Do doctors really look down on nurses?

[Pir8DeacDoc]

"Has patient A received her morning IV Bactrim dose yet? She'd really like to take a shower and can't until she has." and the nurse snaps back at me (in a singsong voice), "No, because she was off the floor until 9:30." Now keep in mind that at this point it's 10:30. The Bactrim is sitting in the med room waiting to be hung. What, exactly, has occupied you for the last hour such that you could not give it and note that in your Medex? That should be, at most, a 3 minute procedure? Any nurses care to correct me?

If I were a nurse I wouldn't give a crap about some med student asking me if so and so got their bactrim. Nurses do take care of more than one patient at a time. This particular nurse of whom you speak might be lazy, but I don't think your example really makes that obvious.

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[fineline]

If I were a nurse I wouldn't give a crap about some med student asking me if so and so got their bactrim. Nurses do take care of more than one patient at a time. This particular nurse of whom you speak might be lazy, but I don't think your example really makes that obvious.

You're not a nurse, but that's stuff that nurses say to defend themselves, which is crap. First of all, why would it matter who is telling you something, med student or not? Does that alter the message itself? No -- except that to most nurses, it does. Nurses consider themselves "senior" to medical students and anyone below PGY-II (or even PGY-III if it's a super-b!tch). And that's hilarious, given that their seniority is not based on actual knowledge, but rather just on "how many days have I worked here."

I had one nurse lecture me on something I "got wrong" and she was completely wrong. When SHE was lecturing ME, she gave me this long spiel about "it doesn't matter if I'm a nurse, you should be glad to learn from anyone." When I corrected HER, she went into conniptions and I deliberately told HER "it doesn't matter if I'm an intern, you should be glad to learn from anyone, right?" Her head nearly exploded. You know why? Because nurses don't care about who is right, all they know is that nobody who is two decades younger than them should be allowed to give them orders.

Also, they have more than one patient, but it's usually something like five patients they carry at most. If they can't hang antibiotics within one-and-a-half hours of someone returning to the floor, they're clearly incompetent. During the time THAT patient was off the floor, they could be doing OTHER work so that when the patient returns they are ready for HIM. But instead, they take a break and chat, then complain that they're behind on all their work.

 

[RockfordWF]

You're not a nurse, but that's stuff that nurses say to defend themselves, which is crap. First of all, why would it matter who is telling you something, med student or not? Does that alter the message itself? No -- except that to most nurses, it does. Nurses consider themselves "senior" to medical students and anyone below PGY-II (or even PGY-III if it's a super-b!tch). And that's hilarious, given that their seniority is not based on actual knowledge, but rather just on "how many days have I worked here."

SO TRUE

 

[Pir8DeacDoc]

My point remains the same, I wouldn't want some overzealous medical student looking over my shoulder seeing when I gave meds if I were a nurse. We all know the type of student of which I speak.

I will say that I've probably been spoiled in terms of nursing competence at my hospital. My med school hospital had really pretty bad nursing but where I am now is much better.

 

[fineline]

We all know the type of student of which I speak.

Yes, we do. However, the fact that there are a lot of hyperactive medical students isn't the reason nurses don't do their jobs (e.g., don't have scheduled medications for like ten hours). It happens to occur at the same time, but it's not the causative factor, which is why it's such a lame argument.

 

[chocomorsel]

Many of the nurses I know are hard-working and caring. I especially appreciate the nurses who listen to me (the medical student) when I tell them my patient is in pain and ask them if they can get their PRN pain meds ASAP. What I don't like is the nurse who responds to my "Has patient A received her morning IV Bactrim dose yet? She'd really like to take a shower and can't until she has." and the nurse snaps back at me (in a singsong voice), "No, because she was off the floor until 9:30." Now keep in mind that at this point it's 10:30. The Bactrim is sitting in the med room waiting to be hung. What, exactly, has occupied you for the last hour such that you could not give it and note that in your Medex? That should be, at most, a 3 minute procedure? Any nurses care to correct me?

Yup, I'm a nurse and I care to correct you. Floor nurses typically take care of 5-6 patients. When you come in in the mornings, you go check on all your patients, assess them, check their charts for new orders/new updates then start your meds. Depending on what type of meds or what type of activities are going on with the patients, meds may take anywhere from 1-3 hours. It's not like you have actual blocked, uninterrupted time to concetrate on nothing but meds. Doctors are calling, giving new orders, PT/OT's are trying to steal the patients and need them premedicated, other patients are in pain needing pain meds, lab wants blood, CT/XRAY's need to get done, IV's need to be replaced, patient may be bleeding/vomiting......., so there are alot of distractions. If your patient leaves the floor, well heck you have 5 others to worry about giving meds to, so when the other one returns you may still not be able to get to them in a timely manner. So what may seem like a 3 minute procedure to you, essentially can turn into an hour. Does that answer your question? Nurses get pulled in a lot of different directions at once. Doctors aren't the only busy ones you know.

