question from a nursing student about what RN programs tell us about MDs

[lazlohollyfeld]

Hi guys,
I joined SDN specifically to ask you this question--thanks for taking the time to read it.

In nursing school I have been told over and over that "RNs treat the whole patient", that RNs approach the patient "holistically", whereas the medical model of care is disease-centered, and does not "treat the whole patient."

I have a finely-tuned bull****-o-meter...I find it hard to believe that MDs (if one can generalize about this at all) are so myopic in their approach to patient care that psychological and emotional elements of a patient's condition aren't addressed. I guess my question for you all is what your perspective on this "whole patient" thing is. I think that nurses don't get enough training in pathophysiology, and that makes the profession feel the need to stake some kind of claim elsewhere. I'm enjoying RN school, but I find this kind of posturing to be pretty embarassing, and I don't like being associated with it.

My feeling is that the empathetic and warm approach that nurses often claim as their domain isn't something that can be taught anyway, in nursing school or elsewhere. Either you care about people, and that comes through in your practice, or you don't...and that's apparent to others too.

Thanks for any replies. Best wishes to everyone.

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[JeetKuneDo]

Hi guys,
I joined SDN specifically to ask you this question--thanks for taking the time to read it.

In nursing school I have been told over and over that "RNs treat the whole patient", that RNs approach the patient "holistically", whereas the medical model of care is disease-centered, and does not "treat the whole patient."

I have a finely-tuned bull****-o-meter...I find it hard to believe that MDs (if one can generalize about this at all) are so myopic in their approach to patient care that psychological and emotional elements of a patient's condition aren't addressed. I guess my question for you all is what your perspective on this "whole patient" thing is. I think that nurses don't get enough training in pathophysiology, and that makes the profession feel the need to stake some kind of claim elsewhere. I'm enjoying RN school, but I find this kind of posturing to be pretty embarassing, and I don't like being associated with it.

My feeling is that the empathetic and warm approach that nurses often claim as their domain isn't something that can be taught anyway, in nursing school or elsewhere. Either you care about people, and that comes through in your practice, or you don't...and that's apparent to others too.

Thanks for any replies. Best wishes to everyone.

Just a premed here, so I cannot answer your question. But, I can say that this question is probably better asked in another thread, like the Allopathic or pre-allo, pre-osteo threads.

 

[RTrain]

From what I can tell about pre-allo, that's the LAST place that such a well-thought-out question belongs. Though the general residency forum might be a good place, if someone with magic thread-moving powers feels like hooking that up.

To the OP, I think that's a pretty perceptive commentary on RN education. I have often wondered if RN's are getting some sort of teaching in that issue, because I do sometimes get the feeling that my abilities to connect with my patients are looked down on - or when nurses witness my (quite good) bedside manner, they're just amazed. In general, I don't care for the attitude that nurses are protecting their patients from me (see this facebook group, for example). Aren't we supposed to be a team?

That said, everyone in a team has a role, and I do think that at in the hospital, RN's are better equipped to understand patients' emotional states, since they spend more time, overall, with the patients throughout the day. Docs aren't the ones who come in when a patient pushes the "call" button to have someone hold their hair while they throw up. I think it is a strength of nurses that they are trained in this kind of intense day-to-day caring, and it's a shame that it's being used as a weapon to attack doctors, who have a different role. Can't we all just get along?

 

[howelljolly]

Good question.

Like you said, I think it depends on the individual clinician. Physicians who really care about really taking care of the whole patient, and helping improve their patient's quality of life overall can even specialize in an area where they can make a serious impact... such as psychiatry, family practice, any primary care with dual certification in psych, physical med and rehab, hospice and palliative medicine, geriatrics, pediatric developmental disabilities, and on and on...
Some physicians have bedside manner, and some might not be so good. n fact, the worst bedside manner Ive ever seen was of a particular psychiatrist.
Same is true for nurses.

But I've got a feeling that youre actually asking something different. I dont believe we consciously think of patients in a "model" at all. Actually I think we make it a point to think as broadly as we can, but in doing so, we often think in terms of organ systems or "how will this change the management", otherwise we are bound to miss something.... As far as treating the whole patient, you're right, physicians treat whole patients also.



At the end of the day, it has a lot to do with why we selected our career paths... what we want to do on a daily basis, whats important to us. To put it another way, we might be in this profession because we want to treat elevated central venous pressures, vs. pneumonia, vs. aspiration pneumonitis..... not a patient who happens to have impaired gas exchange. But we can all make an effort to have a sympathetic bedside manner, even if we arent Patch Adams.

 

[howelljolly]

Oh, and Ive had a nursing student tell me that a majority of all heart murmurs are picked up by nurses, not doctors...

 

[lazlohollyfeld]

Thanks for the thoughtful replies...it's so interesting to get doctors' perspectives on this stuff.

I find it disturbing how my teachers can teach these things without having really explored the meaning of what they're saying. Sometimes I wonder how much nurses and MDs understand about each other's training...I don't think I would know much about medical practice if not for my own curiosity and having a few friends go through med school.

And as for the imprecise language of nursing diagnoses...(*cringe*)...it seems to me that somebody really, really wanted to use the word diagnosis. I suspect that nursing would get more "respect" (whatever that means) if we stopped posturing, did our jobs well, and expressed straightforward pride in what we do. I don't see the need to put other professions down, it cheapens the whole deal. My 2 cents...maybe I will have a more nuanced opinion after I graduate in 6 months and am actually on the floor!

