Why do RN's pimp on interns?

[TripleDegree]

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Well, before I ask the question, is this really true? Every resident I've talked to has told me that besides the attendings, the nurses are the next worst in making your life miserable.

I find that incredible and flabbergasting - if that indeed is true.

Opinions anyone?

 

[hello23]

inferior complex

 

[NR117]

Absolutely true.

They're especially brutal to female medstudents/interns/residents.

Having said that, I've met some pretty awesome nurses too. So I don't want to make generalizations but the few nurses who are complete ^&*^%'s will make life hell for trainees.

How to deal with it if/when faced with it? Recognize it for what it is. Probably half inferiority complex, half jealousy

Thank God those are not the majority of nurses!

 

[Whodathunkit]

When I was on Surgery ICU, the nurses were indeed my best friends. 😍 Friends forever is what I what have told you when I was doing the rotation.

Of course, I was an intern, and it's easy to take advantage of us when we don't know that much, but overall...they were doing what was best for the patient. A little ego stroking didn't kill me at all...plus getting calls for tylenol at 3AM sucks!
SUCKS I TELL YA!!!!

I'd only really had one run in with a nurse as an intern, at a VA system(SURPRISE!!) I quickly tried to diffuse the situation by explaining to the nurse that I was not going to have this type of stressful relationship with her knowing I was going to be there for 2 months, so we needed to squash it. She was miffed, but the other nurses supported me for handling the situation professionally. We were never friendly, but we never had problems after that.

 

[anonymousEM]

show some respect and they will show some to you. as an intern the nurse that has been there for 30 years does in fact know more about some things (including standard management of inpt conditions) than you do on your first day. If you walk in and act like you're the smartest thing in the world and act condescendingly they will make your life miserable for the next 3+ years. But they can really bail you out too...make nice with your nurses!

 

[Bo Hurley]

As a 3rd year student you can always use the old:

"In about 2 years I'm going to be a doctor and you'll still just be a nurse". line 🙂

And when you're a doctor and a nurse ever questions you, you can comeback with:

"Remember I'm the doctor and you're the nurse. So even if I'm wrong I'll always still be more right than you."

I'm just kidding of course but you get my drift. You can really get some good zingers in there if you have a smart mouth like I do. But just keep it playful and not mean-spirited. I've gotten in my fair share of one-liners, and the nurses have ribbed me a few good ones too.

 

[docB]

As a 3rd year student you can always use the old:

"In about 2 years I'm going to be a doctor and you'll still just be a nurse". line 🙂

And when you're a doctor and a nurse ever questions you, you can comeback with:

"Remember I'm the doctor and you're the nurse. So even if I'm wrong I'll always still be more right than you."

I'm just kidding of course but you get my drift. You can really get some good zingers in there if you have a smart mouth like I do. But just keep it playful and not mean-spirited. I've gotten in my fair share of one-liners, and the nurses have ribbed me a few good ones too.

If you say that your pager will beep every 30 seconds until the day you die.

One time when my team was running our list my intern mentioned that he had ordered "enemas until clear" on a patient. I practically ran to that floor to dc the order and apologize. The RNs were cool and I avoided getting paged for q 10 minute status reports for the rest of my residency.

 

[TripleDegree]

If you say that your pager will beep every 30 seconds until the day you die.

One time when my team was running our list my intern mentioned that he had ordered "enemas until clear" on a patient. I practically ran to that floor to dc the order and apologize. The RNs were cool and I avoided getting paged for q 10 minute status reports for the rest of my residency.

Well its pathetic that they wield this kind of power. Jeeeeez - whats wrong with our system??????

 

[Jeff05]

1. if you're nice to nursing, nursing will be nice to you. period. we tell them what to do and when. they'll make our lives miserable when we forget ourselves and treat them as lower class citizens. sounds like a fair checks/balances system to me.

2. "pimping" means being verbally quizzed (usually by attendings/residents). and not whatever the original poster thinks it means. nurses NEVER pimp med students.

 

[MAC10]

Agree with Jeff to pimp is to quiz without mercy. Its usually what attendings do on rounds to show you they know more than you.

