what do nurses hate about doctors?

[s1lver]

This post made me snoop around in the AllNurses.com forum and found this interesting thread - what do nurses hate about doctors?

Future docs, your thoughts?

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[montessori2md]

That forum pretty much sums up my observations on md/surg, but you can add to nurses -the techs, social workers, aides, PT, etc. IMHO most of the MDs are pretty well liked, but MDs who don't work on our floor regularly and don't know the staff can shoot themselves in the foot by a) refusing to listen to staff advice or b) just being really high maintenance or hard to contact. It's really annoying to need orders on a pt and not have them.

This is not a problem specific to healthcare. It's a relationship problem anywhere you have a supervisor who is not always present (construction jobsite, for example, or the school district superintendent). There is a tendency for said supervisor to fail to communicate precisely what he/she expects while absent, and to swoop in unexpectedly and overreact to whatever irks them upon arrival. Because they aren't always there, their ideas to improve things sometimes don't fit reality. It's hard to be a good semi-absent supervisor.

 

[moose21]

"Nurses don't [COLOR=green! important][COLOR=green! important]sleep[/COLOR][/COLOR] at night. Required to stay awake on the night shift. Docs get call rooms and sleep when they can. Just a helpful piece of info."

As far as I know, nurses work 12 hr shifts and the night shift is when night nurses are supposed to be awake. Dr.'s work during the day and are then on call at night, so they've already put in 12 hr's before the night shift even shows up. My point is, this whole idea that nurses have it bad because they have to work at night while MD's get plush little call rooms and nap breaks is bogus.

 

[maceo]

they hate that they are not doctors. They believe they should get the same priveleges as a physician.

 

[PreMedMommy]

"Nurses don't [COLOR=green! important][COLOR=green! important]sleep[/COLOR][/COLOR] at night. Required to stay awake on the night shift. Docs get call rooms and sleep when they can. Just a helpful piece of info."

As far as I know, nurses work 12 hr shifts and the night shift is when night nurses are supposed to be awake. Dr.'s work during the day and are then on call at night, so they've already put in 12 hr's before the night shift even shows up. My point is, this whole idea that nurses have it bad because they have to work at night while MD's get plush little call rooms and nap breaks is bogus.

To bad you can't make an obnoxious speech bubble (that won't go away) pop up every time your curser accidentally rolls over anyword highlighted in green.

 

[Lukkie]

they smell bad

 

[TarHeelEMT]

Nurses' dislike for doctors is nothing next to the constant stream of crap older nurses send to paramedics (not such a problem with younger nurseS). I suppose they view paramedics as a threat to the profession or something.

 

[scrubsaresexy]

I think an even better thread would be "Why do EMTs (and any other allied health care worker) hate nurses?"

Ugh. I could go on and on and on about that. Just because doctors are 'mean' to nurses doesn't mean that nurses aren't 'mean' to other people who are considered to be below them.

Now, of course that isn't all nurses. I've met some really, really nice nurses when I've picked up patients. I've also met people who act all nice and sweet in front of the patient and then will come out and yell at you in the middle of the hallway about something stupid.

 

[DenaliView]

I am an RN and can honestly say I do not hate doctors. Heck I want to be one. While I have seen some pretty hostile nurses come toe to toe with many docs; the majority of nurses really are just looking out for what is going to be best for their patient (whether that is the easiest route for the doc or not).

Personally I get really really angry when I see (typically older) nurses who want to argue with the doctor just for the sake of arguing, and you definitely sense a bit of a chip on the shoulder. And who does this help, absolutely no one. Completely nonsensical...... But on the flip side of this I have encountered some doctors who "in my opinion" are not providing quality care for my patients, whether they are tired or just not in the mood... or maybe have a great plan of care I don’t know about yet, but either way I am the advocate for my patient and need you to either do something about it or communicate why not. What kind of degree you hold and how much more school you currently have over me is not an answer.... Something is Wrong with the F****** Patient..... and it is your responsibility... While our training is substantially less then an MD as a RN we are licensed and with that comes some degree of training that allows us to identify when there is a problem. Many times I am been blown off by doctors and subsequently patients have further unnecessary complications. While we can’t always agree 100% of the time if you simply hear me out and give me a bit of feedback rather then hanging up on me….we might get along a little better.

One more thing that builds resentment in the nursing population..... As a first year intern I realize that you are overworked, extremely tired, and rather irritable and I don’t want to make your life harder. Really I promise! But the intensity of the job is never ever an excuse to completely berate me or a patient.....EVER. If it is that bad then QUIT!!!! Seriously while I do feel empathy for all the residents, I never believe that this is an excuse to treat people poorly..... You choose to be a doctor no one forced you and while the stressors are probably way worse then you ever imagined going into it, you still get up every morning and make a choice on what kind of attitude you are going to have.

Thanks for your ears feel free to shoot back what makes you crazy about the nurses… I know we have some really doozies on our side as well, and that can become incredibly frustrating……. Stepping of the soapbox now!

 

[dezokitty]

I am an RN and can honestly say I do not hate doctors. Heck I want to be one. While I have seen some pretty hostile nurses come toe to toe with many docs; the majority of nurses really are just looking out for what is going to be best for their patient (whether that is the easiest route for the doc or not).

