I started this thread off of another topic, so hey docs, nurses, and all others, what do you perceive what a nurse does.....what a doc does....similarities, differences, and why, sometimes, is there animosity between those 2 positions?

I am an intern in internal medicine. I perceive doctors as the "order-givers" and nurses as the "order-doers." I don't understand what requires such "critical thinking" with regard to nursing duties. Doesn't the nurse just do what they're told?

Please educate me.

Im glad you responded, and wasnt afraid to say what you really think.
Yes, it is true that the docs/residents order medical interventions and the nurse carries them out but oh yeah, nurses have to critically think, let see, what would be good examples.....
1st off, education wise, nurses have to take anatomy, physiology, pathophysiology,pharmacology,microbiology, know what and generally why medical interventions are being ordered, it goes more in depth as far as pt diagnoses and what's involved in the patients care, we have to know signs an symptoms of medical things, educate patients to watch out for such signs, and what preventions they can do to sustain good health. Did you know that if you ordered the wrong doseage of meds, and the nurse gives it, he or she is responsible for it by law? I have to know I am giving a correct dose, and if you order anything I think will harm the patient I dont have to go along with your order?
If I have a patient in with abdominal pain with RLQ abdominal pain and the pain suddenly stops and the abdomen is rigid----I better alert the doc---this means trouble-possibly ruptured appendix. I have to be able to read telemetry monitors and know I am right about what rhythm this patient is in when I call the doc and he gives me an order for a cardiac med to treat the dysrhythmia, if I am wrong, if that patient is given certain meds and I have the wrong rhythym, I can stop the patients heart from treating the wrong rhthym, with the med. When I have 2 patients going down the tubes I have to be able to 1. Know the early signs of the potential complications to be able to prevent the patient from becoming unstable by calling you, when I notice such 2. Know what to do while waiting for you to answer back 3. Prioritize, know which patient needs the more immediate attention, and at the same time handle both. 4. I can code the patient without a doc being present (I am ACLS)
So there is a lot more to it than a lot of people think. Sure we have to pass a buttload of meds, and wipe a butt or two, but it is not the only thing that is expected of us. I hope this helps. I really had no idea that residents, some docs, thought differently about nursing.

Okay. Let me be honest, as twisted as my views may be. :guilty:

No, that's cool, I like honesty. We are all adults here, and we can handle it.
Yes, I agree too about the giving the drug thing, I dont think the nurse should be accountable for the drug, but it is the law, because the nurse gave it to the patient. So any dose I know nothing about, I have to look up, or trust that the doc and pharmacist knows what their doing, since they know more about that stuff than I do.
It does matter that we have to know the symptoms of things, if I was so dumbfounded not to call the doc for certain things I need to be watching out for and miss the big clues, I am basically causing the patient harm, even death in some cases.
Yeah, all those nurses doing bull crap like that, calling for something stupid that can wait makes the rest of us look bad. But please dont think all nurses are mindless because of them. I think that is why, in part, docs dont take nurses seriously when something is going really wrong, (from my own experience), and think all we do is pass meds, start IV's, and wipe butts.

What critcal thinking do you guys do? What is your definition of critical thinking if you dont think some of my examples are? Sure generally, nurses dont have as much of an intellectual challenge, but doesn't mean they dont have to critically think. Would you like it if I let one of your patients go down the tubes, when I should have known to call you based on his symptoms? That is not thinking- it is being incompetent.
Or would it be okay, since we just pass meds, and wipe butts and aren't required to think?
And yes, if you order something that I think will harm the patient, NO, I dont have to give it, I dont mean an ethical conflict, or potential complication, but just as there are nurses out there who you wonder how they got their licenses, there are docs like that too.

If a patient codes on me, and a doc's not readily available, I can begin ACLS, shock, give meds, without a doctor's order. Of course, not any nurse can do this, one must be certified.
Good debate girls!

hmmm...I think I'm beginning to more fully understand.

One additional thing that has kinda bothered me. It seems at if nursing school teaches it's graduates that *they* are the patient advocate, and that docs are uncaring, and lack compassion. It is therefore the nurses duty to provide compassionate care, and be the "patients advocate."

Against who? The doctors? I hear nurses telling docs all the time how *they* are only fighting for the patient....as if doctors don't. As if doctors are uncaring assholes who lack compassion, and need an intermediary to protect the patient from themselves. That ?nursing philosophy is offensive. I care, *I'm* a patient advocate, I am compassionate!!! To imply otherwise is completely misguided.

Why do nurses dislike MDs. I hear them, Dana, I hear them on the medicine floor, I hear them in the CCU, I hear them dissing the docs. They don't like us.

Hi PreMedRN -

I am a fourth year medical student, and I am kind of surprised at the way that Mackayla and Myimd responded to your post. They really do seem to have a very stereotypical view of nurses. :rolleyes:

I know that some nurses DO page docs for things that should be obvious. But wouldn't you rather have a nurse page you just to make sure - rather than never page you at all, even for something serious? And, while it's just one nurse paging you, there are many other more experienced nurses doing their jobs - and d :censored: well - without having to page. So don't think that all nurses are like the one or two that annoy you.

And nurses DO have a great deal of power over what happens to patients. Realistically, who REALLY knows the patient better and has the most influence over the patient? The nurse. It isn't as easy as: the doc writes it, the nurse does it. That would be like telling someone, "This is how you care for a new baby," then leaving, and expecting it to be done exactly as explained. The nurse has to get the orders done as best as can be - given the situation (i.e., crises that arise, uncooperative patients, uncooperative family members, etc. etc.)

I think nurses are invaluable. THEY are the ones who are really in the trenches. They are an excellent source of information, the watchful eyes who see the moment-to-moment changes that occur in the patient throughout the day. They can tell you what the seizure looked like, what the patient's mood has been, how is the family handling the patient's illness, has the patient been asking for lots of pain meds? THEY administer the drugs, bandage the wounds, comfort the anxieties. I wish that doctors could do a little more of this more personal type of care!

