In all seriousness, how does one go about responding to members of the nursing staff who are like this? I mean, especially if they are well-seasoned nurses who more or less have memorized the protocols for virtually every common sort of thing, sometimes they get a little pushy and it's quite clear they're out of their depth yet they are still expecting you to go with what they think is best. Usually they say thing like, "This is what we always do for this" and think you are incompetent and/or just a control freak for not simply signing off on their treatment plan. I've yet to have a resident explain to me the most effective way of dealing with this, especially since the nurses who do things like this typically only do it to younger residents (from what I've seen or heard).
While I don't disagree with you to some degree, I have to say, however, to be careful about generalizing.
I have learned much from residents, fellows, and attendings who were not afraid to share and discuss. But you know, there has also been a give and take dynamic. If I acted the way you described, I wouldn't have learned anything, and also, my patients would not have gotten certain things they needed.
Residents and fellows get super busy. Sometimes they may look at hemodynamic indices while being terribly exhausted--so they might look at wanting to up a particular gtt to solve a problem. Now, you the critical care RN come on shift fairly well rested and review things, and then you carefully point out the elevated SVRI w/ the decreasing CI--if you are lucky enough, you may even have a low colloidal protein level to show the resident--and perhaps this helps get them to move on colloid fluid to increase CI and decrease SVRI. (It's merely one example.)
Finally, you are able to get something more than 'titrate up on this while titrate down on that.' Mind you, it had taken you a good period of time to get the right "recipe" for that patient--but now the person is getting on the dry side and the crystalloids just go out or third space to the extremities. Amazing how colloids can even things out and give you a much improved (reasonably decreased) SVRI and increased CI. Of course you have to be careful w/ them--especially in certain patients.
But what the nurse may also find are some very new residents, who are also very sleep deprived, and so they may tend to be so conservative, that conservative is way TOO out there. Then the fellow comes along and agrees with you, the CCRN, and low and behold, we can move the patient forward. Sometimes the newer docs go the other extreme. They haven't had the clinical experience and application to balance their thinking. If you think most of medicine can function purely on EBP, well, you are in for quite an awakening.
At any rate, sometimes the docs covering are just damn tired and your patient is the umpteenth post-op. So yea. You need some insightful, experienced CCRN to carefully make a point--FOR THE PATIENT. But if the CCRN is an azz about it, it could be your pt that loses out. Sadly I have seen a number of bad choices or delays that came out of pride. The docs that keep the patient first, in light of both the science and art of medicine, IMO, make the best physicians.
In surgical recovery, a nurse that acted as you described probably wouldn't last long. There is a way to get together and get the patient what he needs. Now there are number of Ahole nurses that don't know sh!% from Shinola. But a number do know, and since they are there trending every aspect of the patient's progress, it makes sense to listen to them, and if you have time and they are interested, share the rationale for your approach. I always respect and appreciate this.
Here is something important to learn before residency: You catch more flies with honey than vinegar. Yes, from time to time, you may still get some lazy, could-care-less, or attitude-problem nurse.
Many of us nurses ALSO HATE working with these nurses!!! But there are a number of nurses that do actually care about patients and outcomes and they may know a bit more than you might expect; but this depends upon the individual nurse.
, the professor bring up a blog like that (not sure if it was SDN) showing physicians somewhat bashing nurses... When I decided to go to med school, I asked that same prof for a LOR, she agreed to give it to me. Then I emailed her multiple times to follow up; she never replied to my emails. Later I met another nurse who had a similar experience, she told me that nurses are not usually happy when other nurses are going to med school. I don't know whether that is true or not... Anyway, that was when I figured out she was not going to give that LOR. In nursing school, 'We are the patient advocate' and 'Physicians often times are not in patients best interest' were drilled in our head...