Personally I get really really angry when I see (typically older) nurses who want to argue with the doctor just for the sake of arguing, and you definitely sense a bit of a chip on the shoulder. And who does this help, absolutely no one. Completely nonsensical...... But on the flip side of this I have encountered some doctors who "in my opinion" are not providing quality care for my patients, whether they are tired or just not in the mood... or maybe have a great plan of care I don’t know about yet, but either way I am the advocate for my patient and need you to either do something about it or communicate why not. What kind of degree you hold and how much more school you currently have over me is not an answer.... Something is Wrong with the F****** Patient..... and it is your responsibility... While our training is substantially less then an MD as a RN we are licensed and with that comes some degree of training that allows us to identify when there is a problem. Many times I am been blown off by doctors and subsequently patients have further unnecessary complications. While we can’t always agree 100% of the time if you simply hear me out and give me a bit of feedback rather then hanging up on me….we might get along a little better.

One more thing that builds resentment in the nursing population..... As a first year intern I realize that you are overworked, extremely tired, and rather irritable and I don’t want to make your life harder. Really I promise! But the intensity of the job is never ever an excuse to completely berate me or a patient.....EVER. If it is that bad then QUIT!!!! Seriously while I do feel empathy for all the residents, I never believe that this is an excuse to treat people poorly..... You choose to be a doctor no one forced you and while the stressors are probably way worse then you ever imagined going into it, you still get up every morning and make a choice on what kind of attitude you are going to have.

Thanks for your ears feel free to shoot back what makes you crazy about the nurses… I know we have some really doozies on our side as well, and that can become incredibly frustrating……. Stepping of the soapbox now!

As a pharmacy student, I guess I'm a little more like a third party, but I just had to respond to this. From my observations, you are RIGHT ON!! This isn't a problem that just nurses have with doctors; all the other health professionals have the same issues with MD's. Whatever happened to the supposed "interdisciplinary team" that we're all supposed to be working in? This, of course, is not true of all doctors, but it does make us truly appreciate the ones who treat all us other health professionals with respect.

 

[TamarMD]

In the words of Cherish:

They're feeling really unappreciated
We're taking their work for granted babes
They don't know how much more they can take from us

I sincerely hope this doesn't turn out into a nurse flaming war. We all in some way or another contribute to the patient's care. Nurses just wish that they could contribute more or that when they do contribute people actually listen and don't say "I'm the doctor and you're the nurse". Even if it is true because no one likes anyone who pulls rank.

 

[zdogg]

they just like to hate

 

[diosa428]

The thought that a physician is more likely to "pull rank" just because they can is crap. Nurses who are perfectly nice and helpful with the "real" doctors treat me, a medical student, like crap, all the time. I've had nurses be rude to me when I've approached them with a simple question, like "did so and so have any problems overnight?" I get responses like "I'm the day nurse not the night nurse". Well, ok, but the last time I checked, nurses gave SIGNOUT, during which they refuse to talk to anyone, so if you don't know if there were any events overnight, wth were you doing during signout? Or asking a nurse to get a weight on a patient who's supposed to be weighed everyday, but hasn't been weighed in like 3 days. Sure, maybe they're supposed to do that on night shift. But if I need a weight, it's still your job. And when I make requests like that, I always include a statement like "it's not urgent, so could you do it when you have a chance?" so it's not like I'm demanding that you drop everything to do it right now. Would it kill you to do it, or at least ask the person you sign out to to do it? But no, the nurses act like I'm being ridiculous. But yet I ALWAYS have to be nice to them.

 

[LizzyM]

OMG

This is going to be so useful!

 

[DenaliView]

The thought that a physician is more likely to "pull rank" just because they can is crap. Nurses who are perfectly nice and helpful with the "real" doctors treat me, a medical student, like crap, all the time. I've had nurses be rude to me when I've approached them with a simple question, like "did so and so have any problems overnight?" I get responses like "I'm the day nurse not the night nurse". Well, ok, but the last time I checked, nurses gave SIGNOUT, during which they refuse to talk to anyone, so if you don't know if there were any events overnight, wth were you doing during signout? Or asking a nurse to get a weight on a patient who's supposed to be weighed everyday, but hasn't been weighed in like 3 days. Sure, maybe they're supposed to do that on night shift. But if I need a weight, it's still your job. And when I make requests like that, I always include a statement like "it's not urgent, so could you do it when you have a chance?" so it's not like I'm demanding that you drop everything to do it right now. Would it kill you to do it, or at least ask the person you sign out to to do it? But no, the nurses act like I'm being ridiculous. But yet I ALWAYS have to be nice to them.

Honestly, you are completly right. As the nurse on duty at the time they need to have knoweldge of their shift (simply by being present for it) and also have an overview of what went on during the previous. The fact of the matter is even as a medical student you to are part of the overall team giving care to the patient and should be informed of current and recent status.... And it probably would have taken the nurse more then 45 secs to give you. Probably on of the Med-school drop outs who are jelous! Sorry for your experience. As far as getting the weight.... I don't think they needed do drop everything at that moment and get it but atleast say "Looks like the night nurse forgot again, I will mention it to him/her. Let me finish my rounds and I will get it in the chart" Simply because that is what is needed for the patient!

 

[Tyc00nman]

OMG

This is going to be so useful!

i must say that finger waving smily has been used on me by 2 girls already. women have a tendency to do alot of finger waving.😕

 

[DenaliView]

i must say that finger waving smily has been used on me by 2 girls already. women have a tendency to do alot of finger waving.😕

just as long as the use a pointer finger.....

 

[diosa428]

Honestly, you are completly right. As the nurse on duty at the time they need to have knoweldge of their shift (simply by being present for it) and also have an overview of what went on during the previous. The fact of the matter is even as a medical student you to are part of the overall team giving care to the patient and should be informed of current and recent status.... And it probably would have taken the nurse more then 45 secs to give you. Probably on of the Med-school drop outs who are jelous! Sorry for your experience. As far as getting the weight.... I don't think they needed do drop everything at that moment and get it but atleast say "Looks like the night nurse forgot again, I will mention it to him/her. Let me finish my rounds and I will get it in the chart" Simply because that is what is needed for the patient!

