Dear Nurses

[Wiscoblue]

What is a female doctor supposed to wear then to be able to look different from a nurse?

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[Guillemot]

hospital scrubs or dress clothes

 

[pjl]

I prefer to refer to orders as "commands," it clears up the ambiguity of whether they need to be performed.

 

[Psai]

You should read the law. As long as the buck stops with me, we cannot even begin to compare levels of accountability and responsibility. When as many nurses as doctors will be dragged into court, we can begin talking about equality. When they will be able to do what I do on a daily basis, we can talk about equality.

In the meanwhile, dear healthcare "team" member, either help me take care of the patient, or just stay out of my way, please, while I run circles around you. I don't care that if I work fast I will get more work, I care that my patient gets the best care immediately, especially in fields like critical care. Take your shortsightedness and bureaucracy elsewhere, while I put the patient first. If I can do my paperwork and other non-clinical stuff only after my patient is tucked in, so can you. And it's not "your" pump, or "your" ventilator, it's the patient's, and whoever gets it adjusted the fastest should do it. Also, it's my patient, not ours, not until you are exposed to the same levels of malpractice risks and get to personally bill the patient.

Leadership is a big pompous excuse invented by lazy or arrogant people who put themselves ahead of the patient. Anesthesia and other urgent care fields are not places to flash one's male or female testosterone, or mimosa sensitivities. The leader is automatically the person who knows the most, and s/he shouldn't have to waste time with pleasantries to get the team to do their darn jobs.

I completely subscribe to the notion that one catches more flies with honey, but honey should come after discipline and competence, not as a given. We might all be fighting against the same diseased enemy, but let's not mix up who's in command during battle. "My dear nurse soldier, would you be so kind to shoot at that bug now, instead of after your break? Oh, thank you, you're the best!" There is a reason they are called "orders", not "proposals", in the EMR.

I've noticed at one of the hospitals that I was at that OT started writing in their notes "physician's orders/referrals" as if they were just another consult that we wanted. No, it's not a referral.

 

[jl lin]

You should read the law. As long as the buck stops with me, we cannot even begin to compare levels of accountability and responsibility. When as many nurses as doctors will be dragged into court, we can begin talking about equality. When they will be able to do what I do on a daily basis, we can talk about equality.

In the meanwhile, dear healthcare "team" member, either help me take care of the patient, or just stay out of my way, please, while I run circles around you. I don't care that if I work fast I will get more work, I care that my patient gets the best care immediately, especially in fields like critical care. Take your shortsightedness and bureaucracy elsewhere, while I put the patient first. If I can do my paperwork and other non-clinical stuff only after my patient is tucked in, so can you. And it's not "your" pump, or "your" ventilator, it's the patient's, and whoever gets it adjusted the fastest should do it. Also, it's my patient, not ours, not until you are exposed to the same levels of malpractice risks and get to personally bill the patient.

Leadership is a big pompous excuse invented by lazy or arrogant people who put themselves ahead of the patient. Anesthesia and other urgent care fields are not places to flash one's male or female testosterone, or mimosa sensitivities. The leader is automatically the person who knows the most, and s/he shouldn't have to waste time with pleasantries to get the team to do their darn jobs.

I completely subscribe to the notion that one catches more flies with honey, but honey should come after discipline and competence, not as a given. We might all be fighting against the same diseased enemy, but let's not mix up who's in command during battle. "My dear nurse soldier, would you be so kind to shoot at that bug now, instead of after your break? Oh, thank you, you're the best!" There is a reason they are called "orders", not "proposals", in the EMR.

Sir or Madame, my reply that included accountability and such by no means contradicts yours. I think you may have mistaken what I shared.

"Leadership is a process whereby an individual influences a group of individuals to achieve a common goal."- Northouse (2004, p 3)
Take care then in the attitude you use towards all others with whom you must interact in order to achieve the vision and purpose and the necessary overriding functions. Denigrating others b/c you feel you can, should, or must is not effective use of leadership.

True leadership is all about effective influence--even in the face of some with less than optimal or desirable attitudes. Consider that in fact most people tend to show phlegmatic personalities, thus, they are most apt to be led, particularly if they are led well and with the right attitude.

Everyone knows something, and I have learned that no one knows it all. Hence there are times when it behooves the leaders, if they truly are leaders, to listen to nurses, respiratory therapists, other health care providers, and quite often the patients and their families. There are many types of "knowing." After all, "The master of all is the servant of all." If ego or title is the main drive by which you seek to serve, for that is what true leaders do--serve, you have placed all people within your leadership, service, and care at a grave disadvantage.

One can learn from anyone if one posses the desire and humility required to do so. I have learned enormously from patients and their families for instance. We can learn from insects of even cells or sub-atomic particles.

In response to your comment on discipline and competence, well, particularly in my area of work, which is surgical recovery and critical care, for the most part, this has always been a given.

I know of very few surgeons or anesthesiologist or critical care intensivists and so forth that do not watch the RNs in these areas very careful and require (even as not openly spoken) a proving process, by which they either do or do not earn trust. As nurses, it is in the patients' best interest as well as our own that we demonstrate the required competencies and commitment necessary to build trust with our physician-leaders.

I will say, however, that it has to be built into the particular culture. Where I have worked, which has not been few places over few years, the culture of building competence and trust has been quite strong. You expect to adapt to it or you don't work there.

So, I fear perhaps at least part of what you are describing reflects a lack of the right kind of culture. Do not be dismayed, however, for you and your colleagues have the power and influence to help change it; but it has to be with a productive approach.