Ive never got pimped by a nurse

 

[USAF MD '05]

Pimped= Put In My Place

My wife is a nurse, but using the definition above that one of my attendings taught me, she pimps me every day! 😱

She does it with love however....lol. 😍
Steve

 

[Bo Hurley]

If you say that your pager will beep every 30 seconds until the day you die.

As I said, as long as you keep it good-natured it's all good. You just got to know when you're crossing the line.

That being said a med student or doctor should never feel "intimidated" by nurses or other allied hospital staff. I was taught by a resident that if any of them starting acting up or don't follow your orders then the best thing to do it write them up and file a formal complaint. In fact this resident would do it right in front of the nurses on the ward so the offending nurse knew that a complaint was going in against her. He said after a few times the rest of the nurses got the message and things went smoothly.

 

[Hercules]

As I said, as long as you keep it good-natured it's all good. You just got to know when you're crossing the line.

That being said a med student or doctor should never feel "intimidated" by nurses or other allied hospital staff. I was taught by a resident that if any of them starting acting up or don't follow your orders then the best thing to do it write them up and file a formal complaint. In fact this resident would do it right in front of the nurses on the ward so the offending nurse knew that a complaint was going in against her. He said after a few times the rest of the nurses got the message and things went smoothly.

Either some of the people on this board don't play well with others or the nurses at your institutions are much more difficult than mine. I have never had a problem with a nurse as a 3rd or 4th year student, and I don't anticipate any as a resident. I loved my nurses and several of them contributed greatly to my education and helped me look better in front of attendings.

 

[beyond all hope]

This is a complex relationship.

There are good nurses and bad nurses. The good ones realize that you are working your tail off and just learning the ropes. They will try to help you, give you advice, and steer you towards the right patient care decisions.

Bad nurses see this as a chance to put you in your place. I had a nurse manager at my former hospital who made a point of being a b*tch to any intern. After awhile I got tired of it and started to be nasty back to her. There are some nurses who you will never win over, but you still have to work with them.

Many nurses feel you need to earn their respect. This is especially true of highly trained nurses such as ER and ICU staff. These are the ones that can be great allies once you make them understand you're not an idiot and you're not overwhelmed with your own title.

You're rotating through different departments, so you're frequently new to an area which a particular nurses has been for years. They consider the unit their 'turf', and often they feel like you're an intruder. There isn't really any good way to deal with this except realize that it's a factor.

Be humble, take suggestions, but once you make a decision you have to be firm. Sometimes they will bully you into making decisions which aren't always right. They may have much more experience, but ultimately patient care decisions are your responsibility.

 

[litepath]

Well, before I ask the question, is this really true? Every resident I've talked to has told me that besides the attendings, the nurses are the next worst in making your life miserable.

I find that incredible and flabbergasting - if that indeed is true.

Opinions anyone?

Yeah, it seems to be true of some Rn's in some circumstances; another cross section of society at large. I've seen it more with new nurses(2 years or less) than with older ones. I think the newer nurses do not have any REAL idea how the day-2-day life of an Intern/Residents life works or for how long that road is, or especially how much crap they have to eat and look like they like it. Of course, because of this attitude by some, I've seen the reverse as well. Personally I've made a practice of attempting to understand the plight of Interns and Residents ( Med students too). As an RN I consider it part of my job to find out what assessment data you are most concerned about with a particular patient of "ours" so that I can look out for that while doing the rest of my chores.
As a travel nurse, I've seen differences geographically as well. Additionally, I have noticed the differences of how Residents treat Interns and Med students. In D.C. they were kind, loving and gently guided each other thru the pearls, teaching at almost inaudible tones. In the deep South, I encountered Residents screaming and taunting Interns, doing a terrific job of making the Residents look like asses and the Interns look like victums.

Remember that you have a wealth of information from all of your years of didactics. Be a teacher, share when you can, when you get a poor response from a nurse, either find out why or move on quietly and maintain your professional demeanor. I think its possible thru positive interaction to recruit the staff to your needs about patient care so that you: Not only look good during the next days rounds, but you can put out fires somewhere else knowing the other patients are well cared for and you're tx plan is intact.