Yeah and I don't just make things up to annoy nurses. Typically if I have a question or request, it is because my resident or attending asked me to go ask the nurse. It's not because I'm bored and am trying to make their lives more difficult.

 

[Tyc00nman]

just as long as the use a pointer finger.....

good call. Im sure its the index finger.

apparently, the finger waving is not limited to teenage girls and women that are older. My cousin's 2-yr-old daughter does it all too often and all too well. It is absolutely the funniest thing ever.

now, if only we could get the smily to simultaneously shake its head whilst waving the INDEX finger. The women on SDN would go crazy with these things

 

[TamarMD]

I don't think physicians pull rank. I'm simply repeating what the majority of nurses in the "be nice to nurses we keep doctors from killing you" group say. He asked what do nurses hate about doctors. Since I'm not a RN or PN I have zero contact with a physician as a CNA unless I'm ill, so I can't say what I hate about physicians. I'll tell you what I do hate about my aunt who is a physician. I hate her snooty attitude and the belief she has that her and her snooty children are better than my family. I also hate that she walks around acting like her kid is all that because he's in medical school and forgets to tell others that he goes to med school in mexico because he couldn't get into an allopathic or osteopathic medical schools.

 

[ChubbyChaser]

nurses' Dislike For Doctors Is Nothing Next To The Constant Stream Of Crap Older Nurses Send To Paramedics (not Such A Problem With Younger Nurses). I Suppose They View Paramedics As A Threat To The Profession Or Something.

i Think An Even Better Thread Would Be "why Do Emts (and Any Other Allied Health Care Worker) Hate Nurses?"

Ugh. I Could Go On And On And On About That. Just Because Doctors Are 'mean' To Nurses Doesn't Mean That Nurses Aren't 'mean' To Other People Who Are Considered To Be Below Them.

Qft!

 

[Perrotfish]

Reading through this, I felt like the complaints tended to fall into 3 catagories

1) Useful: Illegible handwriting and giving verbal orders (especially while physically next to the nurse who you want to write the order down) seemed to be the top two.

2) Unsympathetic: Mostly this had to do with physicians not wanting to get woken up. The nurse is technically in the right, and I'm sure he/she would have the EXACT same attitude if it was the nurse that had been up for 48 hours.

3) "There's no reason the doctor can't do xxxxxx just as easily as I could." Whether it's finding a chart, or fetching a piece of equiptment, or relaying information to another doctor, or whatever, this seems to be the majority of complaints. I have no idea whether these are, actually, parts of a nurses job or not. However to me this begs the question, if this isn't the nurses' job, shouldn't it be someone's job other than the doctor's? I mean, unskilled labor is really cheap, and a physician's time is really, really expensive. Top lawyers don't set up meetings, file documents, and fetch coffee for themselves. Why in the world would a top Ortho with a comperable billing rate do the medical equivalent?

I also hate that she walks around acting like her kid is all that because he's in medical school and forgets to tell others that he goes to med school in mexico because he couldn't get into an allopathic or osteopathic medical schools.

Can you even practice in the US, after going to a Mexican medical school?

 

[ZagDoc]

3) "There's no reason the doctor can't do xxxxxx just as easily as I could." Whether it's finding a chart, or fetching a piece of equiptment, or relaying information to another doctor, or whatever, this seems to be the majority of complaints. I have no idea whether these are, actually, parts of a nurses job or not. However to me this begs the question, if this isn't the nurses' job, shouldn't it be someone's job other than the doctor's? I mean, unskilled labor is really cheap, and a physician's time is really, really expensive. Top lawyers don't set up meetings, file documents, and fetch coffee for themselves. Why in the world would a top Ortho with a comperable billing rate do the medical equivalent?

QFT. I've seen so many squabbles between nurses and MDs about whose job it is to find a chart or send a page, etc. In private practice, PAs are filling this role nicely, being the kind of underlying organizer/filter for the MD, but its still a huge problem in the hospital.

Last month I spent almost 40 minutes with an MD looking for a chart. Here she had patients waiting in clinic, pages waiting to be answered, meetings to be attended, fellows to be trained and we're running around like on some magical treasure hunt. It's f#%cking hilarious.

 

[DenaliView]

"There's no reason the doctor can't do xxxxxx just as easily as I could." Whether it's finding a chart, or fetching a piece of equiptment, or relaying information to another doctor, or whatever, this seems to be the majority of complaints. I have no idea whether these are, actually, parts of a nurses job or not. However to me this begs the question, if this isn't the nurses' job, shouldn't it be someone's job other than the doctor's? I mean, unskilled labor is really cheap, and a physician's time is really, really expensive. Top lawyers don't set up meetings, file documents, and fetch coffee for themselves. Why in the world would a top Ortho with a comperable billing rate do the medical equivalent?

Definitely an interesting point. Is it technically their job??? grabbing coffee. no. Fetching equipment, sure if they are assisting you in performing a procedure. In my experience I find that the docs time is limited and they have a lot going on so I personally have no problem grabbing equipment and tracking down paperwork (with the exception of the Doc hanging out in the nursing station talking about what they did on their previous days off). With most doctors schedules that is a rarity..... Fetching coffee.... personally I would find this a little offensive unless I was grabbing some for myself and you asked me to bring you a cup….. and would return the favor…..maybe their should be someone to do these kinds of menial tasks but with the current nursing shortage and higher patient loads not so sure having an RN doing them is wise…or would go over well though (Lol just ask one!). In my hospital even the trained nursing assistants are on a tight busy schedule and have little “fetching time” ….. What ever happen to the Candy Stripper we need some of those….

