I hate to say it, but I agree with premedRN. A bachelor's degree is just an extra year of BS "theory". I *am* glad that I went to a liberal arts college and was able to take a wide variety of classes--that *did* help me think outside the box more than my "nursing theory" classes.

Another note on doctor/nurse relationships. I rarely question a doctor's judgment, but lately I've been realizing that there are some people who JUST DON'T GET IT. Just as some people should have never been nurses, some people should NEVER have been doctors! I won't go into details to protect the poor doc, but good heavens. Its frustrating bc there's nothing the RNs can do but go along with the irrational (but non-dangerous) orders. I'm glad it sounds like all of you have your heads on straight!

amy

Yeah, I hated to say it too, Amy. I had dinner with my gross anatomy class and the BIO/CHEM head (he taught the class and was treating us, there were only 7 hand picked students) well his wife came, and two other of my classmates were in the nursing program taking the Gross class as an elective. We asked her if she thought all the nurses should have a BSN (she's a MSN) and she said yes after she had stated the fact that there is no difference in the competencies judgemental call wise between the two ( because if that were so, ADN's wouldnt competent to be able to pass boards, and be licensed---logically). This is contradictory logic. I dont want to know the nurse theory crap, what matters to me is the patients. I am totally not interested in paperwork and theory to get my bachelor's, I would much rather be more well-rounded as a whole and broaden my horizons. So, I think having an ADN and a BLA, makes me just as qualified of a nurse as a BSN, and more well rounded. I dont mean to down BSN's, I just think I have the equivalence with my two prospective degrees.
Today at work, there was this patient I had whose platelets were low and was having epistaxis as a result, they had been giving this patient ketrolac (Toradol) for fever (he was also neutropenic)....I mentioned to the ONC doc that he had been getting it for a couple days at least and was concerned about him bleeding from a potential ulcer from this med and that I wanted to make sure it hadnt been missed, I also stated how she (the ONC) would know more than I would about it,(so it didnt appear I was stepping on her toes) and she d/c'd it gladly without any problem of seeing me as second guessing her, because some things do accidently get looked over, and when I notice such things it is my job to address to do no harm to the patient. This is just another example how seasoned docs view our issues as being helpful, not as power struggles, and we are often thanked for noticing such things. Doesnt mean the doc's incompetent, when treating so many patients, it is an easy thing to do to not d/c the toradol in this example. So I feel we all need to be not only looking out for each other, but for the sake of the patients whose healths are often times in our hands together.

Maggie, you are right about your last post. ADN's have more education based decisions than LPN's who dont take the same board as nurses. I definately want to be distinguished that I have had more schooling to base my decisions on. Not the LPN's are morons, they are taught to function like a nurse under different requirments, they are the more hands on learn from experience, where RN's decisions are more education based, thus the difference in the names. Im not belittling LPNs, because some are better than some RN's. I just want to be recognized of what I have accomplished and distinguished, so I can see why it is a bigger issue that a female doc being addressed as such, A doctor, not a nurse. That would be frustrating. Maybe I wont feel as bad when it happens to me, because I in fact by definition will always be a nurse, maybe not, Id much rather be distinguished as a doc, that I devoted soo many years to become.

Heehee, I hope your bleeder wasn't getting toradol IM! That would be a mess!

I totally agree with you about "med updates". Docs don't have good access to the MAR, so I can see how things are easily missed. A couple days ago I asked the doc if my ileus lady (NPO) could have some dextrose in her fluids. He had no idea she *didn't* have dextrose in them. I'm glad I asked!

Noo, it was IV thankfully...........

Yes, and isnt it funny to think, given all of this we are sometimes actually thought as just "order doers" who dont have to think, but just DO? :rotfl:

Joining forces with the nurses...just kidding. I am an ADN RN and have been on a tele med-surg floor for three years. Right now, I am also back in school for my BSN. Wouldn't you know that my topic of literary review this semester is the relationship between nurses and physicians. Over the past few months I have found much information on the subject,but mostly from a nursing point of view.(I guess we have more time to dwell
I just wanted to say that I love being a nurse. I have been guilty of becoming upset with doctors in the past, but as I gain experience, I've learned to value each of them greatly. Neither of our positions, at least in the hospital setting, would be of much use without the other.
One other little tidbit.. I have realized one thing that you MDs may not realized since I began studying this subject. Most night shift nurses are the "new nurses" because the more experienced nurses have put in their time and now work day shift.
Thank you all for this thread. It is good to have the heart-felt physician point of view.

I have told my residents for years that nurses do not have as much "book learning" as them, but those with experience can be better at assessing patients. Nurses are not usually allowed to act independently, so everything has to be covered by an order -- which sometimes they have to call you for, or better yet, appropriate protocols have been derived to cover most situations.

The nurses can make your life wonderful, or living hell. If they don't like you, inappropriate calls happen frequently. Unfortunately, this type of nursing staff can't seem to figure out that if you are tired from being waked up, your attitude and resilience usually suffer. When the nurses are good, they figure out the patient has trouble even before it happens.

I learned so much during my rotations in ICU from the surgical nurses with experience. I learned to trust my intuition, and to pick up subtle signs. The relationship will change when you are an attending physician, and the nurses have time to know you and know what to expect from you (and you know what to expect from them).

This thread has been VERY interesting for me. Since I have only done L & D, my perspective is significantly different. We are extremely autonomous. We have standing orders to cover just about everything and we manage labors fairly independently. Of course, we call the docs to let them know when something is out of the ordinary, but those of us that have been practicing for sometime will DO first and call later because the patient circumstance warrants it (or we have another nurse give updates while we are doing what needs to be done). I cannot imagine how exhausted a physician would get (especially in a busy practice) if he/she got a call everytime we needed an order to do something. I feel proud that our docs trust our decisions and critical thinking skills, and I think on the whole that we all work together for the most important outcome.....healthy moms and healthy babies.

That being said, I will also admit that there are docs that are very scary to work with that we all know if it came to his/her license or ours, we would get the shaft. In those instances, we DO call for every little detail. We have those docs on speaker phone for T.O's. We have other nurses listen when we take V.O's. And we try really hard not to ever let the patients see the conflicts.


If I could offer one piece of advice to docs, it would be to never try to make a nurse seems stupid in front of the patient (the patient will usually side with the nurse unless there is a gross incompetence). If there is an issue with a nurse, take her/him aside and discuss it in a calm manner with the attitude that we work as a team to make the best possible outcome. If that doesn't work, then go to the clinical nurse manager and talk to him/her.

Here's one more thing I find that really seperates docs from nurses....Doctors tend to keep their likes/dislikes of each other to themselves. Nurses are very quick to eat their young and berate each other (in public, behind peoples backs, etc.). I have rarely heard a doctor sit around and talk about another doctor in negative terms, but nurses talk about each other all the time! We could certainly learn a thing or two from doctors in that area!

Oh, and not all night shift nurses are new, either. On our unit, many of the night shift nurses (myself included) have been practicing for more than 10 years. In fact, our least experienced nurses seem to be on the evening shift. We work nights because we have children in school and we want to be available for them during the day and be at home with our families during the evenings. Day shift would make being able to go on field trips impossible and evenings would make us miss many of the kids' activities. In general, I do think days is most experienced, but not always.