 

[timtye78]

I do not need or desire the respect of nurses. I simply see patients, make decisions, and write orders. I have had run-ins with nurses before, but I simply go through the proper channels. Writing an incident report is great because the nurse knows she's going to be at least called in to discuss it with her nurse supervisor.

If you get the chance, strike up a friendly conversation with the nurses. Ask them how long they've been working there, are they still in school? This is taken as you are friendly at least. After every order I say please and thank you. What else could they ask for? Your reputation will be that of a friendly, professional person, and might help you later if someone tries to get you in trouble.

As an intern, and maybe even later as a more upper level resident, you may be made to feel like you are in the way. The truth is, you are authorized to not only be there, but make decisions and actually tell them what to do. As long as you stay within the lines of authority, there is nothing to worry about. If you ever get challenged by someone in authority to yourself, then you simply explain how you were concerned with patient safety and care, and made your best judgement.

Don't waste your time trying to butter up the RNs. Brown-nosing is easily detected and some will translate this into thinking you are afraid of them or want something from them. Don't get mad at someone for paging you unless they cannot validate the reason.

Hope this helps!

 

[MD'05]

I prefer to work with male nurses. The majority I have encountered are professional, confident, helpful, have a sense of humor, and are not b*tchy and annoying.

 

[Bo Hurley]

I do not need or desire the respect of nurses. I simply see patients, make decisions, and write orders. I have had run-ins with nurses before, but I simply go through the proper channels. Writing an incident report is great because the nurse knows she's going to be at least called in to discuss it with her nurse supervisor.

If you get the chance, strike up a friendly conversation with the nurses. Ask them how long they've been working there, are they still in school? This is taken as you are friendly at least. After every order I say please and thank you. What else could they ask for? Your reputation will be that of a friendly, professional person, and might help you later if someone tries to get you in trouble.

As an intern, and maybe even later as a more upper level resident, you may be made to feel like you are in the way. The truth is, you are authorized to not only be there, but make decisions and actually tell them what to do. As long as you stay within the lines of authority, there is nothing to worry about. If you ever get challenged by someone in authority to yourself, then you simply explain how you were concerned with patient safety and care, and made your best judgement.

Don't waste your time trying to butter up the RNs. Brown-nosing is easily detected and some will translate this into thinking you are afraid of them or want something from them. Don't get mad at someone for paging you unless they cannot validate the reason.

Hope this helps!

Great post.

In the end remember it is YOU who is the doctor, which means it is YOU who the lawyers will be coming after if things don't go right (or what they think is supposed to be "right").

 

[f_w]

> In the end remember it is YOU who is the doctor, which means it is
> YOU who the lawyers will be coming after if things don't go right
> (or what they think is supposed to be "right").

Actually, the lawyers will go after the 'deep pockets', the attendings malpractice insurance and the hospital. And yes, the nurses actions get questioned 'if things don't go right' and they are regularly named in suits. The person who is dropped first is usually the intern. He/she allways has the excuse of not knowing it better. And with few exceptions, it is usually the attending who is held responsible.

From some of your posts here it becomes increasingly clear as to who will have problems with nursing, and who won't.

Btw. I have never seen a nurse 'pimping' an intern in the classic medschool/residency way.

 

[ForSkin]

i remember openly bitching about an infamously overbearing nurse to my attending, who rolled his eyes and proceeded to march to the icu with his name badge in hand and said to the nurse:

"you see this? MD. That stands for Makes Decisions."
"RN? Reads Notes. Understood?"

she was just floored.

 

[docB]

I do not need or desire the respect of nurses. I simply see patients, make decisions, and write orders.

I have had run-ins with nurses before,

No kidding. I'd imagine you do.

i remember openly bitching about an infamously overbearing nurse to my attending, who rolled his eyes and proceeded to march to the icu with his name badge in hand and said to the nurse:

"you see this? MD. That stands for Makes Decisions."
"RN? Reads Notes. Understood?"

she was just floored.