Catching flies with honey may be deemed by some as to be a bit condescending. I've worked with all types of personalities, thus my ultimate desire is for the wellbeing of the patients and as is relevant, the families as well. So, yes. There are times I have had to tolerate extreme condescension and ill-behaviors. Thankfully, those times have been few, at least coming from the physicians. In complete honesty, I'd have to share, rather sadly, that more instances of ill-behaviors have been demonstrated by fellow nurses--this is my experience. I have been overwhelmingly fortunate in having constructive and positive, if not happy relationships with physicians. I only wish I could say that as strongly for nurses. This phenomenon has perplexed me much over the years. I strive not to take a negative approach toward my own sex (seeing that females make up most of the nurses), out of fear of being, indeed, sexist. Yet, I have seen nurses that are male, of many varieties mind you, adapt to the negative attitudes within a largely populated female-nurse unit. A number of these men, in my opinion, were/are merely striving to survive or move ahead in the female-dominated area. Some have not succumbed to the negativity, but it really depends upon the inner culture of the particular unit. Yes, that is a very sad commentary.

My goal is still the needs of the patient, and going home knowing I have done my very best for each of them, while also not declining into emulating the poisonous behaviors of others. It may be that residents, fellows, and attendings ultimately know they are in a greater position of leadership, so they ignore these problematic behaviors and may not follow suit. I have seen a few that have, however, follow suit, based on the particular social dynamics with the group. Sadly, they do not help the situation--even though, ultimately, they are simply trying to do their best and compete their job well.

My stance is this. Respect each person for their work and stand along side of them as a true leader, guiding them in the right direction. Condescension and denigration is an ineffective approach. There must be patience and tolerance as well. Some may still not catch on, but others will, if the culture is rightly established.

Please accept this in the manner in which it was intended. Wouldn't it be best practices to put time and energy on taking more positive and productive approaches? Best outcomes and practices is ultimately the name of the game, is it not?

 

[jl lin]

I prefer to refer to orders as "commands," it clears up the ambiguity of whether they need to be performed.

Sir, no nurse with any sense or understanding of her/his practice would blow off orders, especially when they clearly represent the best interest of the patient. Using a term like command is condescending, and it will not set the right tone or allow for the building of a tight unit, so to speak. You can say what you like, but you must know that people have free will, and as such, their resentments will spread and grow, either overtly or covertly. You then are undermining the impact and influence of any authority and any respect you can garner. Intelligent and educated people also tend to respond well to reason.

I must say, I am infinitely thankful I have not had to work with physicians, overall, that take on such attitudes. I will understand that you may be jesting and venting. I get that. But really, think about optimal leadership approaches and what stands to be gained by employing them.

Good day.

 

[IlDestriero]

hospital scrubs or dress clothes

I don't think any of our physicians wear custom scrubs at all, nor do they wear the nurse unit uniform of a hospital T shirt and scrub pants. Actually one male GI physician wears custom scrubs, it's weird.

 

[Psai]

I liked the part where there was a reference in that long winded essay. That bsn is sure coming in handy.

 

[getdown]

less talking more doing

 

[deleted171991]

I liked the part where there was a reference in that long winded essay. That bsn is sure coming in handy.

I liked the part where "The master of all is the servant of all." I also believe that "with great power comes great responsibility" (that's not a quote from Spider-man).

Except that the physicians are not treated like masters anymore (more like servants), and that's why the healthcare system is suffering. While the true masters, the nurse managers, behave like anything but public servants.

 

[anesthesiabusiness]

Oh sweet jesus, if there us ever an area of the internet in which an anesthesiolst can express how unappreciated and unloved and misunderstood they are please by all means show it too us all. In the mean time Drs stethoscope to nurses is like to MDA to us. Christ grow some perspective. BTW There is no where I have ever seen on the web that turns on to such a dogpile against nurses except here, talk about insecure. Sheesh grow a pair.

 

[jl lin]

I liked the part where "The master of all is the servant of all." I also believe that "with great power comes great responsibility" (that's not a quote from Spider-man).

Except that the physicians are not treated like masters anymore (more like servants), and that's why the healthcare system is suffering. While the true masters, the nurse managers, behave like anything but public servants.

See, what is wrong with serving others? That is really a big part of the point in being a physician--even with loads of education and great pains and rigors to come to the physician's point of expertise.
Do you honestly believe that many nurses out there do NOT respect this? I am telling you as an experienced nurse, working in recovery and similar areas, it just not true.
I have treated every anesthesiologist with the utmost respect, and fortunately, these anesthesiologists have been quite top-notch. It has been a pleasure as well as a valuable learning experience working with them. I mean unless this is mostly based on the CRNA over-step issue, really, what is with all the animosity?

What's more, I think healthcare is suffering for other reasons, and I am NOT for socialized medicine. But over the decades, what I have seen is the growing expanse of a the business/power approach, as well as greed and a decreasing amount of true ethics, respect, and compassion/empathy--these are a huge part of the withering and blight of healthcare and medicine.

 

[deleted171991]

CRNA over-step, APRN over-step, bureaucratic corporate speak useless clipboard nurses in management, you name it. Most hospitals are run by nurses, and its not a pretty picture for physicians (or medicine in general). Nurse "leaders" have destroyed American medicine, and are still destroying it. It's like the stalinist Soviet Union in the 50's. The physicians are the burgeoisie, the bad influence from the past, that needs to be marginalized and replaced with workers and peasants with "healthy origins", preferably the clapping and brainwashed kind (just look at all the stupid crap on the walls). And the regular nurses are the blue-collar workers watching over the "burgeoisie", making sure that they understand their new worker ant role as "providers", because "if not, we'll call management", and eventually label them as "disruptive", or whatever the latest medical career kiss of death is.

Of course, all it's done in the name of "quality", "cost reduction" and other (oxy)*****ic euphemisms, smoke and mirrors for the unknowing general public, while the managing upperclass spends more than ever on their own salaries and welfare. They are about as efficient as most big governments, the whole reason for their existence being to invent more reasons for their existence. And their army of minions and kapos are many of the regular nurses, at the bedside, who question and report every deviation from the party line "protocol".

What's more, I think healthcare is suffering for other reasons, and I am NOT for socialized medicine. But over the decades, what I have seen is the growing expanse of a the business/power approach, as well as greed and a decreasing amount of true ethics, respect, and compassion/empathy--these are a huge part of the withering and blight of healthcare and medicine.

