Nurses who do not recognize their own limitations

[Tired]

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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.

Ok, I understand.

I kind of like the cycle, and have done my best to perpetuate it throughout my time in this field. Just as real wars have bred technological advancements, I think personality conflicts in medicine provide incentive to be better physicians/nurses.

Besides, if we all got along, where would the fun be in that?

 

[virgo]

To the OP, that nurse is doing a fine job of making herself look like an ass. She doesn't need any help. In the meantime, I learned something new today, thanks to this thread.

 

[45408]

Besides, if we all got along, where would the fun be in that?

when the nurse comes home with you?

 

[JeffLebowski]

when the nurse comes home with you?

Yeah but women love drama, so I'm sure it'd be more exciting for her to end up in bed with one of the doctors with whom she butts heads and supposes sexual tension, just like on "Grey's".

...unless you're talking about landing a male nurse. I don't know much about that.

 

[Samoa]

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.

That's a pretty accurate depiction of what happens. Although I feel compelled to add that these kinds of nurses treat everyone else in the hospital like crap, and aren't just picking on med students as advance payback for their behavior as a resident.

The only reason that the worst abuse is reserved for students and residents is because complaints from other ancillary staff don't require interaction of two separate institutions' heirarchies, and thus are more immediately dealt with and reprimanded. Also, people in the medical heirarchy are least likely to have time or energy to go to all the trouble required to complain about it.

All of which make them easy targets for petty revenge.

Having said that, there are some types of clinical situations where a patient's nurse is the better judge of what should be done. I'm happy to accept input about those things, and will generally let their judgment stand. And I appreciate the extra pair of eyes checking my decisions from their perspective on patient care. It's only annoying when the nurse assumes your patient is typical of the kind of patients s/he normally cares for, when this is not the case, and then assumes that anything you do that they're not familiar with is a mistake, and delays care when it's urgently needed. That pisses me off.

And I'm pretty sure anon-y-mouse is female, just from the writing style.

 

[virgo]

It's one thing to go around calling the doctor an idiot and snickering about his idiocy to all your coworkers, and completely another to simply say "Hey doc, I noticed you didn't do X, Y, and Z for patient Whatzizname. Am I missing something?", or to just call the doc and ask "I noticed you wrote an order for suchandsuch, and I'm concerned because ________; is that what you really wanted to do?". This provides an excellent opportunity to do some teaching. The problem is, some docs aren't very good at teaching, some don't care for it, and some are unapproachable. Responses can range from incoherent mumbling to condescension. But mostly, the docs that I work with are great about just explaining things patiently without making you feel like a blithering idiot, and I really appreciate that.

 

[45408]

Yeah but women love drama, so I'm sure it'd be more exciting for her to end up in bed with one of the doctors with whom she butts heads and supposes sexual tension, just like on "Grey's".

...unless you're talking about landing a male nurse. I don't know much about that.

Oh, I thought all the residents on Grey's Anatomy were hunting down the med students. You mean to tell me that they were actually going after the neurosurgeons and plastic surgeons??

 

[45408]

And I'm pretty sure anon-y-mouse is female, just from the writing style.

 

[caroladybelle]

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

As a nurse, I will tell you what it means....

Blast Crisis.

(Having said that, you really do not know how many ER MDs/community MDs will order neupogen/neulasta on an MDS/leukemic pt order that anyway...only to have the pt come in....with Blast Crisis)

 

[caroladybelle]

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]

Please feel free to expound on that study, to the Attendings at JHUH on the hematology units.

I don't believe I saw Neupogen/neulasta used but once in a year there, and the PI MD had a meltdown over it.

 

[SouthernSurgeon]

Please feel free to expound on that study, to the Attendings at JHUH on the hematology units.

I don't believe I saw Neupogen/neulasta used but once in a year there, and the PI MD had a meltdown over it.

I'm sure they are much more familiar with it than I am.

My train of thought was much simpler. I read the thread; a poster said "OMG how could they be so dumb - look up G-CSF in AML and you'll understand". So I did look it up, and the articles I found all kind of pointed in the other direction (against the concept that GCSF --> leukemia progression). Then I decided to be a wise-ass and post a semi-sarcastic comment (which I do too often, I'll admit).

But more seriously - The discussion in the above article essentially asserted that there was no in vivo evidence that G-CSF precipitates progression, and that in fact there was no decreased survival in long term follow-up of AML pts treated with G-CSF (that result came from a separate publication in Blood)...but the article was kind of limited - the article showed that it was (a) not really very efficacious in their patients and (b) still kind of a scary area due to that theoretic basis for blast transformation despite lack of clinical evidence of such.

Edit for being too tired after surgery and my brain not working: blast crises occur when CML-->AML; an AML patient has already "blasted"