Nurses who do not recognize their own limitations

[anon-y-mouse]

Ugh, what the hell?! How do you put up with people like this? They question your team's every single order in the most arrogant, annoying, and persistent of ways, with some ******ed question... and then when you show them why they are wrong, they retreat to some bull**** copout answer. I've patiently explained my team's rationale for quite a lot of things, and most nurses have asked me quite nicely and patiently, but there are a few people who are simply too caustically critical for words. The worst was when I heard one of them, who was on her way to becoming one of Mary Mundinger's poster children, talk about how she would manage things completely differently when the state gives her the authority to do so. Any other stories? Or ways to quiet these folks? Or let them know what freaks they are?

I KNOW like 897 nurses are going to join SDN now and militantly post against this, so I just want to note that I have had great experiences with nurses before, and I treat them (overall) with respect. My thread is geared towards the "bad apples" (and I'm sure these exist everywhere). Nurses: don't trash my thread!

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[smq123]

Ugh, what the hell?! How do you put up with people like this? They question your team's every single order in the most arrogant, annoying, and persistent of ways, with some ******ed question... and then when you show them why they are wrong, they retreat to some bull**** copout answer. I've patiently explained my team's rationale for quite a lot of things, and most nurses have asked me quite nicely and patiently, but there are a few people who are simply too caustically critical for words. The worst was when I heard one of them, who was on her way to becoming one of Mary Mundinger's poster children, talk about how she would manage things completely differently when the state gives her the authority to do so. Any other stories? Or ways to quiet these folks? Or let them know what freaks they are?

I know. Good nurses who also happen to be nice and "play well with others" are worth their weight in gold.

I hate it when the nurses assume that everything is the med student's fault. One nurse berated me for "losing a patient's narc script," and wouldn't believe my fellow student when he explained that the patient didn't GET a narc script, because that patient had been arrested before (twice, actually) for selling his prescription valium on the street corner. This patient was a known drug-seeker, a fact that was well documented in multiple discharge summaries and operative reports. The attending then started yelling at her, for not realizing that maybe a patient with a known history of incarceration might actually lie to her.

What annoys me is that nurses think that they're invincible because they're less frequently named in lawsuits. But if they had more autonomy and more input on patient care, they'd get sued just as frequently. Some nurses just don't realize it yet.

The nurses that are often the most caustically critical also seem to be the ones that are least competent. If you hang around long enough, they'll make a mistake and get berated for it. As my friend used to say, "Karma's a bi***."

My favorite was when a nurse spent 5 minutes lecturing me on the importance of following JCAHO regulations when writing progress notes. She stressed the need to correctly date and time my notes, and explained this to me as if I were 4 years old. Seriously, she was extremely patronizing. Which made it even more satisfying to show her her own nursing note in the chart, which was incorrectly dated AND timed.

 

[meister]

I KNOW like 897 nurses are going to join SDN now and militantly post against this, so I just want to note that I have had great experiences with nurses before, and I treat them (overall) with respect. My thread is geared towards the "bad apples" (and I'm sure these exist everywhere). Nurses: don't trash my thread!

It's cute that you tried, I'll give you an A for effort at least.

 

[JeffLebowski]

There was this nurse who "held" and didn't give a patient his ACEI prescribed to protect the patient's kidneys (and no history of hypertension) because "his blood pressure was fine".

They really like to "hold" meds here. In my opinion, if you want to hold a med, you should have to clear it with the resident first. Sometimes they're right, and sometimes it's not a big deal, but hey, you should check. Most are great though.

 

[J1515]

Chill out. Why are you hating? What's your complaint specifically have to do with nurses? Sounds like there was this one girl? Are you that easily frustrated? Maybe you have a crush on her and you can't find the right words to express how you feel?

The way you handle it is remove your ego from the situation. They have seniority in respect to the sheer amount of clinical hours they've invested, and you know what? Maybe they're sick of know-it-all, self entitled, med students sauntering around feeling like they're king of the hospital in regard to nurses and techs, and somewhere, in all the confusion, they mistake you for one? Let it go, it's not a big deal. If you make it one, people will notice in a bad way.

He's not making a big deal about it. That's why he's coming on SDN to talk about it rather than making a big stink about it at the hospital. It's true, the majority of nurses are good, recognize their limitations, and if they are unsure about something will call to check first. The same way the majority of medical students are willing to learn the clinical procedures/protocol from nurses who have been on the floor a lot longer than us and play nicely. As the OP said, it's the few nurses who think they are qualified to do the job of a doctor and the few medical students who think they are better than a nurse who has been doing this for 20 years that cause the problems.

And I know all the NPs are gloating about their new DNP degrees and chomping at the bit to manage their own patients. Just wait until they start getting named in lawsuits, or have to pay for their own malpractice.

 

[diosa428]

Chill out. Why are you hating? What's your complaint specifically have to do with nurses? Sounds like there was this one girl? Are you that easily frustrated? Maybe you have a crush on her and you can't find the right words to express how you feel?

The way you handle it is remove your ego from the situation. They have seniority in respect to the sheer amount of clinical hours they've invested, and you know what? Maybe they're sick of know-it-all, self entitled, med students sauntering around feeling like they're king of the hospital in regard to nurses and techs, and somewhere, in all the confusion, they mistake you for one? Let it go, it's not a big deal. If you make it one, people will notice in a bad way.

