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.
Labels: ER, nurses, politics