military nurses driving me crazy

[Ascultator]

So I have yet to sign up as a graduating resident. It's between Army and USN for me.

Which nurses are less malicious?

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[IlDestriero]

Generally, the Navy has better locations. Should be an easy choice. Also as a fully trained staff physician vs GMO, you can protect yourself better from Nurse Corps ******ry. Good luck. See you on the other side.

 

[postpx]

This is a ranting post. I guess I'm looking for folks to commiserate with me just to make me feel better. I'm a flight surgeon at your local MTF and the active duty nurse contingent is driving me crazy with their incompetence, their arrogance and just simple disrespect. The nurses, both male and female, are put in positions of power. Incompetence and authority is the worse combination.

Yes, I'm "only" an O-3 but I am a physician. Not that being a physician entitles me to unconditional respect and admiration, but it does entitle me to the same professional courtesy due to any adult in a professional workplace.

Where do these 0-4, O-5, and O-6 nurses get off treating physicians like crap? Only in the military would this kind of behavior be tolerated. Can you imagine a nurse in the civilian setting telling a CT surgeon that they should wait for all the other nurses and techs to get their fill of pharm rep food before the doc can get any? Unbelievable!

Of course, since it is the military, there's nothing I can do since RANK is above all else. This perverted system could only thrive in the military which is why docs get out as soon as possible leaving behind incompetent, power hungry nurses to continue the cycle. Never mind, line commanders calling and emailing on a daily basis trying to influence your decisions so they can get their troops back to work. The medical corps would be much better off without rank. It has it's own inherent rank structure as it does in the civilian world: senior attendings, junior attendings residents, nurses, med students, techs, etc. That is all. Anyone have similar experiences? Any suggestions on how to get through the next couple years? I have 19 months to go and have had it.

The worst nurses are the career military militant mid levels providers, who hate doctors and will use their position of power to enforce their anti physician agenda. A mid levels provider can kill a patient thorough their own outright incompetence, and not get written up but, These advance practice nurses will comb the charts looking for anything to write up a physician in the hopes of tarnishing your record with a series of baseless complaints.

All too often this career military militant mid levels provider will be your commanding officer.

 

[Magnesium]

That is one important reason in my departure from the Navy. If nurses were good in administration I would not care. But they are (as a group) incompetent to be in the lead. It is absurd to expect them to be able to get good leadership out of nil. As a physician you are trained to think--you depend on this. But nurses are trained to follow, and when you reverse the roles you have the Butler pretending to be the Owner. Sad! They tried that in the French Revolution when the Lumpenproletariat took over after beheading everybody else in France. The created a "tiny" problem: they did not have anyone with brains to govern...so chaos ensued...then the dictatorship of Napoleon arrived (never a happy ending you know!). The Navy is running the Medical Corps with the least capable and trained. The institution is in shambles and the Surgeon General is either oblivious to this or is determined to destroy the Medical Corps--not sure which (with the available evidence).
Cheers!

 

[haujun]

So I have yet to sign up as a graduating resident. It's between Army and USN for me.

Which nurses are less malicious?

It is well known fact that AF nurses are not so nice. However increasingly USN and USA are working side by side with USAF. In the military prepare to have your life control (I mean work together as a team ) by nurses, MSC officer or other staff officers...

 

[jsmittyund03]

A physician should not look at their position as that of power and control, otherwise feelings like this are common. Just like any other business and team, mutual respect is essential for the best care. I find that those who have the most trouble with the nursing staff are those who think their degree elevates them above the rest. People with different responsibilities should learn from others, with dynamic respect, and it will at least alleviate some tension that the military heirarchy creates. I have always appreciated the nursing staff and what they do in team managed care.

 

[Gastrapathy]

A physician should not look at their position as that of power and control, otherwise feelings like this are common. Just like any other business and team, mutual respect is essential for the best care. I find that those who have the most trouble with the nursing staff are those who think their degree elevates them above the rest. People with different responsibilities should learn from others, with dynamic respect, and it will at least alleviate some tension that the military heirarchy creates. I have always appreciated the nursing staff and what they do in team managed care.

What a crock of ****. If you are a military physician, I'll eat my shorts. (edit: you claim to be a 'tern, so my instructions for you are to print your post and put it in your wallet and then read it again 8 years from now without choking).

This greeting card stuff ignores the fundamental realities of medicine. A physician must have the power and control. He has the final responsibility to ensure the best possible outcome and is the ONLY one who will ever face consequences when the system fails a patient.