Anyway, PreMed RN, you sound like a great nurse, and you will make a great doctor one day! (I assume from your name that is the path you are on?)

-Andrea

As I progress further and further in my career, I realize the importance of a good RN on your team!! In the ED the difference between a good RN and a "not so good" RN is astronomical! A good RN has your back, truly. (S)he is there with you, working. While you get the subclavian line, they are working in the antecubital area. While you are thinking of your *next* intervention, they are analyzing the *current* rhythem on the monitor, and has the correct antidysrhythmic in hand before you even ask for it. While you're securing the airway, they are placing code paddles on the chest. While you're running around, confused, they are there to comfort you (since, at this point in my career, I'm usually the novice in the group). They are there to answer all of the family's questions, and divert controvery away from you with regards to the family...thereby protecting you from drama (so you can continue to save lives)!! They are there to place the foley in the perverted PCP intoxicated teenage male who's pissing and swearing to everyone. They are there to place the NGT in the screaming toddler who ingested grandma's pills.

They are there...with you, working side by side. Without them, you'd be SOL. People would die, care would be delayed...afterall, you cannot be everywhere, and do everything, all the time. You need competent nurses around you to be successful in this business.

I used to think that way Andrea. Next year this time, reaccess your feelings and see if you still feel the same way. I used to see nurses as heros, and even envied their jobs because of the bedside care. My mother and father are both RNs and I thought very highly of their careers. And I do (really I do) understand that it's the nursing that makes the difference in the hospitalized patient. The nursing is what they remember, the nursing is what they complain about when things go wrong, and nursing is what they praise when they have a good experience (in addition to the doctor of course).

The reason I stated my area and level of training is so that all can take my perspective with a grain of salt. I am a newbie, and I don't know, really. My experience is so limited, but it's how I feel now.

I can appreciate what PremedRN, and Mya are saying. And now, I have a better idea how a good nurse is a critical thinker, being one step ahead. But, my experience, (obviously) hasn't been with "good" nurses, I guess.

Yes, in nursing school they do teach about nurses being the patient advocate-that's a BIG one. We were never taught to dislike docs, or even that their relationships are sometimes hostile ones believe it or not. I think the passionate thing comes in because the nurses are often times, (more so the aids) doing the physical care, like putting cold wash clothes on foreheads etc.

I think just like your previous post here, how some nurses do stupid things like a 1 am constipation order, makes other nurses look bad, some docs are just plan As_holes, snooty, better than thou, and no matter if you are calling at 1am to tell them their patient is having significant ST elevation with chest pain, they are still crappy. This makes docs look bad. Im not saying it is fair to make such generalizations. I am not bragging on myself, I think I am pretty competent as a nurse, I have NEVER called for stupid crap in the middle of the night and yet I still have problems with a very few of the physicians I deal with, and it is not me, it is them. I think sometimes they are soo worn from what it takes to be a doc they are just sick and tired and take it out on the nurses and remebering the stupid calls from some nurses when they are in that mood makes it even worse. But for the most part, I have good relationships, with the docs at my facility.
The majority of the docs will ask me if I have any concerns, what the patient is like today-especially the IM's who are on call for 3 docs and is making all their rounds.
Want me to tell ya a pointer to score bonuses with the nurses (if you care)?
When you are done seeing the patient and the nurse is in the room and the patient is slouched down, ask "you wanna help me give the patient a boost up in bed?"
There's a doc who did this while I was in the room, and it made me feel great, about the patient, the doctor, and me. It show consideration for everyone. The doc's will even pick up the phone sometimes when I cant make it and say "3rd floor, Dr. Smith". Mind you, this doc wont even be a hospitalist, just doing his rounds and leaving.
I can tell ya, as a new, young, nurse, I was intimidated by the docs, with experience, and as I grew to know them, they are ordinary people with jobs, and lives-----I am so very comfortable.
Oh yeah, as far as the nursing assessment, I dont know, we have to assess our patients on my floor every 4 hours and document, nobody cares, docs never look at it. I think it is just to cover our butts, to show we are monitoring our patients. Dont know why it matters so much in court.

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

A good nurse can make your day- a bad nurse can ruin it...and I am very thankful that I am so...appreciative of good nursing help ( after reading earlier posts)...and I happy that I far enough into medicine to NOT just see them as "order-doers"....
and RN's are liable for carrying out orders that were wrong ( not to the extent the doctor is but they sometimes have malpractice ins also and can certainly be called to court.)

myimd,
I was just rereading the posts, and I misunderstood you, I had thought the hypothetical situation that you gave was tylenol ordered for fever only. Sorry. In that case, there is really NO excuse for that nurse. It doesnt make sense to me either. :scratchchin:
HA definately classified as a pain. But MOST nurses wouldnt call you for that. At least none of the ones I work with.

Just so you guys don't think I'm an arrogant bitch, let me say that I'm kinda playing devil's advocate for the sake of discussion...and also because, as an intern, this is how I felt towards most of our nurses at our hospital. As I progress, I'm halfway thru the 2nd residency year now, and the nurses call my intern before calling me, I feel a bit differently. That filters the BS, and I'm so judgemental anymore. When *I* get a call from the nurse (now) it's the real deal - that means my intern didn't know what to do.

When I first started my internship, I couldn't for the life of me understand *exactly* what nurses did...outside of the obvious IVs, cleaning beds, and answering phones, etc. I didn't really know how to write an order, and didn't know what was *appropriate* for me to order. Do I order "turn the patient q2hrs...check vitals at least once per shift?" Do nurses "set up" the central line tray for me? Can I *order* that they do it? Some things (I learned) were actually *ofensive* if you write an order for it?

