I've read most, but not all, of the posts on this topic... very interesting indeed! I'm a new resident and I've had both good and not so good experiences with nurses, but overall most have been good. They can be very helpful to new docs and I don't hesitate to ask questions of the nurses. I found the nurses on the oncology ward especially helpful during a recent rotation. Some of them still called in the middle of the night with little things, but I didn't mind since I had a pretty good rapport with them. We could usually negotiate over the phone what needed to be done (eg, yes the BP is high but the patient is not symptomatic, so how about you take it again in an hour and call me back if it's not down?)

The nurses that I was not so fond of were the ones in my obs/gyn rotation in med school. The L&D nurses could be quite nasty, and very protective of the patient. I'm sure the care was exemplary, but you do need to be tolerant of the learners when you work in a teaching hospital. From conversations with other students/residents this seems to be a general trend. As students we had to do a certain number of cervical checks on L&D to pass, and the nurses would know this and still not call us when it was time (as one example). Of course, there are always the good ones too, who explain things to you and introduce you to the patient and make an effort to get to know you a bit.

Overall I find nurses to be a great ally. I've had minor arguments with nurses but I always try to respect their opinion.

Gene Queen,
I am sorry you had such a negative experience in OB. We don't have interns in our hospital and the only residents we have (on our unit) are family practice. We used to have OB residents and it was a fabulous experience for us! We miss the OB redients a lot!

I agree that L&D nurses can be very protective of their patients, but on our unit I also know that every possible oportunity we have to get a resident involved we take it (admittedly, we sometimes get so wrapped up in the events at hand that we can forget that there is a resident involved, but I don't believe we intentionally ever leave a resident out fo the loop).

Our patients have all signed a paper in the office during their prenantal course stating their willingness to allow or disallow a resident or student nurse involvement in their care. All of our residents know this and look at the charts prior to visiting a patient. If the patient is open to a resident in their care, so are we nurses.

Over the years, I have seen a huge swing, though. When I first started, I think nurses were less likely to involve the FP residents and more likely to involve the OB residents. Since they have stopped the OB program, I have seen much more openness toward the FP residents and heard fewer complaints that they are not getting enough experience.

I have no problem with any of the residents (as long as they are willing and eager to learn and don't come in with the "I'm the doctor and you know nothing" attitude) and usually enjoy working with them. There's enough work to go around for us all.

IMHO, it's all about who the person is, not their position that determines the treatment he/she receives. I believe that if I treat people with respect, I will receive respect. If I don't, I won't. If someone treats me like dirt, he/she is going to get the same type of reaction from me in defense. It's human nature to be protective of ourselves.

I used to love hospital work (from the medicine,science and patient relationship viewpoint), but I no longer work in the hospital as I found the work environment so negative and hostile. As a resident I was lucky that the nurses seemed to like me ---but I felt I really had to kiss some ass to stay in their good graces ---which frankly sucks. My experience as a med student was a nightmare especially with surgical and L&D nurses ---partly because I am sometimes too nice and got walked all over. Many of the medical students and residents I worked around were treated horribly by the nursing staff for no clear reason I could see. On occasion I would witness someone acting arrogantly or writing a bad order and the nurses would go after them with good reason. But for the most part there was this odd ritual that med students and residents were low class and it was acceptable to treat them like dirt.

Of course med students and residents do some dumb things, but hey, they are there to learn. Nurses make mistakes too. An experienced nurse called me at 4:00 am to pronounce a patient dead. When I arrived I found him alive and well. She was very embarrassed and apologetic. I didn't get upset---it was a mistake.

Once I was out of residency I was treated much better, but my memories don't fade that easily. What bothered me the most was witnessing the older nurses tear to pieces the nursing students ---who seemed so hopeful and excited to learn---but left each day looking miserable.

I did work with some amazing nurses who were secure, kind, knowledgable people, but the not so nice nurses often overshadowed them and made everyone look bad. I am certain some jerky doctors have contributed to all of this too. Maybe I just worked in some really bad places that don't represent the rest of the hospitals out there.

Although I was treated fairly well, I didn't like being around all the negativity and gossip. The patients lose out because there is little team work with that kind of environment and the hospital loses out on some great nurses and doctors.