Yeah, except for the part where they didn't go to medical school and aren't doctors and therefore don't get to make clinical decisions outside of the realm of their profession.

Also - #1 - you're not a medical student if you haven't started medical school yet, and #2 - since you haven't started medical school yet, maybe you should wait until you're on the wards before posting in the clinical rotations forum - since, like the nurses in the OP's post, you clearly have no idea what you're talking about.

 

[silas2642]

Chill out. Why are you hating? What's your complaint specifically have to do with nurses? Sounds like there was this one girl? Are you that easily frustrated? Maybe you have a crush on her and you can't find the right words to express how you feel?

The way you handle it is remove your ego from the situation. They have seniority in respect to the sheer amount of clinical hours they've invested, and you know what? Maybe they're sick of know-it-all, self entitled, med students sauntering around feeling like they're king of the hospital in regard to nurses and techs, and somewhere, in all the confusion, they mistake you for one? Let it go, it's not a big deal. If you make it one, people will notice in a bad way.

He's not hating-- he was talking about crappy nurses. Most nurses are great-- very helpful, good with patients, friendly, etc. He's just here venting. You'll figure this out once you're a med student. And just a little thing-- don't tell med students what to do when you're not a med student. It's irritating because you have no idea what you're talking about.

 

[anon-y-mouse]

He's not hating-- he was talking about crappy nurses. Most nurses are great-- very helpful, good with patients, friendly, etc. He's just here venting. You'll figure this out once you're a med student. And just a little thing-- don't tell med students what to do when you're not a med student. It's irritating because you have no idea what you're talking about.

Thank you, agreed. Lovepark: I (and those who've posted above me) personally feel you should shut your piehole because you have no idea what you're talking about. Not only have you not been on the wards yet, you haven't even started medical school! You can't possibly know the frustration that sets in when a nurse DOESN'T CARRY OUT your team's order, and it potentially kills people. Like the nurse who decides a patient's bowels have been moving just fine and decides NOT to administer a patient's lactulose. which was ordered scheduled, not prn, for HEPATIC ENCEPHALOPATHY and not constipation. If you'd bothered to read what I said, I'm ridiculously patient with nurses and try to explain things as best as I can, but when the caustic attitude comes out, it's when people's lives are at risk and just causes a bad environment at the hospital. So please don't continue to post on my thread if you have no idea what the **** you're talking about.

 

[fab4fan]

Ugh, what the hell?! How do you put up with people like this? They question your team's every single order in the most arrogant, annoying, and persistent of ways, with some ******ed question... and then when you show them why they are wrong, they retreat to some bull**** copout answer. I've patiently explained my team's rationale for quite a lot of things, and most nurses have asked me quite nicely and patiently, but there are a few people who are simply too caustically critical for words. The worst was when I heard one of them, who was on her way to becoming one of Mary Mundinger's poster children, talk about how she would manage things completely differently when the state gives her the authority to do so. Any other stories? Or ways to quiet these folks? Or let them know what freaks they are?

I KNOW like 897 nurses are going to join SDN now and militantly post against this, so I just want to note that I have had great experiences with nurses before, and I treat them (overall) with respect. My thread is geared towards the "bad apples" (and I'm sure these exist everywhere). Nurses: don't trash my thread!

I was going to suggest you start carrying a syringe of sux for such occasions, but that might be seen as "horizontal violence" and put a dent in your career.

FWIW, they get on my nerves too, and I'm a nurse.

 

[smq123]

Still, your followup makes me feel you and your friends are real fragile eggs.

Again, wait until you get to where he is, and pre-MS1s on SDN are telling you how YOU ought to react, to a situation that they've never really experienced before.

 

[smq123]

An intern says give 50mg IV of lopressor in a tachy situation to a nurse, the nurse looks at the intern like they're insane and a short time later nurse calls rapid response to take control of the situation (after NOT carrying out the order). Stuff happens, and you know what? It's okay not to take it personally, like all of you seem to be.

It is NOT okay "not to take it personally."

If the nurse purposely disregards an order, and the patient gets sick or even dies because of that, how do you "not take it personally"?

Fundamentally, you become a doctor to help take care of people. Not to harm them, and not to make their condition worse. These people have entrusted their lives in YOUR hands, and when things go wrong for them, of course you take it personally. You get angry when patients die because someone in the healthcare team caused that death. Negligence and willful ignorance is worse than just an outright mistake. These are real people, and we can do real harm to them. Why are you so blasé about that?

If a nurse mentions to a resident that the patient in bed 6 is having trouble breathing, and the resident purposely blows it off, and then the patient ends up dying, don't you think that that nurse would be angry? So why shouldn't doctors and med students get angry when it happens to them?

I mean hell, you're threatened by even me.

We do not feel threatened by you. It's just that it's, honestly, quite irritating to be told how to react and what "not to take personally" by someone who has never been in that situation.

 

[smq123]

If you thought that that nurse almost caused the person's life that I quoted earlier, it shows how little you really know. 50mg would have killed that patient.

Oh WOW! You know SO MUCH! You should be a doctor already!!!!

I read the 50 mg and thought it said "PO," since 50 is a standard PO dose. Sorry.

What on earth are you talking about?! There was no mention of a nurse killing a patient, or of a nurse defying orders! The OP was in regard to a seemingly "obstinant" nurse who wanted to know WHY things were being done.

