Said the nurse...

[Heeed!]

...about 6-9 minutes ago, in all seriousness: "You don't take care of the patients Dr. Heeed!, we do. They're just names on your list."

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[Coastie]

...about 6-9 minutes ago, in all seriousness: "You don't take care of the patients Dr. Heeed!, we do. They're just names on your list."

She can feel free to care for their medical issues.

We'll see how well she cares for the patients then.

Until then, please, chart the I/O's, give the meds as ordered, call me within certain vitals parameters, and go back to your den. Thanks!

 

[DogFaceMedic]

She can feel free to care for their medical issues.

We'll see how well she cares for the patients then.

Until then, please, chart the I/O's, give the meds as ordered, call me within certain vitals parameters, and go back to your den. Thanks!

Criticize RNs at your peril. The RN has a point.
The RNs in fact do far more direct pt care than physicians ever will.
Until med students and physicians show the dedication to help bath a pt or change adult diapers, they should show respect to those who do.

Before the immature rhetoric begins: please restrain from generalizations about RNs based on the experiences with a few bad ones. Pt care suffers with poor team work amongst healthcare professionals.

 

[iatrosB]

Criticize RNs at your peril. The RN has a point.
The RNs in fact do far more direct pt care than physicians ever will.
Until med students and physicians show the dedication to help bath a pt or change adult diapers, they should show respect to those who do.

Before the immature rhetoric begins: please restrain from generalizations about RNs based on the experiences with a few bad ones. Pt care suffers with poor team work amongst healthcare professionals.

I certainly agree with what you're saying.

On the other hand, the nurse saying something like that illustrates that she is largely misinformed on the duties of a physician and doesn't understand her role on the "team".

I do agree though...both parties should be respected.

 

[rotatores]

Criticize RNs at your peril. The RN has a point.
The RNs in fact do far more direct pt care than physicians ever will.
Until med students and physicians show the dedication to help bath a pt or change adult diapers, they should show respect to those who do.

Before the immature rhetoric begins: please restrain from generalizations about RNs based on the experiences with a few bad ones. Pt care suffers with poor team work amongst healthcare professionals.

Not to be a jerk...but you need to finish medical school before you start making comments like this! I don't believe the OP was slamming the nurse...he was just pointing out how the RN was slamming physicians!

 

[GatorHockeyDoc]

Criticize RNs at your peril. The RN has a point.
The RNs in fact do far more direct pt care than physicians ever will.
Until med students and physicians show the dedication to help bath a pt or change adult diapers, they should show respect to those who do.

Before the immature rhetoric begins: please restrain from generalizations about RNs based on the experiences with a few bad ones. Pt care suffers with poor team work amongst healthcare professionals.

And what point would that be? Doctors don't take care of patients? I don't think anybody was arguing the fact that nurses take care of patients, but instead pointing out the idiocy of view of the doctor's role.

 

[DogFaceMedic]

Not to be a jerk...but you need to finish medical school before you start making comments like this! I don't believe the OP was slamming the nurse...he was just pointing out how the RN was slamming physicians!

Lighten up. I know a great deal more about healthcare than you assume.

 

[rotatores]

Lighten up. I know a great deal more about healthcare than you assume.

You may very well know "a great deal" about healthcare...BUT...not as a physician! Trust me...I too knew "a great deal" about healthcare prior to entering medical school but its different when you're a physician!

 

[Coastie]

Give me a break. We all know that is not what she meant.

We respect nurses, but seriously, know your role. The blurring of the lines, not in merit, but in rhetoric, is what has led to the "nurse practitioner = or > physician " problem we see outlined so eloquently in Forbes and the WSJ.

Speaking of "direct patient care", what exactly do you mean? We depend on the nurses for vitals, I/O, basic care for the patient, and ensuring that our orders get carried out. Stating this isn't criticism of RNs..

Criticize RNs at your peril. The RN has a point.
The RNs in fact do far more direct pt care than physicians ever will.
Until med students and physicians show the dedication to help bath a pt or change adult diapers, they should show respect to those who do.

