Doctor vs. Nurse
I do not like to get involved in the process of evaluating nurses, and the concept of formally complaining about a nurse makes me really uncomfortable. I've been fortunate to work with many excellent nurses during my career. Outstanding nurses make even the most difficult shifts seem to run smoothly. As I have mentioned before, I have actually tried to arrange my shifts so that I work with certain nurses as often as possible. Unfortunately, there will always be plenty of mediocre nurses around as well.Mediocre nurses are not so bad, really. They get their job done and generally cause no harm. Everything just takes longer. Their assessments take longer. IVs and blood draws take longer. Admissions take longer. Orders sit in the rack longer. Nothing is anticipated. They take more frequent cigarette breaks and lunch breaks, so they often just aren't around when you need them. They tend to make a lot of personal phone calls, either whispering into a cell phone or even worse, receiving calls on the business line. I try to only prod them when things start to get dangerous. I like to think that these nurses aren't really slow, but rather the exceptional nurses are just faster. That helps me deal with the situation without going insane. I'm sure there are faster docs than me as well, and so I try to be understanding as long as patient safety is not affected. I'm really pretty laid-back.
Nevertheless, it seems to me that many nurses will complain about each other and about physicians at every opportunity. They will fire off e-mails to their bosses, my bosses, or even the CEO of the hospital about any disagreement or perceived mistreatment, whether or not it affects patient care. Everyone has to walk on eggshells or we will end up at a sensitivity training seminar or get a stern letter of reprimand. Several of our best nurses have been fired (or induced to leave) for ridiculously petty nonclinical complaints....by other nurses! Talk too loudly in the nurses' station, speak a little too bluntly to a patient, make an off color joke or tease an overly sensitive colleague around the wrong nurse and you will get burned. Even those who we think are our friends will stab us in the back. It seems to be the below-average nurses who complain the most, but even the superstars have the potential to bite. There is no discussion; they go right to the keyboard. Nurses seem to consider scathing e-mails about their colleagues the same way that malpractice attorneys consider lawsuits....it's just part of the job. An occupational hazard. Nothing personal. I find this generally disturbing, but it truly seems to be an ingrained feature of the nursing culture.
During my entire career, I have made a formal complaint about a nurse only once, and that was against my better judgement. Everyone knew that "Bertha" was the worst nurse on staff. Even after several months of experience, it was obvious that she was never going to catch on. She was below mediocre. Maybe in another facility she would have been acceptable, but compared to her peers in our ED she was unanimously known as the worst. All the doctors cringed when they saw that she was assigned to their area. The other nurses would always grumble amongst themselves because they knew that they were going to have to do much of her work during a shift. She was not only the slowest nurse ever, but she had essentially zero independent judgement and minimal medical knowledge or skills. She made everyone's job harder. There was an understood but (mostly) unspoken reason why she lasted as long as she did, but I'm not going there.
Despite her incompetence, I would still never have complained about her if one of the nurse managers hadn't beggged me to do so. She suggested that a complaint from a physician would help make the case against Bertha stronger. I told her that I would file a complaint only if she would assure me that it would help make her go away. I didn't want to complain if it wasn't going to do anything but get her mad at me. I really didn't want to complain at all, but desperate measures were called for. During every single shift there were always several potential issues to complain about, from missed orders to unrecorded vital signs to ignoring critical data. Until that point, I had simply tried to encourage her.
"What's this blood pressure of 70/30?" I would ask.
"Oh, I think the patient was just on his side. I was going to recheck it in a little bit."
"Why don't we recheck it now?" I would offer helpfully. And so on.
Finally, I wrote a letter of complaint to her supervisor regarding her care of a patient who was going to emergency surgery who had some missed orders and no vital signs for the entire shift. It was two more months before she was finally fired, and I had to work with her during several very uncomfortable shifts before she finally disappeared. Ugh. From now on, you nurses can police your own. I'd rather stay out of it.
posted by scalpel at 12:55 AM
42 Comments:
a bad colleague is always a big problem at work. you always end up doing his/her job and no one seems to realize. In my case it was my boss. I quit that job a few months ago and a couple of days ago my ex-colleagues told me they finally complained to the CEO. This guy was going to be made partner, now he won't. I enjoy these moments... (sinister laugh here)
70/30?!?! Good heavens, someone with no medical training whatsoever would be pretty darn concerned about a BP like that. Was the patient okay?