I don't find either of these attitudes useful and I say that anyone subscribing to them is in for trouble. If you treat nurses like this they will not watch your back. And any doc who wants to practice without the help of the nurses might as well say that they don't want lab or radiology. If you act like an imperious, pompus jerk you're in for a lot of rude surprises.

 

[NYCDOC74]

not really, I've never found myself in a situation where nurse staff have made my life difficult...on the contrary, the nurses I've encountered thus far have been very, very supportive and will help you out of a sticky situation when one arises.

 

[Whisker Barrel Cortex]

> In the end remember it is YOU who is the doctor, which means it is
> YOU who the lawyers will be coming after if things don't go right
> (or what they think is supposed to be "right").

Actually, the lawyers will go after the 'deep pockets', the attendings malpractice insurance and the hospital. And yes, the nurses actions get questioned 'if things don't go right' and they are regularly named in suits. The person who is dropped first is usually the intern. He/she allways has the excuse of not knowing it better. And with few exceptions, it is usually the attending who is held responsible.

I would think that the majority of time, this is true. However, there are plenty of cases where residents were held responsible. Here is a link to a case at the Children's Hospital of Wisconsin where everybody but the peds resident and the ER doctor were dropped and the resident was found 3/4 responsible for the 17.4 million dollar award: http://www.yourlawyer.com/practice/news.htm?story_id=8710&topic=Medical Malpractice

The reason that the resident was kept on while her attending was dropped from the suit was because of the patient compensation fund and laws in Wisconsin would have limited the payout from fully licensed physicians, but the laws don't include people on training licenses.

Another high profile case includes a carotid stick during central line placement somewhere out east.

When it comes to lawsuits, residents are deep pockets b/c they have malpractice insurance throught the hospital.

 

[timtye78]

i remember openly bitching about an infamously overbearing nurse to my attending, who rolled his eyes and proceeded to march to the icu with his name badge in hand and said to the nurse:

"you see this? MD. That stands for Makes Decisions."
"RN? Reads Notes. Understood?"

she was just floored.

OMG..hillarious!
👍

 

[timtye78]

No kidding. I'd imagine you do.



I don't find either of these attitudes useful and I say that anyone subscribing to them is in for trouble. If you treat nurses like this they will not watch your back. And any doc who wants to practice without the help of the nurses might as well say that they don't want lab or radiology. If you act like an imperious, pompus jerk you're in for a lot of rude surprises.

There are obviously extremes to each side. Aim for somewhere in the middle.
I was a nurse's assistant during highschool, and many of my closest friends became RNs, MDs, and DOs. I have no hate for RNs. But please, do not become these sniveling a$$-kissing interns who thinks this will get them paged less! Without reiterating everything nurses do wrong, I don't need to be their buddies in order to be a good physician. If you think they would keep their job after witholding pertinent 'labs', since you mentioned it, you are crazy.

I am responsible for the decisions I make. I don't require an RN 'to watch my back.' Thank you-I went to medical school!

The attitude I hate most in a nurse is this, "I've been working down here X number of years, and why the he11 do you think we need an EKG on this 1 month old for cyanosis-are you crazy?" (Last night in the ED!)

 

[TripleDegree]

The attitude I hate most in a nurse is this, "I've been working down here X number of years, and why the he11 do you think we need an EKG on this 1 month old for cyanosis-are you crazy?" (Last night in the ED!)

How does one reasonably respond to a question like that?

 

[f_w]

> Here is a link to a case at the Children's Hospital of
> Wisconsin where everybody but the peds resident
> and the ER doctor were dropped

Interesting case. It demonstrates a couple of things:
- big f$)#ups happen
- gastroenteritis and 'irritable bowel' are the most commong misdiagnoses in malpractice cases involving the abdomen and kids
- didn't anybody ever consider involving a surgeon in the care of a kid with abd. pain ?
- sloppy plaintiffs attorney work
- the people really responsible ran for the hills and got away with it

Residents are held responsible at times, but usually they are the first ones to get dropped.

