nurses

[cheruka]

Advertisement - Members don't see this ad

It appears the nurses on the floor do not like confident people. They complained to the PD that I argue too much. They seem to love the young men residents but do not like yours truly, who is a woman. I used to be real nice to them and my PD told me not ever to talk to them more than I should because their training is different and there no point in trying to educate them. No formal compliants were filed by them, just random stuff that seems to be a computer issue more than anything else. My PD was very supportive and said I w ill make a great physician and my knowledge base exceeds ever some of my seniors', though I am just an intern. He also thought my hours were too much (they were, I did not report my hours, don't worry. He just knew based on my presence) and gave me a day off and offered a faculty job after I graduate. So, they complain and I get a day vacation and an offer for a permanent job. ???

 

[RadOncDoc21]

Are you attractive? That usually trumps everything.

 

[cheruka]

I am a total nerd. I suppose I could be called decent looking by some people but I never make an effort to use that to my advantage. I come with bushy eye brows, thick glasses and the whole nine yards. I always baggy pants, and wear no make up. So, I am definitely not attractive per American culture.

 

[Doctor Bob]

My PD was very supportive and said I w ill make a great physician and my knowledge base exceeds ever some of my seniors', though I am just an intern. He also thought my hours were too much (they were, I did not report my hours, don't worry. He just knew based on my presence) and gave me a day off and offered a faculty job after I graduate. So, they complain and I get a day vacation and an offer for a permanent job. ???

This does not pass the sniff test.
http://en.wiktionary.org/wiki/sniff_test

 

[RadOncDoc21]

Doesn't make sense to me either. Every woman I've seen who received special privileges from the PD was at least a 7 on the attractive scale.

 

[TallScrubs]

#humblebrag

 

[123eyes]

...though I am just an intern. ... He offered a faculty job after I graduate. So, they complain and I get a day vacation and an offer for a permanent job. ???

You're an intern who got offered an attending position 2+ years from now??

 

[dozitgetchahi]

Lol I agree this doesn't pass the sniff test...however I've seen and heard even stranger things happen in the bizarre world of residency politics so I don't discredit anything anymore.

That said, OP, I'd your attempts to 'educate' the nurses come off at all condescending, don't be surprised when the complaints start rolling in. Nurses don't take well to this. In fact, I learned pretty quickly that any self righteous effort at 'educating the nurses' generally fails unless a nurse is asking questions and seems genuinely interested in learning more.

 

[cheruka]

OMG, this is for real. It really happened. dozitgetchahi, thanks for your advice. I feel nurses are strange, they want all the respect in the world, they are supposedly more caring than us but don't want to know anything. I agree, I will have to stop having any extended conversations with them.

 

[Arcan57]

You're an intern who got offered an attending position 2+ years from now??

That's the sign of a quality position.

 

[Gastrapathy]

Female intern trying to teach the floor nurses...what could go wrong?

Are you really that unaware of the dynamic here?

 

[FoundAWay]

They also might not have taken it too well depending on your delivery, and based on the tone of the original post, I'd guess that to be part of the problem.

It's also easier to be a stellar intern the 2nd time around. Hard to say one knows so much but "only an intern" when they've done it before.

I get along well with our nurses, and if they seem interested, I'll explain my mgmt. If not, I just type the orders and ask for then to be completed.

 

[Siggy]

Doesn't make sense to me either. Every woman I've seen who received special privileges from the PD was at least a 7 on the attractive scale.

 

[evilbooyaa]

Yeah.... don't piss off the nurses. You're there for 3 years, they're there for way longer than that. Just don't piss off the nurses, especially not the floor nurses.

 

[RadOncDoc21]

Haha Unicorn zone... Great stuff!

 

[da8s0859q]

Pick and choose your battles. Had nurses blatantly ignore orders which were medically sound because they wanted to talk to the attending first. One of which in an emergent setting where the RN just wasn't comfortable with a medication and a dose and went with what they wanted to do. That kind of pissed me off. You know, as an EM resident and all. Fortunately, I've met far more good ones, including the ones above, than not so good. No biggie.

And hey. There is such a thing as a Pyrrhic "victory".

 

[Call Me Dr.]

Wow, all dudes out of the room.

Talking about the OP's attractiveness is really dismissive of a serious issue that female residents have to deal with.

Differential treatment of male and female residents by female nurses is real. I can't tell you how many times I watched female nurses fawn all over male residents and then turn around and bully the female resident. And the more competent the female resident, the worse the bullying.