Since you clearly didn't feel the need to read the rest of the thread before rushing in to defend nurses from those "mean old med students"....

Like the nurse who decides a patient's bowels have been moving just fine and decides NOT to administer a patient's lactulose. which was ordered scheduled, not prn, for HEPATIC ENCEPHALOPATHY and not constipation.

But a little hepatic encephalopathy never hurt anyone, right? So your hands may start to flap a little...that just adds to the fun!

Look. I like most nurses. And when nurses politely ask why things are being done, then that's totally cool. That's encouraged - we're all supposed to check each other, and asking polite questions is fine.

Asking caustic, rude questions in a patronizing way is NOT encouraged. It doesn't matter who the question is coming from - a nurse, a resident, an attending, a student, whoever. And holding medications, or giving other medications, without telling the primary team is NOT a good idea....and it's been known to happen. A lot more than you'd like to believe.

Let the OP vent. It's annoying when a nurse (who doesn't really know what he/she is talking about) questions the resident, or does things just because "this is how it's always been done." Why you felt the need to jump into the discussion is beyond me.

 

[zenman]

I was going to suggest you start carrying a syringe of sux for such occasions, but that might be seen as "horizontal violence" and put a dent in your career.

FWIW, they get on my nerves too, and I'm a nurse.

True. Every day I get less and less able to deal with stupid people. Sometimes I feel like I'm surrounded and I'm running out of ammo. I'm gonna save the last bullet for myself.

 

[silas2642]

How does it feel?
If you thought that that nurse almost caused the person's life that I quoted earlier, it shows how little you really know. 50mg would have killed that patient. The intern was in the wrong, the nurse saved the patients life.
I'm retracting my "I stand corrected", because the conversation you're continuing has no resemblance to the OP. What on earth are you talking about?! There was no mention of a nurse killing a patient, or of a nurse defying orders! The OP was in regard to a seemingly "obstinant" nurse who wanted to know WHY things were being done. And you know what? If a medical student is part of that TEAM, and seemingly leading the team, she or he has every right to inquire. What director wouldn't encourage STRICT OVERSIGHT?! I'm glad you're pursuing this thread, because the more I look at it, the more I see that there's an evolution of justification of bias going on.



Here's the OP's post, I'll leave you to decide whether or not there's any mention of patients dying because of incompetent nurses:



"Ugh, what the hell?! How do you put up with people like this? They question your team's every single order in the most arrogant, annoying, and persistent of ways, with some ******ed question... and then when you show them why they are wrong, they retreat to some bull**** copout answer. I've patiently explained my team's rationale for quite a lot of things, and most nurses have asked me quite nicely and patiently, but there are a few people who are simply too caustically critical for words. The worst was when I heard one of them, who was on her way to becoming one of Mary Mundinger's poster children, talk about how she would manage things completely differently when the state gives her the authority to do so. Any other stories? Or ways to quiet these folks? Or let them know what freaks they are?

I KNOW like 897 nurses are going to join SDN now and militantly post against this, so I just want to note that I have had great experiences with nurses before, and I treat them (overall) with respect. My thread is geared towards the "bad apples" (and I'm sure these exist everywhere). Nurses: don't trash my thread!"

You're basically trashing the OP for being judgmental and condescending to nurses, but you're doing the same thing to the OP-- you're judging a person whom you've never met who is in a situation that you could not possibly understand. You are not a medical student, you know no medicine. Zip. Zero Zilch. Again, students come to these forums to vent, and that's what the OP came here to do-- so why don't you just mosey back to pre-osteo until you start med school next summer, m'kay? And change your avatar until you matriculate because you're not a med student. Finally, no one here is threatened by you-- annoyed is the word.

 

[Samoa]

Look, it was appropriate for that nurse not to give 50mg of IV metoprolol. However, if she were actually a GOOD nurse, then instead of just holding the med and calling the rapid response team, she would have said, "you meant 5mg, right? 50mg is the PO dose."

Pt gets appropriate treatment in a timely manner, intern develops a little more respect for the nurse.

Bottom line: I'm open to discussion if a nurse thinks there's a better option than the one I'm ordering. But if you don't know enough to suggest an alternative, or explain to me the harm you think it might do the patient, then I expect the order to be carried out.

For anon-y-mouse: the nurses ask you because there's less of a power differential, and also to get a feel for whether their question is legitimate and appropriate. So you get all the stupid questions. It's just yet another thing that sucks about being the student on the team.

Over time, as well, the nurses get a feel for which residents know what they're doing, and which ones are dangerous and arrogant. It can be extremely helpful, on the inevitable occasion when you do screw up royally, to be known as one of the former.

 

[J1515]

An intern says give 50mg IV of lopressor in a tachy situation to a nurse, the nurse looks at the intern like they're insane and a short time later nurse calls rapid response to take control of the situation (after NOT carrying out the order).

Awww, so cute. Look at the little pre-med pretending to know medicine! I guess we should all listen to you now.

You have no idea what you are talking about, despite your mommy and daddy being doctors and shadowing for 500000 hours. This is the clinical rotations forum - for people who have actually done clinical rotations. Now begone.