At our hospital (where nurses are completely outta control with their power seeking), and even the patients constantly complain about the quality of their nursing care, it *is* difficult to see past it. :yes: It's to the point at times where you haveta say, "look, if you want to make the decisions, go to medical school, but until then, it's *my* way." I find, as a young woman, the nurses treated me with less respect, questioned all of my orders, rolled their eyes, and seemed (basically) jealous of my position. They didn't even call me "doctor" at times, using my first name, or calling me "Miss." They don't threat the fellas that way...ever!! I see this, and it offends me.

I'll admit, the lack of understanding (therefore appreciation) I had for their duties set me up for a hostile relationship with the nurses. And the fact that I'm a woman probably does provide too much estrogen on the healthcare team. But, that's why I hinted to Dana that this would be a good discussion...because I can't be the only new, female doctor who feels, or felt, this way. And if the more experienced docs, and nurses, could shed some light on this topic, young docs like me would greatly benefit. :yes: (I think med students would appreciate this discussion more once they are housestaff. I've realized that as a premed/medical student I had kind of a twisted view of things - not much pratical experience on which base an opinion on...but here we go, another topic ).

Haaaa, I think we all add a little extra estrogen to the halthcare team!
I heard that nurses can be mean to med students/interns. I thought that it may contribute to some of the less than pleasant relationships between some docs and nurses.
Sorry that you had to experience such disrespect. There's no need for it. I think people who behave like that are insecure in themselves and sometimes do such things because they think some how it compensates for their own feelings of inadequacies. And I also see nurses who think they know it all. It irritates me as a fellow nurse, because they may not have the foggiest clue, and just because you know a little about the med field and a whole lot more than a lay person, doesnt make you comparable to the doc. So I can identify with you on that one. Im not from a very large hospital, but we maintain mostly prof. relationships with the docs, meaning no rolling of the eyes. Women can be very vicious toward one another. I like my docs who are woman.
==Dana

What an interesting discussion. PremedRN you are such a great debater this could have easily turned in to a flame war but didn't, what a pleasure to read

I think Myimd has made an interesting point, with the remarks that she percieves the nurses as being disrespectful and "almost jealous" that the doctor-nurse relationship between women is still being developed becuase until recently women doctors were few and far between. I have seen this dynamic in other women hierarchical relationships as well. Some of this I wonder is the changing of the professions, nursing is being recognized as a more dynamic profession that emphasizes more knowledge and critical thinking than it used to. So nurses are fighting for more respect from docs, male and female. Meanwhile, women docs are striving to earn respect in the workplace, not be mistaken for a nurse, etc, and also coping with the fact that medicine is moving towards a more team-oriented approach. I wonder if the combination of those two might cause some friction...

I think that also managing people and learning to utilize them is a skill, one that unfortunately is not taught in medical school. However I think that that is something that you really start learning on the job. Some people are naturals, others take a little more work. So I am sure there is a learning curve there... some people of course never quite learn it!!

Elma, yeah, I maybe would be a better lawyer than a doc (Just kidding of course!) I try to keep things civil, there is nothing wrong with effective communication.
What you mentioned is probably part of it too. I just think, generally, women are more competitive with each other than men, or at least they show it better when they are. Im sure others dont feel the same way on that as me. Males in nursing is become more and more common too, and one thing I notice is that the male nurses dont take as much heat from the docs (both men and women) as female nurses do. What is up with that? I guess that is another topic.

As far as the intern and nurse relationship, I am starting to wonder if they are intimidated by the nurse's knowlege, when they have been through med school and feel they should know or be confident in knowing more. Surely they arent expected to know everything, they are just "babies".
It is a shame that med schools cant learn the student the role of each healthcare member when providing inpatient care, and just the norms of things. I think I will be ahead of the game in that arena when I get to that point in my life.

And now....thoughts from a new nurse!

Just like interns, new nurses make a lot of mistakes, too! I do admit, I did call a doc 4 times one night (the first night off orientation .

I think you are right in that many nurses have an "I must prove myself" aura about them. They can be incredibly catty, backstabbing and cruel . I think a lot of this stems from being a female-dominated profession. Also, there is not much opporunity for advancement in nursing unless you get an advanced degree. I have the same job and almost the same pay as nurses who've been there 30 years. No wonder they feel threatened by upwardly mobile young women such as ourselves.

Nurses are also *WAY* overworked. Who can possibly take care of 10 patients at once and do a good job--especially if more than one is crashing :yikes: ?

Oh this is long. I'm going to stop now. Flame me if you will!
amy

Hey amysunshine, its about time a fellow nurse arrived to add some input! :wave:

Did you ever think some interns/residents only thought you were just an order doer?

Im just curious. It is hard for me to understand how this comes about after spending many hours in the hospital even with the silly calls from some nurses and not totally being informed during med school of the totality of inpatient care. Surely there has been nurses who made some good catches/calls. If all we had to do was the physical things, I wouldnt think one would need a degree, but only an apprenticeship so to speak.

What are your thoughts?

And this is why I am going to probably end up in a mostly male dominated field...there is way too much backbiting and bitching going around when you get lots of females together. I get along much better with men and even though they can also be catty sometimes they are not as likely to be jealous of you. Some women are just awful always on the defensive and often times putting you down because of what you have or have not accomplished for that matter. Being prior military proved this to me...

efex, I totally agree with you! I get along with men much better than with women, and the estrogen is killing me!

Dana, I don't see too much of the "order doer" mentality. Most of us nurses are friends with the residents (you have to be--they're on call q3d!). Usually if I call for something, they say, "so what do you want"? And i'll say, "can we try 20mg of lasix IV x1 and if that doesn't work in an hour or two I'll call you again?" and they'll say "sure" or give me a different order.

However, the worst trouble I get is from FELLOWS! By far! Ugh! One fellow wanted me to look up a radiology report for her and tell me what it said. Sure, that's fine. However, since it was not up, she wanted me to call radiology, listen to the dictation that wasn't transcribed yet, and then report back to her what the findings were so she could give me an order. WTF?!?! I gave her radiology's # and (very politely) told her I was too busy to spend 20 minutes listening to dictation and gave her radiology's number. I had another cardiology fellow get upset with *me* for calling him because my pt was having an MI! No pain, but she was female, throwing up, ST changes, positive enzymes....but because she did not have crushing chest pain, this (male) fellow thought she didn't need any more intervention. grrr...I ended up calling his superior and she was started right away on nitro and heparin and scheduled for cath lab. Indeed, anterior wall MI. hm... I felt bad for going over his head, but I felt justified that time.