So yes, to respond to a previous poster--let's just all get along....unfortunately that takes more self-awareness than many people are capable of

Best wishes, and thanks again.

 

[lazlohollyfeld]

Any effort to be more like Robin Williams sounds like a terrible idea to me

 

[howelljolly]

And as for the imprecise language of nursing diagnoses...(*cringe*)...it seems to me that somebody really, really wanted to use the word diagnosis. I suspect that nursing would get more "respect" (whatever that means) if we stopped posturing, did our jobs well, and expressed straightforward pride in what we do. I don't see the need to put other professions down, it cheapens the whole deal. My 2 cents...maybe I will have a more nuanced opinion after I graduate in 6 months and am actually on the floor!

.

I had actually written, and then deleted my two cents on the 'nursing dagnosis', but left my take-home point - that doctors may not be in it to treat a patient with a particular physiological derangement, rather they want to correct the pathophysiology. You get the point.

 

[Moozy]

I always wondered why the nurses sometimes have such a negative attitude towards MDs when they walk into a situation. - Now I know the answer.

As mentioned by other people in this thread; RN has a comepletely different role and that allows them to bond with a patient in a different way. You certainly have to take into account that one RN if in ICU si taking care of maximum 2-3 patients and on floors upto 6-7 may be. The amount of time you have to dedicate is certainly a lot and also your effort. At the same time, the MD that is being harassed (by RN) or looked upon for not being in touch with the emotional aspect, is taking care of probaly 5 times that number of patients. We have a different role to play here. But that does not mean we are not humans.

My personal view is that some RNs are great care takers and I resepct their advice. At the same time, the ones who feel that they are the best; are actually not. Infact I have heard many ridiculous suggestions on occassions from the RNs who are the nastiest with MDs. There is this whole war against MDs that we dont even realize until we actually over hear them or are on other side of the phone. It is like we are not the same team. But waht can one say. There are good and bad apples everywhere. But I do think that if not all but most of the RNs do think that have much superior knowledge that they actually may have. As for the MDs; straight out of med school, we do suck and that is partt of the reason of the harrasment that an intern gets, but once we know the system it is another story.

 

[Taurus]

In nursing school I have been told over and over that "RNs treat the whole patient", that RNs approach the patient "holistically", whereas the medical model of care is disease-centered, and does not "treat the whole patient."

The nursing educators indoctrinate their students early on.

If you think this bullcrap is bad, you should listen to what the nursing educators tell NP and CRNA students.

you get the medical knowledge of a physician, with the added skills of a nursing professional​

So I guess DNP's are more qualified than physicians because their online degree and 1000 hours of clinical training trumps 4 years of medical school and minimum 3 years of residency.

 

[Moozy]

lol!!!

 

[doc20]

The nursing educators indoctrinate their students early on.

If you think this bullcrap is bad, you should listen to what the nursing educators tell NP and CRNA students.

you get the medical knowledge of a physician, with the added skills of a nursing professional​

So I guess DNP's are more qualified than physicians because their online degree and 1000 hours of clinical training trumps 4 years of medical school and minimum 3 years of residency.

its not just 4 years of med school + 3 years residency
its really 4 years undergrad + 4 years med school + 3 years residency minimum = 11 Years total
believe it or not lot of us did something productive during undergrad years learning things towards medicine such as research, volunteer, etc

 

[Taurus]

its not just 4 years of med school + 3 years residency
its really 4 years undergrad + 4 years med school + 3 years residency minimum = 11 Years total
believe it or not lot of us did something productive during undergrad years learning things towards medicine such as research, volunteer, etc

Ahhh, but nursing would like you to believe that a 4 year BSN + 2 year master's NP or CRNA is nearly equivalent to 4 year medical school + residency. Nursing doesn't think that college and pre-med coursework should be included.

Did I mention that most people who've gone through nursing school say the level of difficulty is equivalent to high school biology? I got straight A's in high school without even trying very hard. Did I also mention that there are many people get their BSN and NP and even DNP degrees online? It's scary to think that this country allows someone who got their degrees online to treat patients.

Now you begin to understand the propagand and lies put out by nursing.

 

[Tigerz_Fan]

The nursing educators indoctrinate their students early on.

If you think this bullcrap is bad, you should listen to what the nursing educators tell NP and CRNA students.

you get the medical knowledge of a physician, with the added skills of a nursing professional​

So I guess DNP's are more qualified than physicians because their online degree and 1000 hours of clinical training trumps 4 years of medical school and minimum 3 years of residency.

I see your status is "medical student"

You have a lot to learn.

 

[Tigerz_Fan]

Hi guys,
I joined SDN specifically to ask you this question--thanks for taking the time to read it.

In nursing school I have been told over and over that "RNs treat the whole patient", that RNs approach the patient "holistically", whereas the medical model of care is disease-centered, and does not "treat the whole patient."

I have a finely-tuned bull****-o-meter...I find it hard to believe that MDs (if one can generalize about this at all) are so myopic in their approach to patient care that psychological and emotional elements of a patient's condition aren't addressed. I guess my question for you all is what your perspective on this "whole patient" thing is. I think that nurses don't get enough training in pathophysiology, and that makes the profession feel the need to stake some kind of claim elsewhere. I'm enjoying RN school, but I find this kind of posturing to be pretty embarassing, and I don't like being associated with it.

