What's up with New York nurses?

[Belleza156]

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I just started a rotation in New York City at two different sites. Thus far the nurses are either one of two extremes: extremely kind and helpful or downright nasty.

I tried to ask about what the situation is with regard to the NYC nurses, and received a vague answer. They are unionized, so what?

I've never had a nurse be downright rude to me until now. Granted I've had nurses be less than warm, but never mean. Is this the norm in NYC?

 

[RustedFox]

Its New York City; that should be all the answer that you need.

Know why they call NYC the 'Big Apple'? - because its rotten to the core.

 

[RustedFox]

double-post. glitchy tablet.

 

[Birdstrike]

I just started a rotation in New York City at two different sites. Thus far the nurses are either one of two extremes: extremely kind and helpful or downright nasty.

I tried to ask about what the situation is with regard to the NYC nurses, and received a vague answer. They are unionized, so what?

I've never had a nurse be downright rude to me until now. Granted I've had nurses be less than warm, but never mean. Is this the norm in NYC?

NYC

It has the best, and worst, of everything.

 

[deuist]

Sadly, you will learn by training in NYC how to do the nurse's job as well as a physician's job.

 

[Hamhock]

Sadly, you will learn by training in NYC how to do the nurse's job as well as a physician's job.

QFT. (and these acronyms are not my style)

I am still amazed when an RN does anything for me...and they are equally surprised when I more quickly handle all of the "RN" tasks during a resuscitation while still covering the "MD-role". That's how we were trained.

HH

 

[dotcb]

My experience w/ NYC nurses - They are

a) lazy
b) entitled
c) usually unavailable

As a student, I learned to do most nursing tasks, to the extent that I chose to avoid any residency where residents du nursing tasks such as IV's, foleys, etc.

 

[JediZero]

I just started a rotation in New York City at two different sites. Thus far the nurses are either one of two extremes: extremely kind and helpful or downright nasty.

I tried to ask about what the situation is with regard to the NYC nurses, and received a vague answer. They are unionized, so what?

I've never had a nurse be downright rude to me until now. Granted I've had nurses be less than warm, but never mean. Is this the norm in NYC?

The 'so what', as I understand it, is that they have basically bargained the right to do as little as possible. Most of the experiences I've heard with NY nurses involves having minimal nursing coverage, them being on break half the time, and unwilling to do much of anything. I guess when you've 'won' your terms about what you will and won't do, you take a certain attitude in exercising that discretion.

As for the nice ones, well, it seems like you've found the ones that still remember why they went into nursing in the first place. Hang on to those. 😉

 

[The Buff]

JediZero is spot on. It is basically impossible for a unioinized nurse to be fired in New York, so they literally have to do nothing for you. I became an excellent nurse by doing residency in NYC. Thats not all bad, but just be prepared. Ive done everything from Foleys to mixing antibiotics to changing bedpans. If I didnt do it for my pt ano one would (at least not for hours). Part of the problem also is that most NYC hospitals (aside from maybe the big ones with lots of cash) are strapped for money (see LICH, Interfaith, St Vincents, etc) so they have no money to pay for good nursing ratios in the ED so that makes matters even worse. A couple of my favorite nurse stories from training:

There is a famous story at from my residency (from shortly before my time so I cannot confirm) that a pt died from hyperkalemia with hour-old orders for calcium, bicarb, etc. What happend to that nurse who ignored those orders? Nothing, still had a job. I believe it probably did happen because it was routine for septic pts to not get abx for hours unless a doc hung them personally or you badgered the nurses so much you had no time for anything else (no to mention you would then become 'that' pushy resident none of the nurses liked and thus would do even less for you in the future). Was easier for me just to hang them myself many times.

One of the worst nurses (different from the example above) at my residency, who would literally eat lunch as pts died behind her, was finally forced out after years of MD complaints, written letters, documented mistakes. What happened? The union forced the hospital to give giver this nurse her job back. No one is more powerful than NYSNA.