 

[docB]

There are obviously extremes to each side. Aim for somewhere in the middle.
I was a nurse's assistant during highschool, and many of my closest friends became RNs, MDs, and DOs. I have no hate for RNs. But please, do not become these sniveling a$$-kissing interns who thinks this will get them paged less! Without reiterating everything nurses do wrong, I don't need to be their buddies in order to be a good physician. If you think they would keep their job after witholding pertinent 'labs', since you mentioned it, you are crazy.

To clarify I was not inplying that an RN might withhold results. I'm pointing out that your nurses are a great source of info for the physician and if you ignore or antagonize them you might as well try to do your job without other sources of info like the lab or radiology.

I am responsible for the decisions I make. I don't require an RN 'to watch my back.' Thank you-I went to medical school!

Bull. Med school counts for squat. When I'm running a code who do you think I want with me, a good nurse or a med student, or even an intern? It's the nurse hands down.

You do need nurses watching your back wether you know it or not. They spend a lot more time with the pts than we do. They know if a pt is annoyed about something or doesn't understand something. Pts misperceive and misinterpret so many things in medicine. The nurses can head those things off and smooth it over for you. But if you're the kind who busts out with "I'm the one who's paid to think.", or some of the other witty, demeaning stupidity that's come out in this thread your pts will just stay angry. Guess which pts sue? Here's a hint, it's not the ones who got bad care. That's right, it's the angry ones.

When you're on the stand and get asked by the plaintiff's attorney "Dr. why didn't you listen to the nurses? Their notes clearly reflect that they were worried about X." "The nurses? They suck! I went to med school." Get out your check book.

 

[timtye78]

Moderator:
Can we please close this thread now?
Thanks.

 

[f_w]

bohoo, moderator, they are all so mean. There are people out there who don't agree with me.

I think you have some growing up to do.

 

[mikecwru]

There are obviously extremes to each side. Aim for somewhere in the middle.
I am responsible for the decisions I make. I don't require an RN 'to watch my back.' Thank you-I went to medical school!

You're an intern, right? Say that to yourself a few times, then re-read your post. I would suggest that you get humbled, but life will do that to you soon enough.


mike

 

[blotto geltaco]

I do not need or desire the respect of nurses. I simply see patients, make decisions, and write orders.

Bully for you big fella.

 

[Spiff]

I would think that the majority of time, this is true. However, there are plenty of cases where residents were held responsible. Here is a link to a case at the Children's Hospital of Wisconsin...

WOW! What a terrifying case. I did some further digging into the facts of the case, and it appears that the pedi resident in question was an intern. They went after her because she wasn't fully licensed (as in most places where you don't get your licence until the end of PGY-1) and apparently successfully skirted state malpractice caps by nailing an "unlicensed" provider. PGY-2 and above residents wouldn't have to worry about this sort of thing since if they have a state license (as required in most places). Whats even scarier is that they went after the poor intern and didn't even try to make a go for her attending until the statute of limitations was up and they couldn't get anything anyway.

So basically this intern gets a private patient admit with belly pain around 8PM with a chart diagnosis of "IBS" from the patient's attending (a misdiagnosis by the attending... because it turns out to be a volvulus). Intern talks to patient's private doc who says she will see the pt in the morning. Patient gets admitted and doesn't get seen by attending until the am (even though the attending was called)... and then the attending doesn't get the patient into surgery's hands until the patient pretty much codes later that afternoon. So who gets shafted? The intern... who is negligent because she did not override her attending's judgement and diagnosis and then call surgery when her own attending wouldn't come see the patient!!! Everyone else in this case (except an ER doc who ends up not paying anything) including the hospital skates, but the lowly PGY-1 gets absolutely nailed. Now that is scary.

If this decision holds up the, at least in Wisconsin, it is going to be open season on interns. Because now the lawyers know they can skirt the malpractice caps with the intern loophole. Hopefully the Wisconsin Supreme Court will instill some sanity here.