The blight are most of the mid-managers, all the useless middlemen, who are mostly nurses. It's like the inmates running the asylum, while the physicians try to reason with them, like living in "Stonehearst Asylum" on a daily basis. Cookie-cutter medicine healthcare, narrow-minded protocols and criteria left and right, you name it. It's "1984" for doctors (anesthesiologists are somewhat shielded though). Thoughtcrime, doublethink, newspeak, propaganda, hypocrisy, all the good stuff. At least 50% of healthcare costs goes into supporting these leeches and the bureaucracy they surround themselves/us with.

What has this to do with most regular nurses? Everything. Nurses are the majority of healthcare workers, the ones clapping for and supporting the new world order, where (male) physicians are/will be relegated to the secondary role (female) nurses have been for centuries (for a good reason - to let the most educated and competent lead). It's payback time and power grab, clear and simple matriarchy, sold to the public as money-saving, quality or whatever the latest propaganda lie needs to be. All the good stuff that, you know, neeeever happened when all those big bad doctors were in charge.

Thank God that nurses exist to advocate for and protect the patients, because God knows what doctors would do to them otherwise. The former also applies to nurse midlevels, of course.

P.S. I know this is an extreme view of the system for some (it depends a lot on the specialty and hospital setting), but it is pretty much where we seem to be headed. I am not angry or otherwise upset, I just call it as I see it.

 

[Psai]

CRNA over-step, APRN over-step, bureaucratic corporate speak useless clipboard nurses in management, you name it. Most hospitals are run by nurses, and its not a pretty picture for physicians (or medicine in general). Nurse "leaders" have destroyed American medicine, and are still destroying it. It's like the stalinist Soviet Union in the 50's. The physicians are the burgeoisie, the bad influence from the past, that needs to be marginalized and replaced with workers and peasants with "healthy origins", preferably the clapping and brainwashed kind (just look at all the stupid crap on the walls). If one doesn't fall in line with the latest slogans, one is labeled as disruptive and the system will squash him/her. And the regular nurses are the blue-collar workers watching over the "burgeoisie", making sure that they understand their new worker ant role as "providers", because "if not, we'll call management", and eventually label them as "disruptive", or whatever the latest medical career kiss of death is.

Of course, all it's done in the name of "quality", "cost reduction" and other (oxy)*****ic euphemisms, smoke and mirrors for the unknowing general public, while the managing upperclass spends more than ever on their own salaries and welfare. They are about as efficient as most big governments, the whole reason for their existence being to invent more reasons for their existence. And their army of minions and kapos are many of the regular nurses, at the bedside, who question and report every deviation from the party line "protocol".

The blight are most of the mid-managers, all the useless middlemen, who are mostly nurses. It's like the inmates running the asylum, while the physicians try to reason with them, like living in "Stonehearst Asylum" on a daily basis. Cookie-cutter medicine healthcare, narrow-minded protocols and criteria left and right, you name it. It's "1984" for doctors (anesthesiologists are somewhat shielded though). Thoughtcrime, doublethink, newspeak, propaganda, hypocrisy, all the good stuff. At least 50% of healthcare costs is going into supporting these leeches and the bureaucracy they surround themselves/us with.

What has this to do with most regular nurses? Everything. Nurses are the majority of healthcare workers, the ones clapping for and supporting the new world order, where (male) physicians are/will be relegated to the secondary role (female) nurses have been for centuries (for a good reason - to let the most educated and competent lead). It's payback time and power grab, clear and simple matriarchy, sold to the public as money-saving, quality or whatever the latest propaganda lie needs to be. All the good stuff that, you know, neeeever happened when all those big bad doctors were in charge.

Thank God that nurses exist to advocate for and protect the patients, because God knows what doctors would do to them otherwise. The former also applies to nurse midlevels, of course.

P.S. I know this is an extreme view of the system for some (it depends a lot on the specialty and hospital setting), but it is pretty much where we seem to be headed. I am not angry or otherwise upset, I just call it as I see it.

This is exactly what I think and what people don't realize when they rage against the big bad doctors. All that garbage about quality is nonsense and we see through it easily but we have our hands tied behind our backs by lawyers, administrators, corporations and government. The everyone is different but equal crowd is taking over with participation prizes for everyone, never mind education or knowledge or skill. Nurses are doctors now and the doctors are not doctors.

There was a time we had a guy in DTs and a "nurse manager" came by and told us that we couldn't admit him to the icu because of some protocol issue after the icu resident already decided to admit him and the patient was about to go down. She wasted 30 minutes of our time when we were on rounds while this guy was suffering in his room as she was calling this and that supervisor. He ended up in the icu anyway because that's where he needed to go. It was completely insane.

 

[deleted171991]

Any RN gets my respect for having a meaningful, purpose-driven job compared to most people these days who are either, unemployed, working in retail/starbucks, working in finance/corporation, or some other inane field where the only purpose of their job is to get money without regard to humanity.

Mmm... it's not that simple. I personally have a ton of respect for retail/starbucks people. It's very tough to deal with all the personality disorders without being able to talk back.

I am regularly amazed an awed to learn of the heroic and extraordinary acts of seemingly ordinary individuals. I am also so impressed with their modesty and understatement. Over the years, I have learned about their accomplishments because I have asked, not because they have volunteered their heroics, which they often shrug off.

Who’s serving you French fries and a burger? If you’re not in too much of a rush, you might learn that the man who is giving you change, might have changed the world.

http://mdwhistleblower.blogspot.com/2015/09/heroes-behind-counter-in-other-places.html

 

[Man o War]

Oh sweet jesus, if there us ever an area of the internet in which an anesthesiolst can express how unappreciated and unloved and misunderstood they are please by all means show it too us all. In the mean time Drs stethoscope to nurses is like to MDA to us. Christ grow some perspective. BTW There is no where I have ever seen on the web that turns on to such a dogpile against nurses except here, talk about insecure. Sheesh grow a pair.