It's true, nurses do eat their young. Always watch your back, there is a knife waiting to be plunged in to the hilt. On the other hand, if there is a particular nurse that insists upon ignoring protocol and jeopardizing a patient's safety, then by all means, GET RID OF HER! You'd be right to stay out of it though doc, her fellow nurses would have taken care of it eventually (chomp, chomp...ummmmmm... tasty)
You're very right. For some strange reason, many of the nurses I have worked with wouldn't think twice about stabbing each other or doctors in the back for whatever petty reason. This general lack of loyalty and mutual support has always bewildered me. Although I realize that low self-esteem is probably at the bottom of such behaviors, it is extremely aggravating...
Ther is a simple answer to this - professional nurses in most coutries and unionised - this means that nurse managers (or clinical coordinators or whatever other fucking stupid newspeak name we are giving them this month)have their authority vastly diluted by grievance procedures and union rules and have been essentially disempowered from line management function. The concept of seniority is now firmly entrenched as a function of time rather than aptitude or qualification and has spawned a generation of young RN's who have attitudes better suited to GM workers with Local 6969 and consequently , the older , more experienced staff are reduced to whining because their ability to effect change is zero.
We can only become real professionals if we shed ourselves of the unionised "salary and pension" attitude.
For some reasson some people honestly believe that they are entitled to work (and get paid) without ever being offended by anything or anyone.
This misconception has been allowed to ruin the career many good nurses, docs, and others. Anyone remember "I'm sorry" and moving on to the next task?
Same stuff goes on in Medical Records. Aside from nurses, I honestly think women who work down here are some of the nastiest, petty, back stabbing spinsters I've ever come across. My spine crawls every time I see one of my coworkers come in and I do my best to not talk to the other one. 8 hours doesn't seem like a long time but living through it while one continuously swears, throws things, is rude on the phone, slams doors, writes nasty e-mails to the other coworker about me, talks on the phone with the other coworker if she isn't there (one's casual) about me, takes the wind and strength right out of you.
Thank god she's gone in 14 weeks. Her and I are both counting down the days, for different reasons obviously.
I'm just a receptionist in the ED, but yeah...lots of petty back-stabbing and fighting and emails fired off at the slightest provocation. (And because I'm considered "outside" of the nurse circle, I often hear quite a bit of the gossiping/complaining.) My sister is an elementary school teacher and she says that things are pretty much the same way there. I like to consider myself a feminist -- but I've really begun to think that any workplace that is overwelmingly estrogen-o-centric is simply toxic.
Check my blog, it's my take on nurse stupidity.
"There was an understood but (mostly) unspoken reason why she lasted as long as she did, but I'm not going there."
Yeah, we all know exactly where you're not going with that. You don't need to say it. Nothing good ever comes of it.
Its a rather difficult situation to be in.
I know someone who won't ever get fired no matter how bad they are cos they are friends with someone higher up...I know good people who've left becasue of ridiculous accusations...but my industry can be ruthless. Its sad to hear that it happens in medicine as well
The problem is indeed inexplicable... although usually the ones with teeth are the ones who can not handle the workload or stress and can be identified easily... try being married to someone who works in the same ER... the drama is escalated on a logarithmic scale.
Nurses may indeed be backstabbing, but they police themselves more than any other discipline in healthcare. I wonder what would happen if physicians policed themselves as much and ran the ineffective ones out of town on a rail rather than refusing to comment and sweeping glaring fubars under the rug? What ever happened to doing the right thing?
Oh Doc Scalpel, you are very wise man. I've never been able to figure out my peers. I've been told that I'm too blunt, but I guess that's because I don't believe in stabbing people in the back. I'll tell someone to their face if I have a gripe with them. If you ever figure out the psychology of nurses, please drop me a line and let me know what you’ve learned.
MJ
Like bad nurses, bad docs usually do get noticed and dropped eventually. Then they just move somewhere else and start over. Or they seem to go into nonclinical fields as "experts," "managers," or consultants.