Ah, good times, I miss them sometimes *sarcasm*. Now I cant even start an IV without a nurse giving me a hurt look.

 

[deleted480308]

Unions, while once about safety and fair treatment, are now protection for lazy and useless workers

 

[GeneralVeers]

Unions, while once about safety and fair treatment, are now protection for lazy and useless workers

I had similar situation with LA County nurses. I worked at a hospital-which-shall-not-be-named. The County nurses were always on "break". I would be the ED resident representative at some admin meetings and would ask why we couldn't get rid of the lazy and downright dangerous nurses. One of the hospital admins showed me the flowsheet developed with the union detailing how to fire a nurse. It literally was 22 steps before they could actually terminate someone! Generally the county facilities just passed the buck to each other. Although they couldn't fire a nurse, they could transfer her/him to another hospital at the same level of seniority.

Glad I work now in several right-to-work states. The nurses, even the unionized ones are far more helpful.

 

[Belleza156]

Wow, so then there was a lot of meaning in the phrase "they are unionized."

Very insightful, thanks for the responses.

 

[deuist]

I've started lots of IV's, taken people to the bathroom, given meds that were found lying around such as albuterol and nitroglycerin tablets, started foleys, taken vital signs, cleaned patient care rooms, brought patients in from the waiting room, set up monitoring equipment, obtained my own ECG's and labs, taken patients to CT, and the list goes on. I finished residency able to do everyone's job including the nurse, respiratory therapist, transporter, and radiology tech. My worst story came when a patient presented with anaphylaxis. I could not find a nurse who would get epinephrine from the Pyxis. Two of them literally told me that they were too busy. I even offered to draw it up and push it. I just didn't have Pyxis access. I went to another pod of the ED where a nurse rolled her eyes but eventually opened the Pyxis and gave me a vial of epi. In this case I pushed the epi, started the IV, hung fluids, obtained an oxygen tank, and started albuterol. Unfortunately, this event is par for the course. And yes, we were constantly under-staffed. If someone called in sick, well, that was just one less nurse to have for the day. We couldn't bother to call in a agency nurse. And although there were tons of nursing managers, none of them could ever be bothered to see patients when the department got really backed up. We never could fire incompetent nurses. Now, I am at a location where nurses and techs do all of the lab work, place splints, and even suture adults. My productivity has gone way up as a result.

 

[RustedFox]

For the record, when I was a student in NJ, it was just as bad. I made sure I ranked my NJ programs dead last on my list for that, and so many other reasons.

 

[TooMuchResearch]

Thanks. This is really helping me put together a program list. Everything in NY and NJ is out. Any other places where residents do the jobs of everyone else?

 

[gro2001]

My experience doing residency in NYC is very similar to the posters above. Intern year especially I did ALL of my own IVs, blood draws, ECGs, urine collections/dips/UPTs, transport (except out of the ER), abx mixing/hanging, carried around nitro and albuterol in my pocket, brought patients from waiting room, changed sheets/cleaned rooms to turn pts around etc.

I must say that my experience was different in one crucial aspect though: it got easier with time. While I did have to do almost 100% of this intern year, it got better with each year. As a senior resident now I pretty much just say things and they get done. I think a lot of it has to do with how much you are liked by nursing staff and how much credibility with them you earn early on in your training. I would advise people starting out in such residency programs to be as helpful to the RNs as possible. In your intern year, do all you own IVs and blood draws. Offer to help out with what you can if you see the nurses running around super busy. Keep in mind nursing concerns about your orders and respond to them. Not every order is stat. Don't give them grief for things they can't control. You don't get to walk on water straight out, but if you are good to the nurses and good to your patients, eventually you might.

Some people you may never win over though, that's granted. But that's not everyone. Not even at unionized, county, whatever. If EVERYONE is like that with you, something may be wrong with you.

 

[RustedFox]

Thanks. This is really helping me put together a program list. Everything in NY and NJ is out. Any other places where residents do the jobs of everyone else?