My feeling is that the empathetic and warm approach that nurses often claim as their domain isn't something that can be taught anyway, in nursing school or elsewhere. Either you care about people, and that comes through in your practice, or you don't...and that's apparent to others too.

Thanks for any replies. Best wishes to everyone.

Well, I believe it all goes back to the age-old fight between the nurse and the doctor. Unfortunately, as stated before, there are bad apples in every bunch.

I think what gets forgotten sometimes is that we are all a team, and the patient is our focus. Most people in medicine are highly competitive, both nurses and doctors, and that is where some of the problems start. Also, people new to the field forget, that in academic institutions, most nurses see residents come and go.

Remember, these nurses are seeing each one of us start out as a dumb a** intern who can't even start an IV, make a pathetic attempt to take care of a patient. As a result, interpersonal relations/professional relations become strained and shallow. Of course, when we snap at the person on the other end of the phone over a 2am page, that doesn't help.

And yes, I have heard RNs make the strangest recommendations for patient care, but, I have heard that from MDs as well.

So, don't make this thread a bashing session guys.

 

[montessori2md]

I had an RN in the ED ask me if I knew that the RNs run the hospital. I smiled and said, yes, and that's why I'm not becoming an RN.

But back to the OPs post. My school whacks us over the head on a regular basis with touchy-feely holistic stuff. We are graded on our empathy in standardized patient encounters, and attend required workshops on things like ethics and communication. We've also been reminded that MDs who have crappy bedside manner are more likely to be sued by their patients : )

The flip side of that is that MDs are financially rewarded to NOT spend time w/ patients. Most RNs are paid by the hour or a salary which is unrelated to their patient load (however, for NPs, that is less likely to be the case, they can be production oriented like MDs).

It's not about training, it's about the environment. Change the environment, change the behavior. You can tell a patient to quit smoking crack, but it's a lot easier to stop smokin' it if there's no crack to buy.

 

[lazlohollyfeld]

Remember, these nurses are seeing each one of us start out as a dumb a** intern who can't even start an IV, make a pathetic attempt to take care of a patient. As a result, interpersonal relations/professional relations become strained and shallow. QUOTE]

No matter how long I'm an RN, or how tired I am, I will NEVER treat someone like **** because they're still learning...what blows my mind is that some nurses have forgotten what it's like to be a student, fumbling around.

Thanks for the insights...

 

[Hoody]

Remember, these nurses are seeing each one of us start out as a dumb a** intern who can't even start an IV, make a pathetic attempt to take care of a patient. As a result, interpersonal relations/professional relations become strained and shallow.

No matter how long I'm an RN, or how tired I am, I will NEVER treat someone like **** because they're still learning...what blows my mind is that some nurses have forgotten what it's like to be a student, fumbling around.

Thanks for the insights...

Wait till you actually practice as a licensed nurse then you can make more qualified statements about the nursing profession and nurse-doctor relations. Furthermore, for every bonehead nurse out there, there is a bonehead doctor. For every bad nurse, there is a good nurse. For every good doctor, there is a bad doctor. This happens in all professions. Welcome to reality. Worry more about yourself, your work, your relations with doctors and other hospital staff and less about everyone else and their work.

 

[howelljolly]

Wait till you actually practice as a licensed nurse then you can make more qualified statements about the nursing profession and nurse-doctor relations. Furthermore, for every bonehead nurse out there, there is a bonehead doctor. For every bad nurse, there is a good nurse. For every good doctor, there is a bad doctor. This happens in all professions. Welcome to reality. Worry more about yourself, your work, your relations with doctors and other hospital staff and less about everyone else and their work.

Very insightful.

What doesnt change, regardless of if you are a good nurse, or a good doc, or a bad nurse, or a bad doc, or if the co-worker in question is a good nurse or a bad nurse, or a good doc or a bad doc, is that you can allways be professional and courteous. It doesnt take being a super-smart doctor to be courteous.

I think that a simple axiom, like remembering that you were once a fumbling student as well, will take you a long way... especially when you are too busy and frazzled to be your usual courteous self.

 

[Ferrismonk]

My little brother is a soon to be CRNA and he's had the same experience you've had. Nursing school tries to justify itself above and beyond what is really necessary/warranted. Granted, RNs were once looked at as the people who wipe patient's butts and doctors were looked at as demi-gods, which is where the need to self-justify came from imo, but that has all changed. Nurses don't diagnose and doctors don't spend much time with the patients. It's the way our current system works.

On an related note, I was phlebotomist, pharm tech, and finally a med tech before I entered medical school. At every single job I worked at, people were always saying how they do XYZ better than the doctors. I'm not sure if there is some inferiority complex thing that happens in the hospital, but everyone seems to want to say how much better they are at their specialty than the doctors are. It comes with the territory as the defacto high-end of the food chain, either perceived or real, that doctors enjoy. People often forget how much school doctors have had, how many hours they work, how little they get paid (as residents anyhow), how much responsibility they have, and how much they must really know to do their job effectively.

One final comment; as a DO student, we get the whole touchy-feely-holistic-medicine thing up the wazoo as well. The key to the whole thing is just to remember that we are all human and so are our patients.

 

[fab4fan]

Hi guys,
I joined SDN specifically to ask you this question--thanks for taking the time to read it.

In nursing school I have been told over and over that "RNs treat the whole patient", that RNs approach the patient "holistically", whereas the medical model of care is disease-centered, and does not "treat the whole patient."