Cheruka, what you're experiencing is common. Check out if there are Women in Medicine groups where you're training and see if other female residents/fellows have suggestions for getting by with the nurses at your hospital.

 

[Serous Demilune]

Or watch the first season of Scrubs? They cover this in pretty good depth.

 

[Call Me Dr.]

Or watch the first season of Scrubs? They cover this in pretty good depth.

Everything I needed to know, I learned from Scrubs. The right dose of tylenol? The amount that sticks when you throw a handful at a patient. Thanks, Dr. Cox!

 

[Lysinee]

Doesn't make sense to me either. Every woman I've seen who received special privileges from the PD was at least a 7 on the attractive scale.

One man's 7/10 is another man's 3/10 rating of a chick. Very variable. Anyway, I enjoyed reading this thread LOL.

 

[PikminOC]

It appears the nurses on the floor do not like confident people. They complained to the PD that I argue too much. They seem to love the young men residents but do not like yours truly, who is a woman. I used to be real nice to them and my PD told me not ever to talk to them more than I should because their training is different and there no point in trying to educate them. No formal compliants were filed by them, just random stuff that seems to be a computer issue more than anything else. My PD was very supportive and said I w ill make a great physician and my knowledge base exceeds ever some of my seniors', though I am just an intern. He also thought my hours were too much (they were, I did not report my hours, don't worry. He just knew based on my presence) and gave me a day off and offered a faculty job after I graduate. So, they complain and I get a day vacation and an offer for a permanent job. ???

I don't see how the first half of what you wrote is in any way related to the second half...

 

[FCMike11]

.

 

[FCMike11]

.

 

[cheruka]

The missing link: I got very upset when I heard about the nurse's complaints and my PD helped me by counseling on how to deal with them.

 

[atomi]

Be careful. I have known residents who had to go before the acgme board or whatever it is that renews your contract, extend their training, write formal apologies, etc. all for simply raising their voice at a nurse.

While you are a resident and have no power, treat nurses civilly always, no matter how ridiculous they are being. The truth is they do have power, and if you hurt their feels, they will gang up on you and send multiple complaints at once landing you in danger of being jobless.

NOT WORTH IT.

 

[TUGM]

Be careful. I have known residents who had to go before the acgme board or whatever it is that renews your contract, extend their training, write formal apologies, etc. all for simply raising their voice at a nurse.

While you are a resident and have no power, treat nurses civilly always, no matter how ridiculous they are being. The truth is they do have power, and if you hurt their feels, they will gang up on you and send multiple complaints at once landing you in danger of being jobless.

NOT WORTH IT.

It's kind of sad actually... bottom of the totem pole.

 

[Arcan57]

It's kind of sad actually... bottom of the totem pole.

Lack of professionalism is career limiting in most settings. Since the idea of training is to turn out practitioners who are going to be successful at practicing medicine, it would be a little odd for abusive behavior to condoned in residency. Getting into a screaming match with a nurse is NEVER the right move. While I don't think you should get kicked out of residency for a single episode of verbal abuse, a program is doing a disservice to its residents if they graduate without having learned how to appropriately deal with interpersonal conflict in a professional setting.

 

[anonperson]

You have to use your head when dealing with nurses. They follow protocols and generally do not like to deviate from these protocols even if the information is dated etc. It's just how they're trained. What exactly are the arguments about? Medication dosing, treatment plans? Anything in particular?

But you have to pick and choose your battles. There's no point in getting a reputation as being a loose cannon or out of control. If there is an issue, then get your senior resident involved. They can protect you or guide you regarding the best way to navigate these situations.

In residency, I would have to deal with annoying labor and delivery nurses arguing with my lower levels on a regular basis. A majority of the time I would back up my lower levels and that would be that but if it was truly a inconsequential thing that wasn't worth fighting over, then we'd come up with a compromise.

But the key is to be calm. If it needs to be escalated, stay calm and ask for your senior/charge nurse etc.

Trust me, it doesn't end. I'm in fellowship and the attending wants the fellow to prep the patient. It's pelvic surgery, so basically vaginal preps. When the circulating nurse tries to prep, they'd leave part of the posterior vagina unprepped so no povidone/iodine got there because they were too dainty with their preps. Basically a worthless prep and increasing the infection risk to the patient.