 

[Tyc00nman]

What ever happen to the Candy Stripper we need some of those….

WOAH! introduce me to her!

i know, i know...


🙁

 

[TamarMD]

Can you even practice in the US, after going to a Mexican medical school?

I have no clue. I know it's a lot harder for you to match as an FMG if you're an American citizen.

 

[Bacchus]

I have no clue. I know it's a lot harder for you to match as an FMG if you're an American citizen.

My friend's shadowing experience is with an EM physician trained in Mexico.

 

[DenaliView]

Nurses constantly get confused about why they get berated/yelled at.

It's not because interns/residents/attendings are tired or stressed. It's not because physicians don't respect them. It's not because we're mean people.

It's because the nurse screwed up.

I am constantly amazed at how nurses will make drug errors, miss orders, fail to complete critical tasks in a timely manner, then turn around and act all offended when someone tells them they screwed up. I have watched nurses literally kill patients with their mistakes, then get all self-righteous when the doctor comes down on them. What did you think was going to happen when you gave that patient 400 units of Lantus instead of 40?

Here's a tip: When I hurt my attending's patients, I get yelled at. When the nurse hurts my patients, they get yelled at. Welcome to the world of medicine, where screwups cost lives. Grow a thicker skin and don't screw up again.

Lol…. Well that does go both ways….well kind of… When you write out the order for 400 units of Lantus and we catch if, give you a call at 12am not wanting to kill the patient we still get yelled at. .. oh the joys

Also If a nurse is being so careless lackadaisical that he/she is killing patients or putting them in great harm, serious action needs to be taken with that nurse. Screaming at them at the nursing station is probably not the most effective route for anyone involved though. Berating someone in front of a crowd never manifests great results. Either the nurse will yell back and a fight will result…. Not good. Or They will remain quiet let you rant and then be much less open to communication of any kind with you in the future. As well as any of the nurses who are in ear shot.

Personally if I did something so careless that I killed or endangered a patient I am sure that I would already feel terrible and formulating ways to avoid it in the future…listening to you rant at me for a half hour will be the least of my concerns. Typically that is not what nurses get chewed out for…. It is the wake up calls like above that make for a poorer working relationship.

 

[Narmerguy]

It seems to be a big concern that doctors write legibly and that worries me because I've had crappy handwriting since I was about 6 so I can't imagine the kind of chicken scratch I'll be producing after medical school 🙁

 

[Jawbone]

Nurses constantly get confused about why they get berated/yelled at.

It's not because interns/residents/attendings are tired or stressed. It's not because physicians don't respect them. It's not because we're mean people.

It's because the nurse screwed up. .

Now that's a generalization. If every physician only "yelled" at a nurse when they nearly kill a patient, then that's great.

Unfortunately, the nurse ends up being the whipping boy for everyone else.

-The MD writes the wrong dose, the nurse carries out the order, and the nurse gets in trouble.

-The pt is made NPO, yet dietary accidentally delivers a breakfast tray. The nurse gets in trouble.

-MD orders bathroom privs, pt gets out of bed, falls. Nurse gets in trouble.

- MD refuses to order foley/rectal tube on bedbound incontinent pt with Stage IV sacral decub. Pt soils dressing every 1-2 hours, requiring changes. Wound fails to heal. Nurse gets blamed.


There are many more issues at hand than the nurse "screwing up, then getting confused as to why all the verbal abuse."

Verbal abuse is never appropriate. It comes down to the nurse knowing when to call, and what is truly important. It also means that the physician, who may not feel the issue is that important, support, or at least professionally help the nurse understand your rationale...

 

[DenaliView]

Verbal abuse is never appropriate. It comes down to the nurse knowing when to call, and what is truly important. It also means that the physician, who may not feel the issue is that important, support, or at least professionally help the nurse understand your rationale...

Very well stated!

 

[Perrotfish]

Historical question, at what point did a seperate chain of command for nurses get established? I know it wasn't always that way. I mean, it seems like all the yelling comes from the fact that nobody actually works for anybody else: EMTs are seperate from Nurses are seperate from physicians are seperate from the myriad of hospital support staff are seperate from maintinance are all seperate from and greater than medical students. How did hospitals evolve to the point where no one is in charge? Is it this way nation wide, or are there places left with a more linear hierarchy? Was it better or worse before things changed?

 

[DenaliView]

As nice as it is to have the support from other nurses when things begin to get heated (when you are dealing with stressful decisions things are always going to get a bit heated) nurses do tend to have a stand together (regardless of the situation) approach. As a nurse I find this bitter-sweet. On the one hand I appreciate the support when I really feel another staff member is out of line and want someone to stand behind me or I want something to get done. But on the other hand their are times when the RNs do get out of line in the hospital I work. Even if you make a mistake depending on who your supervision is you may or may not see any consequences to poor performance.


With that said do I feel it is the Physicians job to go back behind and shout with the nurse (NOT talking about you specifically Tired…) not at all. This takes a broken system and just add fuel to the fire. Some how their needs to be a liaison between the physicians and the nursing staff (and RT. OT, pharmacy….whatever) that can help keep everyone a little more on track. Knowing that if you make a mistake someone will notice and if you repeat the mistake you will have some type of consequence)……

 

[TarHeelEMT]

Historical question, at what point did a seperate chain of command for nurses get established? I know it wasn't always that way. I mean, it seems like all the yelling comes from the fact that nobody actually works for anybody else: EMTs are seperate from Nurses are seperate from physicians are seperate from the myriad of hospital support staff are seperate from maintinance are all seperate from and greater than medical students. How did hospitals evolve to the point where no one is in charge? Is it this way nation wide, or are there places left with a more linear hierarchy? Was it better or worse before things changed?