I have a finely-tuned bull****-o-meter...I find it hard to believe that MDs (if one can generalize about this at all) are so myopic in their approach to patient care that psychological and emotional elements of a patient's condition aren't addressed. I guess my question for you all is what your perspective on this "whole patient" thing is. I think that nurses don't get enough training in pathophysiology, and that makes the profession feel the need to stake some kind of claim elsewhere. I'm enjoying RN school, but I find this kind of posturing to be pretty embarassing, and I don't like being associated with it.

My feeling is that the empathetic and warm approach that nurses often claim as their domain isn't something that can be taught anyway, in nursing school or elsewhere. Either you care about people, and that comes through in your practice, or you don't...and that's apparent to others too.

Thanks for any replies. Best wishes to everyone.

It's nursing school BS. Don't buy it. There are plenty of nurses out there to disprove this "nurses care for the whole patient" theory. Believe me, you'll run into plenty of them.

I can't believe they're still feeding students this crap. Keep that "BS meter" of yours on; you're going to need it.

 

[ZuperZtar]

Hi guys,
I joined SDN specifically to ask you this question--thanks for taking the time to read it.

In nursing school I have been told over and over that "RNs treat the whole patient", that RNs approach the patient "holistically", whereas the medical model of care is disease-centered, and does not "treat the whole patient."

I have a finely-tuned bull****-o-meter...I find it hard to believe that MDs (if one can generalize about this at all) are so myopic in their approach to patient care that psychological and emotional elements of a patient's condition aren't addressed. I guess my question for you all is what your perspective on this "whole patient" thing is. I think that nurses don't get enough training in pathophysiology, and that makes the profession feel the need to stake some kind of claim elsewhere. I'm enjoying RN school, but I find this kind of posturing to be pretty embarassing, and I don't like being associated with it.

My feeling is that the empathetic and warm approach that nurses often claim as their domain isn't something that can be taught anyway, in nursing school or elsewhere. Either you care about people, and that comes through in your practice, or you don't...and that's apparent to others too.

Thanks for any replies. Best wishes to everyone.

All part of the plan to grab turf from docs.

DNP's, CRNA's, PA's and their residencies and the future nursing specialists.

My next Family doc is going to be a DNP who will refer me to a GI DNP for my colonoscopy. LOL.

Its all part of the philosophy of "Doctors dont know sh**. The 7 yrs of training is worthless and "anything they can do, I can do better."

All in the pursuit of that ' mean green, almight dollar!'

Now there is the American Medical Association and American Osteopathic Association. In the future there will be the American Doctors of Nursing Association and the American Association of Physician Associates (PA's).

It's a mad rush to make physician salaries!

 

[koopa_troopa]

All part of the plan to grab turf from docs.

It's a mad rush to make physician salaries!

Unfortunately the plan is working. Even Obama is falling for it. I don't know how he is going to lower the cost of healthcare by paying nurses more?

 

[notinkansas]

I feel pretty qualified to comment on this topic. My path to MD began with one of those combined RN to NP programs. At the time, I needed extra course work to bring up my GPA. I thought becoming a practitioner would help my MD application, and also I'd have my plan B in place if I didn't get into medical school.

The whole "nurses take care of the whole pt" thing is most likely referring to the touchy feely hand holding stuff. I don't enjoy that, don't want to deal with it. I pretty much only want to deal with the physiology.

I also don't want to deal with information that's not relevant to what I need to do for a patient. It's probably helpful to know that I'm speaking from a surgeon's perspective here. One of my biggest gripes about the nursing staff where I am is a general inability to present their concerns when they call me about an issue in a logical, coherent manner. I do a lot of cross covering, and so I frequently know little about the patient. Often they include a bunch of irrelevant information, but can't tell me what surgery the patient had done, or when, or give me a fresh set of vitals. If it seems to be an issue requiring urgent attention, I just go and figure it out. If not, I often listen to a disjointed list of points, and I have no idea what the concern is. It's my perception that many of the nurses don't want to develop the ability to express their concerns in an organized, logical fashion. (In fact, several have complained that they are "afraid to call me" because I "give them a hard time" by "bombarding them with questions") I don't understand why a nurse wouldn't want to be able to express concerns clearly and succinctly.

Anyway, I say this because I've pretty much gotten the reputation for being a bi*ch. I'm not warm and fuzzy. Never have been, never will be. Doesn't mean I don't care. And sometimes people express caring in ineffective ways. Like family members who try to do everything for the patient, when the patient should be doing things for themselves. Sometimes when I'm rounding, the patient will ask me to raise/lower the head of bed for them. Unless they are paralyzed, I NEVER do. I give/show them the button and make them press the button themselves. This is because they will get better faster the more they do for themselves!

But I think at most hospitals the nurses are too busy to provide much "whole pt care"- if you look at it as hand holding and and such. Most hospitals are too short handed for there to be much time for anybody to be hovering with patients/families.

Just because I don't enjoy the "hand holding" aspect doesn't mean I don't care. I've had nurses complain about me to administration because they perceive I don't care enough. That pisses me off. I don't want anything bad to happen to patients. I want them to get better and go home to enjoy their families. I just don't enjoy talking to them any more than I have to.

When I was doing the RN part of the NP program, the whole nursing diagnosis thing made me want to throw up. It's stupid to call constipation "alteration in bowel function" , for example.