... Edit ... no luck with the Wisc Supreme Court (from current state stautes): "First−year medical residents who have their M.D. degrees but are not yet licensed are not health care providers under this section and not subject to the limitations on the recovery of noneconomic damages in subs. (4) and (5). Phelps v. Physicians Insurance Company of Wisconsin, Inc. 2004 WI App 91, 273 Wis. 2d 667, 681 N.W.2d 571, 03−0580"

 

[chickie]

firstly:

there is no such thing as "just a nurse". same goes for the cleaners, the kitchen staff, the volunteers, or anyone who contributes to making the hospital function. without any of these people the system would not work.

secondly:

many nurses will tell you straight up that they would much rather be an amazing nurse than a doctor. plus, it shows your lack of understanding if you even compare the two professions - remember, it is hard to find any 2 other professions that are as different yet as reliant upon each other as nursing and medicine.

finally:

i wish people would just get over the whole so-called hierarchy and realise that everyone is a member of the health care team, on an even plane giving different types of care to the patient. doctors give medical care, nurses give nursing care, and allied health teams give their own specialised care also. get over it!

as an RN, i really enjoy working as a member of the health care team and the interns, residents and registrars i work with are fantastic. the nursing care given by us is fantastic. i think a lot of the time people's behavioural issues are confused with professional issues and that's where it is clouded. it's just the same for us when some stuffy old consultant comes in and treats us like dirt, it's not really a reflection on the medical profession, but a reflection on that person's own behaviour. if everyone gives a little, then we can go to others for help when it is needed or bail someone out when they need it. 🙂 🙂 🙂

 

[TripleDegree]

firstly:

there is no such thing as "just a nurse". same goes for the cleaners, the kitchen staff, the volunteers, or anyone who contributes to making the hospital function. without any of these people the system would not work.

secondly:

many nurses will tell you straight up that they would much rather be an amazing nurse than a doctor. plus, it shows your lack of understanding if you even compare the two professions - remember, it is hard to find any 2 other professions that are as different yet as reliant upon each other as nursing and medicine.

finally:

i wish people would just get over the whole so-called hierarchy and realise that everyone is a member of the health care team, on an even plane giving different types of care to the patient. doctors give medical care, nurses give nursing care, and allied health teams give their own specialised care also. get over it!

as an RN, i really enjoy working as a member of the health care team and the interns, residents and registrars i work with are fantastic. the nursing care given by us is fantastic. i think a lot of the time people's behavioural issues are confused with professional issues and that's where it is clouded. it's just the same for us when some stuffy old consultant comes in and treats us like dirt, it's not really a reflection on the medical profession, but a reflection on that person's own behaviour. if everyone gives a little, then we can go to others for help when it is needed or bail someone out when they need it. 🙂 🙂 🙂

You make good points.... but the MD will always be the head of the medical team. To claim that this is not true is denying reality. Patients don't turn to allied health folks or nurses (or the physician "assistant") in a crisis, they turn to the leader of the medical team - the Doctor.

Perhaps if nurses and others realized this, there would be less of this inferiority complex that I believe is the cause of this behavior towards interns.

 

[f_w]

> Patients don't turn to allied health folks or nurses (or
> the physician "assistant") in a crisis, they turn to the
> leader of the medical team - the Doctor.

LoL, you are truly a 'joker doctor' as your signature panel points out.

I am not sure in what century you are practicing, but in crisis typically patients will turn to the person whose face and name they can remember first. More typically the nurse than the physician.
And the 'leader of the medical team' is surely not our 8month emergency room intern (the one spouting off about how he/she doesn't need nurses to watch his back bc he has an M.D.)