Before the immature rhetoric begins: please restrain from generalizations about RNs based on the experiences with a few bad ones. Pt care suffers with poor team work amongst healthcare professionals.

 

[haujun]

This role is almost similar to NCO vs Officer. NCO play more direct role in taking care of soldiers by executing officer's order. Both depend on each others in taking of soldiers.

I don't know in what context this RN made this comment to the OP but it sounds like there is break down in communication/respect.

 

[DogFaceMedic]

This role is almost similar to NCO vs Officer. NCO play more direct role in taking care of soldiers by executing officer's order. Both depend on each others in taking of soldiers.

I don't know in what context this RN made this comment to the OP but it sounds like there is break down in communication/respect.

Exactly right.

 

[VolatileNavyDoc]

This role is almost similar to NCO vs Officer. NCO play more direct role in taking care of soldiers by executing officer's order. Both depend on each others in taking of soldiers.

I don't know in what context this RN made this comment to the OP but it sounds like there is break down in communication/respect.

Good point. However, not a good analogy. The doctor/nurse relationship is far from the Officer/NCO relationship. If a Marine NCO said that to a Marine Capt., the NCO would probably no longer be in charge of much of anything. However, nurses are free to mouth off about whatever they like b/c they are protected by their separate chain of command.

It's also a misconception that nurses do more "direct pt care". If changing diapers, bathing patients, and changing bedpans are the extent of pt care, then nurses probably do more. (I would argue that Corpsmen do the majority of "direct" pt care in that case.) However, nurses take care of a few pts in the hospital while the physician is generally responsible for many. The numbers vary depending on the level of acuity, but of course in an ICU where the nurse to pt ratio may be 1:1 or 1:2, the nurse is going to spend more time with the individual pt than the physician who has multiple pts and possibly a clinic to attend.

In my experience, the nurses who have this attitude toward doctors are not the ones changing bedpans and generally getting things done... They are the ones sitting behind a desk ordering the Corpsman with 2 combat tours around. This same nurse will sigh dramatically as she has to lift her large rear off of the seat behind the desk b/c she really was going to win at Solitaire this time. Everyone in the clinic/hospital/OR has to know their role. Obviously, this nurse was out of line. Once the lines start to blur, there is a breakdown in communication. Like it or not, the effective chain of command in patient care has a physician at the top. My $0.02.

 

[Mirror Form]

Lighten up. I know a great deal more about healthcare than you assume.

well when you're disimpacting a patient during internship, lets see how you like having a nurse tell you that "you don't take care of patients."

And oh yeah, going through 10 years of grueling training to be in our position to manage patients is kind of a big deal.

 

[tulane06]

well when you're disimpacting a patient during internship, lets see how you like having a nurse tell you that "you don't take care of patients."

And oh yeah, going through 10 years of grueling training to be in our position to manage patients is kind of a big deal.

And only doctors can give DREs, right? I may be mistaken.

 

[DogFaceMedic]

well when you're disimpacting a patient during internship, lets see how you like having a nurse tell you that "you don't take care of patients."

And oh yeah, going through 10 years of grueling training to be in our position to manage patients is kind of a big deal.

You are being far too presumptuous. My CV is bigger than yours.

A problem for many young MDs is their elitist behaviour that RNs are to be treated as subordinates. Case in point is the kid who complained on this forum that he was bitter about saluting RNs.

I always enjoy it when RNs wake up residents at 3am to tell them the pt's fever is 99.1. Back to original point and not who has the bigger CV: treat RNs badly at one's own risk.

By the way, medical training ain't that tough.

 

[VolatileNavyDoc]

You are being far too presumptuous. My CV is bigger than yours.

A problem for many young MDs is their elitist behaviour that RNs are to be treated as subordinates. Case in point is the kid who complained on this forum that he was bitter about saluting RNs.