Yes, there are many lazy nurses out there, but many times, other aspects of patient care get in the way of pertinent stuff getting done.

 

[Blade28]

Fineline,

You're going to be single forever. You know that, right?

That's not necessarily a bad thing!

Yes, there are many lazy nurses out there, but many times, other aspects of patient care get in the way of pertinent stuff getting done.

Agreed. I think the residents/fellows/attendings in this thread will agree that while sometimes things don't get done because the nurse is truly busy (sick patient, floor transfer to ICU, new admissions, etc.), sometimes it's out of laziness.

 

[Tired]

Depending on what type of meds or what type of activities are going on with the patients, meds may take anywhere from 1-3 hours. It's not like you have actual blocked, uninterrupted time to concetrate on nothing but meds. Doctors are calling, giving new orders, PT/OT's are trying to steal the patients and need them premedicated, other patients are in pain needing pain meds, lab wants blood, CT/XRAY's need to get done, IV's need to be replaced, patient may be bleeding/vomiting......., so there are alot of distractions. If your patient leaves the floor, well heck you have 5 others to worry about giving meds to, so when the other one returns you may still not be able to get to them in a timely manner. So what may seem like a 3 minute procedure to you, essentially can turn into an hour. Does that answer your question?

When orders are written on a certain schedule, it is not unreasonable to expect that either (1) it will be given according to the schedule written, or (2) you can explain to someone who asks why the med wasn't given and when it will be done. This is not unreasonable. As an RN, you have enough education to understand that the septic patient needs the Vancomycin more than PT at 0900. You run the floor, you decide when the patient goes/doesn't go, and so you are responsible for setting the priorities of care delivery.

When an RN tells me, "I couldn't give the Bactrim at 0900 because the patient had a STAT Head CT, so I will give it at 1000 when they return" I say thank you and have a good day. When an RN tells me, "I didn't have time, and I don't know when I'll get to it" that is unacceptable. Ask for help from your coworkers or charge RN. Hell, call me and ask for help, I'll come running. God knows I can't count the number of patients I've pushed down for Xrays and scans, and I can push an IV med. But delaying mission-critical medications is just not an option that should even be considered.

 

[MSI-Scrub]

I am a third year nursing student, and the floor I am on for clinicals has many resident doctors. They are all very polite and work hard. Now I am wondering what they think of us nursing students coming onto their floor. From the threads that I have read on this forum, many doctors view nurses as inept, lazy, and all are conspiring to gang up on doctors to prove them wrong.

I am hard-working, conscientous, and would hate for anyone to view me that way. I hate to say it, but I know that there are huge differences in how some nursing students take studying seriously while others may go out and party. End result: There can be a huge difference in nurses' abilities and their work ethic (as there are in doctors). Please do not generalize all nurses. Many of us (the ones in my clinical group, for example) work very hard and work with the doctors. We also study so much it cuts into our socializing time. We sacrifice that time to work on what is important now. I want to know all I can to make the best decsions for my patients. However, I still have so much to learn and fear making mistakes all of the time. Just as residents and med. students worry about getting yelled at by their attending doctors, I fear getting yelled at by the grumpy charge nurse! We are supposed to be working as a team, and to what benefit is it to our patients if we work against one another.

uggh...and the stories of sleezy nurses? They've gotta go!

Good nurses make the OR fun yet safe, the wards run smoothly, patients happy, and the world a better place.
Bad nurses can make the hospital miserable.

 

[chocomorsel]

When orders are written on a certain schedule, it is not unreasonable to expect that either (1) it will be given according to the schedule written, or (2) you can explain to someone who asks why the med wasn't given and when it will be done. This is not unreasonable. As an RN, you have enough education to understand that the septic patient needs the Vancomycin more than PT at 0900. You run the floor, you decide when the patient goes/doesn't go, and so you are responsible for setting the priorities of care delivery.

When an RN tells me, "I couldn't give the Bactrim at 0900 because the patient had a STAT Head CT, so I will give it at 1000 when they return" I say thank you and have a good day. When an RN tells me, "I didn't have time, and I don't know when I'll get to it" that is unacceptable. Ask for help from your coworkers or charge RN. Hell, call me and ask for help, I'll come running. God knows I can't count the number of patients I've pushed down for Xrays and scans, and I can push an IV med. But delaying mission-critical medications is just not an option that should even be considered.