 

[backrow]

A physician should not look at their position as that of power and control, otherwise feelings like this are common. Just like any other business and team, mutual respect is essential for the best care. I find that those who have the most trouble with the nursing staff are those who think their degree elevates them above the rest. People with different responsibilities should learn from others, with dynamic respect, and it will at least alleviate some tension that the military heirarchy creates. I have always appreciated the nursing staff and what they do in team managed care.

So sayeth the intern.......

 

[AF M4]

What a crock of ****. If you are a military physician, I'll eat my shorts. (edit: you claim to be a 'tern, so my instructions for you are to print your post and put it in your wallet and then read it again 8 years from now without choking).

This greeting card stuff ignores the fundamental realities of medicine. A physician must have the power and control. He has the final responsibility to ensure the best possible outcome and is the ONLY one who will ever face consequences when the system fails a patient.

Agree 100%. One has to actually be in a situation where one has all of the responsibility and little of the authority to fully understand just what being the doc, particularly the doc in the military, is all about.

As I and one of my colleagues said to our commanders the other day, when it's time for someone to take responsibility for the patients and their issues, we're the docs. But when it's time to talk about our suggestions and recommendations for improving clinic processes, patient care, safety and HIPPA concerns, then we're just a captain and a major.

And yes, we'd been much more collegial for months before building up to being so blunt.

 

[pgg]

A physician should not look at their position as that of power and control, otherwise feelings like this are common. Just like any other business and team, mutual respect is essential for the best care. I find that those who have the most trouble with the nursing staff are those who think their degree elevates them above the rest. People with different responsibilities should learn from others, with dynamic respect, and it will at least alleviate some tension that the military heirarchy creates. I have always appreciated the nursing staff and what they do in team managed care.

Ugh.

You know what one of the greatest things about anesthesia is? There aren't any nurses to get in the way. If a patient needs something I can just DO it, without having to worry about some nurse's feelings or opinion or "experience" or whatever other ridiculous ******ed retrospective excuse they'll come up with to avoid doing their jobs while obstructing my own.

 

[jsmittyund03]

What a crock of ****. If you are a military physician, I'll eat my shorts. (edit: you claim to be a 'tern, so my instructions for you are to print your post and put it in your wallet and then read it again 8 years from now without choking).

This greeting card stuff ignores the fundamental realities of medicine. A physician must have the power and control. He has the final responsibility to ensure the best possible outcome and is the ONLY one who will ever face consequences when the system fails a patient.

I didn't say you shouldn't have the power and control, I just stated that you shouldn't approach it as such. Obviously, it's in the definition of the job. Being a power hungry ass is not. Discounting the nursing, when they contribute so much to patient care is a joke as well. The best attendings/senior physicians I have encountered are those who not only lead, but do so with respect to their superiors, subordinates, and the noobs (that many of the nursing staff in military hospitals happen to to be).

And saying the physician is the ONLY one who will ever face consequences is just not accurate. Even as an ignorant "tern," I've seen this and know this for a fact.

 

[haujun]

A physician should not look at their position as that of power and control, otherwise feelings like this are common. Just like any other business and team, mutual respect is essential for the best care. I find that those who have the most trouble with the nursing staff are those who think their degree elevates them above the rest. People with different responsibilities should learn from others, with dynamic respect, and it will at least alleviate some tension that the military heirarchy creates. I have always appreciated the nursing staff and what they do in team managed care.

I agreed with your points. However, I feel that some nurses (O-5) use their position and rank to influence my actions. For example a nurse pointed out that I should not start MEB on this soldier. **I ignored her order and started MEB. A nurse modified my patient template without telling me. Template errors persisted as I am not given authorty to correct them! ***I corrected them. I have few other concrete examples...

Some of them may appear petty, but I feel that there is no respect. Their actions show. My experience is not aberration from the norm as a physician. Other physicians feel disrespect. I turned to my senior physician for guidance. They tell me to do your job and ignore their remarks and actions.

As MC officer I will enforce military regulations and deliver best possible patient care. These Nurses will NOT stop me. Do they have a good reason? Maybe or maybe not. However knowing their reasons will not alter my actions!!!

 

[haujun]

Ugh.

You know what one of the greatest things about anesthesia is? There aren't any nurses to get in the way. If a patient needs something I can just DO it, without having to worry about some nurse's feelings or opinion or "experience" or whatever other ridiculous ******ed retrospective excuse they'll come up with to avoid doing their jobs while obstructing my own.

Crap...I did not thought of this when I selected mine. That is why I am going into further training (Fellowship).