I always enjoy it when RNs wake up residents at 3am to tell them the pt's fever is 99.1. Back to original point and not who has the bigger CV: treat RNs badly at one's own risk.

By the way, medical training ain't that tough.

In the setting of patient care, an RN is subordinate to an MD. Being subordinate does not mean you should be subject to demeaning treatment. It does mean that the leader has the last word in patient care... period. If anyone subordinate to the MD tries to subvert their efforts through any means then that is mutiny by definition in the military and should be treated as such. Subversion is never an effective method by which to increase the quality of patient care.

Subverting a team effort by waking an MD in the middle of the night for frivolous reasons is petty at the least and really should be beneath anyone who considers themselves an officer or an adult for that matter. It is a sign of inexperience and an inability to communicate effectively with other people. Those who take joy in that behavior are only encouraging childish acts in an adult world.

To say medical training is not that tough covers a lot of ground. Hopefully to make a statement like that you are a board certified MD, IDC, 18D, WALS, ACLS, ATLS, TCCC, OEMS, Pararescue, combat experienced medical professional. That would definitely give you a start to having experienced all useful medical training.

 

[DogFaceMedic]

The resident who treated the RNs badly, earned his lack of sleep. He was the one undermining the healthcare team. I applauded the punishment the RNs handed down on the arrogant young punk.

I'll make an assumption: how many MDs ask the RNs what they think should be done for pt care? I've not seen a lot of it. When I ask what they think, the feedback always benefits pt care.

On a separate issue: I agree that RNs who abuse their rank to intimidate inexperienced MDs, harm pts as well as military medicine. It seems that anyone with self-esteem issues can cause problems regardless of their training.

 

[pgg]

My CV is bigger than yours.

You're a student. Like CRNAs who think that 10 years of "experience" qualifies them to practice medicine, you're missing the point.

A problem for many young MDs is their elitist behaviour that RNs are to be treated as subordinates.

When it comes to the delivery of medical care, nurses are subordinates.

I always enjoy it when RNs wake up residents at 3am to tell them the pt's fever is 99.1.

This is a nurse who needs to be QCR'd.

Calling a resident at 3 AM with unimportant information is professionally inappropriate and should be dealt with before it is allowed to become a habit. Calling a resident at 3 AM because you actually believe 99.1 is a fever demonstrates incompetence of a different kind that should be remediated. Either way, formally documenting this kind of thing is important.

By the way, medical training ain't that tough.

Says the student who hasn't even begun the difficult training yet.

 

[DogFaceMedic]

This is going no where, and the comments are silly. I have 10+ yrs on most of the boys here and more significant accomplishments than pronouncing superiority over RNs.

I think the analogy about line officers and NCOs is accurate.

I challenge some of the readers to listen to the RNs and shed the superiority complex. RNs do more direct pt care, and they are not automatons simply executing orders from their master elitists who were born to be superiors. Us old guys know a thing or two.

 

[DogFaceMedic]

And, med training ain't that tough. It just takes hard work and self-discipline.

 

[colbgw02]

And, med training ain't that tough. It just takes hard work and self-discipline.

What you mean is it doesn't necessarily require a 120 IQ to be a physician. The vast, vast majority of people would say that applying hard work and self-discipline for 7-11 years of training is tough, by any metric.

 

[pgg]

Us old guys know a thing or two.

The point, DogFaceMedic, is that much of the "experience" that midlevels and nontraditional med students talk about means less than they think it does.

I humbly submit that you consider the possibility that you know less than you think you do.

 

[rotatores]

And, med training ain't that tough. It just takes hard work and self-discipline.

Well...what I've gathered from all your silly rambling is:

1) You were a murse for some 10+ years

2) You apparently felt abused as a murse

3) You are very proud of your accomplished murse CV

4) You are going to be one of those 3rd/4th year med students who thinks they are above their peers

and 5) "I have 10+ yrs on most of the boys here"

Again...as a murse! This will matter none when you're the "little boy" intern in a few years!

Ok...I feel better now!