Just recently when I was prepping, the nurse starts yelling "You're being too rough!". This was while the patient was intubated in dorsal lithotomy position while I had the paint stick (sponge with a plastic handle). I looked at her and said we are doing a hysterectomy and we need a proper surgical prep. She went off to count or something. But it just gives you an idea of how dumb nurses can be. All she could focus on was a freaking surgical prep being too rough (when it was not rough at all) thinking it would cause the patient discomfort when in just ten minutes we were going to perform a vaginal hysterectomy using a scalpel, sutures, and plenty of retractors. Maybe, just maybe, that would be the cause of the patient's post operative pain and not a f##king surgical prep.

 

[Siggy]

Just recently when I was prepping, the nurse starts yelling "You're being too rough!". This was while the patient was intubated in dorsal lithotomy position while I had the paint stick (sponge with a plastic handle). I looked at her and said we are doing a hysterectomy and we need a proper surgical prep. She went off to count or something. But it just gives you an idea of how dumb nurses can be. All she could focus on was a freaking surgical prep being too rough (when it was not rough at all) thinking it would cause the patient discomfort when in just ten minutes we were going to perform a vaginal hysterectomy using a scalpel, sutures, and plenty of retractors. Maybe, just maybe, that would be the cause of the patient's post operative pain and not a f##king surgical prep.

Besides, what's worse than a rough prep? Infection.

 

[jakeislove]

Someday I'll get bored (and drunk) enough to ask an older doctor if nurses had the same poopy attitude before the ACGME imposed work hour restrictions.

 

[Winged Scapula]

Someday I'll get bored (and drunk) enough to ask an older doctor if nurses had the same poopy attitude before the ACGME imposed work hour restrictions.

Of course they did - why would you think the work hour restrictions changed their attitudes?

 

[jakeislove]

Of course they did - why would you think the work hour restrictions changed their attitudes?

You don't qualify as older. 🙂

Just seems like they must have had less leverage when each resident was considered the equivalent of 3 full time employees.

 

[Winged Scapula]

You don't qualify as older. 🙂

Just seems like they must have had less leverage when each resident was considered the equivalent of 3 full time employees.

I appreciate the compliment but at least half of my training was completed before work hour restrictions (or the 120 hr week, equivalent of 3.33 FT employees [since they tend to work 36 hr weeks]).

 

[anonperson]

I doubt she was worried about the pain. I've seen plenty of people treat a surgical prep like they were doing a freaking dermabrasion.



If you take a layer of skin off with the prep you're going to increase the infection rate, not decrease it. Same rationale for why we use clippers and not a razor for hair removal.

I have never ever seen that for any vaginal preps and I have seen/done hundreds. Majority of the time the nurse never gets to the vaginal fornix or even between the labia leaving all sorts of junk behind. A wasted prep that requires another reprep by the scrubbed surgeon. Have never seen a vaginal abrasion from the use of a freakin sponge stick in the vaginal prep kits.

 

[Tigeracademy]

It appears the nurses on the floor do not like confident people. They complained to the PD that I argue too much. They seem to love the young men residents but do not like yours truly, who is a woman. I used to be real nice to them and my PD told me not ever to talk to them more than I should because their training is different and there no point in trying to educate them. No formal compliants were filed by them, just random stuff that seems to be a computer issue more than anything else. My PD was very supportive and said I w ill make a great physician and my knowledge base exceeds ever some of my seniors', though I am just an intern. He also thought my hours were too much (they were, I did not report my hours, don't worry. He just knew based on my presence) and gave me a day off and offered a faculty job after I graduate. So, they complain and I get a day vacation and an offer for a permanent job. ???

You should know that nurses do not like doctors that freak out and are incompetent hands on, thye like confident [not cockey] calm ,who does not run to fill out complaint reports against RNs and other doctors,while not being able to even put in an IV. Nurses dont like doctors that trash other doctors in front of others,and who gets nervous over nothing and runs around like a chicken with no head.Nurses dont get paid for their dinner breaks so please leave them alone unless it is a true emergency.Being a woman doc nurses dont care about that as long as you mind your manners and demonstate a real desire to L_E_A_R_N...not just show off your limited knowledge, your PD is wrong..whil RN training is different ..many areas overlap..like when we call you to point out you wrote the wrong drug order and save your sorry butt.Be polite say thank you ,please,hello and goodnite and you might become very popular and rspected.

 

[Tigeracademy]

I am a total nerd. I suppose I could be called decent looking by some people but I never make an effort to use that to my advantage. I come with bushy eye brows, thick glasses and the whole nine yards. I always baggy pants, and wear no make up. So, I am definitely not attractive per American culture.

If you look sloppy and smell bad you will not be disliked but put many off.