It's great that you are a team player and are helping out the RN's on the floor. But don't tell me that you've never gotten into situations when other patient's priorities get in front of others which are just as important and things are delayed or God forbid, even missed. In the ideal world, yes you prioritize and go from most important to least on every patient. But that's assuming everything else is held constant which it hardly if ever is. Obviously you will never understand this unless you yourself have worked the floor as a nurse and been pulled in ten different directions regarding important aspects of patient care. And of course I cannot understand what you residents go thru until I get there myself. But yes, I'd like to see a resident hang some meds and work an infusion pump. Most don't know how, unless they are in anesthesia. And seriously, there usually isn't enough help out there. Ever heard of the nursing shortage?
I'm not trying to make excuses, just explaining that things frequently get crazy on the floors. Yes, there are quite a few lazy ones, and even the hard working ones have bad days too. But let's not assume that when things don't get done in a timely manner, people are sitting on their lazy behinds gossiping and neglecting their work.
Anyway, enought of my rant.

To the OP, don't think that all docs look down on nurses. Some do, most don't. Besides there are many nurses who don't give many doctors a chance because they assume that they are all snooty dinguses. Yes some are, but most aren't. But don't let that affect you and your future goals.

 

[fineline]

But yes, I'd like to see a resident hang some meds and work an infusion pump.

I have no idea why nurses constantly think this is a mark of their superiority. Here's why we don't know how to work infusion pumps: WE DON'T NEED TO. That's not our job. Do you know how to build a television? No? Are you crazy? Shouldn't EVERYONE know how to build a television? The fact that nurses think that SOMEONE ELSE should be hanging meds demonstrates how completely inappropriate they are.

I also liked how you listed things like "CT/XRAY's need to get done" and "patient may be bleeding/vomiting" as reasons a med wasn't hung. Nurses have nothing to do with radiologic studies 95% of the time and patients are not routinely sitting around bleeding uncontrollably on the floors. You're just trying to justify nurses not doing their job by acting like it's a catastrophy scene every day you come to work.

If a patient is down getting a study, there's NO REASON that they can't get their nursing duties fulfilled. You know why? Because it's not like they went downstairs and YOU GOT AN EXTRA PATIENT ON TOP. You have five patients, one went down for a study, guess what? Now you have four on the floor, which means you get their stuff done ...patient comes up, you get HIS stuff done. Is this rocket science?

 

[Pir8DeacDoc]

In regards to nurse poster above when they talk about radiology studies, I assume they meant they were tied up calling transpo to get the patient to that study and also helping get the patient off their fat a$$ and into the wheelchair/stretcher and ready to transport to radiology.

We have some ****ty nurses here but it sounds like you guys have sloths running around your hospital. Sorry your experience sucks so badly.

 

[Blade28]

From my many months working at our busy county hospital, I know how to:

(1) Prepare IV meds (Levaquin, Dopamine, etc.), set up the pump, and hang it
(2) Transport a patient to and from the ER, trauma bay, floor, step-down unit, ICU, OR, IR, x-ray/CT/MRI/ultrasound/angio (I probably transport patients 2-4 times any given day)
(3) Start IVs (usually in the AC, wrist, hand or EJ)
(4) Draw blood (usually from the hand, wrist or foot) for Cx, CBC, chemistries, coags, T&S, T&C, etc.
(5) Change the patient's gown, clothes, dressings, bedding
(6) Show other people (nurses, techs, med students, interns, etc.) how to place an NG tube/place a Dobbhoff/replace a malfunctioning Foley/replace a rectal bag or tube/unclog a nasogastric, PEG, PEG-J, G-tube or J-tube
(7) Clean the patient's bed, room floor, room walls, room ceiling, room doors, room windows, bathroom sink, bathroom toilet, bathroom tub, bathroom floor

Etc.

 

[chocomorsel]

I have no idea why nurses constantly think this is a mark of their superiority. Here's why we don't know how to work infusion pumps: WE DON'T NEED TO. That's not our job. Do you know how to build a television? No? Are you crazy? Shouldn't EVERYONE know how to build a television? The fact that nurses think that SOMEONE ELSE should be hanging meds demonstrates how completely inappropriate they are.

I also liked how you listed things like "CT/XRAY's need to get done" and "patient may be bleeding/vomiting" as reasons a med wasn't hung. Nurses have nothing to do with radiologic studies 95% of the time and patients are not routinely sitting around bleeding uncontrollably on the floors. You're just trying to justify nurses not doing their job by acting like it's a catastrophy scene every day you come to work.

If a patient is down getting a study, there's NO REASON that they can't get their nursing duties fulfilled. You know why? Because it's not like they went downstairs and YOU GOT AN EXTRA PATIENT ON TOP. You have five patients, one went down for a study, guess what? Now you have four on the floor, which means you get their stuff done ...patient comes up, you get HIS stuff done. Is this rocket science?