 

[DogFaceMedic]

Well...what I've gathered from all your silly rambling is:

1) You were a murse for some 10+ years

2) You apparently felt abused as a murse

3) You are very proud of your accomplished murse CV

4) You are going to be one of those 3rd/4th year med students who thinks they are above their peers

and 5) "I have 10+ yrs on most of the boys here"

Again...as a murse! This will matter none when you're the "little boy" intern in a few years!

Ok...I feel better now!

Nope. Wasn't a murse. Unfortunately, the labels on SDN are not accurate; consequently, most assumptions are incorrect. Instead of assuming I'm a naif, I suggest you return to my original point that RNs are deservedly proud of their direct care of pts. The original comment that Docs just run lists, is that one RN's equally incorrect assertion.

My observations are that many young MDs think they are special and come into conflict with murses precisely because they treat RNs as inferiors. Bad officers do this to their NCOs.

Military medicine is particularly harsh on fragile egos because the bureaucracy doesn't care and some bad RNs can have advanced DOR which they abuse (amongst its many other faults.) I grant the latter is a real and dangerous problem. Nonetheless, it is important to recognize quality nursing and that RNs do more and know more than younglings usually recognize.

I said more than I meant, off to BBQ.

 

[DogFaceMedic]

The point, DogFaceMedic, is that much of the "experience" that midlevels and nontraditional med students talk about means less than they think it does.

I humbly submit that you consider the possibility that you know less than you think you do.

I know much, Grasshopper. (Couldn't resist.)

 

[AF M4]

I have a great deal of respect for the majority of the nurses I work with. I do not have years and years of experience, but I did work as a nurse's aide for several months in college before I applied for medical school, and that experience has helped me as far as perspective goes. Nurses do not get paid enough for the jobs they do.

However, now that I am on the physician side of things I realize that things aren't as simple as the doc riding in on his high horse and ordering all of the nurses around and then departing to let them get the real work done. You can know a lot of things, but until you know what it's like to have your name on the chart as the person ultimately responsible for another person's care then you don't know it all. I've had to throw a nurse with 20+ years of experience out of a coding patient's room because she was dragging her heels on my orders because I was "just a resident." When things go south because things aren't getting done properly, who do you think is held responsible? Hint: it's the person with the MD after his/her name. That can be a lot of pressure, and it never helps when the people who are supposed to be following your orders are undercutting you, either directly or by being passive-aggressive.

Anyway it's always the easiest thing in the world to criticize the leader and talk up what a better job you could do if you were in charge, but until you've actually been there and done that, you're just another backseat driver.

 

[i want out]

I have a great deal of respect for the majority of the nurses I work with. I do not have years and years of experience, but I did work as a nurse's aide for several months in college before I applied for medical school, and that experience has helped me as far as perspective goes. Nurses do not get paid enough for the jobs they do.

However, now that I am on the physician side of things I realize that things aren't as simple as the doc riding in on his high horse and ordering all of the nurses around and then departing to let them get the real work done. You can know a lot of things, but until you know what it's like to have your name on the chart as the person ultimately responsible for another person's care then you don't know it all. I've had to throw a nurse with 20+ years of experience out of a coding patient's room because she was dragging her heels on my orders because I was "just a resident." When things go south because things aren't getting done properly, who do you think is held responsible? Hint: it's the person with the MD after his/her name. That can be a lot of pressure, and it never helps when the people who are supposed to be following your orders are undercutting you, either directly or by being passive-aggressive.

Anyway it's always the easiest thing in the world to criticize the leader and talk up what a better job you could do if you were in charge, but until you've actually been there and done that, you're just another backseat driver.

ditto the above. You can work for a long time in healthcare, and until your name is the one writing the orders, you don't get it.

You will never get anybody that hasn't been practicing on their own as a physician to understand this though.

its kind of like trying to explain most experiences in life, you just can't put it into words.

i want out (of IRR)

 

[BigNavyPedsGuy]

I'll make an assumption: how many MDs ask the RNs what they think should be done for pt care? I've not seen a lot of it. When I ask what they think, the feedback always benefits pt care.