I can't speak for nurses, but I can speak for the paramedic/EMT spot. Paramedics work under the license of a physician and therefore answer directly to them.

We have a lot of "issues" with older nurses who recall the days when the people who drove the ambulance were know-nothing "ambulance drivers" instead of healthcare professionals with greater autonomy than their own. In terms of knowledge or skillsets, we're totally different - today's paramedics are something of a scaled down PA who specialize in medical emergencies, while a nurse is a specialist in overall quality of patient welfare.

 

[ACSurgeon]

As a pharmacy student, I guess I'm a little more like a third party, but I just had to respond to this. From my observations, you are RIGHT ON!! This isn't a problem that just nurses have with doctors; all the other health professionals have the same issues with MD's. Whatever happened to the supposed "interdisciplinary team" that we're all supposed to be working in? This, of course, is not true of all doctors, but it does make us truly appreciate the ones who treat all us other health professionals with respect.

1- Remember the "captain of the ship" rule/law whatever you wanna call it. If something goes wrong, regardless of who in the interdisciplinary team's fault it is, it's the doctor's a$$.

2- Most doctors realize that if they disrespect other healthcare providers (especially nurses), then their lives can become hell! Thus, most doctors are extremely careful with and nice to their nurses!

 

[umean2tellme]

Most of the time when a doctor has yelled at me I deserved it for calling about something that may not have been as important as I thought it was at the time. Doctors are stressed out, especially the PCP's cuz they are like 24/7 docs that get called at 4 am for stuff.

Doctors are people and all people are different. I have learned that some doctors I can call at certain times and others it's just better not to. Some have "standing orders" and others wanna be called for every little thing.

I will say my favorite call to a physician is when I call them like 10 min after they leave the hospital b/c the patient they just saw conveniently has abdominal pain or something they wanted to tell the nurse instead of the doctor. Always fun.

 

[dienekes88]

I just read through the Allnurses.com thread, and one of the staff members was saying that there was no doctor-bashing going on over there. What? The entire thread is doctor-bashing.

Amazing.

From reading a few threads over there, it seems that nurses think that doctors are all rich lazy bastards with no compassion who are feeding their god-complexes...

 

[TexasTriathlete]

At the hospital where I work (ER), the whole night shift staff goes out to breakfast together when we get off, and a lot of times, one or more of the ER docs will come along and pick up the tab. Everyone gets along great. The only docs they don't like are just young docs who are slow, and order everything under the sun, but once they get out of work, everybody is buddy-buddy.

 

[michaelarose]

I've found reading this topic on both boards very interesting. As a nurse, i wanted to see what the med students thought about this topic. Some of the answers have been complete expected while the others are surprising. Here's my take;

First I have to say that, remember this started because a future MD asked the question what do nurses hate about doctors, this doesn't mean there aren't things to love about doctors.

For those that think nurses want to be doctors, this is not necessarily true, not every nurse that disagrees with you , wishes he/she had your life. As far as some of the pre-med students commenting, I have to ask why? what do you know about it? Have you had a chance to interact with nurses on a level of being in charge of your own patients? of course not. You are not an MD.

As far as the other arguments, I have to say there is a lot of gray. I think depending on the doctor and the nurse, things can get ugly really fast. I know that some nurses have reputations for being difficult to deal with, but so doctors, and ct techs, and pharmacy, and respiratory, etc. I think there are a lot of clashes because each area has reasons why they operate the way they do, we just don't completely understand each other. A doctor's teaching is very different from a nurse, as with all the other occupations mentioned before. It can be frustrating, but I think if each is quick to listen to each other, then things can operate in a smooth fashion.

I also think this could be related to what sort of doctor or nurse is involved as far as the field of medicine in which each individual has decided to practice. As for me, I work with urologists, gynecologist, and orthopedics. From my stand point, these doctors are very chill and easy to work with. There are only about three doctors that the nurses hope never visits the unit where I work... out of three different fields, that's saying something.
There are also doctors with bad reputations. For example, there is one doctor, no matter what a nurse does to follow this doctors orders, nothing ever seems to help his patients, so he is known as "the butcher". His patients almost always have a high EBL during surgery, and his patients die quite frequently. I think this has gone unnoticed for a long time because he has beautiful bedside manner with the patients, and his patients die slow deteriorating deaths over a period from either 6 mos to a year. The unfortunate thing about doctors is that once you gain a reputation for killing people...well that's it.

On the other hand, there's one night nurse on my unit that once she passes her meds, she stays on the internet all night, and works the aids and LPNs to the bone because she's too lazy to do anything herself. Then there is another nurse gives such terrible report that the nurse that follows her has to literally piecemeal her notes about the patients by reading everyone else's notes.

What do nurse like about doctors: well we like it when doctors take the time to talk to us about the patients. We like when doctors are interested in taking the time to teach nurses things they feel could be beneficial for the patients. We like doctors that consider our suggestions, and ones the really put forth an effort to have a good rapport with nurses. We like doctors that write neatly (lots of places are going CPOE, to writing orders will soon be a thing of the past). We like MDs that actually follow through with what they say they are going to do. We like doctors that don't take their problems and stress out on other people, we like doctors that don't intimidate their patients. We like docs with good bedside manners and that consults with the whole medical team, not just nurses, but PT/OT, case management, social work, etc.

There are poor examples and excellent examples on both ends of the spectrum. I wish relations where better than what they are now between doctors and nurses and xray techs and emts and you pretty much get the picture.

Working in the medical field can be a thankless job among those that are medical staff, but I think improvements can be made... i think all sides have to learn to bend a little and work as a team.