 

[GoBuckeyes913]

Ugh, what the hell?! How do you put up with people like this? They question your team's every single order in the most arrogant, annoying, and persistent of ways, with some ******ed question... and then when you show them why they are wrong, they retreat to some bull**** copout answer. I've patiently explained my team's rationale for quite a lot of things, and most nurses have asked me quite nicely and patiently, but there are a few people who are simply too caustically critical for words. The worst was when I heard one of them, who was on her way to becoming one of Mary Mundinger's poster children, talk about how she would manage things completely differently when the state gives her the authority to do so. Any other stories? Or ways to quiet these folks? Or let them know what freaks they are?

I KNOW like 897 nurses are going to join SDN now and militantly post against this, so I just want to note that I have had great experiences with nurses before, and I treat them (overall) with respect. My thread is geared towards the "bad apples" (and I'm sure these exist everywhere). Nurses: don't trash my thread!

One bad apple can make a whole team bitchy for the day. Solution? Chocolate. Go to Wal-mart and buy the jumbo size bags of the bite-size candy bars (like they have out for halloween) and drop it off at the nursing station.
Do this once, and see what happens, you'll be amazed. Chocolate makes everyone happy, and less questions will fly, and stuff will get done. Trust me. Totally not joking. I do this frequently. Works every time.

 

[meister]

removed for sanity, I really should stop going to bed at 3am.

 

[hooperg]

lovepark:
Here's a thought: before you go around acting like you're hot **** because you just got accepted to a school a month ago, why don't you take a second to realize that all you're doing is being a condescending troll. I know you're excited that you're going to be a doctor some day, but in the mean time give us all a break and stop posting for a while, at least until your pre-med chubby goes away. Thanks.

Epic LuLz.

 

[BigRedBeta]

T You can't possibly know the frustration that sets in when a nurse DOESN'T CARRY OUT your team's order

One of my favorite moments of third year was watching an attending tell this **** of a nurse that "they're orders, not suggestions". Should have seen the look on her face...priceless.

 

[Trail Boss]

I never make eye contact with nurses, and I don't ever ask them open ended questions. I don't argue with them either. I just carry they chart up three floors for the intern to sign, and then I carry it back down and put it on their counter. No verbals, fine. No verbals. Don't care. Just want my grade, no friction, no conflicts...no complaints. Everyone pays their dues. Some day I will make them pay theirs. For now, they win.

 

[anon-y-mouse]

Another precious snarky comment from that nurse I just overheard: "God, those stupid doctors. Why the hell don't they see this patient's pancytopenic and give him some neulasta?? I'm not sure why they don't care about patients in this hospital". Patient = s/p chemo for AML.

 

[Rzarecta]

Another precious snarky comment from that nurse I just overheard: "God, those stupid doctors. Why the hell don't they see this patient's pancytopenic and give him some neulasta?? I'm not sure why they don't care about patients in this hospital". Patient = s/p chemo for AML.

This is by far the funniest thing I have read all day.

 

[dilated]

Another precious snarky comment from that nurse I just overheard: "God, those stupid doctors. Why the hell don't they see this patient's pancytopenic and give him some neulasta?? I'm not sure why they don't care about patients in this hospital". Patient = s/p chemo for AML.

Maybe the pharm reps should start detailing the nurses. There could be entire new markets waiting to be explored. Epogen for sicklers!

I think this is an institutional issue though. A certain amount of nurse grumbling is par for the course anywhere and there are some interns and juniors who have no clue what's going on. But if it becomes a serious issue your attendings should have your back (and they usually do at my school so we really don't have this issue).

 

[dragonfly99]

trailboss has the right idea about how to deal with conflict as a med student or intern. Do NOT engage people like this. Do NOT be drawn in. Pretty easy actually when you are a med student. Sometimes not possible when you are an intern.

 

[meister]

Another precious snarky comment from that nurse I just overheard: "God, those stupid doctors. Why the hell don't they see this patient's pancytopenic and give him some neulasta?? I'm not sure why they don't care about patients in this hospital". Patient = s/p chemo for AML.

Some day I will understand what this post means. In the mean time, nope.

 

[LadyWolverine]

Some day I will understand what this post means. In the mean time, nope.

neulasta = pegylated G-CSF. G-CSF stimulates granulocyte (myeloid lineage) colonies to grow and divide. Now, think about what would happen if you gave a patient with AML some G-CSF.

 

[Trail Boss]

Look up neulasta and AML and it will become painfully funny. At least you have the guts to say you don't know. Nurses know more about drugs than I expected, and can discuss them convincingly and confidently, and they should--they spend their whole careers pushing them.

The trouble is that they don't know about diseases. A dangerous situation that breeds arrogance, sometimes convincing arrogance if you don't have the nerve to question them. Some are quite persuasive, and we are pounded so hard with all this professionalism, which can sometimes make it seem like appeasement is more PC than taking a stand and stirring up a dispute. I think that it is important that we all know our place. Doctor's is to make decisions. Nurse's is to carry them out. I got bullied by a nurse into advocating doing something once that turned out to be wrong, very wrong. I will never do it again, since then I have adopted the above mentioned policy in a previous post. Better to just avoid them. The three lines I speak to nurses are 1. "Were there any events overnight......Thank you." 2. "Here is the chart, thank you." 3. "I will mention that to my intern, thank you." I realize this may seem timid, and it is, but it is difficult to walk the line between taking a stand as a novice medical professional and letting the s*** fall where it may and being "unprofessional" in a situation where you are NOT where the buck stops. I think that this is the most difficult part of being a medical student on the wards, when you finally learn your place you realize that you do not fit in it, that it is transient and awkward.