The other day, I had an 11yo patient w/ VATER syndrome and Crohn's with a low urine output (no foley). And I asked the nurse what she wanted to do: She said we should give him lasix instead of in-and-out cathing him or bladder scanning him!!! Good idea, let's mess up his already-TPN-manipulated K+ just so we don't have to do a procedure.

 

[ILUvRVUs]

The resident who treated the RNs badly, earned his lack of sleep. He was the one undermining the healthcare team. I applauded the punishment the RNs handed down on the arrogant young punk.

I'll make an assumption: how many MDs ask the RNs what they think should be done for pt care? I've not seen a lot of it. When I ask what they think, the feedback always benefits pt care.

I think the majority of new interns ask the nurse on duty for their opinion on what is "normally" done in this situation. Nurses have the experience that we don't and it ever hurts to ask. Where I had difficulty is Nurses telling me what should be done for MY patients and expecting me to write an order based solely on their advice. Looking younger than my 26 years didn't help but I am was the doctor and it was still my signature and responsibility. Its not easy for an older nurse to take orders from a younger doctor but thats life. The ones that can't handle it shoul find a new profession. I had one nurse put a patients life in danger because she didn't understand why I ordered insulin/dextrose for a patient with an elevated K+. She didn't call or page, she just didn't do it. Those where typically the RNs that "participated in more patient care" or called for some BS reason in the middle of the night.

The above is the minority and my experience overall with RNs has been very positive. The treatment of patients has been more of a team effort once the mutual respect and trust has been established.

DogFacedMedic: What exactly are your credentials? Corpsman, IDC, Tech, Pre-med, Med, Intern, Resident, Attending, Research? You seem to dislike the colleagues in the profession you are entering or currently training in.

 

[a1qwerty55]

...about 6-9 minutes ago, in all seriousness: "You don't take care of the patients Dr. Heeed!, we do. They're just names on your list."

You live and die by your reputation. Maybe yours isn't.... so good?

One other point. I trust an experienced nurses' assessment 90% of the time over that of an Intern. As an intern your goal should be to be humble, recognize your are very dangerous, and that you can learn from nurses on occassion. The nurses often save the patients from the likes of overconfident and self important first years and upper levels for that matter. I've seen very experienced trauma nurses direct a resuscitation far better than that of many 3-4th year surgical residents.

So, if you came out of medical school with the idea that you are either intellectually superior, or more capable than an experienced nurse, your medical school failed you. Sure the doctor runs the ship and is ultimately responsible (the attending that it), but it is a team sport and if you try to cop an attitude with the nurses, the patient is the ultimate loser. My experience is that if you are on top of your game, and the nurses have confidence in you, they will do backflips for you and your patients. And guess, what,,, the patient's do better.

 

[a1qwerty55]

Of course that's what she wanted you to do, since:

1) <wheels turning in her little brain> "Low urine output + Lasix = adequate urine output"

2) That's how she always seen it done, and if you're not doing what she's always seen everyone else do, you're an idiot.

3) Cath = moderate amount of work, while Lasix = small amount of work. Clearly Lasix is the better choice for the patient. In fact, she heard that's the standard of care in these situations.

Her little brain seems to function a lot like a surgical resident

 

[Heeed!]

You live and die by your reputation. Maybe yours isn't.... so good?

One other point. I trust an experienced nurses' assessment 90% of the time over that of an Intern. As an intern your goal should be to be humble, recognize your are very dangerous, and that you can learn from nurses on occassion. The nurses often save the patients from the likes of overconfident and self important first years and upper levels for that matter. I've seen very experienced trauma nurses direct a resuscitation far better than that of many 3-4th year surgical residents.

So, if you came out of medical school with the idea that you are either intellectually superior, or more capable than an experienced nurse, your medical school failed you. Sure the doctor runs the ship and is ultimately responsible (the attending that it), but it is a team sport and if you try to cop an attitude with the nurses, the patient is the ultimate loser. My experience is that if you are on top of your game, and the nurses have confidence in you, they will do backflips for you and your patients. And guess, what,,, the patient's do better.