(I am doing a rotation right now where we do many percutaneous breast biopsies. This week we received two of our patient 'feedback' letters. Both had a handwritten comment on them 'and special thanks to Liza'. Liza is the medical assistant who talks to the patient and if so desired holds their hand to dispel the anxiety during the procedure. They don't remember the attending who put in 15 years of his life to get to his skill level. They surely don't remember me, the lowly resident who actualy performed the biopsy. )


And for that MCW case:
From my reading of the legal filings that are in the public record, the case is quite unique in a number of respects. Some of the issues are specific to the Wisconsin statutes, others are just a reflection of local politics:

- It was in essence the county of Milwaukee who sued MCW. They were the ones who footed the kids 3m medical bills. Guess what, the citizens on that jury are the ones who won't get a tax hike now that the verdict shifts that expense to MCW.
- A big boboo had happened initially and apparently nobody was smart enough to pay the parents off while the kid was still alive ($1m in time, saves 9)
- the private pediatrician who had f**$+ up the worst, managed to get off bc. he (or she ?) was not named in the original complaint (sloppy attorney craftsmanship). When he got added later, his insurance managed to get him dropped through an interlocutory ($20 word) appeal claiming that the 3 year statute of limitation had kicked in (weasely move, but considering the mega$$ at stake understandable).
- the decision that the cap on punitive damages did not apply to interns was strictly based on the fact that the wording of the statute didn't include it. It doesn't mean that interns everywhere else in the country are 'fair game'.
- the plaintiffs just grabbed whoever they could get. Once they had their verdict, they were happy to drop the ER doc (as his contribution to the punitive damages was capped anyway) as it reduced the likelihood of the case going up the appeals ladder.

 

[fang]

i wish people would just get over the whole so-called hierarchy and realise that everyone is a member of the health care team, on an even plane giving different types of care to the patient. doctors give medical care, nurses give nursing care, and allied health teams give their own specialised care also. get over it!

I agree with this on a personal level-- title or education doesn't make you a more valuable individual. However, on a professional level, what's wrong with enforcing a hierarchy? In fact, from what I've observed it seems like you *need* a hierarchy in order to get things done safely and efficiently. In a company, the hierarchy is in full effect-- first CEO, then VP's, directors, managers, engineers, techinicians, and finally operators. The same kind of hierarchy exists in a hospital, except there seems to be a lot more arguing about who is qualified to do what.

 

[MAC10]

For the most part I get along with nurses, but there are always a few that I butt heads with beacuse they interfere with my job. And yes we are taking care of the same pateint but we have different jobs. As politcally correct as we like to think we are, the fact remains that doctors make decisions and nurses carry out those decisions. Nurses can make suggestions but doctors orders are not suggestions. There are times that I have writen orders and the nurse seems to think its a suggestion and they decide not to do it. This is where I have a problem. Just today I ordered blood cultures on a patient and the nurse is reading the order (dosent know im in earshoot), she says angerly to the ward clerk... now why does this pateint need blood cultures she didnt even spike a fever, they shouldnt be ordering blood cultures just to order them. well this elderly lady with AMS was growing MRSA in her urine and has a raging white count??hematogenous spread mabey?? or should i wait until shes septic to see what the hell else is growing? Everybody wants to play doctor

 

[blotto geltaco]

Nurses can make suggestions but doctors orders are not suggestions.

Actually orders really are only suggestions at the VA.

 

[GMO2003]

Actually orders really are only suggestions at the VA.

Reflections from internship:

Old Battle Scarred Nurse: " You sure look awfully young to be a doctor...are you sure you know what you're doing? "

Young Intern: " Well, I don't know everything, however, I'm working hard to lay a good foundation for the future. "

OBSN: " Really, I thought you were one of the high school volunteers instead of one of the new terns! "

Young Intern: " I may be a young doctor, but make no mistake about it...I AM THE DOCTOR!"

 

[NCHoosier]

Actually orders really are only suggestions at the VA.

So, so true!

 

[artie-lange]

Wah, wah, wah! People are saying things I don't like or agree with! Wah, wah, wah!

Anytime someone generalizes and cracks back on nurses, they should remember that there are good doctors and there are bad doctors just like there are good nurses and bad nurses. When a nurse questions a doctor’s order s/he usually has the best interests of the patient in mind, not making you look foolish. If you take offense to that, you definitely need a thicker skin and you need to get over your own ego. Also, a little bit of “insubordination” isn’t necessarily a bad thing; just like nurses a soldier does not have to follow an order that is inappropriate (remember Abu Ghraib?). Finally, if you want to worship the hierarchy and crack on RNs for being inferior to you, you better be willing to take cracks about being a DO. If you can dish it out, be ready to take it. Late...