 

[njbmd]

As others have said, Choose your battles wisely. In the grand scheme of things, a nurse who is having a bad day or is rude is going to make little difference in your life. I used to just smile, say "thank-you" or "pardon me for leaning on your door" and thought about my graduation day when I would be an MD. That thought just kept me going through all sorts of craziness that didn't actually involve me personally.

Now, when I run into anyone who is rude and unprofessional from one of my colleagues to the custodian, I smile and say that I hope the day gets better for them. I just don't have time for negativity and I keep smiling as I am "livin my dream".

 

[PeepshowJohnny]

Another precious snarky comment from that nurse I just overheard: "God, those stupid doctors. Why the hell don't they see this patient's pancytopenic and give him some neulasta?? I'm not sure why they don't care about patients in this hospital". Patient = s/p chemo for AML.

The best approach to these are to take the "Kung fu master" approach. You know how in martial arts movies, the big badass NEVER fights unless he's forced to? Like, some toughs threaten him, he ignores them/tries to defuse the situation, even letting them think they won?

This is how you handle nurses who behave this way. As long as they're not defying orders or speaking to patients appropriately, I let them get off on their power fantasies about how they could fix all the patients the stupid doctors can't. It doesn't hurt you, doesn't hurt the patient and there's no point in lecturing them because 1) they won't believe it coming from you and 2) they won't change so why waste your time?

 

[cornflakes55]

I'm writing from the UK and am fairly amused by the huge doctor/nurse split that exists globally. In this country there is a definite morphing of roles taking place. The European Working Time Directive reduced junior doctors hours in 2004, resulting in nurses taking on a lot of roles traditionally held by medical staff, such as prescribing, admitting/discharging patients, becoming partners in PCT's (primary care centres), running nurse-led clinics, running minor injury units, etc, etc...Some (nurses) welcome it, others (doctors) fear patient care is being compromised.(Well, that is the official line anyway, which thinly disguises the real fear, which is that nurses may one day be equal to doctors - AAAARGH!) The same themes abound here, such as dissuading nurses from attempting to become mini-doctors. I am not sure what the future holds but I would bet my bottom dollar (or pound) that if we could fast-forward 100 years, 'doctors' and 'nurses' will be job titles of the past. I sincerely believe that the relaxing of professional boundaries which we are all seeing, coupled with the radical canges that are occuring in the education system, will eventually result in generic health care professionals who will be trained to do the whole kit and kaboodle (even ****-shovelling, friends.) And these somewhat grim and bitter power struggles between medical and nursing staff will be a thing of the past also. Maybe I should change it to 200 years....resitance from the docs will be strong. After all, if there are no nurses to feel superior to, what's the point in all thse arduous years of medical school?

 

[anon-y-mouse]

Maybe this lowly nurse is just more up to date on their EBM than you hotshots...

Sierra J, et al. A single dose of pegfilgrastim compared with daily filgrastim for supporting neutrophil recovery in patients treated for low-to-intermediate risk acute myeloid leukemia: results from a randomized, double-blind, phase 2 trial. BMC Cancer. 2008 Jul 10;8:195.

A pertinent quote:
Concerns that hematopoietic growth factors might stimulate growth of the myeloid leukemic clone in patients have not been confirmed in clinical studies: to date, leukemic clone stimulation has been demonstrated only in vitro [26-28]. Long-term follow up (median 7 years) of patients in the Heil et al. study showed that filgrastim treatment did not have any adverse effects on complete remission or long-term survival rates [29]

Man, I love it when nurses register and post all sorts of irrelevant crap. I think a lot of nurses have an undiagnosed inferiority complex and think they know it all. The patient in this case would have been excluded from this study's parameters... way higher than "low-to-intermediate risk".

 

[anon-y-mouse]

Irrelevant crap? You guys are all having a laugh at the dumb nurse for wanting to give neulasta b/c you think it will cause cancer progression when in fact multiple clinical trials have shown that to be a bogus concern.

The more relevant study is the one I noted in the pull quote (by Heil et al) that showed no detrimental effects of filgrastim tx in patients with AML.

Not a nurse btw, not that you will believe me or care. 3rd year med student who gets driven crazy by the floor nurses all the time (esp. at the VA). I actually heard a nurse today reminiscing about college - and complaining about having to take "all those science and math courses" because "I never use that crap"

Yes, but the study criteria from your paper excludes my patient unfortunately. Nevertheless, it is not standard of care to provide neulasta for leukemia s/p chemo. It's something you could think about doing on a case-by-case basis, but without considering individual cases, it is committing malpractice... to simply adopt it for every case of pancytopenia no matter what is negligent. Do you know WHY neulasta has not been shown to be associated with recurrence? Until then, it should clearly be used with extreme caution, as it goes against common sense principles.

My point was that this nurse was thinking "low wbc"=>"give neulasta" in the algorithmic way that they are taught, not because she was banging the hematologist down the hall who encouraged her to read this journal article. There are simply a ton of other things going on that sometimes we don't bother to explain in full detail to nurses... for whatever reason or another. Another example, another nurse was pissed off that we didn't give NTG for a hypotensive patient with a clear right-sided MI. I explained that one, but she still had a chip on her shoulder about it.