The comment was made by a SrA and directed at doctors in general.

 

[notdeadyet]

1) <wheels turning in her little brain> "Low urine output + Lasix = adequate urine output"

Is that really indications of her "little brain" or just logic that is appropriate for her level of training?

I agree with most of the posters above that the idea of "doctors don't care for patients, nurses do" is silly and short sighted. Nurses and doctors have different jobs. But you can't ask a nurse about treatment plans that are outside of her field of training and then rag her for having a "little brain" when you don't get the answer you'd expect from a physician.

I understand your frustration, Tired, but the "little brain" comments might indicate why there is some of the friction between nurses and physicians, no? A respect issue?

 

[Miss Mab]

The comment was made by a SrA and directed at doctors in general.

The real irony, of course, is that we now learn the original comment wasn't even made by a nurse in the first place.

The rips are still good and perhaps even deserved on occasion.

But general tip, if it's not a fellow officer talkin' smack--then it's not an RN.

 

[Heeed!]

Some of us went back and talked with several of the nurses involved and we worked it all out. The SrA who was chiming in was the tech of the 1LT who said the original statement (my mistake on last post).

The amazing thing to me was how fast little problems spread. I mean like wildfire! Some nurses were having a bad day, patients being mean, doctors being butts....next thing you know, the entire floor is mad. And by the time it was all over, nobody even knew what they were upset about in the first place.

One thing I dislike about medicine is there always seems to be someone arguing with someone else. My observation is it usually involves someone not wanting to do some sort of work. IMHO.

 

[BigNavyPedsGuy]

Everyone from the corpsmen to your attendings will cut your throat the moment you drop your guard.

The pediatrician in me just wants to hug you because your dead inside. But the GMO in me wants to join forces and punish every non-intern out there.



I'm so conflicted . . . .

 

[OCHO]

You are being far too presumptuous. My CV is bigger than yours.

A problem for many young MDs is their elitist behaviour that RNs are to be treated as subordinates. Case in point is the kid who complained on this forum that he was bitter about saluting RNs.

I always enjoy it when RNs wake up residents at 3am to tell them the pt's fever is 99.1. Back to original point and not who has the bigger CV: treat RNs badly at one's own risk.

By the way, medical training ain't that tough.

That sounds like an episode on ER, "Dr. Carter I presume" hehehe

 

[notdeadyet]

Consider: the OP told a story where a nurse accused all physicians of not caring about their patients. I responded by refering to this specific nurse as having a little brain.

Not true, Tired. Read your post again. You were not referring to the nurse Heeed! was talking about. Your "little brain" comment referred to the nurse that gave BigNavyPedsGuy bad Lasix advice. She had nothing to do with the docs not caring about patients comment. Read your post and you'll see what I mean.

Thinking docs don't care about patients could very well be indicative of a little brain. But I wouldn't say a nurse has a little brain because she couldn't come up with the best treatment for a peds case with VATER syndrome and Crohn's with a low urine output. That's why we need doctors.

 

[bustbones26]

Allow me to jump in here. We can go round and round about doctor vs. nurse, etc. etc. etc, blah blah blah! So on and so forth and it will go nowhere. In fact, it looks like it already has.

We all know that there are some good nurses out there (bad ones too), and we all know that there are some good docs out there (bad ones too). I am under the impression that the OP's intention was not to necessarily bash insubordinate nurses because this can be done virtually on any forum here on SDN. I feel that his intention was to note that military medical centers seem to be a breeding ground and safe haven for insubordinate nurses and ancillary staff in general for that matter. In essence, if there is a ****ty nurse out there somewhere, they will find a welcome home in the military healthcare system.

Of course, we always appreciate the hard work of nurses otherwise. Unforunately, just likes docs, a few bad apples in the bunch sometimes can spoil the whole barrel.

