Wednesday, July 6, 2016

Nurses vs. Doctors



I've observed something in the hospital setting that will come as no surprise to many of you, which is that many doctors and nurses don't like each other. Part of this can be explained simply with the suggestion that some doctors are pompous a-holes, while some nurses (male and female) are bitches. These particular doctors and nurses probably don't get along well with their bank tellers, their children's teachers, or the people who are unfortunate enough to inhabit residences with them, either. It's not surprising that they would have trouble getting along with one another.

I've written before about the hierarchy that exists in hospitals. In practice, we third-year medical students are on the lowest part of the bottom rung of the hierarchy. Theoretically, we outrank nurses at least in terms of orders concerning a given patient. If we give an order, in theory a nurse needs either to abide by the order or to contact an intern, resident, or attending physician to override the order given by us. In practice, third-year medical students usually want the input of nurses before even doing so much as turning light switches on or off, much less in formulating patient orders. 

In my current surgical rotation, I have fewer opportunities for conflict with nurses than I will have in most settings of my career.  A substantial portion of my time is spent preoperatively, in surgery, and in in post-op. I don't have to make much in the way of decisions concerning patient care. I talk to patients, record vital signs, insert IVs, and observe surgical procedures.  It's not an environment conducive to conflict with nurses. For this I'm grateful. While eventual conflict with a nurse is an inevitable part of this job, neither do I look forward to it.

My brother is in a pediatric clinical rotation. A nurse derided him him because he left her to clean a bed of a patient who had defecated. Because I'm a total wimp and I want the nurses to like me, I probably would have stuck around and helped the nurse to change the bedding and clean up the patient. My brother chose to alert a nurse and to move on to his next patient.  He was within his rights to act as he did. Cleaning up patients and changing bedding are duties of nurses, not of physicians, except in the most extreme of situations. Would there have been anything inherently wrong with my brother helping the nurse with the rather unpleasant task? No. Was he obligated to don his rubber gloves and clean up the mess. Again, no.

The nurses in the hospital make a monthly "Shit List" (no pun intended) of med school students and interns. Matthew would have had an excellent chance of making the list for the month of July had his conflict with the nurse happened later in the month. As it is, he still has three weeks to flash dazzling smiles at the nurses, most of whom will think he is a reincarnated Ben Casey, assuming either the fictional Ben Casey or the actor who played him have moved on. Chances are that by the end of the month, even the nurse he left to deal with the soiled patient and bedding will have forgotten all about Matthew having been less than chivalrous.

Meanwhile, I'll toil away and try as far as possible without surrender to avoid offending anyone.



11 comments:

  1. This comment has been removed by the author.

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  3. Sounds like being a medical student can be shitty work at times.

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    1. I assume the pun was intended. It is a shitty job, but not nearly so shitty as is being a nurse or, even worse, a CNA, which is what I'm mistaken for if I'm not wearing my white coat.

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    2. Your brother did the right thing.
      I had a good laugh when I read your hospital still has CNAs. In our area of the country budget cuts have eliminated them from most hospitals.
      Most CNAs here work in nursing homes and sub-acute physical rehab facilities.
      If I ran the world, every nursing student would spend a shift with a CNA, and every medical student a shift with a RN early in their education. A lot of enlightenment would occur.
      Never heard of a monthly list before.
      No good comes of public shaming. But we don't hesitate to share our experience with attendings and faculty immediately. And the outstandingly good and awful practitioners are discussed long afterward with your prospective employers and patients.
      The manner in which medical students and residents treat the staff and patients when nobody else is around is a good measure of character.

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    3. My reply to this comment is below.

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  4. That's funny because I think of you as my outspoken heroine, being willing and - importantly - quite able to dish out the clever responses that I may think of 12 hours later...

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    1. I was probably that person in the past, and I may become that person again next year, but for this year, I really want the nursing staff to catch any mistakes I make and to quietly fix them without calling any undue attention. I'm a bit of an opportunist.

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  5. I agree that Matthew had no obligation to help with the soiled bedding. Such is not within the scope of our training.

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