I am flattered that you decided to register simply to post on my thread. However, your contribution of "oh but in this case!" is demeaning and insulting- we are all taught to incorporate new research into our treatment regimen, but not without understanding what or why we do what we do.

 

[45408]

Especially when the poster I replied to specifically said to go look it up, and when I did that I found the exact opposite to be true.

...in a certain subset.

 

[JeffLebowski]

I'm writing from the UK and am fairly amused by the huge doctor/nurse split that exists globally. In this country there is a definite morphing of roles taking place. The European Working Time Directive reduced junior doctors hours in 2004, resulting in nurses taking on a lot of roles traditionally held by medical staff, such as prescribing, admitting/discharging patients, becoming partners in PCT's (primary care centres), running nurse-led clinics, running minor injury units, etc, etc...Some (nurses) welcome it, others (doctors) fear patient care is being compromised.(Well, that is the official line anyway, which thinly disguises the real fear, which is that nurses may one day be equal to doctors - AAAARGH!) The same themes abound here, such as dissuading nurses from attempting to become mini-doctors. I am not sure what the future holds but I would bet my bottom dollar (or pound) that if we could fast-forward 100 years, 'doctors' and 'nurses' will be job titles of the past. I sincerely believe that the relaxing of professional boundaries which we are all seeing, coupled with the radical canges that are occuring in the education system, will eventually result in generic health care professionals who will be trained to do the whole kit and kaboodle (even ****-shovelling, friends.) And these somewhat grim and bitter power struggles between medical and nursing staff will be a thing of the past also. Maybe I should change it to 200 years....resitance from the docs will be strong. After all, if there are no nurses to feel superior to, what's the point in all thse arduous years of medical school?

Yikes, man.

I think this whole egalitarian "we're all colleagues and equally valuable members of the team" is all nice and warm and fuzzy, but the truth of the matter is that the hierarchy and distinct role system is there for a damn good reason. We're not all doctors. We're not all nurses.

Talk to people. The vast majority of nurses don't want to be doctors. They like their jobs, they like their scope, they weighed the pros & cons and made a decision to serve in a specific role in patient care. Likewise, doctors don't want to be nurses. We like our jobs, we like our scope, we weighed the pros & cons and made a decision to serve in a specific role in patient care. Both of our roles are valuable. Whose is "more valuable" is a stupid discussion, since healthcare wouldn't function without either of us.

The important point is that we are not the same. We are trained differently...to serve a different purpose...to deliver patient care in very distinct ways. Our training enables us to do that. You start forcing everyone to undergo the same training (doctors, nurses), and all of a sudden you've got one big group of people, not one of whom wants to sit around administering drugs Q2hrs, doing accuchecks, taking vital signs, doing dressing changes, transporting patients, disimpacting, emptying foleys, collecting stool. If you want to redistribute those tasks and feel that nurses are above doing those things, fine, make that argument for them to be done by nurses assistants. But to say that because we're all special and have strengths and are smart and experienced that everyone should have the same job & role in patient care (and therefore the same training) is just ludicrous. We can't all do every task. And we can't all be plastic surgeons or radiologists or nursing supervisors or department chairmen or spine specialists. The nature of a capitalist system (and one composed of humans, each with their own preferences, personalities, and limitations) is such that the best jobs will be competitive and you'll see high achievers pursuing them. You blokes across the pond can do what you want, but healthcare isn't a democracy and we don't all get the same input on how a patient is managed. A hierarchy is not inherently oppressive, and it's the system used in numerous industries without complaint.

 

[SLUser11]

Man, I love it when nurses register and post all sorts of irrelevant crap. I think a lot of nurses have an undiagnosed inferiority complex and think they know it all. The patient in this case would have been excluded from this study's parameters... way higher than "low-to-intermediate risk".

Your attitude toward nurses is hilarious. You label them as "know it alls" with an "inferiority complex," and then you make a bunch of know-it-all statements in a super-defensive tone, trying to prove your superior knowledge. I wonder if you butt heads with them all the time because you are so similar......

Either way, you really need to get some insight before you start residency. If you act in person anything like you post on SDN, it won't just be the nurses that can't stand you, but your co-residents as well.

Also, I can promise you I'm not a nurse that made an account to fight back. I'm a resident that has seen your type a thousand times before over the last seven years. Keep this crap up, and someone in your environment will eventually feel compelled to take you down a peg or two, and you won't like the results.

 

[KempDrumsalot]

I wasn't trying to be overly insulting, or to suggest that your patient should have been put on the drug. I just kind of thought it was funny the number of knee jerk reactions saying "OMG! That nurse totally would have given a drug that would have made the patient's leukemia worse!" when that's really not the case.

Especially when the poster I replied to specifically said to go look it up, and when I did that I found the exact opposite to be true.

Except for the face that the opposite isn't true? This patient case would not go along with the research you cited, making everyone else correct and the validation of your statement inccorect.

 

[SouthernSurgeon]

Except for the face that the opposite isn't true? This patient case would not go along with the research you cited, making everyone else correct and the validation of your statement inccorect.

Huh?

The assertion by the prior posters was that G-CSF drugs would potentially make myeloid leukemias progress, and that the nurse was an idiot for not realizing this.

No, anonymouse's specific patient wouldn't have qualified for that one study - but that was never the argument I was trying to make. The only point I was putting forth (as I noted in the quote I included in my original post) is that it has been shown that filgrastim does NOT lead to AML progression in vivo, and has no adverse effect on median survival in long-term follow-up. There are multiple large studies backing up this point - I just quoted the one I happened to read first.