 

[Gastrapathy]

I didn't say you shouldn't have the power and control, I just stated that you shouldn't approach it as such. Obviously, it's in the definition of the job. Being a power hungry ass is not. Discounting the nursing, when they contribute so much to patient care is a joke as well. The best attendings/senior physicians I have encountered are those who not only lead, but do so with respect to their superiors, subordinates, and the noobs (that many of the nursing staff in military hospitals happen to to be).

And saying the physician is the ONLY one who will ever face consequences is just not accurate. Even as an ignorant "tern," I've seen this and know this for a fact.

See, as an intern, you have mostly interacted with the O1/O2 nurse. Once you get to where you run a clinic, mid-grade staff physician, you mostly interact with the O4/O5 nurse. All those motivated, likable young nurses are long gone or transformed kinda like gremlins (only larger).

Nurses can get in trouble for breaking the law. Thats about it Your credentials are always on the line.

Like I said, reread your post in 8 years.

 

[a1qwerty55]

I didn't say you shouldn't have the power and control, I just stated that you shouldn't approach it as such. Obviously, it's in the definition of the job. Being a power hungry ass is not. Discounting the nursing, when they contribute so much to patient care is a joke as well. The best attendings/senior physicians I have encountered are those who not only lead, but do so with respect to their superiors, subordinates, and the noobs (that many of the nursing staff in military hospitals happen to to be).

And saying the physician is the ONLY one who will ever face consequences is just not accurate. Even as an ignorant "tern," I've seen this and know this for a fact.

I think both your posts are pretty accurate.

Doctors, especially those who lack confidence in their skills and/or knowledge are a big part of the problem. When a nurse askes a question, those docs interpret that as some type of insult and get defensive- usually b/c they are wrong or don't know the answer. Their egos get a bit bruised and physicians don't do well with bruised egos.

A good physician leader teaches, leads, inspires, and makes the TEAM better for the benefit of the patient. That leader can do so without losing any conrol. Many docs discount the importance of team function and dynamics and focus on the physician piece. Ultimately great outcomes are often more a function of great nursing care than surgical or medical acumen. That is why surgical centers of excellence have better outcomes -- not better surgeons,,, better post op care.

Of course not all nurses are team players and the more rank they have the less team playing they become but I've worked with some great O-5/6 nurses.

 

[a1qwerty55]

Ugh.

You know what one of the greatest things about anesthesia is? There aren't any nurses to get in the way. If a patient needs something I can just DO it, without having to worry about some nurse's feelings or opinion or "experience" or whatever other ridiculous ******ed retrospective excuse they'll come up with to avoid doing their jobs while obstructing my own.

I guess you don't need the OR nurse, what about your CRNA's, they suck too?

 

[pgg]

I guess you don't need the OR nurse

No, I don't. Not really.

I basically like and respect all the OR nurses I work with, in and out of the military. The better ones stop their paperwork during induction and offer an extra pair of hands should I need it. For the most part, they're unscrubbed extensions of the scrub tech. Their impact on my actual anesthetic and perioperative care is minimal to non-existent.

So no, I don't need OR nurses.

what about your CRNA's, they suck too?

CRNAs are a special case - they have specifically chosen a MORE clinically oriented path, with MORE direct patient care, and MORE responsibility.

Don't get me wrong, I have issues with independent practice and I personally favor the care-team model endorsed by the American Society of Anesthesiologists. There are rare militant CRNAs (and by militant I mean shoulder-chippy angry people lobbying for expanded scopes of practice and independence, not merely 'in the military') but that's an altogether different issue. Actually, military-trained CRNAs are almost always among the best CRNAs I work with, and I personally feel a more collegial bond with them than I do their civilian counterparts. There are many reasons for this but I don't want to derail the thread too much.


The problem under discussion here is heavily, heavily slanted toward senior nurses WITHOUT any direct patient care responsibility. They've lost what made them valuable contributers to patient care - and they made the transition voluntarily, more or less.

Gastrapathy got it exactly right:

[...] the O4/O5 nurse. All those motivated, likable young nurses are long gone or transformed kinda like gremlins (only larger).

I say again, one of the best things about anesthesia is that it's like working in an ICU, minus the nurses (and social work, and nutrition consults, and service rocks, and ancillary service chasing, and and and and ...).

 

[IlDestriero]

I guess you don't need the OR nurse, what about your CRNA's, they suck too?