These are usually rare occasions, though. I think I get along well with the medical staff . There are definitely many times when *I'm* wrong, and they let me know, too. Hooray for teaching hospitals.

amy

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.

I've been pretty lucky in my relationships with the nurses, they really have for the most part deserved the title "professional" and all of the benefits that go with it. I have found the same problem with the night shift nurses, and a few in particular. I finally got crazed one night and spelled it out for a particular nurse much in the way that Taurus did in her post "I started rounding at 6 am and you were here...then you went home and I did cases in the OR all day...then you came back and I was STILL here...and in the morning when you go home AGAIN, I will be back in the OR doing cases...THEN I will get to go home...for 8 hours until I start the cycle again.And while you get a day off once in a while, I DO NOT, so please give me as much rest as possible!" She said (? prentended ?) that she didn't know that was my schedule and to give her the benefit of the doubt, things DID improve after that little rant. I'm lucky though, I can fall asleep anywhere, and I found that if I would pull a cardiac chair next to my most critical patient in the ICU and sleep there, I would NEVER get bothered...it was only when they couldn't actually see me that I would start having problems.

Again, overall I have had very good experiences with nurses and have actually learned a ton from some of them. I have found that if I include them to some point in the discussion/issue at hand they are far more willing to respect my authority. Just my 2 cents. I also think that a lot of the nurses were so pleased to have a female surgery resident that didn't treat them like dirt or have an explosive personality that we got along!

Taurus, I AM in a teaching hospital! hehe :rotfl: I started out (as a GN!) in ICU and loved it, but my hospital's making cutbacks and I was sent to the acute care for the elderly unit (ick!).

I love the replies--keep them coming!
amy

myimd,
Referring to one on your previous posts,I cant relate to any situation of my own having to do with charting against docs. If I notified a doc about something, I MUST chart this, regardless if orders were received or not. By law, if I dont chart it, I didnt do it. Can you ellaborate one this issue?

A seperate reply to a previous post:
No, just because doc make money doesnt mean they deserve to earn their money by answering stupid 3 am calls. But one has to know this will happen. Sometimes nurses call with appropriate things and the doc on the line will still have a crappy way about him (note, I have NEVER had problems with the female docs). My thing is, in this circumstance, if you dont want to be paged in the middle of the night you should have A)picked a specialty you would be paged less B)Reconsider your postion as a doctor. Plain and simple. I feel like lets get past the personality issue, and deal with the real issue at hand.
Somehow from previous posts, I am getting the feeling that some of the nurses at the teaching hospitals take for granted that they are always there to handle anything, even the BS, and what does it matter to call them? Not the way I necessarily think. I also think it appears to be like a power struggle to gain the position and respect as a doctor even though one is in training. I dont really see this at my nonteaching hospital. The docs there are done with training, and confident. Many times I have mentioned things to some of the docs as a nurse, and they well tell me whether I am wrong or right, and even tell why. They dont see me as a challenge. They see me as an interest in learning.
Sure the doc is the leader in prescribing medical interventions. And is there a reason why those nurses dont trust the interns, or residents? I ask, because I have a friend who does work at a teaching hospital and sometimes talks about how some of the residents dont know their butts from a whole in the ground. I dont know if that was a profound judgement or not. But it makes me wonder.
I think too, like I had posted earlier about how patients demand to talk with, or me call in reference to their problem--that yes, I will have to address it. If not a) I could, and more than likely be reported to patient care adm, and second of all, if they are tha raulled up despite trying to apease them, more than likely the nursing supervisor will some how be involved and Ill have to call the doc to please the patient anyway. Believe me on this one.

I think premedRN is right. I worked in a community hospital and a teaching hospital, and the nurses call about EVERYTHING in the teaching hospital. They do take it for granted--one nurse (in the teaching hosp) told me, "I don't have a problem with calling them in the middle of the night. It's their job" and I think she mentioned something about a learning experience for them. I hope that doesn't happen to me in residency!
amy

amysunshine,
what you just said validates my thinking. Maybe it is not an issue of whether those nurses doing that arent critically thinking or arent able to, it is just they dont CARE to. Their mentality about the issue doesnt seem to allow them to be considerate. There's a difference between not choosing to critically think, and choosing to.
A lot of the above mentioned calls, I think, happens more at the teaching hospitals. Not to say some calls will happen at a nonteaching, but I have never known of someone calling a doc at home to especially at 4 freaking am to renew a MOM order. That is CRAZY. I think nurses are getting a bad name from unrightful generalizations from some of the nurses at the teaching hospitals. I think when the docs are done with training they will see what REALLY goes on as far as what a nurse does, and should have been doing.

I'm sure you are right, my thinking will no doubt change some once I'm done. And I do realize that not all nurses are incompetent...and I don't doubt that many doctors are. So, I guess my gripe is more with *our* nurses, than with nurses in general - as I am strongly against over generalizations. But, given the experience of some of us as interns/residents, it's no wonder the nurse-md relationship is less than rosey.

I think that the nurses who truely have their patients interests in mind when they perform their duties are obvious. Most of the "gripe" we young physicians have with the RNs is when they start "doing things" just to cover their ass at the expense of the rest of the healthcare team and the patient. We have nurses who chart all night but *never* go see the patient. Their charting is pristine, but the patients are miserable and the doctor is frustrated (because of bogus calls, because orders are left hanging, because the nurse wants so *document* she called the MD, not because it's a pressing medical issue present. And ladies, this happens more than you realize.