First of all, this reads like the email I just received from Zimbabwe saying I simply need to send 500 american dollars to receive my 2 million. You can't even spell anesthesiologist or correctly use "to" vs "too". I smell a troll.
Second of all, there is a big difference between insecurity and having the training to know when patient care is actually being compromised. Most of us go into medicine to help people, not hurt them. It's extremely difficult to stand by and watch people who don't know what they don't know put patients in harm's way, all the while beating their chests and railing about how equal their training is to ours. Oh, and work under our licenses and malpractice insurance because they're equal until it's time to sit through a 4 hour deposition and have all they have worked for put at risk. I'm all for turning CRNAs and NPs completely loose. I'd love to see who actually has the balls to work independently when there is nobody there to bail them out, and their butt gets nailed to the wall when a lawsuit gets settled.

 

[Hoya11]

Mmm... it's not that simple. I personally have a ton of respect for retail/starbucks people. It's very tough to deal with all the personality disorders without being able to talk back.

http://mdwhistleblower.blogspot.com/2015/09/heroes-behind-counter-in-other-places.html

If you dont have any increased degree of respect for health care workers > someone working at starbucks you need to check yourself.

 

[deleted171991]

If you dont have any increased degree of respect for health care workers > someone working at starbucks you need to check yourself.

I will always have more respect for somebody who eats crap on a daily basis for close to the minimum wage, versus a well-paid healthcare worker with job security, union protection etc. There is a reason nurses encourage their kids to go into nursing, and not retail/fast food.

That doesn't mean I don't appreciate the hard work some nurses do, which includes most of my ICU nurses. Hard work deserves respect, regardless of occupation.

 

[Hoya11]

But you seem to be missing that there is a PURPOSE to healthcare work, regardless of it being hard or well payed. Did some nurse wrong you badly at some point in your career? I would reflect on your feelings presented in this thread.

 

[deleted171991]

I don't idolize healthcare workers because most of them don't go into the profession for its high ideals, but for its advantages. That includes doctors, too. Yes, I think nurses are overrated by the public opinion; I see more slackers than heroes.

The only people I bow before are those who risk(ed) their lives defending my liberties. And beautiful minds, people who are way more intelligent than I am (since you mentioned a higher purpose).

 

[deleted480308]

If you dont have any increased degree of respect for health care workers > someone working at starbucks you need to check yourself.

When you've done everything including food service/janitorial/construction labor/management/health you realize that field has little to do with deserving respect

 

[pjl]

Sir, no nurse with any sense or understanding of her/his practice would blow off orders, especially when they clearly represent the best interest of the patient. Using a term like command is condescending, and it will not set the right tone or allow for the building of a tight unit, so to speak. You can say what you like, but you must know that people have free will, and as such, their resentments will spread and grow, either overtly or covertly. You then are undermining the impact and influence of any authority and any respect you can garner. Intelligent and educated people also tend to respond well to reason.

I must say, I am infinitely thankful I have not had to work with physicians, overall, that take on such attitudes. I will understand that you may be jesting and venting. I get that. But really, think about optimal leadership approaches and what stands to be gained by employing them.

Good day.

I should clarify, on the internet I call them edicts, in real life, I bow to the nurse overlords.

 

[jl lin]

CRNA over-step, APRN over-step, bureaucratic corporate speak useless clipboard nurses in management, you name it. Most hospitals are run by nurses, and its not a pretty picture for physicians (or medicine in general). Nurse "leaders" have destroyed American medicine, and are still destroying it. It's like the stalinist Soviet Union in the 50's. The physicians are the burgeoisie, the bad influence from the past, that needs to be marginalized and replaced with workers and peasants with "healthy origins", preferably the clapping and brainwashed kind (just look at all the stupid crap on the walls). And the regular nurses are the blue-collar workers watching over the "burgeoisie", making sure that they understand their new worker ant role as "providers", because "if not, we'll call management", and eventually label them as "disruptive", or whatever the latest medical career kiss of death is.

Of course, all it's done in the name of "quality", "cost reduction" and other (oxy)*****ic euphemisms, smoke and mirrors for the unknowing general public, while the managing upperclass spends more than ever on their own salaries and welfare. They are about as efficient as most big governments, the whole reason for their existence being to invent more reasons for their existence. And their army of minions and kapos are many of the regular nurses, at the bedside, who question and report every deviation from the party line "protocol".

The blight are most of the mid-managers, all the useless middlemen, who are mostly nurses. It's like the inmates running the asylum, while the physicians try to reason with them, like living in "Stonehearst Asylum" on a daily basis. Cookie-cutter medicine healthcare, narrow-minded protocols and criteria left and right, you name it. It's "1984" for doctors (anesthesiologists are somewhat shielded though). Thoughtcrime, doublethink, newspeak, propaganda, hypocrisy, all the good stuff. At least 50% of healthcare costs goes into supporting these leeches and the bureaucracy they surround themselves/us with.

What has this to do with most regular nurses? Everything. Nurses are the majority of healthcare workers, the ones clapping for and supporting the new world order, where (male) physicians are/will be relegated to the secondary role (female) nurses have been for centuries (for a good reason - to let the most educated and competent lead). It's payback time and power grab, clear and simple matriarchy, sold to the public as money-saving, quality or whatever the latest propaganda lie needs to be. All the good stuff that, you know, neeeever happened when all those big bad doctors were in charge.

Thank God that nurses exist to advocate for and protect the patients, because God knows what doctors would do to them otherwise. The former also applies to nurse midlevels, of course.

P.S. I know this is an extreme view of the system for some (it depends a lot on the specialty and hospital setting), but it is pretty much where we seem to be headed. I am not angry or otherwise upset, I just call it as I see it.

OMG. Wow. Such hyperbole in the extreme. And what minions sadly follow this line of reasoning without balanced consideration. Well, that's the path of least resistance I suppose.

I don't know where you are located. I have not worked under such severe extremes.
LOL The midlevel manager is the one often in the crappiest position, hence many nurses leave the middle management position, unless they are indeed looking out for their own career trajectory--to the ignorance and/or exclusion of everything else--as their top priority. But heck, that mentality extends well beyond nurse managers for God's sake.