As anonymouse stated correctly, neulasta isn't standard of care for leukemias, and it certainly wouldn't be called for in most cases or this specific case - that was never what I was trying to argue. My only point was that the original knee jerk reaction by a couple of people (that G-CSF --> leukemia progression) was not correct.

 

[Rzarecta]

Huh?

The assertion by the prior posters was that G-CSF drugs would potentially make myeloid leukemias progress, and that the nurse was an idiot for not realizing this.

No, anonymouse's specific patient wouldn't have qualified for that one study - but that was never the argument I was trying to make. The only point I was putting forth (as I noted in the quote I included in my original post) is that it has been shown that filgrastim does NOT lead to AML progression in vivo, and has no adverse effect on median survival in long-term follow-up. There are multiple large studies backing up this point - I just quoted the one I happened to read first.

As anonymouse stated correctly, neulasta isn't standard of care for leukemias, and it certainly wouldn't be called for in most cases or this specific case - that was never what I was trying to argue. My only point was that the original knee jerk reaction by a couple of people (that G-CSF --> leukemia progression) was not correct.

I hate to beat a dead horse, but I didn't laugh because of the G-CSF--> leukemia angle. When I was on my IM block I did a rotation on the heme/onc inpatient floor and saw basically this same situation verbatim. I just love how the nurse in this scenario calls the medical team "stupid" for not treating the pancytopenia with the obvious "miracle cure." G-CSF use in AML hasn't consistently shown reduction in mortality in patients s/p chemo, so I think it kind of hilarious that this nurse thinks "no cells? give stimulation stupid!" when the research doesn't really support this. I also liked that she used the sexy trade name.

Holler.

 

[anon-y-mouse]

Your attitude toward nurses is hilarious. You label them as "know it alls" with an "inferiority complex," and then you make a bunch of know-it-all statements in a super-defensive tone, trying to prove your superior knowledge. I wonder if you butt heads with them all the time because you are so similar......

Either way, you really need to get some insight before you start residency. If you act in person anything like you post on SDN, it won't just be the nurses that can't stand you, but your co-residents as well.

Also, I can promise you I'm not a nurse that made an account to fight back. I'm a resident that has seen your type a thousand times before over the last seven years. Keep this crap up, and someone in your environment will eventually feel compelled to take you down a peg or two, and you won't like the results.

Hey, I recall butting heads with you before- you're the resident who taxes his students, makes their lives hell, has no understanding of student schedules, and has completely forgotten what it's like to be a medical student. I've forgotten exactly what your completely horrendous actions were (probably just as well, I'd rail on you again systematically for acting like a massive jerk), but it's not surprising you chose to respond this way again. At any rate, this is the "clinical rotations" forum, and (a) you're a resident (so none of these issues are relevant to you) and (b) your contribution to this thread is completely useless, even if you did have experience as a clerkship student at one point in your life. It's really funny that you say people "won't like me", as your post alone is the functional equivalent of the freshly-minted intern ranting about "med students" (hello, look back 2 months ago), the socially awkward resident crashing a med school party and hitting on the third years, or quite simply, the 7th grader who bullies the 3rd graders. I am not very surprised, as I see that you are a surgical resident and it would seem to fit the stereotype (although in all fairness, the surgery residents I had were the coolest people ever). I would appreciate it if you could cease to post in my thread if you are unable to provide meaningful contributions that are on topic with the thread.

FYI, I'm able to get along really well with my classmates, my interns, residents, and attendings -- I have really no worries that I'm going to alienate anyone or convey any wrong impressions.

 

[anon-y-mouse]

I hate to beat a dead horse, but I didn't laugh because of the G-CSF--> leukemia angle. When I was on my IM block I did a rotation on the heme/onc inpatient floor and saw basically this same situation verbatim. I just love how the nurse in this scenario calls the medical team "stupid" for not treating the pancytopenia with the obvious "miracle cure." G-CSF use in AML hasn't consistently shown reduction in mortality in patients s/p chemo, so I think it kind of hilarious that this nurse thinks "no cells? give stimulation stupid!" when the research doesn't really support this. I also liked that she used the sexy trade name.

Holler.

Holler.

 

[SLUser11]

Hey, I recall butting heads with you before- you're the resident who taxes his students, makes their lives hell, has no understanding of student schedules, and has completely forgotten what it's like to be a medical student. I've forgotten exactly what your completely horrendous actions were (probably just as well, I'd rail on you again systematically for acting like a massive jerk), but it's not surprising you chose to respond this way again. At any rate, this is the "clinical rotations" forum, and (a) you're a resident (so none of these issues are relevant to you) and (b) your contribution to this thread is completely useless, even if you did have experience as a clerkship student at one point in your life. It's really funny that you say people "won't like me", as your post alone is the functional equivalent of the freshly-minted intern ranting about "med students" (hello, look back 2 months ago), the socially awkward resident crashing a med school party and hitting on the third years, or quite simply, the 7th grader who bullies the 3rd graders. I am not very surprised, as I see that you are a surgical resident and it would seem to fit the stereotype (although in all fairness, the surgery residents I had were the coolest people ever). I would appreciate it if you could cease to post in my thread if you are unable to provide meaningful contributions that are on topic with the thread.