But thanks for your feedback (everyone) this is a wonderfully enlightening thread

Yeah, it is the opposite for me, I am always finding myself trying to chart at the last minute so I can go home. It seems as though the way hospitals have now, if we did everthing perfect and done the way they want things done, there would be NO patient care. In addition to the normal horrendous task of what we have to chart, my hospital mandated that anytime we pass pain meds, it must be charted in the computer--WTF!!!!!!! Shouldnt putting your initials by the med on the med sheet with a space beside it to check after you have followed up on whether or not the pain was alleviated be good enough? My goodness. REDUNDANT. I cant imagine the time constraint the surgical floors are now faced with. I guess what I want to point, is that some nurses probably do that (mostly chart instead of patient care) because they dont know how to multitask and get both things done, or they are just plain lazy and ought to look into secretarial work. When I went to school, I had NO IDEA there would be as much paper work involved as there is. Yuk. But as for me, Id rather slack in the paper work, and provide good patient care.

Wow, this discussion has been amazing. In the sense of how much was brought up. I am a RN in the field of Public Health. I can admit that I went into nursing because I didn't have the confidence, nor the finances to go premed in undergrad. I am jealous as all heck for the people who could afford to go to med school right out of undergrad. After 4 years of nursing school and learning all that "theory" I feel no more confident about the technical "skills" part of nursing (I gave one heparin shot in nursing school). I realized that most of the "skills" must be learned on the job. Now, 4 years into public health and policy, and forgeting any skills that I did learn, I want to know more of the whys to medicine and don't feel that nursing will be able to provide me with the depth I want.

I applaud amysunshine and PremedRN, your careers seem very exciting:)

~Katie

Really? I gave heparin shots, IM shots, did gain experience in clinicals--but yes the more technical equipment operating skills are learned on the job. But I think most important is that nursing school made me competent enough in my decision making/judgement, not everyone in my graduating class felt the same however. Im an associate's degree RN, and to be honest, having a bachelor's will not make me a better nurse as far as making judgement calls, etc. Which is kinda what turns me off about getting the BSN for med school. Im in Liberal Arts divison now.

There should be some major communtiy-wide campaign to NOT CALL EVERY FEMALE WALKING AROUND a "nurse" ....
and I will admit to slipping and calling my office medical assistant a nurse once in a blue moon...
but RN's are most def different from LPN ( although some of those are xtremely useful), and assitants...and CNAs (!!!)

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.

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.

There are lots and lots of problems with any occupation. Instead of accepting things "as they are" and "sucking it up" because you decided to become a doctor...you should work to change the way things are done to improve everyones experience. So in the end, solution is not necessarily "suck it up."

At many teaching hospitals residents are abused, by both faculty/staff and nursing staff. Residents are overworked, female residents are harassed and made to feel guilty about having babies and breastfeeding, etc. Should we as women doctors say "well, this is what I signed up for...I guess I should just suck it up?" No, we fight to change an antiquated system. A system that's male oriented, and sexist.

In the same way. Young physicians and nurses need to learn more about one another...and appreciate what the other is going thru. With this understanding, things will get better for all involved...nurses, doctors, their families, patients, and their families.

I'm not disagreeing with your post...I just think the last line...should be used with caution. Afterall, that's what's said to young doctors as justification for abuse and disrespect.

If you read my whole post, I stated that there are some bad nurses out there, and some who cant seem to think logically. So of course there are times when docs get called at 4 am for no real reason. When I say " suck it up" I am referring to the docs who are just annoyed at being called PERIOD. Regardless if it's a legit call or not, some docs are just mean. I have had coworkers ask me " call you call Dr so-and-so, he is always mean when i call". There is NO REASON any nurse should ever be afraid to call any doctor for a legitimate reason , no matter what time. Believe it or not there are some docs out there who still have the "I'm God" attitude and treat nurses very badly.

I wasnt directing that statement at all doctors. You are SO RIGHT that we all need to be sensitive of each other's needs.

Here is an example:

An Obstetrician was talking about sleep deprivation at the nurses station last week and all the night shift girls ( myself included) were of course weighing in on it since we all get no sleep either. So I said to him " well at least you guys can sleep in the call room, we arent allowed to close our eyes at all!" I meant NO HARM to the doctor at all. I was stating a fact. They get to sleep a few hours, we dont. SO he proceeded to go into how " yeah then after being on call all night I get to go to the office and SAVE LIVES". Ok what kind of office do you work in that you are saving lives? I pointed out to him that #1 I wasnt attacking him so please dont attack me, and #2 you DO get to sleep several hours even with a laboring patient on the floor b/c we call you when we need you and let you sleep the rest of the night. Another nurse pointed out to him " these girls get to go hom after being up for 24 hrs straight and then take of their kids all day". He again said " yeah and IM SAVING LIVES". Ok buddy. Whatever. THAT is the attitude I am talking about... I'm the doc, youre just a pion. No one was attacking him, yet he HAD to make the nurse look insignificant compared to his LIFESAVING doctor status. I ended up saying to him... listen, we ALL have to be up at night and it sucks any way you look at it, and we are ALL losing sleep. He again mumbled something under his breath and walked away. If he would be sensitive to OUR issues , we could easily understand HIS issues.... but he just doesnt care about what the nurses go through!

I've just skimmed through this discussion, but the idea of respect jumps to mind as I read of others' experiences.

I, too, got a lot of attitude and grief from many nurses in residency and med school. (Interestingly enough, as a female, I was often treated much more poorly by the nurses than my husband who was a year ahead of me... And I am a NICE person who never treated any nurse rudely at any time.) On the other hand, I also had invaluable experiences with many nurses (especially in my OB rotations). I really learned a lot from many nurses, once they saw I was just there to work and learn and not be a jerk to them.

We just need more respect in the world in general, and definitely in medicine. Whether you are Christian or not, the "treat others as you wish to be treated" applies everywhere! I really think those individuals who treat others like dirt are acting out of their own unresolved issues...they are unhappy in life, issues at home, unresolved problems, frustrated, etc. We've all seen the attending who tears into the student or resident and seems to live for belittling others. I feel sorry for those individuals and wonder what in their experiences has made them so bitter/unhappy/miserable to treat others this way.