When I finished the NP part but hadn't begun my MD training yet, I thought I could be nearly as good as any doctor. It wasn't until I was in medical school, and especially the clinical years, that i realized how much I didn't know. It's kind of embarrassing to know that I was one of those mid levels. But it's because that's what you are taught to believe.

At the same time, I think nursing staff and the general public need to realize how much doctors don't know. We're not gods. There's a lot about medical science that is not cut and dried. We frequently don't know what's going on and need to try to figure it out. That doesn't make us bad doctors.

I don't recall ever being told in medical school about "nurses treat the whole patient, while doctors focus on physiology" In fact, we aren't formally taught much. There is a lot of talk about the degree to which nursed can be trusted to get orders correct, or their understanding of how NG tubes or JP drains work, etc. Nothing formal, it just comes up though the normal course of work. Sadly, there is a lot of variation in the level of understanding about things I'd expect and willingness to learn, etc, among nurses I've worked with. It's also sad that there seem to be a number of nurses who appear to want to take pretty much a passive role, not learn practical things, and who just want to be able to write "MD notified" in the chart to take any liability off of them.

A good nurse is worth his/her weight in gold. They will be proactive, make some effort to learn what their patient population's needs are and what kind of things doctors may want to know.

One of my worst nurse stories is the following call in the evening on a patient I was cross covering: "I was looking over the chart and the patient takes hydrocodone/apap at home. But the team didn't write for that, they wrote for Vicodin" I was stunned. I asked the nurse if she had a drug reference handy. She did. I had her look it up. She learned that they are indeed the same. She then turned around and complained to her supervisor that I "made her feel stupid". WTF??? That's the kind of call that pisses doctors off big time and gives the nursing profession a bad name. If a nurse can't be bothered to look up meds they don't know......

Anyway, there is nothing specific taught in medical school about what nurses do or don't do. You have the disadvantage of some colleagues creating a bad rap for you. I get the feeling that you'll turn out to be a pretty darn good one, though!

 

[maia]

When I was doing the RN part of the NP program, the whole nursing diagnosis thing made me want to throw up. It's stupid to call constipation "alteration in bowel function" , for example.

When I finished the NP part but hadn't begun my MD training yet, I thought I could be nearly as good as any doctor. It wasn't until I was in medical school, and especially the clinical years, that i realized how much I didn't know. It's kind of embarrassing to know that I was one of those mid levels. But it's because that's what you are taught to believe.

At the same time, I think nursing staff and the general public need to realize how much doctors don't know. We're not gods. There's a lot about medical science that is not cut and dried. We frequently don't know what's going on and need to try to figure it out. That doesn't make us bad doctors.

I don't recall ever being told in medical school about "nurses treat the whole patient, while doctors focus on physiology" In fact, we aren't formally taught much. There is a lot of talk about the degree to which nursed can be trusted to get orders correct, or their understanding of how NG tubes or JP drains work, etc. Nothing formal, it just comes up though the normal course of work. Sadly, there is a lot of variation in the level of understanding about things I'd expect and willingness to learn, etc, among nurses I've worked with. It's also sad that there seem to be a number of nurses who appear to want to take pretty much a passive role, not learn practical things, and who just want to be able to write "MD notified" in the chart to take any liability off of them.

A good nurse is worth his/her weight in gold. They will be proactive, make some effort to learn what their patient population's needs are and what kind of things doctors may want to know.

One of my worst nurse stories is the following call in the evening on a patient I was cross covering: "I was looking over the chart and the patient takes hydrocodone/apap at home. But the team didn't write for that, they wrote for Vicodin" I was stunned. I asked the nurse if she had a drug reference handy. She did. I had her look it up. She learned that they are indeed the same. She then turned around and complained to her supervisor that I "made her feel stupid". WTF??? That's the kind of call that pisses doctors off big time and gives the nursing profession a bad name. If a nurse can't be bothered to look up meds they don't know......

Anyway, there is nothing specific taught in medical school about what nurses do or don't do. You have the disadvantage of some colleagues creating a bad rap for you. I get the feeling that you'll turn out to be a pretty darn good one, though!

having also gone through the same route, it makes me cringe now when i remember how "amazing" i thought we nursing grads were with all our nursing diagnoses and our "sensitive bedside skills" compared to the doctors and residents who we thought weren't listening enough or doing enough for the patients we cared for. it didn't also help that our instructors keep harping into us at how much better we were than them and how we were the "patient advocate". almost like we were lawyering for the patient against the "insensitive paternalistic" MD. there was also this self-satisfaction at the opportunity to report something to the MD if s/he missed something, or an intervention.

now in medicine, it was embarrassing to realize, that i didn't really "knew anything" important at all as a nurse. sure i could state the rationale for procedures, but they were just memorized. truth was i never really knew.

OTOH, as an intern, i've met more great nurses (vs the arrogant ones) who helped me a lot with procedures, managing the patients and or report some problems, and even teach me their methods.

in my experience, it seems this "we're better w/ patients" attitude is more prevalent among those in academic nursing compared to those actually in practice. although i did have some nursing professors too who were really good clinical teachers but didn't have the arrogance of those with lesser skills and i've also seen the same in medicine.

guess it depends on the individual to decide what attitude to take. many people will tell us how to act, what to believe in, what to do, what to think of others...but it still will be your decision

 

[unhappyrnstudnt]

Sorry for bringing up an old thread (I don't know if any of the OPs are members anymore, but hopefully someone can give me a bit more insight), but I ran into this in a Google search because I'm having similar problems. And I'm only barely a month into the program.