Also, I can't even tell if perhaps you are at least somewhat misogynistic, because of some of the things you have said--especially about nurses that are male, etc--as well as comments in other posts strike of some level of possible misogynism. IDK, but your hate and agitation towards a female-dominated profession seems quite severe. BTW, in general, nurses that are male often end up making more for doing the same job--and this is just as true, if not more so, when they move into management/leadership positions.

Extremist thinking either way is problematic, and helps nothing. If you truly believe that such an extreme hyperbolic presentation is productive or even healthy, I honestly have nothing much more to share. This is your own sad condition of thinking, which sadly, you seek to spread to others. This is your choice, and it's also your choice to incite the negativity and expand it. I fear that you sir are simply preaching hyperbolic hate.

These are the kinds of people that wield the most power in hospitals and hospital systems:

http://www.beckershospitalreview.com/lists/50-of-the-most-powerful-people-in-healthcare-2013.html

Oh what the heck, might as well keep it most current:

http://www.beckershospitalreview.com/lists/50-of-the-most-powerful-people-in-healthcare-2015.html

Mind you, I speak in neither support or dissent of any of these people or others in power like them or their policies. In general, I tend toward being of a more conservative ilk, by far.
But you are placing a lot of rage against the wrong group of people--nursing, especially if you believe they hold such insurmountable power. They do not, in general. Often those in high places are only figure heads.

Also, although I disagree with various points this author makes, the overall picture should help clarify from where the real power-wielding and influential forces come.
http://healthaffairs.org/blog/2014/06/12/how-much-market-power-do-hospitals-systems-have/


Could it then be that nurses and their whole profession are, as not historically unusual, the kicking-dogs (objects of displacement) or the scape goats in your rant?

 

[jl lin]

I will always have more respect for somebody who eats crap on a daily basis for close to the minimum wage, versus a well-paid healthcare worker with job security, union protection etc. There is a reason nurses encourage their kids to go into nursing, and not retail/fast food.

That doesn't mean I don't appreciate the hard work some nurses do, which includes most of my ICU nurses. Hard work deserves respect, regardless of occupation.

Even smarts, dedication, handwork, or amiable qualities do not mean there is job security for a nurse, not even for those that work in various ICU settings. Honestly, unit and hospital politics can have more influence on that than any of the formerly mentioned qualities. I won't at all deny the incredible amount of politics in certain areas, particular in say cardiac intensive care areas or pediatric cardiac areas. Sometimes the inside politics is so severe that I have seen where playing dumb, while making both other nurses and physicians look "right," is what is required so that a nurse isn't squeezed out. I don't tend to do that dance, but if it is for the sake of optimal patient outcomes I will. For the safety and good outcomes of the patients, I will play "dumb blonde" at times--b/c I have to know that I did all I could for these patients. That's where I draw the line. I won't, however, dance, as such, in order to get ahead.

Don't get me wrong. Critical care units do love their weeding out processes--and some are more constructive and objective, and other times, they are not. I'd rather be barked at with a ton of orders by docs--where such orders have merit and constructive purpose for the patient's wellbeing than have to tolerate a lot of the exceedingly nauseating political nonsense. I loathe the idiotic games, but I try to keep my focus on the patients and families. If I don't, I would simply be pulled down into the perfidious cesspool of politics, which holds more power as to whether a nurse may hold on to her/his job over anything else. Of course, I speak at the exclusion of unions. I have not worked in hospitals with nursing unions. Even still, the exclusivity of the specialized units has allowed for the ripping out of more than few nurses with excellent skills and potential. I have stood and watched, wondering why in the hell a manager would let just about any nurse function as a preceptor. This is not a role for which just any RN or person is suited--with or w/o some hospital or unit-based course on precepting.

No, I have to tell you, short of getting past the probationary period into a union, nurses do NOT have job security. Sir, I don't think you understand how it works, and I am wondering now if you work in a hospital system that is unionized for nurses.

 

[bronx43]

No, I have to tell you, short of getting past the probationary period into a union, nurses do NOT have job security. Sir, I don't think you understand how it works, and I am wondering now if you work in a hospital system that is unionized for nurses.

I work at a large academic center, in which the nurses are unionized. It takes nothing short of KILLING a patient to get fired. I'm not exaggerating even a little bit.

 

[deleted171991]

I used to work at a similar place, where they were not. Still, what you said applied perfectly to CRNAs. Almost killing one of my patients, without even calling for help, did not merit even a slap on the wrist.

 

[jl lin]

I work at a large academic center, in which the nurses are unionized. It takes nothing short of KILLING a patient to get fired. I'm not exaggerating even a little bit.

Again, I have not worked in unionized hospitals, probably b/c of the kinds of units I choose--at fairly particular medical centers/hospitals. I will say that working almost exclusively in critical care units, they tend to weed out--either for the betterment of patient care (understood) or for idiotic political reasons--who likes whom--who is considered a threat to whom, etc. From what my unionized nurse colleagues in such areas have told me, there is no guarantee of a nurse staying in a particular unit--b/c these units are pretty much indoctrinated with either productive or unfair weeding behaviors or some combination of both. They may not necessarily lose their jobs, but they will be ousted from the particular unit in which they desired to function and learn. So you not only should be bright and competent, as well as eager to learn. You must also be able to figure out the particular political culture and landscape of the unit. One thing or the other can easily sink you.

I have mixed feelings re: unionization of nurses. There are those that should not be maintained simply by union protection. If they are dull and cannot grow in competence and caring and truly cannot work together with others, well, they need to be weeded. OTOH, I have watched a number of nurses get raked over the coals, the endless acts of discouragement and going out of the way to find fault, b/c someone didn't like the pretty, nurse new to the unit, or b/c she is a bit too bright, or b/c she has high standards.

So, no. I don't believe people should be weeded out b/c of capriciousness or such silly nonsense. I believe in striving for objective standards of evaluation. I don't know if you realize how mean of an environment some units can be. Sad but true. Yes, some of us continue/have continued to work in such units in order to learn and grow. Doesn't mean we like or agree with the vicious games. You have to grow some tough skin to work in some of these units.