I was responding to the poster above who said that nurses should ask him for help. No one said SOMEONE ELSE should be doing nurses jobs either. Infer what you want, it's not what was said. Thing is, if residents wanted to learn, and some do, about simple things as infusion pumps, nurses would teach them. It's not rocket science. Nurses don't think they are superior over some simple **** like that. All I'm saying is that you guys are on the outside looking in, and you tend to generalize ****. Don't really know what it's like, just like nurses don't know what you guys' job is like. But whatever, because next year I will be a resident. One who understand what nurses are faced with and can relate.
I'm out.

 

[chocomorsel]

From my many months working at our busy county hospital, I know how to:

(1) Prepare IV meds (Levaquin, Dopamine, etc.), set up the pump, and hang it
(2) Transport a patient to and from the ER, trauma bay, floor, step-down unit, ICU, OR, IR, x-ray/CT/MRI/ultrasound/angio (I probably transport patients 2-4 times any given day)
(3) Start IVs (usually in the AC, wrist, hand or EJ)
(4) Draw blood (usually from the hand, wrist or foot) for Cx, CBC, chemistries, coags, T&S, T&C, etc.
(5) Change the patient's gown, clothes, dressings, bedding
(6) Show other people (nurses, techs, med students, interns, etc.) how to place an NG tube/place a Dobbhoff/replace a malfunctioning Foley/replace a rectal bag or tube/unclog a nasogastric, PEG, PEG-J, G-tube or J-tube
(7) Clean the patient's bed, room floor, room walls, room ceiling, room doors, room windows, bathroom sink, bathroom toilet, bathroom tub, bathroom floor

Etc.

Good for you. But many residents don't know a lot of this stuff. And they can learn all this simple things but many are too busy or just don't care to. It's funny because when nurses can't get in difficult IV's they sometimes ask the residents. Do they not realize that most residents are poor at that job? I wouldn't want a resident besides one in anesthesia starting my IV. It's just not a daily thing like it is for nurses. Anyway, good that you learned all this stuff. Comes in handy.

 

[Blade28]

Good for you. But many residents don't know a lot of this stuff. And they can learn all this simple things but many are too busy or just don't care to. It's funny because when nurses can't get in difficult IV's they sometimes ask the residents. Do they not realize that most residents are poor at that job? I wouldn't want a resident besides one in anesthesia starting my IV. It's just not a daily thing like it is for nurses. Anyway, good that you learned all this stuff. Comes in handy.

I agree.

I always laugh when nurses ask me to place an IV, because 99% of the time, if they can't get it, there's no way I'll be able to!

An exception is if I go for the EJ - apparently nurses aren't allowed to use this vein?

I'm much more comfortable placing a central line or arterial line than a plain ol' IV.

 

[Tired]

It's great that you are a team player and are helping out the RN's on the floor. But don't tell me that you've never gotten into situations when other patient's priorities get in front of others which are just as important and things are delayed or God forbid, even missed.

Of course I have. I'm human. But I guess the difference between you and me is that you feel it's okay when you're "too busy" and "things get missed", whereas I do not. You can pretend like being busy and the "nursing shortage" is an excuse for harming patients if you like, I suppose. But I will still be right behind you asking why the patient with sepsis didn't get their antibiotics on time.

 

[Winged Scapula]

I agree.

I always laugh when nurses ask me to place an IV, because 99% of the time, if they can't get it, there's no way I'll be able to!

I'm much more comfortable placing a central line or arterial line than a plain ol' IV.

Exactly. If you call me for a line, they're almost assuredly getting something central.

 

[fineline]

Thing is, if residents wanted to learn, and some do, about simple things as infusion pumps, nurses would teach them.

What I don't think you understand is that I'm not interested in learning how an infusion pump works. Because as soon as I start working it, then I start inheriting it as a duty. I don't pretend that I know everything about how a nurse's day goes -- I do, however, have eyes and see how quickly they work, how they spend their days, and how they go about doing their duties. (Don't anyone get me started on night nurses, either. I've seen a minority -- but a constant minority -- of night nurses sleeping on the job.)

 

[jessica84]

Okay....here's for my semi off-track vent. I know that many nurses get a bad rap for just being, well dumb. This is really frustrating when you are new and really are quite literally thrown into clinicals, not realizing that there is so much that you were never exposed to in a hospital setting. And I am not even talking about patients and their conditions...that I can handle. It's the other stuff. I, for one, probably looked pretty dumb today in clinicals. I had to ask questions about basically every machine I had to work. In a workplace that expects you to know what you're doing and be good at it (rightfully so), I started to question my training and my future as a nurse because I felt scared and incompetent. I am not dumb by any means (but anyone who would have followed me probably would have seen my lack of knowledge in syringe pumps, med. computer scanning, bolus IV drugs, etc. and would have quickly came to the conclusion that I was an idiot.) Why is it that I was never taught these things previously (like BEFORE setting foot into a hospital???) I understand a lot of the pathology, signs and symptoms of the patient, effective treatment, nursing parameters, can do a thorough physical on my patient, but the essentials in the hospital (IV pushes, bolus, etc.) have been bipassesed along the way (and I'm not sure if this is at most nursing schools). I'm going to be looking pretty ignorant for a while. I feel that there is so much crap that I have to do in nursing school (i.e. give presentations on, for example toilet training....well, crap and a bunch of common sense...when I could be learning important things) and so I am left to go off on my own, research what I can to learn the essentials so that I am not left swimming on my own in the hospital...which is what I am doing. I feel as though I have to teach myself a lot on my own.