You're misinterpreting his post. As an anesthesiologist providing direct care, there is little opportunity for outside interference with your plan. You want blood, give it, want a central line, place it. His comment has nothing to do with CRNAs or OR nurses.
The problems arise in small commands with LCDR MDs and CDR and CAPT nurses who don't provide patient care. It has nothing to do with respecting the roles of the Jr nurses. You'll see in time. Maybe you'll get lucky and end up at a big center. GMOs are the most at risk.

 

[haujun]

The problems arise in small commands with LCDR MDs and CDR and CAPT nurses who don't provide patient care. It has nothing to do with respecting the roles of the Jr nurses. You'll see in time. Maybe you'll get lucky and end up at a big center. GMOs are the most at risk.

AF MTF. It can affect anyone. BTW I am not GMO. I am ready to move on.

 

[a1qwerty55]

You're misinterpreting his post. As an anesthesiologist providing direct care, there is little opportunity for outside interference with your plan. You want blood, give it, want a central line, place it. His comment has nothing to do with CRNAs or OR nurses.
The problems arise in small commands with LCDR MDs and CDR and CAPT nurses who don't provide patient care. It has nothing to do with respecting the roles of the Jr nurses. You'll see in time. Maybe you'll get lucky and end up at a big center. GMOs are the most at risk.

17 years, never altered a plan nor had a senior nurse significantly question a plan, be that a board etc. I too was an O-3 once.

 

[haujun]

17 years, never altered a plan nor had a senior nurse significantly question a plan, be that a board etc. I too was an O-3 once.

You made this point clear last time. 17 Years...3 (big) hospital...Army. Well most posters consist of diverse group of physicians. We are working as GMO, operational environment, smaller clinic, AF MTF (different branch) etc.

I on the other hand working in OP environment as well as AF MTF and Army hospital. I do not have any issues with line officers or nurses at Army hospital (smaller than MEDCENS). Well as for AF MTF....

I worked and trained in Army MEDCENS/MEDDACS without encountering these issues. We are not all self-righteous physicians posting here. We cannot be all wrong here.

 

[IlDestriero]

17 years, never altered a plan nor had a senior nurse significantly question a plan, be that a board etc. I too was an O-3 once.

It's not just interference with care, but also profound, unnecessary changes to the practice. Senior administrators changing clinic structure, planned meeting times, funding, training, etc. to generate minimal metric changes for fit rep bullets and promotion.
The OR/anesthesia was pretty isolated from a lot of the BS.

 

[haujun]

It's not just interference with care, but also profound, unnecessary changes to the practice. Senior administrators changing clinic structure, planned meeting times, funding, training, etc. to generate minimal metric changes for fit rep bullets and promotion.
The OR/anesthesia was pretty isolated from a lot of the BS.

Are we working at same AF MTF?

 

[pgg]

17 years, never altered a plan nor had a senior nurse significantly question a plan, be that a board etc. I too was an O-3 once.

You've also probably never had a flag rank NC officer shut down a MTF's outpatient clinic for an afternoon and put everybody to work with trash bags beautifying the hospital grounds, either.


They just don't get it. It's not even malicious, usually. They're like cats walking through the china cabinet - they're genuinely startled by the noise when they break something. They're just as useful when it comes to cleaning up, too.

 

[a1qwerty55]

You've also probably never had a flag rank NC officer shut down a MTF's outpatient clinic for an afternoon and put everybody to work with trash bags beautifying the hospital grounds, either.


They just don't get it. It's not even malicious, usually. They're like cats walking through the china cabinet - they're genuinely startled by the noise when they break something. They're just as useful when it comes to cleaning up, too.

As I recall, that NC officer was a USN one correct at NNMC?
As for AF we've all established the USAF medical establishment is a disaster.
Believe me, I'm am not oblivious to crappy medical leaders be they nurses or doctors... trust me the doctor leaders are as inept as the nurses if not worse. Frankly the worse Commanders are the MSC's b/c they actually believe the bull**** metrics. I no doubt have been lucky.

My take isn't that there is not a problem with nursing leaders especially in MTF's where they actually can lead clinical departments (a bad idea in my opinion) it is that most military nurses are actually pretty good - I've deployed on several occassions and trust me the nurses had it far worse than the docs, and still kept it together. They were young, idealistic, professional and were paying a price being deployed I appreciated. All docs sit around and bitch about stupid nurses, or more often our idiot physician colleagues, but to label all or most as rude, incompetent whatever as this string generally has is unprofessional.

 

[pgg]

As I recall, that NC officer was a USN one correct at NNMC?

but to label all or most as rude, incompetent whatever as this string generally has is unprofessional.