 

[jl lin]

I used to work at a similar place, where they were not. Still, what you said applied perfectly to CRNAs. Almost killing one of my patients, without even calling for help, did not merit even a slap on the wrist.

Of course I agree that such behavior from a CRNA should be held up to a high standard of accountability. This is why I said what I did earlier about how the culture must be influenced. It shouldn't be catty and capricious, but it should absolutely require the maintenance of strong SsOP, Best Practices, and thorough accountability.

Sadly if this is the case, I would feel terrible for the patients--or my family member as potentially being a patient at one of such places.

 

[deleted171991]

Also, I can't even tell if perhaps you are at least somewhat misogynistic, because of some of the things you have said--especially about nurses that are male, etc--as well as comments in other posts strike of some level of possible misogynism. IDK, but your hate and agitation towards a female-dominated profession seems quite severe. BTW, in general, nurses that are male often end up making more for doing the same job--and this is just as true, if not more so, when they move into management/leadership positions.

Extremist thinking either way is problematic, and helps nothing. If you truly believe that such an extreme hyperbolic presentation is productive or even healthy, I honestly have nothing much more to share. This is your own sad condition of thinking, which sadly, you seek to spread to others. This is your choice, and it's also your choice to incite the negativity and expand it. I fear that you sir are simply preaching hyperbolic hate.

1. I don't remember ever saying anything about male nurses.
2. I don't like sex- or any other unearned criteria-dominated agendas (such as affirmative action, or diversity-based). They tend to fall in the other extreme, where they discriminate against the others (such as Asian American students when applying for medical school). I dislike the "old boys' clubs" as much as feminist agendas. I tend to appreciate people by what they bring to the table, not what they were born as, the smarter and hardworking the better, the stupider and lazier the worse.
3. I would be careful with personal attacks like this. They say more about you than about me. I can agree to disagree on the current subject (and on most others). I think a plurality of opinions is what makes a society powerful, and moves it towards progress, not the sheep-like brainwashed political correctness as in "Four feet good! Two feet bad!".

 

[deansrv72]

I'm all for turning CRNAs...completely loose. I'd love to see who actually has the balls to work independently when there is nobody there to bail them out, and their butt gets nailed to the wall when a lawsuit gets settled.

It's good to hear you're all for turning them loose. It's been happening on a daily basis for years. Maybe not academic/big city centers, but definitely occurs.

That being said, it seems the dearth of malpractice/liability suits against those Indy practicing CRNAs is still just that...lacking.

Short arms deep pockets? C'mon

 

[deleted171991]

Of course it's lacking, as long as they rarely do sick patients. Even the "independent" groups like to hire an MD for the sicker patients, as a firefighter, and for triage. We've made anesthesia so safe that, for ASA 1-2 cases, it's almost idiotproof. It takes a lot of effort to kill a healthy person with anesthesia (it's usually unrecognized airway problems).

No lawsuits doesn't mean that those patients get excellent care, just that they don't know what they got.

 

[Promethean]

I feel really, really bad for those of you who have had such terrible interactions with the nurses in your OR. I'm not sure what is up with that. In the OR I left in order to go to med school, Anesthesia and nursing had to have each others' backs. We collaborated to make the schedules work and we helped each other in the rooms.

That didn't happen because I was a good "underling" as someone put it earlier in the thread. Rather, we had a culture of mutual respect. We had to, else administration and a handful of line-stepping surgeons would have walked all over us.

I'm sorry to hear that my experience of the OR is not terribly common, or at least not based on what I read here.

 

[deleted171991]

I feel really, really bad for those of you who have had such terrible interactions with the nurses in your OR. I'm not sure what is up with that. In the OR I left in order to go to med school, Anesthesia and nursing had to have each others' backs. We collaborated to make the schedules work and we helped each other in the rooms.

That didn't happen because I was a good "underling" as someone put it earlier in the thread. Rather, we had a culture of mutual respect. We had to, else administration and a handful of line-stepping surgeons would have walked all over us.

I'm sorry to hear that my experience of the OR is not terribly common, or at least not based on what I read here.

It usually depends on the size of the place. In smaller places, where everybody knows everybody, fewer people misbehave, because they can't get away with it. Also, because surgeons are the rainmakers for most hospitals, there is much less bureaucracy in the OR. There is a more "can do" mentality, than hiding behind protocols and debating the physician. It's truly teamwork, and I only had problems with OR nurses in bigger places, where there is shift/passing the buck mentality, and lazy/incompetent people can survive by playing politics.

 

[Man o War]

It's good to hear you're all for turning them loose. It's been happening on a daily basis for years. Maybe not academic/big city centers, but definitely occurs.

That being said, it seems the dearth of malpractice/liability suits against those Indy practicing CRNAs is still just that...lacking.

Short arms deep pockets? C'mon

Let's talk when it's apples to apples....Until then, keep practicing independently in the boonies and punting most of the crappy high risk patients to the MD covered CRNAs in the city (all while claiming your lawsuit records are better or equal to MDs). Are you really suggesting that you can make any type of comparison in lawsuit frequency for MDs vs independent CRNAs when the case types aren't even close to similar? If you are, that just speaks to exactly the kind of scary militant attitude I've encountered over the years with nurses who don't know what they don't know.

 

[jl lin]

1. I don't remember ever saying anything about male nurses.
2. I don't like sex- or any other unearned criteria-dominated agendas (such as affirmative action, or diversity-based). They tend to fall in the other extreme, where they discriminate against the others (such as Asian American students when applying for medical school). I dislike the "old boys' clubs" as much as feminist agendas. I tend to appreciate people by what they bring to the table, not what they were born as, the smarter and hardworking the better, the stupider and lazier the worse.
3. I would be careful with personal attacks like this. They say more about you than about me. I can agree to disagree on the current subject (and on most others). I think a plurality of opinions is what makes a society powerful, and moves it towards progress, not the sheep-like brainwashed political correctness as in "Four feet good! Two feet bad!".

