RN abuse from NP's and PA's
Started by InfoNerd101
I never endured any type of "abuse" from NPs, PAs, or doctors. Most of the doctors I worked with genuinely appreciated nurses. They understood just how hard we work to take of their patients.
Are there disagreements and misunderstandings that occur from time to time? Absolutely. But we discuss what happened, why it happened, and how we can prevent it from happening in the future. There is no "abuse". In the extremely rare event that it does occur, we have protections too - supervisors, managers, directors, even nursing unions. It's not how it appears on TV or in the movies.
The only negativity I experienced was with other nurses - usually older, more bitter, thoroughly burnt out nurses. That old wives tale about "nurses eating their young"? It's less of a tale and more like reality.
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deleted480308
While loaded questions rarely end well.....go ahead and specify what you mean by "abuse"...what have you personally seen happen?
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Like how you always heat of nurses getting talked down by and pushed around by physicians.
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deleted480308
I don't always hear that....I'll repeat, what have you actually seen happen?
Me personally? Nothing, I'm strictly speaking of what I commonly hear from nurses
So, from personal experience, I will say that most of my interactions with other health care professionals have been largely abuse free.
The handful of unpleasant interactions that I can look back on have involved people in various positions of power and/or authority taking out their frustrations and personality disorders on those with less power / authority. Physicians are often in the positions of greatest power / authority, and so are more able to throw their weight around when they want to do so. I am thinking of a particular surgeon or two who were uniformly terrible to everyone, but got away with it because the hospital viewed them as "profit centers." In general, those doctors could throw things, curse at staff, and even physically assault technicians (I saw it!) and get away with it, where if the nurse/tech had responded with similar behavior they would have been fired on the spot.
However, it doesn't always work that way. I've also met a couple of abusive surgical techs, who were low on the pay scale, but who were unofficially able to wield quite a lot of de facto power within their setting. Someone with poor interpersonal coping skills who is in the position to create a problem for others without facing retribution will do so, no matter what their title. That behavior is permitted less and less, and I'd say that enforcement of policies against workplace violence is stricter on those who are in positions of greater recognized authority (MD/DO, NP, PA.) That is why you will hear a lot of people in those positions complain about nurses, techs, unit secretaries, etc. who are able to make their lives miserable with apparent impunity.
But these interactions are far and away the exceptions. Most of the time, most health care workers know that we are all in it together, with a common purpose. We work together surprisingly well for the intensity of the challenges we face. But stories about how well everyone gets along don't spread as far as those rare instances when someone rocks the boat.
The handful of unpleasant interactions that I can look back on have involved people in various positions of power and/or authority taking out their frustrations and personality disorders on those with less power / authority. Physicians are often in the positions of greatest power / authority, and so are more able to throw their weight around when they want to do so. I am thinking of a particular surgeon or two who were uniformly terrible to everyone, but got away with it because the hospital viewed them as "profit centers." In general, those doctors could throw things, curse at staff, and even physically assault technicians (I saw it!) and get away with it, where if the nurse/tech had responded with similar behavior they would have been fired on the spot.
However, it doesn't always work that way. I've also met a couple of abusive surgical techs, who were low on the pay scale, but who were unofficially able to wield quite a lot of de facto power within their setting. Someone with poor interpersonal coping skills who is in the position to create a problem for others without facing retribution will do so, no matter what their title. That behavior is permitted less and less, and I'd say that enforcement of policies against workplace violence is stricter on those who are in positions of greater recognized authority (MD/DO, NP, PA.) That is why you will hear a lot of people in those positions complain about nurses, techs, unit secretaries, etc. who are able to make their lives miserable with apparent impunity.
But these interactions are far and away the exceptions. Most of the time, most health care workers know that we are all in it together, with a common purpose. We work together surprisingly well for the intensity of the challenges we face. But stories about how well everyone gets along don't spread as far as those rare instances when someone rocks the boat.
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762513
I've found it very rare for a Physician or midlevel to berate another person. The few that are awful are uniformly awful to everyone. It has not seemed to have a whole lot to do with where the other people rank in the power structure. The worse abuse is by far nurse to nurse.
