Nurses in Rehab.

[pmr222b]

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As a third year med student i am seeing nurses, especially in ICU and ER being downright rude to interns and residents and even arguing with junior attendings.
sometimes it makes me not want to even talk to them or ask about my patients.
how are the nurses on the rehab floors? are they also so difficult to deal with? and why do nurses in ICU be so mean?
thanx

 

[topwise]

Just like doctors, some nurses are good, some nurses are bad, and some nurses are mean. I've met all three kinds both on medicine wards and rehab wards.

 

[SSdoc33]

i may get castigated here, but rehab nurses are generally mediocre. their salaries are lower and they are typically not as well trained or ambitious as floor/ICU nurses.

i cant speak to how "mean they are" vs other nurses, probably not all that different

 

[Finally M3]

i may get castigated here, but rehab nurses are generally mediocre. their salaries are lower and they are typically not as well trained or ambitious as floor/ICU nurses.

i cant speak to how "mean they are" vs other nurses, probably not all that different

That's about right. The good ones generally move on to positions with more autonomy (ICUs).

 

[mdvol]

That's about right. The good ones generally move on to positions with more autonomy (ICUs).

I would agree with this. I would routinely see the student nurses on rotation show up as "hired" on the rehab ward. Fresh out, less pay - usually nice at that point though until the cynicism sets in.

 

[caedmon]

Sounds like some folks have had a bad experience.

Nurses that I've worked with in my residency setting have been great. There are many nurses on our rehab unit that have been around for a LONG time. Those that have had the opportunity to move up in the ranks, seem to have chosen rehab related positions (rehab nurse managers, rehab coordinators, etc.). My experience is that they've been very good at what they do. They make all efforts to calm an agitated patient before calling you for meds or giving prescribed meds, can recognize signs of autonomic dysreflexia and take basic steps to alleviate, and are dang good and particular about their patients bowel care amongst other things. The list of their rehab specific expertise goes on and on.

Not all rehab nursing is sub-par.

 

[drusso]

When I was in residency, someone circulated among the residents the results of a recent survey of top 10% nursing graduates and what areas of nursing they intended to practice.

Not surprisingly, the top areas among the top grads were ER, ICU, Anesthesia, Cardiac, and OR. As I recall, rehab nursing ranked just above correctional prison nursing (which was dead last) as a viable career choice for top nursing graduates.

I always regarded the findings of this survey as having tremendously powerful explanatory value when I interacted with most rehab nurses.

 

[Finally M3]

Sounds like some folks have had a bad experience.

Nurses that I've worked with in my residency setting have been great. There are many nurses on our rehab unit that have been around for a LONG time. Those that have had the opportunity to move up in the ranks, seem to have chosen rehab related positions (rehab nurse managers, rehab coordinators, etc.). My experience is that they've been very good at what they do. They make all efforts to calm an agitated patient before calling you for meds or giving prescribed meds, can recognize signs of autonomic dysreflexia and take basic steps to alleviate, and are dang good and particular about their patients bowel care amongst other things. The list of their rehab specific expertise goes on and on.

Not all rehab nursing is sub-par.

We had some great rehab nurses. But I can think of 5 of them off the top of my head in the two years I was doing a lot of inpatient...

What happened?

1) NICU
2) CCU
3) Cardiac stepdown
4) Surgery Center

One stayed.

 

[truthseeker]

I have noticed that some nurses, fresh out of school are eager, educated, and want to take care of patients. The older they get (not all, but all too common) they seem annoyed at the "inconvenience" of helping people. They feel that they are underappreciated, feel like they have no power (they don't if they don't make good decisions when they have the opportunity) and generally feel like they are at the bottom of the food chain.

Some docs feel threatened by the good ones, some of the nurses come out of a 2 year RN program and are ill equipped to deal with people maturely, some of the good ones are corrupted by the cynical older ones.

Here comes the non-political correct but true statement. Nursing is mostly women and many women don't play fair when it comes to confrontation. It sometimes reverts to the Jr. High gym class clique-y backstabbing. The targets can include other nurses, docs, PTs, administrators, CNAs, and lab techs.

The rehab nurses have probably the most physically demanding area of nursing because of the inability of many of the patients to move or make decisions (TBI, stroke, dementia) and maybe their backs hurt or something.

I do echo what was said above though, there are good and bad in every specialty and in every discipline. The OP may just be in a rehab department with an unhealthy attitude. We had an outside consultant come to our hospital and actually say that the culture was "clinically depressed". that about summed it up.

With unions today, it is much harder to get rid of the crabby ones.

 

[PMR 4 MSK]

Most of mine, residency through private practice, have been very good, with a few notable exceptions. One was the worst - aleays had something to say about my orders, asked for clarifications and changes. On one pt who was a CVA not taking much fluids we ordered strict I's and O's. Apparently that was too hard for her, for several days, her shift showed no results. Her suggestion: "Have you ever heard of a CBC ?!?!"

Biotch left 3 weeks b4 I finished my residency.

 

[Ludicolo]

As a third year med student i am seeing nurses, especially in ICU and ER being downright rude to interns and residents and even arguing with junior attendings.
sometimes it makes me not want to even talk to them or ask about my patients.
how are the nurses on the rehab floors? are they also so difficult to deal with? and why do nurses in ICU be so mean?
thanx

Nurses come in many different sizes, shapes, scrub colors, levels of experience, personalities. As do therapists, social workers, and physicians. Part of the hidden education of medical school and residency is learning how to work with all sorts of personalities. Not everyone is friendly and satisfied with their job. Not everyone is intelligent or competent. Acknowledge and learn from the ones who are. Be humble, pick your battles carefully, and most of the others will come to respect you.

For those that seem to be forever crabby – bring ‘em a box of Krispy Kremes and they’ll eventually leave you alone.

 

[axm397]

A lot of people - nurses, therapists, receptionists, etc. just want to be acknowledged for how hard they feel they are working (notice I said feel - not necessarily really are working). If you take a moment to tell them you appreciate their work, and you realize they are feeling overwhelmed by all the work they have to do it can go a long way. Actually introducing yourself to them when you first meet them can go a long way. I had an OR nurse almost faint when I went over to her to shake her hand and say "Hi, I am Dr. _____, I'm going to be working with you today. Thanks for being here."

It might feel fake at first but the response you get is genuine - and if you can see things from their perspective, it can really change your perspective. I think you still have to maintain some boundaries (don't want to be too buddy buddy) but can at least be respectful.

 

[PMR 4 MSK]

pick your battles carefully,

The #1 advice you can give anyone, anywhere for any situation involving conflict.

I also like the Krispy Kreme idea. Nurses run on coffee and donuts.

 

[truthseeker]

Nurses come in many different sizes, shapes, scrub colors, levels of experience, personalities. As do therapists, social workers, and physicians. Part of the hidden education of medical school and residency is learning how to work with all sorts of personalities. Not everyone is friendly and satisfied with their job. Not everyone is intelligent or competent. Acknowledge and learn from the ones who are. Be humble, pick your battles carefully, and most of the others will come to respect you.

For those that seem to be forever crabby – bring ‘em a box of Krispy Kremes and they’ll eventually leave you alone.

Brilliant