Smartest post I've seen on here for awhile. Just kidding. Kinda.

No really; it hit me one day when I was an MS-4 driving 'in' to my rotations as UMDNJ/Newark Beth Israel. I lived in a nearby "livable" town which was (I google mapp'ed it) 9.7 miles away. It was a 45+ minute drive, each way. I lived in a two-bedroom shoebox with my good buddy and my girlfriend, paying about $650 for my tiny-sized room, which didn't have a closet. My buddy (bless him), took the 'smaller' room out of being a good buddy. I figured; I got the lion's share of the room/space, so I'd pay more rent than he did.
Sorry, I'm rambling.

So anyways, 45 minute drive to 'work' each way, each day. When I got there, I was abused by entitled patients who would never pay a dime for their care, and who would inevitably be back in 3-4 days because they couldn't be bothered to do things like take care of themselves, practice reasonable hygiene, and take their meds... yet they had all the time in the world for narcotics, alcohol/tobacco/whatever, and other nonproductive activities. As a student, sure, I did all those things listed above (got meds, started IVs, wheeled pts around, yadda yadda), and watched in horror as my attendings were doing the same.

I thought to myself: so, I'm paying for the 'privilege' of treating these people (both in tuition and in taxes), and would be soaking up the liability as an attending?

I was done with NY/NJ. Done.

Thank christ I matched somewhere 'normal'.

 

[Cerberus]

I graduated from an NYC residency program. I only put lines in patients when our nurses had failed or I was rotating on a floor unit. I did do stuff that a nurse or tech would do in other locales but never felt it hampered my education.

 

[laserbeam]

How about nurses in NY/NJ hospitals without residency programs? They are not seriously expecting attendings to do the scut work, right?

 

[JediZero]

Thanks. This is really helping me put together a program list. Everything in NY and NJ is out. Any other places where residents do the jobs of everyone else?

I don't know if it's wise to write it all off in one fell swoop, but just know what the tradeoffs are. Honestly, I feel like being a physician and team leader means that you should know how to do everyone else's job, too. I would feel like a total idiot if I were practicing someday and had to run around like an idiot looking for a nurse to start an IV for me.

Now, would I want to practice like that for the rest of my life? Hell no. But as training, I feel like there's at least some value to it.

 

[GeneralVeers]

I disagree with what has been said by some. As an attending I would not routinely be putting in IVs, getting bedpans, catheters, etc. If a place is that dysfunctional, and the nurses that bad/lazy, it's not a place I would want to work.

If the nurses can't get an IV, I will help them with the ultrasound doing a peripheral. I will not be the primary one to go put one on a patient. Very rarely is a patient in that much danger, that they need ME to put in an IV. If the patient is that critical, then I would expect every nurse to be focusing on that patient anyway.

We as physicians have to protect our practice, and not let the nurses force us to do their scutwork. If a patient complains because they waited too long, just point out to admin the time you saw the patient, the time you ordered the meds, and then point out how long it took for the nurses to actually get around to doing it. The conversation should be pretty much over right then and there.

 

[Rendar5]

Thanks. This is really helping me put together a program list. Everything in NY and NJ is out. Any other places where residents do the jobs of everyone else?

Don't cross out NY. Just cross out certain NYC Hospitals (could give you a list). I did residency in NY and never had to do a foley and never had a nurse kill a pt. Not only that, but nurses would routinely be fired with no way back in. All you need to do is ask the residents at certain institutions if nurses are like that and they should tell you honsetly.

 

[Apollyon]

Not only that, but nurses would routinely be fired with no way back in.

If firing nurses was "routine", that sounds pretty chilling. Why would a nurse work somewhere where discharge was "routine"?

 

[secants]

I rotated at a few NYC hospitals and I think it really depends on city vs private and the overall reputation the hospital has. In most cases the nurses did do what they were supposed to but it is sometimes faster just doing it yourself. Although one thing common to all nurses I've met is that they will complain about the work they have to do and will use the "I'm on break right now" excuse as much as possible.