 

[fineline]

There's always a period of adjustment when you go from the classroom to dealing with real patients. Usually, you spend most of your classroom time learning about theoretical stuff and not practical things that help you on a day-to-day basis. Those things are easier to pick up, anyways. You can learn how to bolus someone in about thirty seconds, all you need to do is be shown once.

 

[jessica84]

Yes, for some things, you learn it once and that's it, but there are things that are a little more complicated...and there is so much thrown at you at once. I know I'll get it eventually, but this is doing nothing for my confidence right now.

 

[fineline]

Once you start doing things on a daily basis, you'll get used to it. Physically doing something is easier than thinking about it. It's like driving a car -- if you start telling a kid all the things they have to do and check all at once, it seems like it's impossible. Then they do it a few times and it's simple.

 

[jessica84]

Thanks. This is true...eventually it will all become old hat. I just need to be patient and get over my worries while I'm adjusting to all of this. Hey, you actually can give some good advice.

 

[fineline]

I give great advice. I also cut through the B.S. That saves me a lot of time to talk about big breasts.

 

[jessica84]

...should have known

 

[fineline]

It's not like I was keeping it a secret. LOL

 

[jessica84]

On a different note, I'm not so sure I'm liking acute care/med. surg. bedside nursing. (That's what I'm in for clinicals.) I feel as though I'm generally running from patient to patient dealing with alarms, giving meds., and running around like a chicken with my head cut off (Very little pt. interaction). From what I hear, that's what most new nursing grads. are doomed to do for the first few years unless they are lucky enought to get into their particular choice (i.e. OR, ICU, etc). Anyone know of any tips to get into a field of choice? I'm working so hard and excelling at school (haha, yeah well, ummm...not today)...

 

[Blade28]

Wouldn't working in an ICU be tougher than med/surg when you're fresh out of nursing school?

That would be a pretty terrifying environment, IMHO. Patients are MUCH sicker.

 

[elwademd]

On a different note, I'm not so sure I'm liking acute care/med. surg. bedside nursing. (That's what I'm in for clinicals.) I feel as though I'm generally running from patient to patient dealing with alarms, giving meds., and running around like a chicken with my head cut off (Very little pt. interaction). From what I hear, that's what most new nursing grads. are doomed to do for the first few years unless they are lucky enought to get into their particular choice (i.e. OR, ICU, etc). Anyone know of any tips to get into a field of choice? I'm working so hard and excelling at school (haha, yeah well, ummm...not today)...

Wouldn't working in an ICU be tougher than med/surg when you're fresh out of nursing school?

That would be a pretty terrifying environment, IMHO. Patients are MUCH sicker.

while icu/dou are tougher, it's easier to step down in the future (go from icu down to med/surg) then it is to step up (from med/surg to icu). from what i've seen, and what my g/f has told me (she's 2 years out of nursing school, works in step down/dou) you learn your skills in nursing school, work on them a bit, then "get the hang of it". on med/surg, there's no drips, little calculation... hell, you might not even be able to give ativan iv or im!

with that said, most hospitals have a lot more med/surg beds than beds in other units... and thus have more potential slots for nurses.

but to be more marketable as a nurse, you should truly think of starting off in icu or stepdown/dou- easier to move from unit to unit within the same hospital, take a charge nurse position, or go to another hospital... or whatever the case may be. also, many hospitals start of the new grads precepting under another nurse for a month or so, to "get the hang of it."

 

[core0]

while icu/dou are tougher, it's easier to step down in the future (go from icu down to med/surg) then it is to step up (from med/surg to icu). from what i've seen, and what my g/f has told me (she's 2 years out of nursing school, works in step down/dou) you learn your skills in nursing school, work on them a bit, then "get the hang of it". on med/surg, there's no drips, little calculation... hell, you might not even be able to give ativan iv or im!

with that said, most hospitals have a lot more med/surg beds than beds in other units... and thus have more potential slots for nurses.

but to be more marketable as a nurse, you should truly think of starting off in icu or stepdown/dou- easier to move from unit to unit within the same hospital, take a charge nurse position, or go to another hospital... or whatever the case may be. also, many hospitals start of the new grads precepting under another nurse for a month or so, to "get the hang of it."

