not intimidated by the nurses, they are not usually even phased by the (now less frequent) nursing attitude. You get to the point where you're attitude is "yeah, yeah, roll you eyes, smack your lips, whatever, just do your job!! And if you don't I'll just write you up, or worse, report you to the nursing board for jeapordizing patient safety." You're removed (above) that petty crap, mentally. You're confident in your abilities, and the nurses usually stop trying to "help" you in your practice of medicine.

With regards to the 4am phone calls...as time passes you get more saavy with those as well. One time, as an intern, when a nurse called me every 10 minutes for bullshit...I sat at the nurses station pretty much all night. My attitude was like, why leave if she keeps calling me back? And throughout the night I went thru all the charts and wrote so many orders that they were like "please leave doctor." I was there as they were trying to "wrap up things" before they signed out in the am, and continued writing orders. So, either she could *not* do the orders, in which case I'd report her, OR she'd be working all night, and still have a bunch of stuff to sign out, which would look bad in the eyes of her colleagues who would be stuck doing all of the remaining work. After that night, that nurse never called for that BS again.

And another thing I realized, the nurses just wanted to write "MD notified" in their nursing note. I used to do one of two things - either tell them "it's okay to go ahead and write that phrase, then actually notify me in the am." OR I would be a bad intern and just stop returing pages from certain floors. If it was something major going on, the nurse would be obligated to go over my head...and call either the resident or the attending. It was never anything serious, so I was never burned doing this. But I figured, if the RN thought enough of the situation to call my senior, then it must be a "real" issue. They can get away with bothering me all night, but that nonsense wouldn't be tolerated by more senior docs. I've seen nurses "moved" because the (more senior) physicians didn't like them for whatever reason - and calling for BS ranks right at the top of the list of annoying things, which in turn could cause a nurse to be "moved/reassigned."

But, as I stated previously, in the ER my nurses are great (at least most of them). And the ones who aren't so great are nice enough, but just kinda slooooow, and frazzled. Slow and frazzled are two bad qualities in the ED.

You know, after reading all of these posts, I started going to work thinking, "who the hell cares what I do at work? All I do is pass meds and take vital signs." What a disgusting feeling! And you know what? If I had kept thinking like that, I would have started acting like that. Maybe that's the kind of "bad nurse" you're talking about.

Nurses have the title "professional" for a reason. They have college degrees. They have legal responsibilities. Most of them care about their work. And *all* of them care about their patients. Some more than others, but they do care.

I really wish doctors would write more standing orders like "do not call unless BP >240/120" or "if K <3.5 give 40mEq KCl po x1". And I wish they would DC the @#$#@% telemetry/foley/blood sugars if they don't want to treat them! There have been so many times when the doctor and I knew this wasn't a big deal, but we both knew I was responsible for reporting it because otherwise I could/would be written up by my colleagues.

Nurses do not just need to answer to medicine, the also need to answer to the hospital's administration. If it's a hospital policy, THE NURSE MUST FOLLOW IT! S/he's much more concerned about keeping her job than potentially annoying the doctor. Granted, some nurses are just stupid, but I think most are doing the right thing.

Also, why do docs have such trouble with nurses who question/clarify orders? I personally have *never* seen a nurse do it for spite. They are really concerned! But Taurus, that OOB story definitely takes the cake. What an idiot! I think it's important for the nurse to get a good reasoning for your decision so THEY WON'T ASK AGAIN NEXT TIME!

Just my thoughts. Flame me if you will! I think we needed more fuel for the fire from the other side :-D
amy

I agree myimd...it is simply a power struggle. I well remember when I was a nurse how much I taught interns about titrating hemodynamic drips, ventilator management, ABG interpretation, and I liked that feeling of knowing more than they did. That experience actually bolstered my desire to go to med school. I think that because interns are, in general, very green, unsure of themselves, that they are more easily taken advantage of; it is hard to "respect the doctor" who often knows so little in the real world of patient care. But it is also true that an intern will seek out a knowledge nurse for some help/support...there are times the intern would rather get the answer from somebody who does not write their evaluations!

Mya, your words show much wisdom and a calmer demeanor than I possess. Tactics such as sitting in the nurses' station all night because of frequent calls is clever when you are a resident doing in-house call anyway, but I am not interested in leaving the comfort of snuggling with my hubby in my own bed at home in order to make the point. As I said, private practice does not have near the nurse/physician issues that happened in residency.

amysunshine, what a bright name! You go on being the best nurse you can, because we physicians learn who you are! We count on those whom we can develop trust. I agree with DCing orders that no longer really matter and with more standing orders. It sounds like you are in a non-teaching hospital. If that is true, maybe sometime you could get some experience in a teaching hospital and interact with doctors-in-training. I think you would enjoy it. There were times as a nurse that I felt like me and the intern were both learning something together. Since there was so much teaching going on during rounds, I would listen in at the pt's bedside and learn so much. I disagree with one thing (no flaming from me): in the OOB story, I do not think that the resistant nurse was trying to clarify the order. What well-trained nurse does not realize that the worst place for patients is an extended bed-rest? I am sure you know that, right? The nurse simply did not want to do the chore and was trying to find an excuse that the "dumb intern" would accept so she would not have to do it. It might have worked with an intern who did not have nursing experience, but she picked the wrong one. With your nursing past, you will make a better physician, just wait and see!

Wow. After reading some of these posts I can definitely understand why there is a nursing shortage and why there will continue to be... :boggled: . I hope some of the younger docs here take advice from the older. There's no need to tear down a profession and the two nurses who are posting here because of some nurses that you are having a hard time with. Nurses also have to deal with abusive docs and balance whether to call or risk their license. Plus, they get paid a LOT less in the end than you will when you finish your training. You are going to get paid a lot of $$ for having to answer calls in the middle of the night, I'm sure that you can figure out how to handle bad calls graciously. I'm not a nurse but I respect what they do. I hope this is not representative of the doctor population out there but unfortunately it probably is...

Elma: I have been on both sides of the fence and there is not a doctor who worked as a nurse who does not understand what nurses provide for patients. Honestly, I think from my nursing days that I put up more with patients than with doctors. Not to say that I did not run into a doctor I did not care for (still the case now that I am also a doctor). I have never considered nurses just "order doers" and doctors as "order givers," and know from my own experience how much more a nurse can contribute to the welfare of the patient. But, just because a doctor makes more money than a nurse (I did go to school a whole lot more to become a doctor than I did to become a nurse) does not mean that doctors do not have the right to be annoyed with nighttime phone calls that show lack of thinking on the nurses' part I will never complain about calls that are truly necessary to deal with at 3 AM because I want the best for my patients.