 

[deleted480308]

Tiger, your bold button is stuck in the "on" position

 

[jl lin]

You should know that nurses do not like doctors that freak out and are incompetent hands on, thye like confident [not cockey] calm ,who does not run to fill out complaint reports against RNs and other doctors,while not being able to even put in an IV. Nurses dont like doctors that trash other doctors in front of others,and who gets nervous over nothing and runs around like a chicken with no head.Nurses dont get paid for their dinner breaks so please leave them alone unless it is a true emergency.Being a woman doc nurses dont care about that as long as you mind your manners and demonstate a real desire to L_E_A_R_N...not just show off your limited knowledge, your PD is wrong..whil RN training is different ..many areas overlap..like when we call you to point out you wrote the wrong drug order and save your sorry butt.Be polite say thank you ,please,hello and goodnite and you might become very popular and rspected.

I will probably get slammed for this here, but honestly, there is some truth in that. Yes there are nurses that are aholes. I will never lie about that. There are nurses that know squat in many ways. But there are also nurses that actually do have a lot of insight--and yes, some realize the delicacy with which they must present their concerns to physicians, and others just don't care anymore or are just not in touch with their approach. At the end of the day, two wrongs do not equal a right. If everyone's focus is on the patient, but the other BS aside and focus on the patient. As an RN these are the people I respect and will go out of my way for--and even walk on eggshells if necessary. As a hopeful physician one day, I hope to be this way as well. And yes, I will still be aware of the ahole nurses--but that does not equal all nurses. I know it gives people some vent to bitch about nurses, but in many cases, things would be a lot worse for the patients and you if they were not there. So, the attitude, while seemingly one that vents, only perpetuates the problems.

I do agree, however, with Grover. I am not sure how the first part relates to the second part. And when it comes to patients and working together, everyone needs to be OK with some humble pie. B/c it's about the patients, or at least should be.
But trust me. I too have work with some nurses that I wish I could have slapped outside the universe--seriously--more issues with nurses, sadly, that physicians by far. That does say something to me. But many nurses are more knowledgeable than you think--maybe not as far down into the nitty gritty patho-b/c you might be surprised if you didn't generalize them and evaluated them on a case-by-case basis. The only reason there is less bitching about the med technologists is b/c they are in the lab and don't have to work directly with you as much. Leadership means knowing how to deal with people--and listening as well.

My rant is done. Try not to kill me in your replies. I mean I'll suck it up; but I'm about balance, so. . .whatever.

 

[rokshana]

You should know that nurses do not like doctors that freak out and are incompetent hands on, thye like confident [not cockey] calm ,who does not run to fill out complaint reports against RNs and other doctors,while not being able to even put in an IV. Nurses dont like doctors that trash other doctors in front of others,and who gets nervous over nothing and runs around like a chicken with no head.Nurses dont get paid for their dinner breaks so please leave them alone unless it is a true emergency.Being a woman doc nurses dont care about that as long as you mind your manners and demonstate a real desire to L_E_A_R_N...not just show off your limited knowledge, your PD is wrong..whil RN training is different ..many areas overlap..like when we call you to point out you wrote the wrong drug order and save your sorry butt.Be polite say thank you ,please,hello and goodnite and you might become very popular and rspected.

let me guess...you're a nurse.

rest assured that residents are not filing complaints at the drop of a hat and even if they are....it has absolutely no weight.

and you really think residents get paid extra for hours over 40 a week, or 12 hours a shift....or that they get time and a half if they work a holiday?

 

[jl lin]

Sorry OP. I feel like what you have said that your PD supposedly shared is quite condescending. Again. It depends on the nurse. And I like attractive males also. That has no bearing on whether or not I will find that they are truly advocating for the patient or not. Plus, a lot of experienced RNs know how certain attendings work. Believe it or not, they may have more insight into that than you.

And I am not going to lose sleep over whether you talk to me or not, b/c I'm there about the patient. I am not there to bolster you ego. And I can learn from you. Can you learn from another? I can learn from a damn grasshopper for God's sake. Learning has noting to do with superiority or "confidence." If you were as truly confident and secure as you say, maybe you wouldn't have so many nurses annoyed with you. And if they feel something is not right-b/c of safety or advocacy and experience, well if you want to go ahead and push some medicine, but they for some reason don't feel right about it, go ahead and do it. They have standards of practice within which they must practice also. Trust me. I have worked with more than my share of ahole nurses. But I have worked with a hell of a lot of good ones too.