If I identify a clinical mistake by a nurse, I will tell them straight to their face what they have done wrong and try to help them improve. I have never once yelled at or publicly berated a nurse either. If the same sort of problem keeps happening, I will talk to their supervisor and let them address the problem. I don't think a written complaint is proper or necessary at that stage, and I would expect the same courtesy from anyone.
I would never complain about someone's personality quirks or practice style, because these issues do not affect patient safety. This is my beef with nurses, and it isn't necessarly just the female ones.
If I were empowered to choose between the blunt, gruff, unkempt but clinically expert nurse who gets the job done and the "patient friendly" politically correct but clinically inferior nurse I would take the first one every time. ANd yet it's the first one who gets complained about and run out of town and the second who gets promoted to managerial status. Grrr.
Me again....
I'm hosting Change of Shift on Feb 8th, and I'd like to include this post. Please let me know if that's OK.
Thanks, MJ
Of course you can, MJ, I would be honored.
'ANd yet it's the first one who gets complained about and run out of town and the second who gets promoted to managerial status'
I had to laugh when I read this, I bumped into a colleague the other day who never could cut it as a nurse on the unit but is now director. She was wearing four inch stilleto's, guess her staff can't count on her being on the floor helping much, huh?
Seems like you struck a chord with this one, sir scalpel. I never filed any complaints. I did get into a couple of rip-roaring "discussions" over something I thought egregious (because it was); the upshot, of course, was that I was called on the carpet for being impolitic.
Hi fellow Texan!
My first time here, glad I found you.
Great post, There's always "That" nurse on every unit. On my unit "that" nurse scares the socks off me...I hate following her and I'm afraid she's gonna kill someone.
Despite multiple complaints she's still there.
Well, here goes. Nurses lashing out at other nurses. An author who stereotypes and uses patriarchal nomenclature to label and judge nurses - and nurses jump right in and reinforce that this is OK to do.
No, it's not.
While speed and efficiency are two pieces of practice, they, in an of themselves, do not characterize expert practice. Neither does the willingness and availability of the nurse to assist a physician.
Come on, nurses - assert your autonomy. Explain how you are practicing with the patient's welfare as primary goal. Assisting another professional is inherent in the practice arena, but nurses don't exist to serve physicians or other therapists. They exist to provide intelligent, timely and planned care to patients, to educate patients and to assist them in being able to care safely and effectively for themselves (or by providing the professional care that they need to survive and recover or which lead to a peaceful death).
I practiced administratively as a support to nurses and patients. To label all managers and administrators in the way that was done here is bigoted, insulting and doesn't do a damn thing for the profession.
Come visit my blog, Universal Health where all nurses (physicians, and patients, too) are welcome, where you can learn to overcome the seemingly overwhelming problems that nursing faces, and where you can learn to advocate more effectively for nurses and for patients.
Couldn't cut it in the trenches, eh ;? LOL.
;) you are bad scalpel ... but very funny!
What the previous comment failed to grasp was the POOR practice of the nurse in question. I mean 70/30 ?!? I share your dislike for complaining about anyone - more crap gets on you than gets where you want it anyhow. But when patient safety is compromised that is enough.
I also quasi-agree with the comment against the union. I feel that it takes a alot of managerial essense away from managers and does protect nurses who perhaps wouldn't make it.... but I do disagree that it is something to be abandoned. How about a new model.
Thanks for the good read!
Linda
It's refreshing to hear these observations from a physician. We don't have peer review, we have a time clock. Not in all states are we "required" to do continuing education. The nursing station can, at times, feel like a typing pool.
I like to think that those of us that are second-career bring a wider variety of attitudes to careers and how and why one can smooth things out in the workplace. When a nurse is not practicing professionally, there's little many nurses have learned how to address the problem than "tattling", and email has allowed some to do so without having to look at a person or consider their words carefully.
It's a BIG job to try and change this, but nurses have to. We really must.
/jo
When Nursing Practice Isn't Up To Snuff may be of some help to you - or not.
Wow! You got the comments going here!
I've noticed talking behind backs in the ER.
It was amazing to me that someone would ask a doctor to complain about a nurse because it would have more clout than all the nurses complaining.
How can I put this delicately?
Some of us in ER are quicker to jump up than our colleagues and then to have more work and charting to do.
