Yeah, fortunately this article doesn't represent all nurses, though. There are some who are, quite simply, awesome. In this first group, there are ones that I trust and listen to and respond to quickly because they don't waste my time with trivial things. When the come get me, it's because something desperately needs attending to. They don't interupt rounds with insignificant "clerical" order requests. They ask cogent questions. They are interested in the patient. They want to do a good job. Most of these nurses, I've found, are with rare exception over the age of 45.
Group 2 sees themselves as the "new" breed, and empowered. When they don't want to do something or don't understand something, they often state that they are "advocating for the patient." This essentially means that they disagree with your plan, and they have been given the right to refuse your order. This, in my estimation, is the biggest problem with modern-day nursing - the so-called "proactive" nurse. They follow protocols, and if you do something they perceive to be outside the protocol they will refuse to implement it. This can delay effective treatments and the real irony is that they are doing exactly the opposite of "advocating for their patient." With rare exception, most of these nurses are under the age of 25. They rarely care about what you think, say, order, or do. They are going to deliver care how they see fit, sometimes including things like "forgetting" to give a medicine they don't believe a patient needs or titrating pressors or other meds you've told them not to titrate. The scariest part about them is that they often have no idea what the longterm consequences of their actions may be. They just care about the numbers they've been told to chase in nursing school. I've seen brittle CHF patients on fluid restriction get bolused when their urine output drops (etc.) despite no order being there to do so. It's madness.
The third group seems to be those falling in the age range of 25-45 and are a mixed bag. The better ones want a reason why you want to do something. The worse ones form opinions about you quickly, mock you (either behind your back or to your face), and generally feel an impunity to any redress. Why? Because there's a huge nursing shortage and they feel like they can say or do whatever they want without fear of job, or worse, licensure loss. It's not just me, as a resident, either. I see the same general disrespect and disregard for the attendings.
Bottom line is that nurses have WAY too much power these days. And, they always have a Vice President of Nursing Administration in the hospital who's going to undoubtedly side with them over you. Who do I blame for this? I blame JCAHO and plaintiff's attorneys who put them on the hook of "blame diffusion" and "shared responsibility" in patient care. It's one of the other ways that effective patient care is being ruined by a crazy system that wants to marginalize and protocolize the delivery of healthcare to the point that it becomes most cost-effective, with the patient ultimately becoming secondary in the process.
(Yes, I had a sh*tty day today including an argument with a "Group 2" nurse as described above.)
-copro