 

[cbrons]

As a pharmacy student, I guess I'm a little more like a third party, but I just had to respond to this. From my observations, you are RIGHT ON!! This isn't a problem that just nurses have with doctors; all the other health professionals have the same issues with MD's. Whatever happened to the supposed "interdisciplinary team" that we're all supposed to be working in? This, of course, is not true of all doctors, but it does make us truly appreciate the ones who treat all us other health professionals with respect.

I'm really glad I have the experience of working as a pharmacy technician in a very busy pharmacy. The rural township (its small but there is a large percentage elderly population + a university of 13,500 students) gives me great insight. For instance, since there are not many docs in town, our pharmacy knows all of them. My boss has been a pharmacist in the area for about 25 years now and has developed, good or bad, a relationship with all of the doctors. I have another coworker pharmacist (actually he is technically my boss too) who is only 7 years older than me and fresh out of school with a Pharm.D (all of our other pharmacists are older, from the B.S. crowd). Now heres two points I want to make...

The older MDs here in town are extremely condescending towards the pharmacists I work for. They get irritable anytime they are called to clarify a mistake on a prescription (today, one doctor wrote for "Tramtrine 30-5"... no one knows what the hell that's supposed to mean. We assume its Triamterene/hctz with 30 mgs of triamterene and the second number is supposed to be the strength of hydrochlorothiazide hence the 30 slash something... but we the strength of 30/5 does not exist). So we have to call this doctor and find out what's wrong. Usually if we call some of the older MDs who have been practicing for awhile they find our call extremely annoying. One of the doctors here is very inflammatory... he treats medication issues as if our bosses call just to see if they can get a rise out of him. But the deal with this guy is that his rudeness transcends his dealings with pharmacies in the area; he is notorious in our local rural hospital for being rude to the nursing staff. I've done a ton of shadowing in family practice with a couple of doctors and it is a common theme wherever I go that the older doctors hold a sense of superiority over the other members of the health care team, be it pharmacists or nurses. Their superiority complex (although that sounds extreme) is certainly not expressed in an overt way many times, as I know the majority of the older doctors in town are well-respected and well-liked. Hell one of them is even my own personal physician and I wouldn't change doctors if someone paid me.

The fact that the older doctors hold these attitudes is, at least I assume, a reflection of the old system of medicine (in the days before there were nurse practitioners, before pharmacy students made rounds with medical students and came into frequent contact with them in residency). These older practitioners feel they are more educated than the others and therefore more qualified to make judgments. Anytime their judgments are called into question, they react negatively, because they were inculcated into medicine during a time in which they did not understand the extent to which pharmacists were trained. Through circles of informal socialization, they may have come to view pharmacists as nosy and unqualified annoyances. In the present day, however, there is a lot of evidence that recent graduates of medical school hold much more respect for pharmacists... this can be seen in my job where many of the physicians 35 and younger frequently call my bosses for suggestions and are much more receptive to the suggestions my bosses make without being asked to comment (i.e. "This isn't covered by the patients insurance but drug X is much cheaper and is on formulary and it works just as well")..

The nursing thing is roughly similar to how pharmacists deal with store managers in larger chains. The pharmacists desire a great deal of autonomy in their profession. Indeed they have gone through at least six years of education (nowadays its more) and they don't want to be told what to do by a high school grad. who worked his way up the Walgreens/CVS/etc. ladder by having a good "customer is always right" attitude. But the formal structure indicates that store managers are to be in charge of all personnel within the store, including all members of the pharmacy staff. Now obviously there are laws that check a lot of the power store managers have over pharmacists (i.e. a store manager could never tell a pharmacist to fill a script that the pharmacist judged to be harmful to the patient). Additionally, members of store management such as loss prevention personnel wrongfully believe they can demand the keys to the C-II cabinet to make counts (checking for theft by pharmacy personnel) .. but federal law stipulates that pharmacists are the only ones allowed to access the CII cabinet and the pharmacy is not to be entered unless a pharmacist is present)... but still, even in other stuff the pharmacy-store manager relationship is one wrought with hostility and misconception even though it is mostly below the surface. The store managers feel that their power over the pharmacy is one they deserve by virtue of their position; the pharmacists feel the store management is unqualified to make any sort of pharmacy judgement - even generalizing this to issues not related to drugs or patient safety such as the management of cash registers or bad customer service practices...

At any rate, this may be the same situation with the doctor-nurse relationship to a degree - the doctors have more education and are more qualified to make decisions about the direction of treatment - but there are several sociological studies out there that suggest two key things to employment satisfaction: 1. a feeling of impact (making a meaningful difference by virtue of how you carry out your job) and 2. a sense of autonomy.

I would suggest that nurses (necessarily so) lack a complete sense of autonomy in the health care system because, for the safety of the patient, a qualified physician must be supervising care. The physicians want to maintain their autonomy - and attempts, real or perceived, to circumvent this will be met with hostility. The nurses know that they don't exercise decision-making authority but they still are satisfied with their jobs when they feel that even though they aren't at the top of the chain of command, they still make a difference in the care of the patient. They don't want to be treated like robots; simply doing whatever the doctor tells them - in effect, being replaceable by anyone off the street. Yes they are willing to follow the physicians orders but they do want to be treated as though they too are professionals who can input meaningful comments or actions that will be accepted by the doctor and lead them to a more satisfying feeling of impact. Sometimes, though, the nurse will try to satisfy this by recommending or offer alternative solutions or even advice to the doctor and the doctor may come to perceive this as an attack on his autonomy (they may perceive the nurse to be inappropriately questioning his/her decision making)... so thus misunderstandings are what cause much of the conflicts between members of the health-care team.