Oh and to this guy who thinks that he is special because he has some huge CV or some garbage like that, just remember, the wisest thing I think I ever heard a fellow colleague say was this, "The largest blade of grass is the first one to get cut down".

 

[Coastie]

I see that knowing the definition of a fever isn't on your CV.

I smell a rat..

You are being far too presumptuous. My CV is bigger than yours.

A problem for many young MDs is their elitist behaviour that RNs are to be treated as subordinates. Case in point is the kid who complained on this forum that he was bitter about saluting RNs.

I always enjoy it when RNs wake up residents at 3am to tell them the pt's fever is 99.1. Back to original point and not who has the bigger CV: treat RNs badly at one's own risk.

By the way, medical training ain't that tough.

 

[Coastie]

Is this guy serious?

The resident who treated the RNs badly, earned his lack of sleep. He was the one undermining the healthcare team. I applauded the punishment the RNs handed down on the arrogant young punk.

I'll make an assumption: how many MDs ask the RNs what they think should be done for pt care? I've not seen a lot of it. When I ask what they think, the feedback always benefits pt care.

On a separate issue: I agree that RNs who abuse their rank to intimidate inexperienced MDs, harm pts as well as military medicine. It seems that anyone with self-esteem issues can cause problems regardless of their training.

 

[Coastie]

90% maybe in July or August, but come March, April, May of intern year, if that hasn't dipped well below 50% then you have some sorry interns on your hands.

You live and die by your reputation. Maybe yours isn't.... so good?

One other point. I trust an experienced nurses' assessment 90% of the time over that of an Intern. As an intern your goal should be to be humble, recognize your are very dangerous, and that you can learn from nurses on occassion. The nurses often save the patients from the likes of overconfident and self important first years and upper levels for that matter. I've seen very experienced trauma nurses direct a resuscitation far better than that of many 3-4th year surgical residents.

So, if you came out of medical school with the idea that you are either intellectually superior, or more capable than an experienced nurse, your medical school failed you. Sure the doctor runs the ship and is ultimately responsible (the attending that it), but it is a team sport and if you try to cop an attitude with the nurses, the patient is the ultimate loser. My experience is that if you are on top of your game, and the nurses have confidence in you, they will do backflips for you and your patients. And guess, what,,, the patient's do better.

 

[Mirror Form]

You are being far too presumptuous. My CV is bigger than yours.

No doubt it's longer, but you're the one being far to presumptous in thinking that your experience as a mid level provider gives all that much insight what it's like to be a physician. Sure, nurses carry out doctor's orders, but they have no idea of the stress and responsiblity involved with being the person who makes the ultimate decisions. It's not even remotely compareable. As a nurse, how many times were you the primary surgeon on a case? I've been the primary on over a hundred, it's a bit different than carrying out someone else's orders to administer a med.

BTW, I'm guessing your ego is going to grab you some pretty horrendous grades on your clinical rotations. The med students who think they know everything are always funny to watch to get shot down right and left.

A problem for many young MDs is their elitist behaviour that RNs are to be treated as subordinates. Case in point is the kid who complained on this forum that he was bitter about saluting RNs.

Sorry, but in the real world, nurses are supposed to be subordinates in regard to the patient care team. The doctor shouldn't be saluting the person he orders to do things.

 

[Mirror Form]

I always enjoy it when RNs wake up residents at 3am to tell them the pt's fever is 99.1.

This just shows how clueless you really are. Unlike nurses, the doctors are the ones who really have the patient's life in their hands. What if that resident you just woke up has going to be the primary surgeon on a case the next day? When you prevent the resident from sleeping, it's the patients who are put at risk.

It's unfortunate that your career as a mid-level gave you zero insight into truly taking care of patients.

 

[Mirror Form]

I'll make an assumption: how many MDs ask the RNs what they think should be done for pt care? I've not seen a lot of it. When I ask what they think, the feedback always benefits pt care.