As a non nurse I would disagree. The skill set is very different for a floor nurse vs. an ICU nurse. The principle thing you learn on the floor is time management. How to provide nursing care for 4-6 patients at a time. I have seen lots of ICU nurses get in trouble when floating because of this. As far as drips, I'm not sure where your girlfriend works but drips are very common on the floor where I work.

The other issue is assessment skills. They are very different between the floor and the unit.

Usually not pressors but Insulin drips and other contiuous meds. My advice if asked is work on the floor for a year to get good time management skills and assessment skills. Then move where you want to go. The caveat is that if you want to do Peds/OR/OB/some other specialty just go there the skills won't really help you there.

David Carpenter, PA-C

 

[gutonc]

but to be more marketable as a nurse, you should truly think of starting off in icu or stepdown/dou- easier to move from unit to unit within the same hospital, take a charge nurse position, or go to another hospital... or whatever the case may be. also, many hospitals start of the new grads precepting under another nurse for a month or so, to "get the hang of it."

As in critical care medicine, there is a trend toward extra training/experience for CC nurses. Our Univ hospital requires 2y as a floor nurse plus a 3 month ICU internship before you can work on the unit. This isn't obviously the case everywhere but I think things are headed that way.

 

[Top Gun]

Okay....here's for my semi off-track vent. I know that many nurses get a bad rap for just being, well dumb. This is really frustrating when you are new and really are quite literally thrown into clinicals, not realizing that there is so much that you were never exposed to in a hospital setting. And I am not even talking about patients and their conditions...that I can handle. It's the other stuff. I, for one, probably looked pretty dumb today in clinicals. I had to ask questions about basically every machine I had to work. In a workplace that expects you to know what you're doing and be good at it (rightfully so), I started to question my training and my future as a nurse because I felt scared and incompetent. I am not dumb by any means (but anyone who would have followed me probably would have seen my lack of knowledge in syringe pumps, med. computer scanning, bolus IV drugs, etc. and would have quickly came to the conclusion that I was an idiot.) Why is it that I was never taught these things previously (like BEFORE setting foot into a hospital???) I understand a lot of the pathology, signs and symptoms of the patient, effective treatment, nursing parameters, can do a thorough physical on my patient, but the essentials in the hospital (IV pushes, bolus, etc.) have been bipassesed along the way (and I'm not sure if this is at most nursing schools). I'm going to be looking pretty ignorant for a while. I feel that there is so much crap that I have to do in nursing school (i.e. give presentations on, for example toilet training....well, crap and a bunch of common sense...when I could be learning important things) and so I am left to go off on my own, research what I can to learn the essentials so that I am not left swimming on my own in the hospital...which is what I am doing. I feel as though I have to teach myself a lot on my own.

Its the same thing for med students. We learn a lot of anatomy, biochem, physiology, and path during our first two years of med school. But in the first two years, we don't learn anything about how to write orders, write SOAP notes, or even do simple procedures like blood draws, etc.. All of these things are much more useful during third-year than memorizing the different steps in the Krebs cycle. So naturally, we're in the same boat as you during our clinicals and often have to ask lots of questions as well. There are days when we may look like *****s as well. However, like everything else, once you get enough practice in doing all of the skills I mentioned above, they become like second nature. The same thing will happen for you.

 

[jessica84]

Good point, TopGun. The med. students at our teaching hospital just started their new rotation yesterday on my floor (peds) and looked just as confused. Some looked quite stressed, and I felt bad for them (even through my own stress). I am in a peds. clinicals (by choice)..that's definitely what I want to get into, and my patient I was assigned had a buretrol. I never learned about a buretrol (i.e. its significance or even that it existed) in my peds. class...frustrating. Then, on the floor, I was quickly taught how to use it, but didn't know that an alarm would go off every half hour (for ex. after the flush, etc.). I didn't even know why it was used, so I had to go off and do some exploring on my own. Yeah, and I also had to learn about the Kreb's Cycle ...memorizing every last step. My physiology professor had us write it out in essay form. Do you think I remember all of it in excessive detail? I need to start my own nursing school...

And to the other posters, thanks for the input on specialties. I wouldn't mind having to do med. surg. to start if it would lead to something else (though I honestly don't enjoy it), but I've heard of so many new grads. who get stuck and can't find anything else once they're there. I'd love to find a great orientation program that taught me all to know about ICU, OR, or another specialty...I'm keeping my options open.

 

[Blade28]

As far as drips, I'm not sure where your girlfriend works but drips are very common on the floor where I work.

Only some of them, right? The commonly used ones here are insulin, heparin, MAYBE morphine/fentanyl for the terminally ill.