You're right. Our current DSS is worlds better than the last. I'm a little grumpy today because I spent part of yesterday and today revising the command's uniform instruction so they'd stop griping at us for wearing scrubs without a white coat when walking between the surgical suite and L&D (same floor, 50 feet apart), or non-white shirts under scrubs. Somebody cares about this sort of thing, but there's something wrong about parking a board certified anesthesiologist in an office to retype a uniform memo.

 

[a1qwerty55]

You're right. Our current DSS is worlds better than the last. I'm a little grumpy today because I spent part of yesterday and today revising the command's uniform instruction so they'd stop griping at us for wearing scrubs without a white coat when walking between the surgical suite and L&D (same floor, 50 feet apart), or non-white shirts under scrubs. Somebody cares about this sort of thing, but there's something wrong about parking a board certified anesthesiologist in an office to retype a uniform memo.

Funny, I recently did exactly the same thing, but by writing it, I was able to protect my people from the stupidity from above.

 

[pgg]

Funny, I recently did exactly the same thing, but by writing it, I was able to protect my people from the stupidity from above.

I agreed to do it precisely for that reason, and it really didn't even take much time, but that's not the point.

The point is that such protection maneuvers shouldn't be necessary in the first place, and they wouldn't be, if not for a bunch of administrators with nothing better to do than get anxious about how and where the worker bees wear their scrubs.

This is not normal. This is not sensible. This ought to be called in to the fraud, waste, and abuse hotline.

Perhaps you take satisfaction in navigating the bureaucracy and memo-minefields to 'protect your people' from pointlessly irrational threats idly fabricated by people who haven't touched a patient in 10 years (if ever, in the case of some MSC types), but it just irks me. And it should irk every American who's paying for doctors like you and me to sit around writing memos.

 

[a1qwerty55]

Perhaps you take satisfaction in navigating the bureaucracy and memo-minefields to 'protect your people' from pointlessly irrational threats idly fabricated by people who haven't touched a patient in 10 years (if ever, in the case of some MSC types), but it just irks me. And it should irk every American who's paying for doctors like you and me to sit around writing memos.

I do not really take satisfaction in writing any policy document and I agree it is a complete waste of my time and skills, but the problem of crappy administrators crafting crappy rules and policies permeates our entire bloated, inefficient government. I've dealt with more insane crap in the past year than I could have ever imagined. Take a look at the Joint Comission website if you want an example. Our elected leaders are *****s b/c the voters are *****s. We are essentially screwed, military and civilian alike. I'm just saving and planning so I can eject from all of it and work on my terms not anyone elses.

 

[bobbyseal]

stop griping at us for wearing scrubs without a white coat when walking between the surgical suite and L&D (same floor, 50 feet apart), or non-white shirts under scrubs.

Funny, I just found out the other day that I'm not supposed to wear a non white T shirt under my scrubs. I've been wearing blue, green, gray, and even V-necks! No one has said anything to me yet. My corpsman say it's because I'm an officer. Who knows? From the sound of this thread, it doesn't matter.

 

[DD214_DOC]

I just thought of something. Our current hospital CG is a MSC guy, which is pretty unique from what I have heard. Has anyone ever heard of a nurse corps CG running a hospital? I imagine that would be terrible.

At any rate, as an intern I really haven't had any of the same issues with the O1/O2 nurses fresh out of school. I get pages for stupid stuff a lot of times but I chalk that up to inexperience. I generally enjoy working with the O1-O3 nursing crowd and they reciprocate. They enjoy seeing me, know I'm pretty laid back (I don't care if they call me "doctor" or not) and are a pleasure to work with. In general, I think the nurse most of the docs don't like are also not well liked by the nurses.

 

[pgg]

I just thought of something. Our current hospital CG is a MSC guy, which is pretty unique from what I have heard. Has anyone ever heard of a nurse corps CG running a hospital? I imagine that would be terrible.

A NC admiral ran NNMC for a while ~10 years ago.

I was told that the Navy Dental Corps gets one Navy hospital CO billet at a time. Not sure about the #s there, but I do know the next CO of my little Navy hospital will be DC. I think (hope) that'll work out OK.

 

[backrow]

A NC admiral ran NNMC for a while ~10 years ago.

I was told that the Navy Dental Corps gets one Navy hospital CO billet at a time. Not sure about the #s there, but I do know the next CO of my little Navy hospital will be DC. I think (hope) that'll work out OK.

I would rather have a dentist than an MSC or NC. At least they have the background of being a provider.

Obviously this is a very broad generalization as there can be great MSC/NC commanders and horrible DC/MC commanders, but without knowing each person individually I'd rather have a provider as the CO.