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The worst abuse I've experienced or heard of comes from certain nurses in admin positions. The only poor interactions I've personally had have been from admin, and even that has been rare. The most frequent issues I've had have actually been from CNA's. My workplace is really interested in the notion of everyone feeling equal to each other (of course, not in payscale). That sounds nice, and I like to come to work with that mindset, but sometimes it clashes when you have a worthless employee that wants to vent, or a sanctimonious CNA that thinks that them "caring" about a patient matches your nursing judgment. This manifests itself when you ask them to do something, and they think you are offloading work on them, or when they ask you to do something and you say no because you have something higher in priority to do at that moment. I've been shouted at in break rooms over those kinds of situations, and had charges sit and act sympathetic and not support me when I've been right, all in the spirit of fostering some sense of balance that exists regardless of the truth. When I charge, its case by case in situations like that rather than being social justice warrior. If management really cared about things being really equal, they would quit blaming nurses for mistakes aids make.
Nope. You are the licensed professional, they are the unlicensed technician who is supposed to be working under your direction.
If your employer doesn't appreciate that responsibility that you have by giving you the authority you need in order to carry it out, you need to address that directly or else find a different workplace. But the fact that they don't doesn't mean that you can offload that responsibility. Because in court, when you are answering to the Board, when you have to tell the family... all things aren't equal.
You are the one with the license. And the liability that it imposes upon you doesn't evaporate, even if your employer were to shift blame to someone with less education who was supposed to be working under your supervision and direction.
My last sentence was meant to be hyperbole, but I wasn't skilled at delivery there. I liked your elegant explanation of how delagation in nursing is meant to be. That was spot on, and was my arguement at the time almost verbatim. It was met with crickets chirping and a charge nurse and aid then moving on to dissecting all of my actions that shift, which was inappropriate as well. The aid thought the patient that arrived covered in hours old vomit needed my undivided attention (rather than only her attention) vs me obtaining meds from the pharmacy before the on call pharmacist went home and had to be called back in, and a medication delay took place. Since customer service meant more to the charge nurse than delay of care, we got to play "all the NCLEX answers are right, but which is the most correct?", which, of course, I lost because of the unwritten policy of "don't ask the aid to do something unpleasant without being there to experience the unpleasantness with them so they don't feel picked on by the nurse trying to play boss."
Sorry I missed the nuance there.
I've just heard that sentiment delivered without any irony at all more often than I care to recount. So glad that you didn't mean it.
I'm sorry to hear that your charge was so unsupportive. I've been there, too, sadly.
I think that because nobody gets sued 99.9% of the time, workplaces feel fine letting techs and aids to do their job with little regard to nurses delegating, and that the charge nurse is really the only person they need to answer to. They load them up with functions that are more geared towards throughput rather than truly assisting, and you get left with someone that thinks they are in the position to be free from delegation. Fun times. Fortunately this is rare for me to have bad interactions, but when I have, it's been a mouthy lazy tech rather than a physician or np. I've had one know it all new NP think that they were an expert RN who tried to call me on something she thought she knew, but was wrong. I think since she was struggling really bad and was unprepared in her job, she felt like that was a way to make up for it. Her last position wasn't as a floor nurse, so she didn't know what the heck she was talking about.
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762513
New NP's and especially DNP NP's are put in a stressful position of "expert novice" or "novice expert." It's difficult to go from being competent in nursing to incompetent in NP. I had the same transition as a new nurse with 10 years of experience as a paramedic. Unfortunately, sometimes the stress is taken out in an inappropiate fashion. It isn't right, but it happens.
The easy way around it is for an NP in that situation to simply mind their own weaknesses and not look for ways to improve upon a practicing floor nurse's actions. I can appreciate how that struggle works for a new NP with a boat load of fresh RN experience, but the problem was that the NP in my case wasn't correct about her assessment of my interventions. Becoming an NP didn't backfill her RN knowlege and make her awesome along the way, unfortunately.