FYI, I'm able to get along really well with my classmates, my interns, residents, and attendings -- I have really no worries that I'm going to alienate anyone or convey any wrong impressions.

We butted heads before because of your knee-jerk willingness to get a lawyer and sue the hospital if you didn't get a daily big hug from your resident and a button that says "I'm special" on it.

As for how I treat my students, I promise that I treat them very well, which is reflected in my student evaluations and teaching awards. I do "tax" them, however, by making them do critical thinking and work hard, etc, as opposed to letting them write a progress note and then disappear to the library for the rest of the day. I promise, however, that I don't scut them.

I like reading the "clinical forums" because I do remember what it was like to be a student. Threads like "how are absences viewed" are absolutely served by a resident's perspective, since we can provide actual insight into the situation. Unlike you, I've been both a student and a resident, so I have more perspective. It's very "7th grade" of you to not want to share the playground.

As far as "on-topic" discussions, your attack on SouthernIM is what drew me in, I have to admit. It's hard to stay on topic when I hate the tone of your posts, though. They always reak of arrogance and false knowledge.

Look up Child Neuro's posts from the past. She also had the "know-it-all who doesn't know s#$t" thing going....it's much more of a stereotype than what you accuse me of filling......trust me, you don't want to be that person.

And finally, I stick by my original statement about your attitude and resulting future problems. It didn't come from my dislike of your posts, but instead it came as a true warning. Hopefully, you don't act in person like you post on SDN....but if you do, it will eventually bite you. The thread title says it all: You need to recognize YOUR limitations.

Now take a week or so like last time and come up with a snotty retort that just further cements your arrogant know-it-all stereotype.

 

[Tired]

And finally, I stick by my original statement about your attitude and resulting future problems. It didn't come from my dislike of your posts, but instead it came as a true warning. Hopefully, you don't act in person like you post on SDN....but if you do, it will eventually bite you.

ie - "I can tell by your posts that you will be a bad doctor!!!!!"

Have you thought about posting in pre-allo more?

 

[SLUser11]

ie - "I can tell by your posts that you will be a bad doctor!!!!!"

Have you thought about posting in pre-allo more?

Not necessarily. There are plenty of good doctors with bad personalities.

 

[Tired]

Not necessarily. There are plenty of good doctors with bad personalities.

True 'dat.

But to clarify, what exactly is your agenda here? Are you suggesting that there are not any nurses who fail to understand their own limitations? Do you really take every assinine nursing suggestion seriously?

Or (more likely) are you just taking an opportunity to pick on another poster you don't particularly like?

 

[45408]

Hey, I recall butting heads with you before- you're the resident who taxes his students, makes their lives hell, has no understanding of student schedules, and has completely forgotten what it's like to be a medical student. I've forgotten exactly what your completely horrendous actions were (probably just as well, I'd rail on you again systematically for acting like a massive jerk), but it's not surprising you chose to respond this way again. At any rate, this is the "clinical rotations" forum, and (a) you're a resident (so none of these issues are relevant to you) and (b) your contribution to this thread is completely useless, even if you did have experience as a clerkship student at one point in your life. It's really funny that you say people "won't like me", as your post alone is the functional equivalent of the freshly-minted intern ranting about "med students" (hello, look back 2 months ago), the socially awkward resident crashing a med school party and hitting on the third years, or quite simply, the 7th grader who bullies the 3rd graders. I am not very surprised, as I see that you are a surgical resident and it would seem to fit the stereotype (although in all fairness, the surgery residents I had were the coolest people ever). I would appreciate it if you could cease to post in my thread if you are unable to provide meaningful contributions that are on topic with the thread.

FYI, I'm able to get along really well with my classmates, my interns, residents, and attendings -- I have really no worries that I'm going to alienate anyone or convey any wrong impressions.

holy stream of consciousness

 

[45408]

True 'dat.

But to clarify, what exactly is your agenda here? Are you suggesting that there are not any nurses who fail to understand their own limitations? Do you really take every assinine nursing suggestion seriously?

Or (more likely) are you just taking an opportunity to pick on another poster you don't particularly like?

RESIDENTS: fight!

 

[Samoa]

RESIDENTS: fight!

 

[tkim]

Two men enter, one man leave! Two men enter, one man leave!

 

[SLUser11]

No fighting here. Anonymouse doesn't have to take my advice. He can assume that I'm wrong and he'll have no problems.

In response to tired, there are definitely bad nurses. What I am suggesting is that we're sort of stooping to their level when we get in a pissing match.

The nurses are thinking "that med student doesn't know anything. I have 15 years of experience in heme/onc nursing. Do they think they're better than me?" And the med student in response is thinking, "I've done 3+ years of school about this, and I have much more intricate knowledge of the pathophysiology...how dare they get off condescending to me, when my knowledge is superior?"

And the nurses mention for the 500th time that we should be nice to them or they'll make our lives hell, their only true position of power.

And the med students continue to have wet dreams of showing the nurse up with some detailed superior display of knowledge that really puts them in their place.....

So the two sides battle, and the cycle of antagonism continues. Those med students go on to be residents, treat the nurses like crap, nurse turns to the med student and yells, nursing student watches all this go down, thus learning the bad behavior..........

In my opinion, it's just better to grin and bear the nurses' bad behavior, and do your best as a student and resident to break the cycle.