Step back, b/c communication is a two-way street. And get over yourself. It's not about you. It's not about them. It's about the patients. BTW, over the years, every once and a while, I have been told to do some pretty damn stupid things by inexperienced docs--and have been thanked by the attendings for not doing them. Interestingly, if someone that has the legal ability to administer something feels so strongly about doing it--from a safety perspective, I find it interesting that they get pissed when a nurse with strong experience and insight says, "I don't think so." I'll do anything that is safe. And don 't give a crap if you are physician that is male, female, in-transition, whatever. If it falls short of intelligent and safe standards of practice, you'd better give me a good damn reason or do it yourself. If I still think it will lead to me having to code the patient in a matter of minutes or so, yea. I'm probably going to want to talk to the fellow or attending. Sorry.

Again, please remember that in my years of experience, I have had excellent relationships and rapport with the physicians--and more pain in the arse problems with nurses than I care to share. So, if I am saying, step back and re-check this thing out of your own good, maybe you might want to do so. And if your PD said what s/he said, listen, sometimes that PD is right and sometimes that PD is not right. Doesn't meant you shouldn't try to talk, share, teach, etc. A lot of nurses, like me, love it when we are learning new things from interns, residents, fellows, attendings, specialists, RTs, Med Technologists, Nutritionists, you name it. I am not too good to learn from anyone. I have also learned a lot from my patients (who have spanned all age groups) and their families. If you want to be listened to, listen. And if you want to teach, be humble and open to be teachable as well. If we can learn from viruses, can't we learn from others regardless of letters behind a name?

 

[Bacchus]

let me guess...you're a nurse.

rest assured that residents are not filing complaints at the drop of a hat and even if they are....it has absolutely no weight.

and you really think residents get paid extra for hours over 40 a week, or 12 hours a shift....or that they get time and a half if they work a holiday?

I filed a report once over an important lab never being drawn despite being ordered. Nothing came of it. Sigh. Won't ever fill one out again.

 

[jl lin]

I filed a report once over an important lab never being drawn despite being ordered. Nothing came of it. Sigh. Won't ever fill one out again.

Curious. What was the reason you were given for the lab never being drawn? I can't see something like that being ignored in the unit/s--especially when the RN is supposed to understand the reason/urgency for the lab. Yea. Was this a nurse thing or a lab tech thing? Cause that's definitely something a nurse would get blasted about. Also, most of us would feel guilty as hell if something was missed or not tx'd b/c one of us blew off a lab. Heck yea I would have said something.

Now if a number of nurses tried to draw the lab and it was a problem player/no-go, or if a central line was occluded, well, then that would go back to the resident or fellow; b/c there are just times when "You can't get blood out of a stone." But just blowing it off. . .nah. Someone is going to get their butt burned.

 

[Winged Scapula]

@jl lin - you surely understand that as a unit nurse you are a different breed.

I've had the same experience as @Bacchus with orders being ignored, including stat labs. The most recent was an order for a pre-op tox screen which is abbreviated by the hospital EMR as UTS.

The reason given for it not being collected and sent?
"I didn't know what UTS stood for."

The reason given for not calling and clarifying (or just reading the "order information tab")?
"I've never seen it before so assumed it was a mistake."

 

[jl lin]

@jl lin - you surely understand that as a unit nurse you are a different breed.

I've had the same experience as @Bacchus with orders being ignored, including stat labs. The most recent was an order for a pre-op tox screen which is abbreviated by the hospital EMR as UTS.

The reason given for it not being collected and sent?
"I didn't know what UTS stood for."

The reason given for not calling and clarifying (or just reading the "order information tab")?
"I've never seen it before so assumed it was a mistake."

God. Common sense would tell the nurse that if it was pre-op Rx, he or she better clarify and get it done. Holy crap. My one dog is elderly, and the vet, understandably, is adamant about not doing a dental cleaning without pre-op blood work. Sure, she makes a little extra money from it, but since she knows he's going to be under anesthesia for a good period of time, and since he is 11 y.o., well it's getting done. Point is, there are good reasons for pre-op orders, and if a vet assistant has the good sense to question and follow through, shouldn't a nurse?

 

[Winged Scapula]

God. Common sense would tell the nurse that if it was pre-op Rx, he or she better clarify and get it done. Holy crap. My one dog is elderly, and the vet, understandably, is adamant about not doing a dental cleaning without pre-op blood work. Sure, she makes a little extra money from it, but since she knows he's going to be under anesthesia for a good period of time, and since he is 11 y.o., well it's getting done. Point is, there are good reasons for pre-op orders, and if a vet assistant has the good sense to question and follow through, shouldn't a nurse?