It seems to me you have not carefully read what I stated. What I said was neither stated as a matter of fact or absolute opinion. It was one of curiosity and uncertainty, based on things you have stated. You did mention nurses, which are male, and what they might be relegated to in one of your previous posts. For both of us, I suppose it would be wise to leave it at that.

I agree with the value of a strong work ethic and intelligence; although to me, wisdom and character rate just as highly as those other characteristics. And it is difficult to not note from what you have written, a generalized sense of loathing toward a particular group of people--specifically nurses.

Not all nurses are stupid and lazy, just as this is not so with all physicians. Only you can face what is truly motivating you to move to such an "extreme" (admittedly your chosen word--then later, mine) and negative regard toward nurses. It seems as if from your POV, they are all produced straight from the nurse factory as loathsome, unnecessary beings. I only point out the absurdity in taking such an extreme approach, and how indeed it can be only counterproductive to anything good.

 

[deleted171991]

It seems to me you have not carefully read what I stated. What I said was neither stated as a matter of fact or absolute opinion. It was one of curiosity and uncertainty, based on things you have stated. You did mention nurses, which are male, and what they might be relegated to in one of your previous posts. For both of us, I suppose it would be wise to leave it at that.

You are inaccurate and, thus, defamatory, and now you are persisting in your mistake. Here's the list of posts where I mentioned the word male: http://forums.studentdoctor.net/search/17089908/?q=male&o=relevance&c[user][0]=171991

I have never posted (what you said) about male nurses. Please prove me wrong.

I don't like words being put in my mouth, or personal attacks. I am afraid our conversation ends here.

 

[jl lin]

You are inaccurate and, thus, defaming, and now you are persisting in your mistake. Here's the list of posts where I mentioned the word male: http://forums.studentdoctor.net/search/17089908/?q=male&o=relevance&c[user][0]=171991

I have never posted (what you said) about male nurses. Please prove me wrong.

I don't like words being put in my mouth, or personal attacks. I am afraid our conversation ends here.

Yet you attempt to put the aggression on to me by stating "personal attacks." ??? Since there is this dandy feature called edit, expunging something one has stated is an easy enough task. As an attempt at kindness, it was not my intention to throw back, verbatim, every word you have stated. Perhaps I should have parsed all, but please by all means, I will give this to you. Besides, only those that work with a person or live with a person can known what said person's true character really is. All I can attempt to understand is based on actual and fuzzy statements written on an Internet forum. Furthermore, I will share again that I did not state anything, as absolute about you personally, as either being fact or opinion. So, let's not get nonsensical here.

I must say that your response is severe in that you are quick to write such generally negative things about a particular body of people--nurses, yet, when asked to considered how unfair and generalizing and unproductive such an attitude is, you come back crying foul, b/c you believe that it is YOU that has been offended. But it was your cacophonous intonations that have been quite offensive, and needlessly so.

I do not care to be unduly affected by such negativity. Although you were not attacked personally, for nothing was stated as such in any absolute terms, while you OTOH, trashed a whole group of professionals out of hand--and sadly encourage others to do so--potentially making work relationships even more difficult--I am quite content with pretending we never even engaged in any true conversation per se. This is so, since such is not what I would call a true and fair-minded conversation. You have offended nursing in just about every possible way and now could have nothing further to say.

Good day.

 

[deansrv72]

Let's talk when it's apples to apples....Until then, keep practicing independently in the boonies and punting most of the crappy high risk patients to the MD covered CRNAs in the city (all while claiming your lawsuit records are better or equal to MDs). Are you really suggesting that you can make any type of comparison in lawsuit frequency for MDs vs independent CRNAs when the case types aren't even close to similar? If you are, that just speaks to exactly the kind of scary militant attitude I've encountered over the years with nurses who don't know what they don't know.

I don't practice independently, nor in the boonies. I don't disagree with much you've said here. I only stated that CRNAs are already loose. And in CAHs, I'm pretty sure the patient-load is more than PS 1s and 2s. 3s? Yea, I'm willing to bet for sure. 4s? Obviously not nearly as much as larger (trauma-type) facilities, but depending on type of case, totally not unheard of.

 

[deleted171991]

Yet you attempt to put the aggression on to me by stating "personal attacks." ??? Since there is this dandy feature called edit, expunging something one has stated is an easy enough task. As an attempt at kindness, it was not my intention to throw back, verbatim, every word you have stated. Perhaps I should have parsed all, but please by all means, I will give this to you. Besides, only those that work with a person or live with a person can known what said person's true character really is. All I can attempt to understand is based on actual and fuzzy statements written on an Internet forum. Furthermore, I will share again that I did not state anything, as absolute about you personally, as either being fact or opinion. So, let's not get nonsensical here.

I must say that your response is severe in that you are quick to write such generally negative things about a particular body of people--nurses, yet, when asked to considered how unfair and generalizing and unproductive such an attitude is, you come back crying foul, b/c you believe that it is YOU that has been offended. But it was your cacophonous intonations that have been quite offensive, and needlessly so.

I do not care to be unduly affected by such negativity. Although you were not attacked personally, for nothing was stated as such in any absolute terms, while you--OTOH, trashed a whole group of professionals out of hand--and sadly encourage others to do so--potentially making work relationships even more difficult, I am quite content with pretending we never even engaged in any true conversation per se. This is so, since such is not what I would call a true and fair-minded conversation. You have offended nursing in just about every possible way and now could have nothing further to say.

Good day.

I did not edit/delete anything regarding male nurses. You are simply confusing me with somebody else and don't have the guts to admit it. I called it out because you turned a conversation about nurses in general into ad hominem attacks.

I can respect that you disagree with my possibly exaggerated view of the healthcare field (and I was the first to admit that). I just can't stand to have words put in my mouth. Don't attack the person, attack the idea.

 

[pgg]

It's good to hear you're all for turning them loose. It's been happening on a daily basis for years. Maybe not academic/big city centers, but definitely occurs.