If the nurse feels that something must be done that isn't being done, then the nurses should say something. In my experience nurses rarely add much to the medical treatment plan (that's why we dont' ask ).

 

[a1qwerty55]

90% maybe in July or August, but come March, April, May of intern year, if that hasn't dipped well below 50% then you have some sorry interns on your hands.

It all depends, a medicine or surgery intern in the second half of the year is generally pretty good. There however are a lot of "special" kids coming through the pipeline now, learning disabilities etc. Some are not trainable no matter where they are in their academic year. I suspect some of them are the ones posting how they are getting "screwed". Usually the really dangerous ones have zero insight, that is the problem.

Without sounding like I'm bashing residents, the bottom line if to recognize something if helps to have seen it before. This is a function of time, exposure and aptitude. Often the nurse has seen shock many more times that the intern, and is better at recognizing something needs to happen, not necesarilly knowing what that something is.

 

[Mirror Form]

One other point. I trust an experienced nurses' assessment 90% of the time over that of an Intern.

LOL, that's because nurses just say what the most likely diagnosis is, and they're right 90% of the time. It's easy to say "oh, the patient obviously have diagnosis X," when you're not the one who's responsible if you're wrong.

Nurses don't have to worry about ruling out all the things in the bottom 10%.

 

[a1qwerty55]

If the nurse feels that something must be done that isn't being done, then the nurses should say something. In my experience nurses rarely add much to the medical treatment plan (that's why we dont' ask ).

That b/c you aren't listening. Remember doctors are teachers, not just to residents but to nurses and patients. Example: If you are a CT surgeon, and you spend time at the bedside getting to know your heart nurses, explaining your expectations and the why's of your orders, you will grow a nurse who will help you and thus the patient. I come off sounding like some kind of nurse lover, but the reality is if you marginalize them, the care suffers.

 

[i want out]

That b/c you aren't listening. Remember doctors are teachers, not just to residents but to nurses and patients. Example: If you are a CT surgeon, and you spend time at the bedside getting to know your heart nurses, explaining your expectations and the why's of your orders, you will grow a nurse who will help you and thus the patient. I come off sounding like some kind of nurse lover, but the reality is if you marginalize them, the care suffers.

didn't think I would see a time when I would agree with A1qwerty, but I would agree, that you really do have to train the nurses to what you want.

Most of you have seen nurses at teaching hospitals where they do frequently have more experience, if not more training than some of the folks coming through the rotations.

what your failing to understand, is that when you get to a private hospital (not a military hospital), your nurses will actually probably care a little more what you personally want, because you won't be rotating through for 30-60 days you will be there long term.

When in a teaching hospital, it is important to understand the perspective of the nurses even if you don't agree with it, because they can indeed make your life hell.

Like most things, you must pick your battles, and if you want to have a pissing contest with a fresh batch of nurses every month, then you go right ahead and knock yourself out doing it.

As for me, I am going to continue to treat the nurses like we are all on the same team, and if I have time, talk to them enough about what they have seen going on with my patient, that they know that I am interested in more than just a name on the list.

i want out (of IRR)

 

[Mirror Form]

That b/c you aren't listening. Remember doctors are teachers, not just to residents but to nurses and patients. Example: If you are a CT surgeon, and you spend time at the bedside getting to know your heart nurses, explaining your expectations and the why's of your orders, you will grow a nurse who will help you and thus the patient.

This is a situation that sounds nice. I'll admit that nurses in the CCU and ICU tend to be very good. Although I don't see how getting to know everyone could be that applicable to interns. Most of the time when I asked the ICU nurses for what their diagnosis was during internship (we all made that mistake a few times early on in July and Augusts) the answer was clearly not a good one (even to me at that time).

Of course i've done most of my training in public state hospitals, the VA, and military hospitals where there aren't lots of experienced good nurses like at private facilities.

BTW, i'm curious. As an interns and resident, did you take the extra time by the bedside to get to know the nurses and discuss your expectations? Or is that one of those things that you have time for now that you're staff?