I doubt you'll see pressors, vasoactive substances, blood product drips, etc. on the floors!

 

[chimichanga]

Any nurses care to correct me?

No...

Nurses have been known to punish pts for being human...

But so do some ER docs...that's another thread...

 

[chimichanga]

Yup, I'm a nurse and I care to correct you. Floor nurses typically take care of 5-6 patients. When you come in in the mornings, you go check on all your patients, assess them, check their charts for new orders/new updates then start your meds. Depending on what type of meds or what type of activities are going on with the patients, meds may take anywhere from 1-3 hours. It's not like you have actual blocked, uninterrupted time to concetrate on nothing but meds. Doctors are calling, giving new orders, PT/OT's are trying to steal the patients and need them premedicated, other patients are in pain needing pain meds, lab wants blood, CT/XRAY's need to get done, IV's need to be replaced, patient may be bleeding/vomiting......., so there are alot of distractions. If your patient leaves the floor, well heck you have 5 others to worry about giving meds to, so when the other one returns you may still not be able to get to them in a timely manner. So what may seem like a 3 minute procedure to you, essentially can turn into an hour. Does that answer your question? Nurses get pulled in a lot of different directions at once. Doctors aren't the only busy ones you know.

Yes, there are many lazy nurses out there, but many times, other aspects of patient care get in the way of pertinent stuff getting done.

(Most) meds are to be given on time, period (not talking about Vit C, or oyster shell calcium)

Tired is right...Hell, I've run to CT to give the med, but 99% of the time, I control when the pt leaves, and manage meds accordingly...

 

[core0]

Only some of them, right? The commonly used ones here are insulin, heparin, MAYBE morphine/fentanyl for the terminally ill.

I doubt you'll see pressors, vasoactive substances, blood product drips, etc. on the floors!

I've seen "renal" dose dopamine used on the floor. Blood gets hung all the time. We hang blood in the clinic here. I would agree that pressors should only be used in the ICU. I saw Amniodarone on the floor at another hospital which is kind of scary.

David Carpenter, PA-C

 

[mrdowntoearth]

My view is it comes down to your ego. You tend to look down on people when you're a doctor, thinking you're the smartest person in the house. It's human nature. I will never look down on nurses, students, volunteers, or even janitors when I'm an attending simply because I don't know everything. Although it's probably true that I may know more about medicine than they are, but there are other topics in life (eg. history, music, or whatever) that I'm certain I'm an idiot compared to them.

 

[Tired]

I've seen "renal" dose dopamine used on the floor.

Renal dose dopamine? Do they call in zenman to do shaman dances too?

 

[fineline]

I will never look down on nurses, students, volunteers, or even janitors when I'm an attending simply because I don't know everything.

Zounds, can I give you an award for being the best human being ever? I wish I could! Tell you what, just put it on your CV.

 

[jessica84]

Hey...being humble is a wonderful thing and makes for a great doctor and person.

 

[fineline]

Alternatively, you could just be awesome like me. As a bonus, I let people admire me from both close AND afar.

 

[jessica84]

*deleting complaint about irritating instructor who fails to show up on time when giving meds which she has to be present for, and she doesn't care even when I page her two times... but she is too busy with other students when clearly mine is in the worst shape (immunocompromised with staph. infection, a PIC line, G-tube, and is only 7 years old) while my peers have patients with ear infections and she is busy with them first and my patient has to wait because she doesn't know how to prioritize...
because I don't want to complain.

On a happier note, I honestly appreciate the staff at the hospital I'm at who do help each other out and don't play the totem pole game (as an above poster mentioned.) We have the nicest janitor at our hospital. Seriously, she is not grumpy and is always so cheerful to us. The nurses on my floor were so helpful and empathetic to the newbies on the floor and remembered what it was like to be a student. The residents are nice too, and the med. students are stressed, look scared and are kind...hehe

 

[elwademd]

As a non nurse I would disagree. The skill set is very different for a floor nurse vs. an ICU nurse. The principle thing you learn on the floor is time management. How to provide nursing care for 4-6 patients at a time. I have seen lots of ICU nurses get in trouble when floating because of this. As far as drips, I'm not sure where your girlfriend works but drips are very common on the floor where I work.

The other issue is assessment skills. They are very different between the floor and the unit.

Usually not pressors but Insulin drips and other contiuous meds. My advice if asked is work on the floor for a year to get good time management skills and assessment skills. Then move where you want to go. The caveat is that if you want to do Peds/OR/OB/some other specialty just go there the skills won't really help you there.