That being said, it seems the dearth of malpractice/liability suits against those Indy practicing CRNAs is still just that...lacking.

Short arms deep pockets? C'mon

Of course it's lacking, as long as they rarely do sick patients. Even the "independent" groups like to hire an MD for the sicker patients, as a firefighter, and for triage. We've made anesthesia so safe that, for ASA 1-2 cases, it's almost idiotproof. It takes a lot of effort to kill a healthy person with anesthesia (it's usually unrecognized airway problems).

No lawsuits doesn't mean that those patients get excellent care, just that they don't know what they got.

There's another point deansrv72 is surely unaware of, and that you (FFP) neglected to mention.

Surgical morbidity and mortality at the small, rural places out in BFE where pseudo-independent and genuinely independent CRNA practice is common, is actually higher. A lot higher. But the confounder on the surgical side is that while the hospital is settling for CRNAs, they're also settling for poor surgeons. There's more malpractice in the OR, more malpractice on the wards, more malpractice in the ICUs, more malpractice in the clinics.

At these places, adverse events often don't get reported and don't get RCA'd, partly because those adverse events aren't even recognized much of the time. Everything from non-lethal quality issues like pain / BP issues in the PACU to repeat ER visits for missed diagnoses to postop MIs. Some of these places, no one really has any incentive to detect and discuss M&M ... because they know it's not fixable with the staff they can hire and retain.

In a sea of such risk factors, the risk that fully independent CRNAs bring to the table is practically lost in the noise.

The irony here, of course, is that maybe there's a non-dismiss-able argument that independent CRNA practice at those places is actually acceptable, because they're not the biggest risk to the patient.

 

[jl lin]

I did not edit/delete anything regarding male nurses. You are simply confusing me with somebody else and don't have the guts to admit it. I called it out because you turned a conversation about nurses in general into ad hominem attacks.

I will give you the benefit of the doubt; b/c I will not take the time to comb through any more of this ridiculous noise about the whole of nursing. If anyone was called out, it was you, for such severe and negative generalizing about nursing--and not only by me. If I misspoke or was mistaken, I fully apologize. Would that you might apologize for generalizing such negativity about nursing; but you know, if you would just step back, think, and change your tone, that would be a great start and example to others.

Of course no one can make you do this. You must choose to set the tone. That's what a fair-minded leader would do.

 

[Man o War]

I don't practice independently, nor in the boonies. I don't disagree with much you've said here. I only stated that CRNAs are already loose. And in CAHs, I'm pretty sure the patient-load is more than PS 1s and 2s. 3s? Yea, I'm willing to bet for sure. 4s? Obviously not nearly as much as larger (trauma-type) facilities, but depending on type of case, totally not unheard of.

No, that is not what you only stated, because I would agree with that. This is what I took exception to:
"That being said, it seems the dearth of malpractice/liability suits against those Indy practicing CRNAs is still just that...lacking."

As FFP stated, of course those lawsuits are lacking. Anyone with common sense would predict that based on acuity differences.

Also, my version of CRNAs being turned loose means no supervision at all anywhere. CRNAs do their own cases on their own, MDs do their own cases on their own. I'm in favor of that because I'm 100% confident that the outcome differences would be pervasive and glaring, and then I never have to have conversations like these again.

 

[Psai]

No, that is not what you only stated, because I would agree with that. This is what I took exception to:
"That being said, it seems the dearth of malpractice/liability suits against those Indy practicing CRNAs is still just that...lacking."

As FFP stated, of course those lawsuits are lacking. Anyone with common sense would predict that based on acuity differences.

Also, my version of CRNAs being turned loose means no supervision at all anywhere. CRNAs do their own cases on their own, MDs do their own cases on their own. I'm in favor of that because I'm 100% confident that the outcome differences would be pervasive and glaring, and then I never have to have conversations like these again.

She already said good day multiple times I'm sure she is done with this topic

 

[deansrv72]

There's another point deansrv72 is surely unaware of, and that you (FFP) neglected to mention.

Surgical morbidity and mortality at the small, rural places out in BFE where pseudo-independent and genuinely independent CRNA practice is common, is actually higher. A lot higher. But the confounder on the surgical side is that while the hospital is settling for CRNAs, they're also settling for poor surgeons. There's more malpractice in the OR, more malpractice on the wards, more malpractice in the ICUs, more malpractice in the clinics.

At these places, adverse events often don't get reported and don't get RCA'd, partly because those adverse events aren't even recognized much of the time. Everything from non-lethal quality issues like pain / BP issues in the PACU to repeat ER visits for missed diagnoses to postop MIs. Some of these places, no one really has any incentive to detect and discuss M&M ... because they know it's not fixable with the staff they can hire and retain.

In a sea of such risk factors, the risk that fully independent CRNAs bring to the table is practically lost in the noise.

The irony here, of course, is that maybe there's a non-dismiss-able argument that independent CRNA practice at those places is actually acceptable, because they're not the biggest risk to the patient.

Does the data identify CRNAs, specifically, as the root cause for increased surgical M&M? If so, I'd like to see it. It's not that difficult to consider that poor surgeons, poor nursing care, poor etc., could be a major contributor to all that increased M&M, is it?

 

[IlDestriero]

She already said good day multiple times I'm sure she is done with this topic

That never stopped her before.

 

[pgg]

It's not that difficult to consider that poor surgeons, poor nursing care, poor etc., could be a major contributor to all that increased M&M, is it?

Well yes, that's what I wrote.

Lots of rural care is substandard, which is why independent CRNAs can hide out there. That's the point.

 

[deansrv72]

Well yes, that's what I wrote.

Lots of rural care is substandard, which is why independent CRNAs can hide out there. That's the point.

True. As well as physicians.

 

[IlDestriero]

I've said it before, but that's one of the reasons that I didn't moonlight when I was in a rural location during my .mil time and a reason that I chose the job that I have now. Crappy surgeons and lazy dullard staff make an anesthesiologists job much harder and increase your risk of litigation entanglements, and well compensated superstars make your train wreck cases survivable.