Well one would think.

Since you bring it up, there's little utility for routine pre op labs without a prior history of disease/abnormality, but they're ordered and drawn all the time. I'd be curious if any of our vet members could comment on the role for an 11 yo dog having routine dental work; an EKG I could understand but how often does lab work change management in an otherwise healthy patient? Selective testing is now the norm in humans.

 

[jl lin]

Well one would think.

Since you bring it up, there's little utility for routine pre op labs without a prior history of disease/abnormality, but they're ordered and drawn all the time. I'd be curious if any of our vet members could comment on the role for an 11 yo dog having routine dental work; an EKG I could understand but how often does lab work change management in an otherwise healthy patient? Selective testing is now the norm in humans.

I think she is thinking basic chem panel--got to view that Bun/Cr--concerns on renal fx, and then just a CBC, PT/PTT. Plus it's nice to have a baseline.

 

[Winged Scapula]

I think she is thinking basic chem panel--got to view that Bun/Cr--concerns on renal fx, and then just a CBC, PT/PTT. Plus it's nice to have a baseline.

I understand what's
being ordered but am curious if there is any data to substantiate its routine use in animals.

While an elderly animal may be expected to have some renal insufficiency, how likely is a bleeding diathesis or other CBC anomaly which would change management? Not very in humans which is why we no longer order routine labs or to "just get a baseline". Couple that with making money off the labs, I'm honestly curious about the data to support such practices in animals. There may very well be some data for all I know.

 

[Bacchus]

@jl lin - you surely understand that as a unit nurse you are a different breed.

I've had the same experience as @Bacchus with orders being ignored, including stat labs. The most recent was an order for a pre-op tox screen which is abbreviated by the hospital EMR as UTS.

The reason given for it not being collected and sent?
"I didn't know what UTS stood for."

The reason given for not calling and clarifying (or just reading the "order information tab")?
"I've never seen it before so assumed it was a mistake."

Do you order EKGs on all your pre-ops and then get pissed when they see their PCP who reviews the EKG 3d before surgery (because the patient thinks its going to be smooth sailing) and says, "Nope, you gotta see cardio/get an ECHO/get a stress test/etc"? 😉

 

[Bacchus]

Curious. What was the reason you were given for the lab never being drawn? I can't see something like that being ignored in the unit/s--especially when the RN is supposed to understand the reason/urgency for the lab. Yea. Was this a nurse thing or a lab tech thing? Cause that's definitely something a nurse would get blasted about. Also, most of us would feel guilty as hell if something was missed or not tx'd b/c one of us blew off a lab. Heck yea I would have said something.

Now if a number of nurses tried to draw the lab and it was a problem player/no-go, or if a central line was occluded, well, then that would go back to the resident or fellow; b/c there are just times when "You can't get blood out of a stone." But just blowing it off. . .nah. Someone is going to get their butt burned.

It was a troponin in a r/o ACS patient who had a somewhat convincing story. I don't know if I was given a reason besides a "sorry."

 

[Promethean]

OP, your story has other interpretations besides the one you present. The fact that you lump all the nurses together and paint yourself as a pure victim of their ignorance and gender discrimination suggests to me that you don't have a clear, objective perception of the situation.

Your PD made you a job offer for years from now? Doesn't sound like a firm offer. Any chance that he was just smooth talking you? Does he have the even have the authority to make an offer like that unilaterally?

Also, "sent home for a day off" has more than one interpretation. One way that this episode could be read was that other professionals have found you so difficult to work with that they actually complained to your PD. Also, he is aware that you have been violating policies, like the duty hour guidelines, and also failing to report your hours accurately. Nothing damning, but possibly problematic if there is a pattern of behavior. The organizational savvy that allowed him to become a PD tells him that he has a troublemaker on his hands, but that the best way to deal with it initially is to try to counsel you. He takes a friendly approach, hopeful that this will avoid future concerns and sends you home for a day. In his documentation of the incident, however, he writes up that he had to verbally warn and discipline you. Should additional complaints reach his ears, this becomes the basis for progressive discipline, potentially leading to termination.

My interpretation may be a little paranoid, but I have often seen these "friendly conversations" turned into ammunition to be used later. Hospital politics can be brutal. Be careful where you put your faith and never rock the boat unless a patient is at risk.

You should probably keep being polite to the nurses, but not trying to educate them unless they need to know or ask you questions. You might also try learning from them, too. Their training may be different and not as comprehensive as yours, but they have a body of knowledge that you need in order to really excel at what you do. It can be a two way street.