WHOOOHOOO! Had to jump in on this one. I don't know what took me so long to find it! As some of you know, I'm an RN on ICU step down. I haven't even been a nurse for a year yet!

Well, great discussion. Some I agree with, some I disagree with. I'm not even going to get into the whole BSN vs. ADN thing. :scratchchin: I did not go through nursing school with the mindset: I'm a semi-doctor. I also do not want to go to medical school because I think that nursing is inadequate and beneath me. Rather, I have come to realize that a different perspective on medicine is what I want out of life. This has been an agonizing decision for me because there are SEVERAL interesting areas of nursing that I would like to explore. However, because I really don't want to be a professional student or a Jill-of-all-trades-but-master-of-none, I made the decision that medicine is what I want to pursue.

Well, that's my two cents and I'm sticking to it!

as a female physician and nurse, i see this issue as having a LOT to do with gender roles and power issues. i know how much good nursing staff means to patient care. and i chose medicine partly so i would have more power and independence and pay. could it be women are bitchier sometimes because they DON"T have other power?

if i was still in the nurse role, just how gracious would i be with an arrogant appearing intern who wasn't any smarter than i am but had more power, prestige* and training and earning power. it isn't fair that most nurses are women and in the past, most doctors men, it isn't fair that women do the majority of childcare and household work, it isn't fair that big systems seem not value all the work that helps patients, it isn't fair that as a women i've been shut out of mens locker room discussions of surgical technique AND been resented by female nurses and secretaries for stepping out of typical female roles. it doesn't make sense the way we do a lot of things in our "health care system", but blaming the nurses!!!! (or, conversely, the physicians) seems amazingly off the mark.

*i know, i know that medicine is less prestigious then in the past, but i know how people respond to me differently if they think i am a nurse or a doctor

thanks for the invigorating thread!

I agree with DRHEIDI
Aren't we supposed to be on a team? I also include dietetics, PT, OT and RT in this. The goal here is to help the patient. I truly don't understand MD's who are sooooo nasty to nurses and I don't get nurses who hate docs and say things like "I could have been a doctor but I wanted to go into a caring profession" We all need to work together (don't I just sound like Pollyanna ) and get over our own egos and do the job at hand!!
BTW I'm an MD

Guess I will make a few comments. Nurses are taught out of "book learning" human anatomy, physiology, pathophysiology, pharmacology...there is educational basis to the decisions we make. We were taught signs and symptoms of this, when to intervene etc, but we were not taught when to call the doctor in every single instance that may arise. And lets face it, we were not taught to the same degree or got the same hospital exposure as docs do in their training. It must be realized that if a nurse does not call for something that is "not right" and she thinks it can wait and that it will be okay, and then it ends up not being okay and something bad happens to the patient, guess who is responsible?!--The nurse. So if I ever am unsure of something, it is not my call to think "ohh, it will more than likely be okay but maybe not", it is the doctor's call to tell me if it is--and I as a patient, would prefer this for my own safety (nurse calling the doctor for any uncertainty). We nurses cannot be expected to know what the docs do--I learn to recognize when problems arise, now what to do with it-- the rest is left up to the doc. This does not mean that I cant have my own independence--sure I will initiate things without the docs order because I feel the patient is in immediate danger--but I will only do so if I am certain Im doing the right thing, but ultimately by law Im still stepping out of my bounds. I will give an example, I was working on a medical/surgical floor and some other nurse's patient was blue-tinged, had a pulse and had shallow respirations, (I noticed she was in trouble as I was passing her room). I summoned for her nurse and she told me she had given her morphine recently, she paged the doctor and in the meantime I gave the patient some narcan to reverse the morphine, I thought this may be the reason. Not long after she pinkened up and began breathing better, the doc didnt call back right away and an anesthesiologist by chance had come on the floor and the other nurses directed him to the patient's room. He came and I told him what I did (I admitt I was nervous because I did not know him and how he would react to me having already called the shots)and he said "okay, you have my order." Fact is though, there was no standing order for narcan, this patient wasnt a surgical patient, and I over stepped my bounds by law. We nurses get put in situations and we have to make decisions---sometimes by law and what a nurse feels compelled to do, just doesnt mix--some nurses arent willing to put their licenses on the line.