As far as the 70/30 BP, I would have not left the room until I had (1) verified the BP by repeating it on one or both sides (2) look at the patient to see if they really looked as if they were hypotensive [diaphoretic, pale, tachycardic, dizzy].
But you are right - the level of compentency and the personality of the personnel be they RNs or MDs really make a difference in how the shift progresses! More so in ER than anywhere else - ER is like a dance and sometimes we waltz and sometimes we break-dance, but we need to do it together!
I will state that N=1's link to the post on nursing quality is worth checking out - there is actually a plan to deal with performance issues discussed there that makes a lot of sense to nursing!
Nurses have an inferiority complex, duh!
And, I am neither a nurse nor physician, but am I correct in assuming that Bertha was a double minority? Black and a woman? Wow, we've got you held hostage like that??!! Wish we all knew we held that type of power: the inability to be fired. Then maybe we wouldn't be poverty stricken, with ten kids, no husband/father to speak of, no education...
Nobody has absolute protection against being fired. But some folks are given a little extra consideration (for one reason or another), and I don't really have a problem with that. I had no problem with her personality, her race, or her gender. Her performance (or lack thereof) was the reason she had to go.
Dr. Scalpel,
A 74 yo male, had a CT inserted, via interventional radiology. At change of shift,a Resident placed a new bandage. @1930 a surgeon appeared and replaced the dressing. He showed me EXACTLY how to do it. Every 45 minutes, i needed to change the dressing as pt was oozing profusely. As I was a OR tech before nursing, I kept all the gauze containers to keep track of all the sponges I went through. Despite 45 minutes of direct pressure,he was still bleeding, the resident okay'd 10 lbs of sandbags. While applying direct pressure, I noticed the patient was a vegetarian...aha..herbals! He was on VitaminE, garlic, gingo, etc, all OTC which thin the blood. I listed 30 items he was taking and fax'd to the pharmacist to aide in medication reconciliation. By MN, i had my charge RN call the attending surgeon. He was rude and said,'Just do what I tell you to do." And I replied angrily and with frustration, that what he told me to do was not working. By the AM , he had dropped his HGB 2 points.
This surgeon reported me to my agency and the hospital does not want me to return to work there. I am a single Mom, age 53, I've been an RN for 23 years. Also,that 12 hour night shift, I admitted 2 patients to the floor, while attending to this patient.
What is the best professional way for me to handle this? (He is a surgeon, so therefore he makes the money for the hospital, not me. Other RN's have complained about him,(amongst themselves) yet are too busy and stressed to bring it to administration attention. )
Looks like MD's really are bitter snobs...
Egotistical pigs like you make me barf!
This post makes me want to scream and punch something. If only physicans knew how hard we really have it.
Hey Doc,
R U interested in a solution to this what seems to be an ongoing problem? (Because I Do have it)
Or is this just a way to vent like all the rest? We can either be a part of the solution or part of the problem. I commend you for not doing what is considered lowering yourself to the levels of those who obviously have nothing better to do. The nurses in this country have a tremendous amount of responsibility on them,more than they can safely handle ( in most cases).I for one along with many other professionals in the medical field believe that the middle management (not the nurses or the nursing managers) but the P.A'S of this country should be the ones to eliminate this crisis by assuming the roles of advocate on behalf of the best interests of the patients and their health, by assuming the duties of some of the paperwork that would allow the nurses to do the job that they were trained to do....I do believe that there are exceptions to every rule, but with that said; what ever happened to the patient comes first? We all as pro's must remember WHY WE R HERE!!!!
Hey Doc,
R U interested in a solution to this what seems to be an ongoing problem? (Because I Do have it)
Or is this just a way to vent like all the rest? We can either be a part of the solution or part of the problem. I commend you for not doing what is considered lowering yourself to the levels of those who obviously have nothing better to do. The nurses in this country have a tremendous amount of responsibility on them,more than they can safely handle ( in most cases).I for one along with many other professionals in the medical field believe that the middle management (not the nurses or the nursing managers) but the P.A'S of this country should be the ones to eliminate this crisis by assuming the roles of advocate on behalf of the best interests of the patients and their health, by assuming the duties of some of the paperwork that would allow the nurses to do the job that they were trained to do....I do believe that there are exceptions to every rule, but with that said; what ever happened to the patient comes first? We all as pro's must remember WHY WE R HERE!!!!