David Carpenter, PA-C

i guess it depends on the set up of a given institution, as well as the nursing school that the nurse went to as to what floor he/she will work on. at my hospital, it seems as though it's been rather difficult for nurses to move from one unit to another, which seems to be (to me at least) an issue regarding interfloor politics, as well as some religious (seventh day adventist institution) issues.

assessment skills are, in my experience, highly variable and seem to more dependent on the nurse, rather than the school that he/she went to and even the floor that he/she works on. i've seen clueless nurses in icu, as well as on med/surg... though on average, i think the icu nurses have better skills than the floor nurses... but then again, the icu nurses are typically older and have been on the unit for years (a few have been nurses longer than i've been alive!).

As in critical care medicine, there is a trend toward extra training/experience for CC nurses. Our Univ hospital requires 2y as a floor nurse plus a 3 month ICU internship before you can work on the unit. This isn't obviously the case everywhere but I think things are headed that way.

my hospital seems to have two different tracks... one that is the same as the one you've mentioned, and another for new grads right out of nursing school- they actually call it "residency" ("versant nursing residency program "i think). the new grad shadows an experienced/seasoned icu nurse for 6-9 months (i'm not exactly sure of the length, but it's something like that, lol) and takes classes and has tests with mandatory minimum scores. after that, they're in the icu.

interestingly enough, they have this nursing "residency" in our hospital for all floors.

 

[core0]

Renal dose dopamine? Do they call in zenman to do shaman dances too?

I prefer to sprinkle it over the patient it seems to be as effective.

 

[caroladybelle]

Only some of them, right? The commonly used ones here are insulin, heparin, MAYBE morphine/fentanyl for the terminally ill.

I doubt you'll see pressors, vasoactive substances, blood product drips, etc. on the floors!

Wrong, my friend. Oh so wrong.

M/S Onco floor in GA, with only remote tele.... no monitors on the floor itself - Therapeutic dopamine (not renal dosing) and cardizem drips on a regular basis. Several episodes of us having to start nitro drip and manage for a couple hours, pending availability of an ICU bed. Not to mention loading doses of dilantin, digoxin and doses of IV apresoline, vasotec, and metoprolol.

I have worked several non-ICU onco floors that ran IV pressors, and cardiac drugs. My favorite was having to go to double pressors for high dose IL-2.

(I hate pushing digoxin, or load dosing phenytoin when I can't see the monitor).

I have also had the usual alcohol, haldol and ativan gtts on the MS floors.

My favorite is the MD that knowingly sending a patient to said floor and ordering a procainimide infusion. This, despite knowing that the nurses had 6-7 patients apiece and has only remote tele.

Multiple blood products are rote and done on all M/S floors. But they are pretty routine, unless I have to give granulocytes, but those are rarely ordered on "standard" M/S onco. And the usual hemo units that handle those, the staffing, while not ICU level, is better than the community hospital standard.

Is it safe to put drips on nontele floors? Not really unless those floors have staffing up to the level of tele floors....which never happens. But many specialists do not want their patients off the specialty floor.....not to mention onco/hemos hate sending their patients to the ICU, especially the severely pancytopenic.

I hae also seen at least one teaching hospital (TJUH - Philly) that puts occasional vent patients on the M/S floors - supposedly only "stable" vents. At the time that they were doing this - The night shift nurses would have 10-12 patients apiece and shared 2 techs for 34 patients, for vital signs. Though, I have been told that staffing has improved, when they were attempting to get magnet status.

 

[MadameLULU]

Only some of them, right? The commonly used ones here are insulin, heparin, MAYBE morphine/fentanyl for the terminally ill.

I doubt you'll see pressors, vasoactive substances, blood product drips, etc. on the floors!

I've definitely seen pRBCs given on the floor multiple times, but no pressors. From my experience, if a patient needs pressor, then s/he definitely needs to be in the unit.

 

[Winged Scapula]

I've definitely seen pRBCs given on the floor multiple times, but no pressors. From my experience, if a patient needs pressor, then s/he definitely needs to be in the unit.

pRBCs doesn't count as a "blood product drip" that Blade was speaking of. He's talking about patients being on continuous FFP drips and the like, not getting discrete units of blood products.

 

[Blade28]

Wrong, my friend. Oh so wrong.

M/S Onco floor in GA, with only remote tele.... no monitors on the floor itself - Therapeutic dopamine (not renal dosing) and cardizem drips on a regular basis. Several episodes of us having to start nitro drip and manage for a couple hours, pending availability of an ICU bed. Not to mention loading doses of dilantin, digoxin and doses of IV apresoline, vasotec, and metoprolol.

I stand corrected!

You're not working at the same hospitals where I am, are you?

I've definitely seen pRBCs given on the floor multiple times, but no pressors. From my experience, if a patient needs pressor, then s/he definitely needs to be in the unit.

PRBC drips? You sure?

Usually the blood products given as drips include things like FFP (for its colloid properties as well as to help a coagulopathy).