My mother used to tell me as a little girl, "It's nice to be important, but it's more important to be nice." It sounded a little cheesey at the time, but I've lived by it and it's worked for me.

PS: I think we need to remember that medicine is a TEAM project. I could probably work without my nurse, but it would be a miserably difficult experience and I'd accomplish little. Likewise, she would only get so far in her day if I wasn't there to see the patient! I make a point to NEVER say that my nurse works FOR me; she works WITH me as a partner on a level playing field. And we are both working for the patient's best interests and well-being.

mom1st-
I think that you hit on a good point. Your attitude about us being a team is an excellent one to have, unfortunately not had by too many people on both sides of this issue. When I worked as a nurse I always used to say: Hospitals exist because patients sometimes have MEDICAL conditions that require NURSING care. That is the entire premise of hospitals, neither part functions without the other, you hit the nail on the head.
-Plum
PS-I can't stand nurses or docs or RTs or PTs or whoever that think what they do is more important or deserving of more respect than anyone else. I am a firm believer that all of our works have interent worth, no matter what it is.

Being an intern and a nurse during her shifts is WAAAAAY different. Sure nurses arent getting sleep on the night shift but many of them most of the time get a decent amount of sleep before coming in and have more days off. So I dont know that I would have argued the loss of sleep issue: RN loss of sleep va Intern loss of sleep. At least the nurse on nights has the option of changing her shift. Interns dont have a choice.

One thing I dont agree with is the "IM SAVING LIVES", uuuuhhh, dont nurses do the same? I cant tell you how many times I started running the codes at my hospital (nonteaching) b/c the ER docs couldnt make it up to the code right away (Im ACLS certified). And one doesnt have to actively participate in a code to be saving lives. How about the many times nurses have identified a patient going into ARDS, or Heart block, or SVT? Without noting such by the nurse many of these patient would have died but no!! The nurse observed and identified and alerted the doctor! The doctors cant be at all the patients bedside 24/7 so largely the nurse definately is the eyes and ears of the doctors.

And my goodness YES. There are doctors who will be irritable no matter the call. I had a 28 year old not long ago who had a hx of diabetes, hypothyroidism, and was morbidly obese. She was admitted with chest pain and bradycardia. The cardiologist who admitted her was not on call after he admitted her. Her heart rate on admission was in the high 40's. Now I am quite aware that when one sleeps, usually the HR lowers. This patient's droped to 30. I awakened her to take her blood pressure and to check on her. She said she was a little SOB. I called the on call cardiologist and he basically thought I shouldnt have called. He wasnt extremely rude. He went on about how patients can go into heart block while sleeping, I was like "You as a cardiologist may know this, but I am a RN and I dont have the knowledge base to call the shots." He said okay "Dont call unless her heart rate drops to 20 for greater than 3 minutes."
I didnt feel comfortable with that, buy what do I know, Im no cardiologist!! It is not like this patient was an athlete and just has an overall healthy heart that can beat little and perfuse well. I thought maybe it was due to her hypothyroidism, but there were no labs ordered to check on that. Anytime I feel the patient is threatened Im going to call!

I have to disagree with nurses getting sleep before they come to work. Most of us on nights are there b/c we have small children at home... so we get NO sleep during the day b/c we are up with the kids early in the morning, then go to work all night. Many of the girls I work with then go home and stay up ANOTHER 12 hrs until they can finally go to bed when their husband gets home... so its something like 36 hrs without sleep. And we cant always change our shift.... like I said, many have small children so that is why we work nights to begin with.

I agree with everything else you said... and since youre a nurse you can see both sides of the coin!

I do see your point about nurses with little ones. But usually daycare is an option to get sleep. Losing sleep verses finding a sitter to get some sleep is often times a personal choice. No choices for interns/residents--and to many of them, 3 12 hours and 4 days off sounds awfully sweet. My friend does nights, her husband drops them off at daycare in the morning, she sleeps then picks them up.

Yes I do have my kids in preschool so *I* can sleep AFTER I have worked an dbeen up for 24 hrs straight.I dont get any sleep before I go into work though. But a lot of people cant afford daycare costs even if they are working.Despite what people think nurses do not make that much money. I paid over $800 a month to have my kids in preschool PART TIME. A lot of people cant afford that. I am lucky my husband makes more money than i do, but a lot of nurses arent in that boat.

It sucks for ANYONE having to stay up all night, and we all knew what we were getting into when we went into this profession.

No doubt that it does suck for everyone who has to stay up for hours but just because a person chooses this profession or that doesn't take a way a person's right to complain/vent. I would never think to say "suck it up" to an intern, doctor or fellow nurse no matter the differences in pay-that's irrelevant.

Again, I do see your point. I still dont think one can compare a nurse not getting sleep working 3 12's, 4 days off and an intern working most days of the week and taking call q 2 or 3 days staying up all night for the most part, and regular hours being 12 hours + in between call plus having kids at home. Now, this doesnt means nurses dont have the right to complain about how much sleep they lack due to childcare issues. Dont we all need a little empathy?

In all honesty, I havent met a nurse yet that could not afford daycare. But I bet there are some who are in certain situations who for some reason cannot.

Yeah, nurses dont make as much as FPs (at least where I am at) but the pay isnt shabby comparable to other fields. Per diem makes 55-60K full-time, where regulars probably would make 38-43K--that is assuming no weekend packages.

ALOT of nurses cant afford daycare. LIke I said, I paid over $800 a month for PART TIME childcare. I am per diem on labor and delivery and I work about 32 hrs a week and last year I made under $50k. I dont think that is much money considering what we do. We have a lot of respnsibility not to mention liability and we make about as much as the men you see collecting your trash on trash day. Yes, trash men make about as much as a nurse, at least where I live they do.