 

[TooMuchResearch]

Don't cross out NY. Just cross out certain NYC Hospitals (could give you a list). I did residency in NY and never had to do a foley and never had a nurse kill a pt. Not only that, but nurses would routinely be fired with no way back in. All you need to do is ask the residents at certain institutions if nurses are like that and they should tell you honsetly.

Fair enough. Honestly, my desire to live in NYC is low anyway.

 

[Rendar5]

If firing nurses was "routine", that sounds pretty chilling. Why would a nurse work somewhere where discharge was "routine"?

good pay, good rep. And you wouldn't get fired if you were good. but either generate complaints or pis someone off and you could get fired. This mostly applied to newer nurses. those who had been there awhile were those good ones that had no reason to be fired.

 

[Rendar5]

Fair enough. Honestly, my desire to live in NYC is low anyway.

NY is not the same as NYC =p That said, if you don't want to live in the northeast, no reason to look there anyway.

 

[deleted109597]

I don't know if it's wise to write it all off in one fell swoop, but just know what the tradeoffs are. Honestly, I feel like being a physician and team leader means that you should know how to do everyone else's job, too. I would feel like a total idiot if I were practicing someday and had to run around like an idiot looking for a nurse to start an IV for me.

Now, would I want to practice like that for the rest of my life? Hell no. But as training, I feel like there's at least some value to it.

Honestly, there are two sides to this. Yes, as a leader you should be able to at least demonstrate an understanding of the job, even you can't do it. (Sub commanders can't run the nuclear engines, etc).
But to do it routinely interferes with what you are there to do, which is to practice medicine. Sure, I can go get icewater, towels, blankets, mop the floor, run tubes to the lab, etc, just like everyone else. But I don't do it. Not because I'm better than it, but because that's not what I'm there for. If its slow I'll pretty much do anything. But if there is medicine to be practiced, that's why they pay me to be there for.

 

[TooMuchResearch]

NY is not the same as NYC =p That said, if you don't want to live in the northeast, no reason to look there anyway.

The non-NYC programs in the state are still on the potential list : )

 

[Arcan57]

I don't know if it's wise to write it all off in one fell swoop, but just know what the tradeoffs are. Honestly, I feel like being a physician and team leader means that you should know how to do everyone else's job, too. I would feel like a total idiot if I were practicing someday and had to run around like an idiot looking for a nurse to start an IV for me.

Now, would I want to practice like that for the rest of my life? Hell no. But as training, I feel like there's at least some value to it.

I did a second look at SUNY-Downstate back in the day because I had really liked the resident's ethos and was coming from another hard-core county shop. I watched as a PGY-3 spent the majority of their shift wheeling patients to radiology and ended up bagging a patient for over an hour while waiting for RT to show up (again, on a second look) while an intern repeatedly stuck the same hematoma trying for a femoral central line with absolutely no supervison for the majority of that hour. It was easily the most useful second look I did...

 

[TeamZissou]

Stroger of Cook County has unionized nurses. Many of the same problems but it seems some departments of the hospital managed to find the good ones and hang on to them tooth and nail.


I particularly liked the educational signage up in throughout the hospital with phrases like "Manager want to meet with you regarding tardiness, productivity or attitude? Don't go to that meeting alone! You are entitled to have union representation by your side!"

Watching critically ill patients not get care bc nurses were on "break" blew my mind, especially since as a med student we eat, sleep, jump, piss/$h!t when told.

 

[NdNThunder]

I know you can't generalize this to every ED/hospital etc., but how has your experience been at UMDNJ(now Rutgers)-New Jersey Medical School & Beth Israel? Both in Newark, NJ. Would really appreciate feedback from med students who rotated through or residents who work(ed) at either ED. Current MS4 applicant here. Thanks🙂

 

[goodoldalky]

I don't know if it's wise to write it all off in one fell swoop, but just know what the tradeoffs are. Honestly, I feel like being a physician and team leader means that you should know how to do everyone else's job, too. I would feel like a total idiot if I were practicing someday and had to run around like an idiot looking for a nurse to start an IV for me.