As notinkansas said, the nursing diagnosis stuff is really stupid. That's pretty much ALL we've done and I want to beat my head against a wall until I'm unconscious because I'm so sick of hearing it. It sounds 100% unnecessary, pointless, and impractical. We, as nurses, can't give any kind of medical diagnosis (from what I'm understanding, that crosses outside our "realm of practice"), which means we can't even write constipation on the charts?! That, quite honestly, sounds more like playing a freakin' game than actually doing something worthwhile.

And like I said, we've pretty much ONLY learned about the nursing process (oh, sorry, I have to give the program a bit of credit...we've also learned bed baths and vital signs). Anyone who asks a "why" question (I'm usually the only one) in terms of physiology gets immediately shut down. In front of the class, it's always "we'll be going into physiology later, guys...we have to cover the basics first," but after looking through the text book, there's almost NOTHING about physiology. The few physiology topics in the book are only VERY basic stuff we've already learned in our A&P classes. Another experience I had with this was emailing my Pharmacology professor with a question about how the body metabolizes antibiotics (not at the cellular, pharmacodynamic level, but the pharmacokinetics of antibiotics) and how that may vary among people. Her response was that information is outside the scope of nursing practice and we would talk about metabolism later in class (fyi, that lecture has passed and my question remains unanswered).

On top of all of this, it still sticks with me that this "RN's are better than MD's" attitude and "nurses are holistic, doctors only care about physiology" line was fed to us in our very first lecture. That raised a HUGE red flag to me, because if I'm not going to get my questions answered about physiology because it's "outside the RN's scope of practice," then I'm more out of place than I ever would have thought.

Like maia wrote, I feel like I'm going to end up not "knowing anything," despite this claim from all of my (condescending) nursing professors about how well prepared the program makes students. We may be well prepared to play this nursing game, but I already feel like I'm not really training for the medical field. Everything is one huge shade of gray and from what I can tell with the other students, I'm the only one who really sees it. The tests are another big indicator...multiple choice "choose the most correct answer out of all these correct answers" for a situational, "caring" question? It really sounds like the politically correct way of saying "I'm weeding out for my favorite students based on your answers." And I'm also in the same boat as notinkansas with not wanting to "hold hands" with the patient. The best way to care for someone is to fix them. I'd much rather have someone be logical and straightforward with me (if you had told me to look up what hydrocodone/apap was, I would've felt stupid, but I probably would've laughed after our conversation was done because I deserved it...and I never would have made that mistake again. I certainly wouldn't have ran to the charge nurse about it, though) than emotionally play games with me and keep everything this nice shade of gray...or blue, then red, then green, then everything mixed together (the professors and other students currently appear like a contemporary piece of artwork...the ones with disorganized paint splattered all over a blank canvas that for some reason sell for millions because it's "emotionally invigorating").

So after all of that griping, my questions for maia and notinkansas (or anyone else who reads/is interested), since you've gone the RN route before med school, will it be this way throughout my entire nursing career? Will I always be denied knowledge just because it's "outside the RN's scope of practice"? My classmates are very impatient when anyone asks questions that are the SLIGHTEST bit off topic, and it's slowly appearing to me like RN school and the RN field will be one big popularity contest. Is that the culture of the profession? If so, I'm in the wrong place. And how long did it take for you to go from RN to NP to MD?

Thanks in advance.

 

[D elegans]

Sorry for bringing up an old thread (I don't know if any of the OPs are members anymore, but hopefully someone can give me a bit more insight), but I ran into this in a Google search because I'm having similar problems. And I'm only barely a month into the program.

As notinkansas said, the nursing diagnosis stuff is really stupid. That's pretty much ALL we've done and I want to beat my head against a wall until I'm unconscious because I'm so sick of hearing it. It sounds 100% unnecessary, pointless, and impractical. We, as nurses, can't give any kind of medical diagnosis (from what I'm understanding, that crosses outside our "realm of practice"), which means we can't even write constipation on the charts?! That, quite honestly, sounds more like playing a freakin' game than actually doing something worthwhile.

And like I said, we've pretty much ONLY learned about the nursing process (oh, sorry, I have to give the program a bit of credit...we've also learned bed baths and vital signs). Anyone who asks a "why" question (I'm usually the only one) in terms of physiology gets immediately shut down. In front of the class, it's always "we'll be going into physiology later, guys...we have to cover the basics first," but after looking through the text book, there's almost NOTHING about physiology. The few physiology topics in the book are only VERY basic stuff we've already learned in our A&P classes. Another experience I had with this was emailing my Pharmacology professor with a question about how the body metabolizes antibiotics (not at the cellular, pharmacodynamic level, but the pharmacokinetics of antibiotics) and how that may vary among people. Her response was that information is outside the scope of nursing practice and we would talk about metabolism later in class (fyi, that lecture has passed and my question remains unanswered).

On top of all of this, it still sticks with me that this "RN's are better than MD's" attitude and "nurses are holistic, doctors only care about physiology" line was fed to us in our very first lecture. That raised a HUGE red flag to me, because if I'm not going to get my questions answered about physiology because it's "outside the RN's scope of practice," then I'm more out of place than I ever would have thought.