Having to stay up all night sucks for everyone. Yes for doctors too. You are a different breed in that you understand how much it sucks... but a lot of docs just flat out dotn care that we have been awake for 24+ hrs. And yes we have off 4 days a week BUT those days are spent either A- sleeping b/c we were up for 24+ hrs prior to that or B- staying up ANOTHER 12 + hrs until our spouses get home to take over the kids so you can FINALLY go to bed. It's not as great as it seems!

All of this being said... I still wouldnt be anything else in the world if I could choose another profession :0)

As an RN, I have to chime in here...

Doesn't doctor's and nurses have different philosophies, different goals? Nurses don't want to become doctors just because they don't want to go through so much school and spend so much time working. MDs and RNs are working for the same patient, they are just doing it in different ways. As an RN, previously, I didn't used to care about WHAT was making them sick, the scientific WHAT. The MD decided that, with my input, whatever he wanted to make of it. Then he decided how to treat the patient. I am thinking, other than the disease pathology, what made this patient sick? How is this illness affecting this patient's life, and the life of their family? How are they coping? What do they know about their illness? Do they know why they are taking these meds? Can they care for themself? To whom or what do they rely on for support?I had a patient who was in for a CABG. She was elderly, and her husband was in middle-stage Alzheimer's. They both lived home together alone, an hour away from the hospital. Her husband left home almost every day to go to the hospital to visit her, but almost every day never made it there because he got lost along the way and had to call one of their children to come and get him. One day he was lost for four hours before he called someone. He was also a diabetic. Who found this out? Not the MD. Not the Social Worker. The RN. Her family situation was causing her so much stress that that was all she worried about. She didn't absorb any of the information the docs were giving her because she was so preoccupied.

And the comment about the helpful doctors, that is so correct! Pick up the phone if you're standing right there and it's ringing off the hook...fix her stockings, give her an extra pillow. I'm not saying spend all day with one patient when you have 100 of them, but if it is easy for you to do, within your means, and will take you 2 minutes, why not?

In my area, daycare is not as expensive as $800/mo. for full-time, depending on the number of children of course but definately not for one child.

I just don't see why there's any doctors vs nurses issues. As an intern in my 3rd month, I can't say enough positive things about the nurses that I work with. They can be SO helpful if we interns are willing to acknowledge that in some areas their expertise exceeds ours. I think we definitely have a knowledge base that nurses just don't have, but nurses' experience with patients is a resource that can 1) save us lots of time and 2) benefit our patients greatly. Knowledge only gets you so far in treating patients.

linz

I agree Lindsey, but saying is like saying "my parents are so cool, they support me, they have my best intersts at heart...I don't see why other people don't love their parents..."

Obviously, some people may not like their parents because their parents may not be like your parents.

All nurses are different. All institutions are different. At some places, most of the nurses like most of the doctors. The nurses chose to work at a particular place *because* it's a teaching hospital. At other places, most of the nurses hate any resident. It varies.

I'm not saying I don't understand that these drs vs nurses problems exist. I understand very well that they do. BUT if folks could keep their egos in check, then there's no reason that there have to be these kind of silly issues. It's pretty clear what each of our jobs are.

Was just giving the nurses at MY institution some thanks because they help me out a LOT! That's all....

Peace~
linz

quick comment - today in my physiology class, I was talking with another classmate. She asked what I am doing. I said premed. I asked what she is doing. prenursing. She laughed and said we're supposed to hate each other. interesting. just thought it was funny how the negative feelings have trickled down to the pre-years...

Hi,
Just returning to this site after a fairly long break. Also if I repeat something already posted - oops, it's a long thread.

I find this discussion interesting because I have certainly come across situations where I have had enormous respect and reliance on nursing staff and others where I have left the ward after issuing a terse directive "to just do it please" whilst fuming inwardly.

But what I have noted is that it all comes down to respect, professional courtesy and the feeling that you are in a team - for the patient's benefit.

Working in psychiatry I cannot do my job alone. On the whole the nurses have more face to face interaction with my patients, and I seek out their opinion as my management decisions esp. prescribing meds impacts on how they manage an agitated or at-risk patient. They then feed back how my patient is progressing due to my decisions. The nursing staff rely on me to keep abreast of the issues, co-ordinate the care of the patient's physical well-being/Mental state and medicate them sufficiently to treat them, relieve their suffering/torment and keep themselves, other patients and staff safe. With the common goal of returning the patient to functionality and living in the community as best as possible.

It is also comforting to have another staff member in the interview room with a patient that you do not know, or has a history of impulsivity - safety in numbers. Hats off to 'my' nurses who on finding out that a patient is unwell will be proactive and alert me early and direct staff to assist me by doing such things as taking vitals, handing me their drug chart, organising an ECG and getting stuff together to take bloods. It makes my decision making process and initiation of my response a lot quicker. Then there is the quick nudge esp. on a long, late shift over inconsistancies in prescribing - does not happen often (thank goodness only a couple of times - and really bloody embarrassingly obvious!). I think our system in Australia is slightly different - the doctor is ultimately responsible for the medication error. So it's nice to know they mostly have your back on that.

Now the flip side. I hate nurses that assume because I am not with the patient as much as they are I don't know what's going on - I'm nosy and observant. Nurses that assume that they are the sole patient advocates - Pl-eeze that just smacks of narcissism and professional discourtesy - they need a refresher in the concept of a clinical team. Then there is when they do not agree with your diagnoses or management (rather wider latitude in psych than other areas of med - We haven't isolated the Schizococcus bug yet! )and rather than discuss it with you in professional way they sprout off to all and sundry how stupid your management is and they could do it better - If that is the case I'd be happy to support them going back to study and become a doctor. Then there is the 'lazy' nurse or one that cannot prioritise according to clinical need - that's when I put on the 'Me doctor - You nurse' hat and direct more forecefully.