Now, would I want to practice like that for the rest of my life? Hell no. But as training, I feel like there's at least some value to it.

I disagree for the same reasons Veers outlined. This outlook, which I once had, is maybe a bit naive. Putting in IVs is not difficult. This atmosphere being talked about in NYC, in my opinion, is dangerous, bad for patients, increases liability for everyone (mainly the physicians), does not contribute to patient care or your training in any positive way.

👎

 

[GeneralVeers]

I disagree for the same reasons Veers outlined. This outlook, which I once had, is maybe a bit naive. Putting in IVs is not difficult. This atmosphere being talked about in NYC, in my opinion, is dangerous, bad for patients, increases liability for everyone (mainly the physicians), does not contribute to patient care or your training in any positive way.

👎

Exactly. I can mop the floors and fill the printers with paper too. Does that mean I should do these jobs?

I am hired to do a specific job: To practice emergency medicine as a physician. I'm not a nurse, I'm not a Janitor, I'm not a unit support. They aren't expected to do my job for me, and I'm not going to do theirs either.

Run from any place that expects you to put IVs on patients. It is a sign of larger systemic/staffing issues and will only make your job harder.

 

[diphenyl]

Agree completely with veers. Why should I learn/ do the job of everyone else? Not one of them will actually do my job and assume the liability. Let's also face it (this will sound extremely arrogant I know) but there are jobs that are beneath us as physicians. I didn't go through 8+ years of university training and residency to push gurneys. These are jobs that people with 2 year associated degrees are specifically trained to do (push meds/ bedside nursing care etc).

 

[Doctor Bob]

Why should I learn/ do the job of everyone else?

I make a point of knowing how to do everyone else's job in the department... that way in a crisis I can do anything in the ED that needs to be done.

With that being said, I learn everyone's job so I can do it when I -want- to or feel the need to. I wouldn't work at a place where it was expected of me.

 

[Siggy]

I make a point of knowing how to do everyone else's job in the department... that way in a crisis I can do anything in the ED that needs to be done.

With that being said, I learn everyone's job so I can do it when I -want- to or feel the need to. I wouldn't work at a place where it was expected of me.

I think there's a difference between knowing how to do the technical skills of the nurses/techs/therapists, and routinely being required to perform them as a matter of course. As a naive OMS4, I think it's important to, say, be able to set up a CPAP instead of simply waiting for the RT to show up. I did most of my 3rd year and a 4th year rotation at a unionized county hospital in California and, while I never had any problem with the ED staff doing their job or systemic staffing issues, stuff happens. Just because there is adequate staffing coverage doesn't mean that there's adequate staffing at that specific moment when the fecal matter is hitting the fan in multiple parts of the ED.

 

[QuackaDO]

I think we are all in agreement that hospitals with these types of conditions that have been described are less than ideal on the positive side and possibly dangerous on the negative end of the spectrum. Since some places are like this and some are not what WOULD be useful is if we created a list of hospitals in the NYC/NJ area (or anywhere really) where this type of stuff is expected so those of us who are considering going to these places will have the proper "buyer beware" knowledge going into the process. Feel free to copy and add on the ones you know of that function this way...

 

[sylvanthus]

There are definitely more rude nurses and other ancillary staff in new york state than anywhere else I have worked (chicago, minneapolis, seattle). But thankfully where I am at we are not doing everyone elses job. IVs only when nursing staff cannot get it.

 

[Beargryllz]

If I were a union, I wouldn't allow terrible employees to join. Why even defend bad employees? Get rid of them imo.

 

[GeneralVeers]

If I were a union, I wouldn't allow terrible employees to join. Why even defend bad employees? Get rid of them imo.

Simple. Like almost everything else it's about the money. The guys at the top of the union want as many dues-paying members as possible to join. It makes them more powerful, and it makes them more money. They have no incentive to care about the quality of employees.