Like maia wrote, I feel like I'm going to end up not "knowing anything," despite this claim from all of my (condescending) nursing professors about how well prepared the program makes students. We may be well prepared to play this nursing game, but I already feel like I'm not really training for the medical field. Everything is one huge shade of gray and from what I can tell with the other students, I'm the only one who really sees it. The tests are another big indicator...multiple choice "choose the most correct answer out of all these correct answers" for a situational, "caring" question? It really sounds like the politically correct way of saying "I'm weeding out for my favorite students based on your answers." And I'm also in the same boat as notinkansas with not wanting to "hold hands" with the patient. The best way to care for someone is to fix them. I'd much rather have someone be logical and straightforward with me (if you had told me to look up what hydrocodone/apap was, I would've felt stupid, but I probably would've laughed after our conversation was done because I deserved it...and I never would have made that mistake again. I certainly wouldn't have ran to the charge nurse about it, though) than emotionally play games with me and keep everything this nice shade of gray...or blue, then red, then green, then everything mixed together (the professors and other students currently appear like a contemporary piece of artwork...the ones with disorganized paint splattered all over a blank canvas that for some reason sell for millions because it's "emotionally invigorating").

So after all of that griping, my questions for maia and notinkansas (or anyone else who reads/is interested), since you've gone the RN route before med school, will it be this way throughout my entire nursing career? Will I always be denied knowledge just because it's "outside the RN's scope of practice"? My classmates are very impatient when anyone asks questions that are the SLIGHTEST bit off topic, and it's slowly appearing to me like RN school and the RN field will be one big popularity contest. Is that the culture of the profession? If so, I'm in the wrong place. And how long did it take for you to go from RN to NP to MD?

Thanks in advance.

Unhappyrnstudnt,

How wonderful to have someone who wants to be an informed member of his/her nursing profession. I am sorry that you are experiencing such disappointment in your program. It's distressing to know that your intellectual curiosity is being shut down by the people who should be the ones expanding your knowledge base.

I'm a medical student, so I'm probably not the best person to answer your question, but it does seem like you're very interested in diagnosis and the basic science of medicine. It seemed implied in your question, but are you considering NP or MD in the future? I would say if you're considering MD, you're early enough in your program to get out and take the path to MD. Your constant frustration of not being able to delve deep enough into pathology and diagnosis is likely not going to go away, and what I've heard from several nurses, older and young, is that they are told very explicitly NOT to diagnose. You'll always hit this brick wall and I fear you'll be frustrated in actual practice as well, wanting to contribute more to diagnosis and feeling left out.

Sounds to me like you have the intellect, drive, and curiosity for medical school if that's something you're considering. Best of luck to you and it's a shame you're having to deal with such frustrations.

 

[unhappyrnstudnt]

Unhappyrnstudnt,

How wonderful to have someone who wants to be an informed member of his/her nursing profession. I am sorry that you are experiencing such disappointment in your program. It's distressing to know that your intellectual curiosity is being shut down by the people who should be the ones expanding your knowledge base.

I'm a medical student, so I'm probably not the best person to answer your question, but it does seem like you're very interested in diagnosis and the basic science of medicine. It seemed implied in your question, but are you considering NP or MD in the future? I would say if you're considering MD, you're early enough in your program to get out and take the path to MD. Your constant frustration of not being able to delve deep enough into pathology and diagnosis is likely not going to go away, and what I've heard from several nurses, older and young, is that they are told very explicitly NOT to diagnose. You'll always hit this brick wall and I fear you'll be frustrated in actual practice as well, wanting to contribute more to diagnosis and feeling left out.

Sounds to me like you have the intellect, drive, and curiosity for medical school if that's something you're considering. Best of luck to you and it's a shame you're having to deal with such frustrations.

I would love to be an MD if possible. That has always been much preferred to nursing, though nursing has always been more practical. I'm a single mom (though living with my parents) and almost 28. I have a BA already (in my RN school interview, I mentioned this in response to a "how are you going to handle the difficulties of nursing school" question, and the head of the department cuts me off mid-sentence to tell me very sternly, "that doesn't matter"), though it's not in the sciences and the school I'm at now is a 2 year college. So I don't know if med school would be practical if I don't get out of school until I'm 40 years old.

I thought about eventually going on to become a nurse anesthesiologist, but I could literally walk away and never look back at this point. I loved my prereqs...A&P was great, as was micro, and those professors never shut me down if I had a question. But what I'm doing now rates in the bottom-most layers of hell for me. I've worked in animal hospitals as a receptionist and vet tech...I loved the medical aspect but hated the feeling like I wasn't really doing anything besides cleaning up poop and sticking thermometers up animal butts all day. After talking with my parents, they convinced me that nursing would be a good path because it didn't take long to get a degree but it would be a better crowd and I'd be able to do more. Well, I can already tell the crowd isn't that much different. They are superficially nice to everyone, but the people who are normally bitchy are already showing the signs (I'm just waiting to get back-stabbed now...if it happens to anyone, it will be me, even if I'm trying to lay low and don't open my mouth). And dealing with bitchy women for the rest of my life is NOT what I wanted.

Guess I should've gone with my gut before I started school in the first place. What I'm finding out about nursing is fitting in line pretty well with all the "preconceptions" I had before I even decided to go back to school.