And about the nurses ripping on med students, student nurses---people really get off sometimes by belittling others. It is pathetic, and when ever I see it at my hospital I address it, I dont care if it involves me or not. It is not right, and I will not stand for it period.

Ok. This hits a nerve with me.

Nurses ARE legally responsible if they give a wrong med or wrong dosage even if it is ordered by the doc. Docs arent perfect and they do make errors. It is our job to make sure the dosages we are giving are correct and question anything that doesn't seem right. Yes, nurses CAN be held liable for this in court.

Nurses are not there just to follow orders. Yes that is part of it but to think that we just do what the doctor tells us to do without any question is just arrogant. WE are the ones there 24 hrs a day monitoring the changes in the patients, talking to the patients, knowing how they feel, what they need etc etc. The doc spends what? 5 minutes with the patient? So when a nurse calls you *REGARDLESS* of what time it is, it is probably for a good reason. If we think something may be wrong and we *DON'T* report it, and god forbid that patient is seriously ill, how would that look? It is OUR JOB to report any changes to the doc or ANYTHING we think needs to be addressed.

I do understand the frustrations with nurses who cant give Tylenol ,etc or use simple common sense. But this all comes with experience. A less experienced RN just isnt going to feel comfortable doing this. I work in L&D and I know that it takes a long time to get a feel for each of the docs as to their personal attitudes regarding certain issues. We have some docs that absolutely 100% DO NOT want you giving the patient anything other than exactly what is ordered. Other docs dont mind if you take a verbal and have them sign in the AM for things like Motrin etc. b/c they trust the nurses to make that call. But some docs just dont trust nurses ( and they make this known!) so we HAVE TO call them. And yes, there are nursing protocols that WILL be followed b/c that is our job and we CAN be held liable if they are not followed ... so if someone calls about a blood pressure at 4 am so be it. That is YOUR job to take calls in the middle of the night.

To say that nursing doesnt require critical thinking skills is an arrogant and antiquated way of thinking. We all went to school for a long time, no one went to Kmart and applied for a license, and we have all taken state boards....so give us some credit where credit is due!!!

That post hit a nerve with me too, being an RN in my former life before med school. I think in med school we should really be taught about healthy nurse/doc relationships. I have a friend who is an ER intern right now and I can tell he thinks he is so smart. If he were really smart he would relaize that the night charge nurse who has been there 25 years probably will have a cooler head and know what to do when the crap hits the fan before he does. Man this subject gets ME going.
Here is a good example. I was caring for a patient in the recovery room a few years ago. In the midst of his stay his EKG changed. I thought, "probably A-fib". He had a history though he hadn't been in A-fib for 20 years. So I called the float anesthesiologist and he ordered a 12-lead. It showed A-fib. So my point is, if nurses weren't supposed to think critically or assess their patients then that patient would have gone home in A-fib, because if only the doctor's assessment was done and nurses just acted as order doing robots than it would have gone unnoticed.
And patients in the hospital get assessed by their nurses every 8 hours (or more if in critical care), some of those docs are in the room for 5 minutes or less not even every 24 hours. I think the nursing assessment is a very important tool. However I think that doctors and nursing notes should be together because we are after all a team.
There are bad nurses and good nurses. And bad docs and good docs. I don't want to call you at 3am as much as you don't want to get called, but if I am unsure, I'm going to call. We have to because we can't read your minds. I would for sure give the tylenol for the headache even if it was ordered for fever though. Who cares? Its tylenol If you don't want to get called at 3am for every little thing write orders that give nurses som wiggle room and choices to get to what works for your patients. (like always write for tylenol a sleeper and an anti-emetic and a stool softener and write at what fever above you want to be called) One doc was always getting called when his patients were having fevers at all hours of the night and he finally wrote on his standing orders "Don't call me for fever unless it is >103!!!!" Problem solved.

Exactly my point as far as being called in the middle of the night. We dont enjoy calling docs at 3 am, really, we dont. But sometimes we have to. And to be quite honest, if they get mad at me I dont care. My concern is the patient and not whether thes docs are losing sleep. The nurses are up at all hours of the night not getting any sleep and we dont make half as much money... so suck it up, its part of being a doctor! If you didnt want this then you shouldnt have gone to medical school.