Great article. I have been thinking about this a lot lately.
As a second degree student in an accelerated BSN/MSN program, I am appalled at how dysfunctional my class is (and we are still students!) as compared to the students at my first degree institution.
I am wondering, is there something about the nursing profession that attracts snotty women? (I should add that there is one male in the program who is the biggest gossip of all...)
Though people like me (to my face, at least), I feel very lonely. I would rather read a book than talk to my classmates because the only topic they can discuss is each other. Though I am sure because I am reading a book, I am talked about even more!
Maybe you should show a little more respect for the stress that us nurses go through just in the day to day annoyances - demanding families, patronizing MDs, managers tacking on even more non-nursing responsibilities. Maybe after you stop and thank a nurse for all she does even while not being appreciated by the general public who has more respect for MDs will you stop getting complaints about you. Isn't this whole bitchy article contradictory to your point that nurses complain a lot? Pretentious bastard doctor.
The doctor is right, first off. A hospital is a place of health care of patients, and safety. It is not high school, who cares about what you don't like about the person, maybe you should focus more on patients and the patients care, if a nurse is not doing there job correctly that is fair for you to report, however being to blunt? how childish. I will be honest, If you cant stand working with many different people, and You dont like the way your fellow nurses personalities are, maybe you should think about what you could be doing in the time that you are using to write a spiteful email, and I don't know do your JOB as a nurse and care for your patients!.- A Medical School Grad!
Firstly, I agree completely with what this blog says. Unfortunately, it seems like many incometent nurses have the ability to control hardworking doctors by filing irrational complaints because their "feelings are hurt" when a doctor gets upset because an incompetent nurse puts a patient's well-being at risk. But, what can a doctor do to protect himself? It seems like nurses have so much potection from unions and such but really, how can a doctor relay his side of the story? I used to be a nurse and some days, I would make minor mistakes and get yelled at for it. This made me want to cry at times, but I realized my mistake and worked harder! We're dealing with life or death situations!
I'm raising this issue because my husband, who is a very mild-tempered physician, has been having trouble with one particular nurse who constantly fails to perform when she is expected to, leaving patients bleeding, slowing down procedures, and bringing down quality of care. Today, after many of these mishaps, he raised his tone for the first time. He did not insult her, he did not hit her, he merely expressed that she do what is expected of her in emergency situations so the patient can be well taken care of! She apparently filed a complaint and he was reprimanded by an administrator. What can he do to protect himself? Should he get an attorney involved? Ugh- what a pain!
Is the nurse you mention in the beginning "overly sensitive" or are you perhaps overly unaware of professional boundaries? Nurses, like any other person may have hx of abuse and deserve respect, courtesy, and space. Those concepts still seem difficult for many MDs. It's a typical ER doc view that the nurses are there for you (rather than for the patients) and are judged by you in terms of order delivery and speedy care. I would assume you would be fine with robots too if they were able to put IVs in and wipe butts. It's very sad sign that your dept. manager did not have the backbone to use discipline against XY, and rather relied on your assumed authority.
I am really interested in the comment that was made about how unions have changed the face of nursing and created a new generation of young nurses that would be better suited as GM`s...or something like that. What is interesting is that in my experiences, it is the more senior nurses that seem to enjoy their seniority and have a certain disregard for the importance of staying up to date on the most recent evidence based practice guidelines. I am not saying that this is true for all experienced nurses that I have worked with, but in the 8 years I have been an LPN I have certainly ran into a fair share of those that fit the description....mostly in LTC, where I am expected to do the bulk of their job while they sit around and gossip. Please excuse me for sounding bitter. On the other hand, I have never met a young nurse that didn`t always strive to find the right information so that they were confident about what they were doing and able to back it up. There have been numerous instances when RNs have taken for granted the fact that I understand how to conduct research properly and can prove them wrong with what they didn`t even bother to look up...only assumed that they knew.
I am not in the medical field but and I have met plenty of doctors and nurse in public and quite a few of friends in both professions I am a restaurant owner in Los Angeles.
I am always annoyed when nurses constantly bash doctors and claim that they are the most important people in a hospital.( I truly doubt that since they are part of a team )
Doctors > nurses
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