Now to the subject of hours - Sure we have some horrid hours. 4 out of five weeks one night on call being on the ward/ED/Community facilities/phone contact until 10pm and then phone contact and being available to come in until 08.30 the following morning. Then we are still rostered for that following day, but can take the morning off if it has been a horrid night. Our catchment area covers hundreds of square kms. Then there is the 1 in 6 weekends as well - from 08.30 saturday to 08.30 monday, with 4.5 hours on the ward on Sat/Sun mornings. There is little flexability in this due to staff shortages. Then I know that the nurses are regularly being asked to do double shifts and fill in for sick collegues (due to fatigue) especially when the ward is unsettled. They also sit out in the High Needs Area for an hour at a time with some very unwell and unpredictable patients (some of whom have past history of assault). So both doctors and nurses don't have it easy. It is sad that there is a focus on the things that divide us rather than the common stressors that unite us.

I am lucky I have had the opportunity to have worked/still work with some really brilliant and experienced nurses who have shaped my professional development (and we socialise too ). I tell the med students/junior docs that I supervise to take on board what nurses say, as they often have a great wealth of experience to draw on. But also to temper this with your own experience and knowledge, because you are the one responsible for your clinical judgement - No one else .

Re. the 1am constipation order or similar trivial seeming requests - I find its either an inexperienced nurse asking or an experienced nurse fed up with repeatedly asking the home team to write it up it - and it's forgotten. But you have to be careful you need to assess whether there is a reason it has not been prescribed. But hey what heck I am paid to be on-call...

One caveat to all of this discussion, while valid, is what the director of the medicine residency told me the first day of my medicine clerkship in 3rd year: "Nurses usually don't like women doctors, especially interns or students, so watch your back and don't piss them off."

This seems kind of harsh, but I think it comes from years of experience. Unfortunately, I must say that he's been right all along the way. Women have a different social hierarchy. We collaborate with each other on the same level or when we have stuff in common but resent/envy/despise those outside of these cliques. And there are cliques in all arenas of life - scholastic, social, professional. It has been established long ago. . .us and them. The foundation of the physician-nurse relationship was that of boss-employee. The field is very chauvinistic still, despite the large number of women in the field.

Not to wax philosophical...I can say what I know to be true: all of the interns are frustrated by the frivolous 3AM pages. And most of them respond to them in the same fashion. Yet if a male and a female intern/resident/staff physician is abrupt with a nurse, nine times out of ten, she will tell on the female physician.

There is a reason women are called catty. That seems sexist but it is simply based on the way we naturally socialize.

This all sounds very sexist. It is naive to believe that there is no difference between men and women in social hierarchy/infrastructure/relationships/behavior.

I am reviving this post from the dead because I just wanted to add my two cents. As an RN working straight weekends, I try to limit my calls to the MD as much as possible-it's the weekend, for crying out loud! I have told particularly rude patients/families that I am not going to call on 6pm on a Saturday night because your mom sneezed once. (no joke!) However, there are times when patients or families tie your hands, so to speak. I usually preface those calls with, "I'm sorry for calling, but I know you'd probably rather deal with me than an irate Mrs. Smith who has your beeper number".
Then there are the times when I just don't know whether or not I should call or wait. I always err on the side of caution and call-sometimes I am wrong. But here's the thing-I really think that if when MDs get stupid calls, instead of getting mad at all nurses and letting it fester, take the opportunity to TEACH the nurse why it wasn't neccessary to call, what else you'd like him or her to do, etc. The next time a similar situation comes up, that nurse will know that it's OK to let it wait until morning, and will know why. Granted, you'll still get stupid calls from less intelligent nurses or new nurses who are scared shitless, but I really think it would benefit both parties to use it as a teaching tool. When MDs explain things to me that I may not fully understand, it helps me take better care of my patients.

I have to agree with HAM in terms of women being treated differently by nurses-totally true. They suck up to the men way more and respect them more, in my opinion. That being said, you can earn a lot of respect by giving it. I was a certified nursing assistant in college and med school and being on that end of things really helped me understand nurses. I have been in practice 9 years and to this day when I help lift or turn a patient I get a surprised look. Like I'm going to leave someone sitting in a mess! It's my job too!!

Dreamer, that was a very good post (I am an RN, too). Teaching one nurse how you like things means that s/he can teach all the new/dumb nurses, too, before they call.

One thing I have noticed in L&D and ICU is that the nurses drive the docs crazy when the patient has a non-reassuring finding that just needs to be monitored with no intervention for now. That drives the nurses bonkers because they have to watch every minute of the tachycardia/late decels/whathaveyou....

I guess what I'm trying to say is while a doc is comfortable with watch and wait from a patient management point-of-view, it can just be mentally hard for the front line nurses who have to stand by watching it, and that's why they keep calling and pestering for "something" to be done.

asunshine, your observation is very accurate. Why do you think it is that nurses have such trouble watching and waiting when physicians do not? Perhaps because nursing is geared more towards DOING things to/for the patient, and if you're not doing something, you feel like you aren't being the best nurse you can be for your patient.

For me, it was because I knew I had seen the Ominous Finding before and knew what badness could happen. To be brutally honest, the reason in my mind is because the nurse then has to take over all the worry--checking on the patient obsessively, evaluating the strip, getting the code drugs and backup staff geared up just to "watch", whereas the doc who is comfortable with watching is asleep in bed, assuming they'll be called if there's a problem. Meanwhile the nurse is going bonkers. Bonkers!

I know, that sounded insensitive, but it's at least the perception.

It's not that I don't have trouble watching and waiting, it's that sometimes that's really the best thing to do. Often, taking action when not warranted causes more harm (as I'm sure everyone has seen to some degree). And I'm not sleeping (Ha! I wish!), I'm watching the monitor/BP/UOP too, and worrying, and obsessing about whether I should do something and hoping things will go well in the next few hours and trusting that I'll get a call if they don't and coming up with a plan for when that call comes. Good to know we're all developing ulcers together....
Honestly, it's about trust, respect, and communication just like any other relationship.