Moderator:
Can we please close this thread now?
Thanks.

 

[f_w]

> When a nurse questions a doctor’s order s/he
> usually has the best interests of the patient in
> mind, not making you look foolish.

90% of the time this is probably true.

But actually, there are a couple of other reasons:
#1 inertia
#2 this order will interfere with my break
#3 this order will increase the number of things I will have to tell the LPN and PCA to do. It will also increase the length of my note.
#4 just to make the intern look foolish

The reason why we should put up with beeing questioned about orders is this one:
#5 it would positively kill the patient to execute the order as written

I know, nurses with their obsessive compulsive attachment to 'policies' can be a royal pain. Except for maybe some sort of combat situation, the answer when questioned about an order should never be any of the following:
- I am an MD, and this is how it is written.
- I wen't to medschool, how dare you questioning me.
- Just do it !

If you wrote a legit order, and what you wrote for didn't happen, ask the nurse who had the patient 'why'. At times, there is a valid reason (e.g.#5), if you have reason to believe that reasons #1-4 apply, write an incident report.
You will be long gone, the hospital staff will still be there. They have seen generations upon generations of pompous interns come and go....

 

[MAC10]

> I know, nurses with their obsessive compulsive attachment to 'policies' can be a royal pain.....

This is true.

I usually have no problem with a nurse second guessing my orders..IF she pages me and asks me I will explain my reasoning. BUT to just disreguard the order and me not find out untill the next day on rounds really pisses me off. And I agree with the above poster MOST nurses are not like this but there are a few that are lazy, feel like your order is a suggestion, feel that they know better than you, doing work disturbs their break...i could go on.

BTW artie-lang, in the hosptial hierarchy RNs are below interns (even DOs my friend). Its not a bad thing its just the TRUTH. 😀

 

[timtye78]

to artie whatever:

At my program, my title beyond intern is House Officer. MD or DO is irrelevant. I must admit some guilt at taking some pot-shots at nursing staff. I have authority to write orders, not suggestions. If someone decides not to do something I have written, they must be prepared to explain either to me or someone else, especially if the patient crashes whatever-I do my best whatever happens.

As far as disagreement with other posters: I have been challenged, and rightfully so on multiple topics in other threads. This is why I keep reading the posts on the SDN site-the discussions are interesting for me. Sometimes, I must admit guilt here as well, topics move off from what the OP tried to discuss, and the posts degenerate into flame wars. This leaves a bad taste in my mouth, as well as others. So someone politely requests the attention of the moderators, and the thread closes after its purpose is served.

Believe you me, I am ready for cracks against DOs. I bet you I have heard every joke or jab at DO there is. My DO degree brought me to where I am today, and I am very happy about it.

 

[f_w]

No flame war here.
You made some immature comments and people called you on it. Running to the moderator to get the thread closed at that point has more to do with your own personality getting bruised than the 'hygiene' of the board.

 

[candycane]

I think that everyone needs to get over their egos.... nurses and interns alike! Seriously people we are here to care for the patient. If there is mutual respect and active communication then all this EGO BS would not be an issue. 😍 spead love and respect

 

[artie-lange]

BTW artie-lang, in the hosptial hierarchy RNs are below interns (even DOs my friend). Its not a bad thing its just the TRUTH. 😀

Thanks for missing my point completely. Besides, what made you think I don't know or respect the hierarchy of the hospital? All I was trying to say was check your ego at the door when you come into the hospital. If you want hierarchy, I can give it to you. If you were the intern on my team, I would not allow you to page me with a question until you had gone through the R3 first. I'd also make you buy breakfast for the team on Fridays (including the NP who helps you out with your scut while you're still trying to figure out how to tie your shoes)! Finally, just because RNs are low on the food chain does not mean you have carte blanche to treat them like crap.

 

[DrMom]

I think this has gone on enough. Closing.