 

[GeneralVeers]

There are definitely more rude nurses and other ancillary staff in new york state than anywhere else I have worked (chicago, minneapolis, seattle). But thankfully where I am at we are not doing everyone elses job. IVs only when nursing staff cannot get it.

What unique skills do you possess that the nurses don't? If a nurse can't get a peripheral IV, I sure as hell can't. Unless you are talking about U/S-guided, IJ or central line.

 

[sylvanthus]

US guided IVs or midlines in those whom it is appropriate for.

 

[joeDO2]

Agree completely with veers. Why should I learn/ do the job of everyone else? Not one of them will actually do my job and assume the liability. Let's also face it (this will sound extremely arrogant I know) but there are jobs that are beneath us as physicians. I didn't go through 8+ years of university training and residency to push gurneys. These are jobs that people with 2 year associated degrees are specifically trained to do (push meds/ bedside nursing care etc).

😱This is really a bad way of thinking, not only from a professional standpoint but also a human one. You may have more education, but its important to remember that doesn't mean you are any better of a person than the person changing the toilet paper. You have to have respect for everyone. I prefer Dr. McNinja's assessment:

"But to do it routinely interferes with what you are there to do, which is to practice medicine. Sure, I can go get icewater, towels, blankets, mop the floor, run tubes to the lab, etc, just like everyone else. But I don't do it. Not because I'm better than it, but because that's not what I'm there for. If its slow I'll pretty much do anything. But if there is medicine to be practiced, that's why they pay me to be there for."👍

 

[deleted480308]

😱This is really a bad way of thinking, not only from a professional standpoint but also a human one. You may have more education, but its important to remember that doesn't mean you are any better of a person than the person changing the toilet paper. You have to have respect for everyone. I prefer Dr. McNinja's assessment:

"But to do it routinely interferes with what you are there to do, which is to practice medicine. Sure, I can go get icewater, towels, blankets, mop the floor, run tubes to the lab, etc, just like everyone else. But I don't do it. Not because I'm better than it, but because that's not what I'm there for. If its slow I'll pretty much do anything. But if there is medicine to be practiced, that's why they pay me to be there for."👍

From an employer standpoint, those jobs actually are beneath a physician if ther is anything else that requires a physician that the physician can do......assuming the most expensive employee in the room has thing that only they are qualified to do, they should almost never do anything but those things unless there is a crisis or a ridiculous overstaffing

 

[JediZero]

I disagree for the same reasons Veers outlined. This outlook, which I once had, is maybe a bit naive. Putting in IVs is not difficult. This atmosphere being talked about in NYC, in my opinion, is dangerous, bad for patients, increases liability for everyone (mainly the physicians), does not contribute to patient care or your training in any positive way.

👎

Exactly. I can mop the floors and fill the printers with paper too. Does that mean I should do these jobs?

I am hired to do a specific job: To practice emergency medicine as a physician. I'm not a nurse, I'm not a Janitor, I'm not a unit support. They aren't expected to do my job for me, and I'm not going to do theirs either.

Run from any place that expects you to put IVs on patients. It is a sign of larger systemic/staffing issues and will only make your job harder.

Agree completely with veers. Why should I learn/ do the job of everyone else? Not one of them will actually do my job and assume the liability. Let's also face it (this will sound extremely arrogant I know) but there are jobs that are beneath us as physicians. I didn't go through 8+ years of university training and residency to push gurneys. These are jobs that people with 2 year associated degrees are specifically trained to do (push meds/ bedside nursing care etc).

I'll accept the criticism of being naive. Hell, it doesn't take a lot of imagination to see myself getting sick of that crap real fast. I guess you probably pick up a lot of this stuff along the way, regardless of whether or not it's 'required' of you. Probably better to be in a program that prepares you for the physician role and be proactive about the other stuff than to be stuck getting really good at dirty work. I do still think that's something we should learn how to do, though.