 

[D elegans]

I would love to be an MD if possible. That has always been much preferred to nursing, though nursing has always been more practical. I'm a single mom (though living with my parents) and almost 28. I have a BA already (in my RN school interview, I mentioned this in response to a "how are you going to handle the difficulties of nursing school" question, and the head of the department cuts me off mid-sentence to tell me very sternly, "that doesn't matter"), though it's not in the sciences and the school I'm at now is a 2 year college. So I don't know if med school would be practical if I don't get out of school until I'm 40 years old.

I thought about eventually going on to become a nurse anesthesiologist, but I could literally walk away and never look back at this point. I loved my prereqs...A&P was great, as was micro, and those professors never shut me down if I had a question. But what I'm doing now rates in the bottom-most layers of hell for me. I've worked in animal hospitals as a receptionist and vet tech...I loved the medical aspect but hated the feeling like I wasn't really doing anything besides cleaning up poop and sticking thermometers up animal butts all day. After talking with my parents, they convinced me that nursing would be a good path because it didn't take long to get a degree but it would be a better crowd and I'd be able to do more. Well, I can already tell the crowd isn't that much different. They are superficially nice to everyone, but the people who are normally bitchy are already showing the signs (I'm just waiting to get back-stabbed now...if it happens to anyone, it will be me, even if I'm trying to lay low and don't open my mouth). And dealing with bitchy women for the rest of my life is NOT what I wanted.

Guess I should've gone with my gut before I started school in the first place. What I'm finding out about nursing is fitting in line pretty well with all the "preconceptions" I had before I even decided to go back to school.

There are several people in my MD entering class who are in their 30s and we have one who is in her early 40s. Several people have children and we have at least one single mom I know of who has three kids. Which is all to say that people certainly enter medical school and become physicians who are a little older than the average 23-24 (or whatever the average age is of entering) and you wouldn't be alone.

Still, if you think that med school is a little too long for you, have you ever considered becoming a PA? Much shorter time frame than medical school AND you get to diagnose and treat AND you don't have to deal with the aspects of nursing you dislike. This might be a good option for you.

Still, if being an MD is truly what you want to do, I say go for it. You get one life and you might as well do what you want to with it.

 

[CherryTree1305]

unhappyrnstudnt - I am sorry you are so unhappy. It sounds like you were never a good match for nursing profession in the first place. Sadly, as a recently retired RN, you don't sound like you would be a terrific doctor to work with either. I suggest you go into research or something that keeps you away from other people. You complain about your peers, your previous jobs, etc. I strongly recommend some counselling to help you "diagnose" yourself and heal yourself of you prevailing unhappiness.
There is absolutely NOTHING holding you back from seeking answers and learning more on your own. Yes, diagnosis is outside the realm of nursing practice - as it should be. On the other hand, no one but YOURSELF is stopping you from researching answers to the questions you have about the pathology, etc.
I have been reading a lot of nurse bashing on these threads. I am sorry to hear that, nurses and doctors really need to pull together for the sake of the patient. We all have a role in patient care. It is NOT a competition. I could do a lot of "doctor bashing" from my 32+ years on the floor, but that is not productive. Nurses AND doctors need to approach each other with respect and EACH listen to the other for the good of the patient. Many times I have wondered why I bother to chart each and every little bradycardia/desaturation of my 25 week preemie only to have the doctor making rounds ignore all 93 episodes during the previous 8 hours. When I attempt to update the rounding physician on the current concerns, I am totally ignored. However, for patient welbeing, I must persist and the doctors get annoyed. Sadly that is part of being a nurse. On the other hand, times when I've gotten a call from a physician at home to let me know that an infant I was responsible for picking up on lived because of something I alerted them to. That also is part of nursing and the part I stayed in for.
As far as the "nursing diagnosis" goes - that came into being about a year before I was in nursing school and we were all struggling with it. I agree it is seems stupid that we have to write "altered bowel status" rather than constipation - but you doctors are the reason for that. When nursing first started using these "nursing diagnosis", doctor's raised a HUGE stink about nurses "diagnosing" patients, so we had to learn to phrase things so that it doesn't step on your toes, yet still gets the message across.
I was a NICU nurse in a teaching Children's Hospital. I loved it when the 1st and 2nd year residents came in with a mindset to learn and would ask us questions because frankly a nurse that has been in the NICU for years DOES know more about what is the standard of care for a given situation than a new resident. Notice, I did NOT say that I knew more than the resident, just more about the standard of care for a given situation/diagnosis. As they progressed in there knowledge base in the NICU we loved watching them learn and become more confident in their decisions. On the other hand, I had a 1st year resident in the NICU on his VERY FIRST DAY out of medical school and in the hospital come in with the attitude that "I'm the doctor and I know it all and you are the stupid nurse so get out of my way." I was one of 23 nurses in the NICU that night that wrote that resident up for inappropriate orders, attitude, and actions. The next week, he spent finding all 23 of us on the floor and apologizing - his fellow and attending read him the riot act. He did an about face and a year later when he returned for another rotation, you would not believe he was the same person. He gave and received respect. It is a two way street.
I have my own reasons for not caring for a lot of NNP's, but some I loved! I have no problem seeing an andvanced practice nurse in my IM's office for minor issues, but I would not and do not think they should be in "independent practice" without supervising physicians.
I hope you find what you are looking for, but I really don't believe nursing is where you belong.
TO ALL MD & OD (students and attendings and all inbetween): I see a lot of people on these threads going into nursing to use it as a "stepping stone" to an MD or OD. I resent that. It is entirely seperate profession. Please treat us as you would like to be treated. You might be surprised what the response will be.