This is where I think much of the conflict comes from...

 

[175961]

😱 wowzers.....long post up there

 

[dienekes88]

I'm really glad I have the experience of working as a pharmacy technician in a very busy pharmacy. The rural township (its small but there is a large percentage elderly population + a university of 13,500 students) gives me great insight. For instance, since there are not many docs in town, our pharmacy knows all of them. My boss has been a pharmacist in the area for about 25 years now and has developed, good or bad, a relationship with all of the doctors. I have another coworker pharmacist (actually he is technically my boss too) who is only 7 years older than me and fresh out of school with a Pharm.D (all of our other pharmacists are older, from the B.S. crowd). Now heres two points I want to make...

The older MDs here in town are extremely condescending towards the pharmacists I work for. They get irritable anytime they are called to clarify a mistake on a prescription (today, one doctor wrote for "Tramtrine 30-5"... no one knows what the hell that's supposed to mean. We assume its Triamterene/hctz with 30 mgs of triamterene and the second number is supposed to be the strength of hydrochlorothiazide hence the 30 slash something... but we the strength of 30/5 does not exist). So we have to call this doctor and find out what's wrong. Usually if we call some of the older MDs who have been practicing for awhile they find our call extremely annoying. One of the doctors here is very inflammatory... he treats medication issues as if our bosses call just to see if they can get a rise out of him. But the deal with this guy is that his rudeness transcends his dealings with pharmacies in the area; he is notorious in our local rural hospital for being rude to the nursing staff. I've done a ton of shadowing in family practice with a couple of doctors and it is a common theme wherever I go that the older doctors hold a sense of superiority over the other members of the health care team, be it pharmacists or nurses. Their superiority complex (although that sounds extreme) is certainly not expressed in an overt way many times, as I know the majority of the older doctors in town are well-respected and well-liked. Hell one of them is even my own personal physician and I wouldn't change doctors if someone paid me.

The fact that the older doctors hold these attitudes is, at least I assume, a reflection of the old system of medicine (in the days before there were nurse practitioners, before pharmacy students made rounds with medical students and came into frequent contact with them in residency). These older practitioners feel they are more educated than the others and therefore more qualified to make judgments. Anytime their judgments are called into question, they react negatively, because they were inculcated into medicine during a time in which they did not understand the extent to which pharmacists were trained. Through circles of informal socialization, they may have come to view pharmacists as nosy and unqualified annoyances. In the present day, however, there is a lot of evidence that recent graduates of medical school hold much more respect for pharmacists... this can be seen in my job where many of the physicians 35 and younger frequently call my bosses for suggestions and are much more receptive to the suggestions my bosses make without being asked to comment (i.e. "This isn't covered by the patients insurance but drug X is much cheaper and is on formulary and it works just as well")..

The nursing thing is roughly similar to how pharmacists deal with store managers in larger chains. The pharmacists desire a great deal of autonomy in their profession. Indeed they have gone through at least six years of education (nowadays its more) and they don't want to be told what to do by a high school grad. who worked his way up the Walgreens/CVS/etc. ladder by having a good "customer is always right" attitude. But the formal structure indicates that store managers are to be in charge of all personnel within the store, including all members of the pharmacy staff. Now obviously there are laws that check a lot of the power store managers have over pharmacists (i.e. a store manager could never tell a pharmacist to fill a script that the pharmacist judged to be harmful to the patient). Additionally, members of store management such as loss prevention personnel wrongfully believe they can demand the keys to the C-II cabinet to make counts (checking for theft by pharmacy personnel) .. but federal law stipulates that pharmacists are the only ones allowed to access the CII cabinet and the pharmacy is not to be entered unless a pharmacist is present)... but still, even in other stuff the pharmacy-store manager relationship is one wrought with hostility and misconception even though it is mostly below the surface. The store managers feel that their power over the pharmacy is one they deserve by virtue of their position; the pharmacists feel the store management is unqualified to make any sort of pharmacy judgement - even generalizing this to issues not related to drugs or patient safety such as the management of cash registers or bad customer service practices...

At any rate, this may be the same situation with the doctor-nurse relationship to a degree - the doctors have more education and are more qualified to make decisions about the direction of treatment - but there are several sociological studies out there that suggest two key things to employment satisfaction: 1. a feeling of impact (making a meaningful difference by virtue of how you carry out your job) and 2. a sense of autonomy.

I would suggest that nurses (necessarily so) lack a complete sense of autonomy in the health care system because, for the safety of the patient, a qualified physician must be supervising care. The physicians want to maintain their autonomy - and attempts, real or perceived, to circumvent this will be met with hostility. The nurses know that they don't exercise decision-making authority but they still are satisfied with their jobs when they feel that even though they aren't at the top of the chain of command, they still make a difference in the care of the patient. They don't want to be treated like robots; simply doing whatever the doctor tells them - in effect, being replaceable by anyone off the street. Yes they are willing to follow the physicians orders but they do want to be treated as though they too are professionals who can input meaningful comments or actions that will be accepted by the doctor and lead them to a more satisfying feeling of impact. Sometimes, though, the nurse will try to satisfy this by recommending or offer alternative solutions or even advice to the doctor and the doctor may come to perceive this as an attack on his autonomy (they may perceive the nurse to be inappropriately questioning his/her decision making)... so thus misunderstandings are what cause much of the conflicts between members of the health-care team.

This is where I think much of the conflict comes from...

Good post.

I think that the nurse's desire to avoid being "robots" as you describe also results in the constant repetition of the mantra "doctors don't care of patients; nurses take care of patients" and the repeated stories of the time the nurse caught the doctor's mistake. That doesn't signal a mere misunderstanding. It's the proverbial chip on the shoulder. A nurse walking around with a chip on his/her shoulder colors every single contact with a physician with this negative light and might even become bitter without any true affront. Naturally this goes both ways, and a paranoid physician (after reading too many CRNA and NP/DNP threads on SDN) may see everything as an attack on his/her autonomy.

As an aside: the rise of the NP/DNP and CRNA is a real threat to physician autonomy. These people are practicing medicine.

 

[cbrons]

Good post.

I think that the nurse's desire to avoid being "robots" as you describe also results in the constant repetition of the mantra "doctors don't care of patients; nurses take care of patients" and the repeated stories of the time the nurse caught the doctor's mistake. That doesn't signal a mere misunderstanding. It's the proverbial chip on the shoulder. A nurse walking around with a chip on his/her shoulder colors every single contact with a physician with this negative light and might even become bitter without any true affront. Naturally this goes both ways, and a paranoid physician (after reading too many CRNA and NP/DNP threads on SDN) may see everything as an attack on his/her autonomy.

As an aside: the rise of the NP/DNP and CRNA is a real threat to physician autonomy. These people are practicing medicine.

Just another interesting thing to think about... Nurses and pharmacists both rank above doctors as the most trusted profession. I wonder why this is? Doctors are the most qualified members of the health care team but yet are not the most trusted... why is this and moreover, how can it be changed?

 

[TexasTriathlete]

I do not believe that most nurses want to be doctors. It is two completely different skill sets and approaches. They are both part of a team, with each serving a different function.

I think that, in a pinch, the average nurse could handle all aspects of patient care. I do not believe the same is true of the average doctor. Nurses are much more versatile. Doctors are necessary for the really tough problems (such as diagnosing something unusual).

This is just what I've observed.

Posted via Mobile Device

 

[dienekes88]

Just another interesting thing to think about... Nurses and pharmacists both rank above doctors as the most trusted profession. I wonder why this is? Doctors are the most qualified members of the health care team but yet are not the most trusted... why is this and moreover, how can it be changed?

I don't think this is necessarily an informed opinion. It likely stems largely from the belief that the rich doctor is out to make a buck. On top of that, there is the belief that there are two negative beliefs that many Americans hold: 1) a lot of unnecessary procedures are performed that can damage your health and 2) drugs are very powerful and can actually make you worse. Oddly enough, if you don't give them the drugs, they'll be upset... and if you don't do the CT scan, they'll sue your pants off. Great.

In comparing physicians to nurses, the patients more often see the nurses. It's a matter of proximity. The one who is around more often will be viewed as the "compassionate" healthcare provider. Automatically, the qualities of trustworthiness, ethicism, morality are assigned to this individual regardless of their applicability. Surgeons who spend more time with patients are sued less often, and the difference is only a matter of a couple minutes (I can't remember which article it was exactly, but it was something that Dr. Atul Gawande wrote...).

 

[JustMe198027]

If you read the original post, it was a question asked by a med student so that he would be able to form better relationships with those he worked with. It's true that there are some inappropriate responses, but there are also many good tips in there for a new student (being polite, writing legibly). My (very limited) experience has shown me that the vast majority of both physicians and nurses are great to work with... unfortunately there are always a few of both that ruin the envirnoment for everyone. I do my best to have positive relations with everyone and hope that it will continue🙂

 

[TheRealMD]

Is it that nurses hate doctors or employees hate "supervisors with huge egos and power trips"?

No need to make sweeping broad statements, but it's less about the profession and more about the person than what broad generalizations make it out to be. If you take the doctors nurses DO complain about and stick them in any other profession, I'm pretty sure employees under that guy/gal would still be complaining.

Medicine doesn't always create the imperfections in people, but only makes them worse.

 

[Pedsbro]

I do not believe that most nurses want to be doctors. It is two completely different skill sets and approaches. They are both part of a team, with each serving a different function.

I think that, in a pinch, the average nurse could handle all aspects of patient care. I do not believe the same is true of the average doctor. Nurses are much more versatile. Doctors are necessary for the really tough problems (such as diagnosing something unusual).

This is just what I've observed.

Posted via Mobile Device

Really? That's a pretty bold statement...

 

[coldweatherblue]

I think that, in a pinch, the average nurse could handle all aspects of patient care. I do not believe the same is true of the average doctor. Nurses are much more versatile.

So you're saying that if you and your family lived on an island with 1000 other people and a fully stocked medical center with room for only ONE health care provider, and you had to choose between an RN and an MD to care for the entire population for the next 10 years, you'd choose the RN?

 

[cbrons]

I do not believe that most nurses want to be doctors. It is two completely different skill sets and approaches. They are both part of a team, with each serving a different function.

I think that, in a pinch, the average nurse could handle all aspects of patient care. I do not believe the same is true of the average doctor. Nurses are much more versatile. Doctors are necessary for the really tough problems (such as diagnosing something unusual).

This is just what I've observed.

Posted via Mobile Device

even so... whenever I go into the school heath center here on campus, I still always ask to see one of the MDs even though they, by default, usually give you one of the NPs.

I work with a former NP in the pharmacy and she thinks the whole DNP push is a stupid idea. She thinks that NPs should be out seeing patients rather than getting more schooling...

But what NPs get granted more and more it seems as the years go on. Maybe its because they have such a powerful lobby...I assume this is why. I know that in my state starting next year NPs are going to be allowed to write for DEA schedule II narcotics... which, from what I can tell, is making a lot of pharmacists pretty nervous.

By the way, the nurse-pharmacist relationship is oftentimes no better than the nurse-doctor relationship (yeah there is one)....