Do doctors really look down on nurses?

[caroladybelle]

I stand corrected!

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

Actually this was in a community (nonteaching) hospital, about 50-60 miles from Atlanta....of course, "Atlanta" covers a lot of territory, these days. I worked there for about 7 years.

I no longer work there. I am a traveler in hemo/onco, mostly leukemia and BMT units and the occasional high dose IL2/biologics dedicated unit. Some assignments include Johns Hopkins, Beth Israel Deaconess, HUPenn, Thomas Jefferson, NYP - Cornell, the NIH plus a whole lot of heinous comm hospital med onco units in FL (have to help out Mom for at 13 weeks each year and she lives there). So you might say I see the best and the worst practices.

The bad part is many M/S units will take tele these days, but the staff neither have the experience or education to really handle it adequately. You can pass off the staff on basic tele skills, but that doesn't mean that they know what to do with all of the arrhythmias, and depending on the accuracy of the equipment, really read the tele. What is in the books and what you see on the monitor varies greatly with your dementia patient writhing all over the bed and your DTer ripping off the leads on a regular basis.

Prior to being passed off on tele, I worked a (again, a FL community hospital) that had recently started taking tele patients and had the staff "inserviced" in tele. As a traveler, I did not take teles, but an LPN on another section did. His 78 year old CHFer starting complaining of severe chest pain. She and the covering charge are trying to figure out "the official" rhythm, to notify the MD, as the MD will ask it on the phone. I (who knew very limited tele) look immediately at the admitting strips, and note that as the CP is worsening, that the QRS is widening and flatting, and that the tell tale "rabbit ears" are present on the newer strips. Now there is that point where "common sense" should take over, and someone should stop worrying about the "official reading" and just call and stat the pt to a cardiac unit.

But many admission departments and many MDs will see the indication that a certain M/S floor takes tele, and automatically place Cardiac patients there, without regard to the actual skill level of the personnel nor the ratios involved. There is more to taking care of primary cardiac patients than being able to pass a basic tele test. Though as an onco/hemo nurse, I like to have tele (too many patients on ambisome that need faster lyte replacements than permitted off tele), I also dread as it means that we will invariably get cardiac patients that DO NOT belong on a noncardiac floor.

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[Blade28]

That's a very impressive array of experiences and settings! Wish you had come to work here...we could have used people like you.

 

[core0]

I stand corrected!

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



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).

You should come up to 9E some time.

 

[mrdowntoearth]

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.

Dude, what's your problem? Don't tell me if you're one of those obnoxious docs...

 

[Blade28]

You should come up to 9E some time.

I was just there for liver in April! They know me well there. Why, something up there?

 

[swpm]

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.

I'm an anesthesia resident, and it's been my (limited) experience that nurses get upset when I touch "their" pumps. The worst though, are the respiratory therapists who have hypertensive crises when I touch "their" ventilators.

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

The bane of anesthesia residents is the page to start an IV, or worse, to draw blood. Most of the time, no one's even tried, either because of past troubles or just the rumor that a patient is a tough stick.

It got to be so bad last year that if I was walking through a ward to do a pre/post op visit, I'd be accosted by nurses who'd ask me to stick their patients. These days, when I get paged for an IV, I tell them that when I have time, I'll give it one stick, and then the patient's getting a neck line (or a femoral stick for their labs). And if the home team's not OK with that, then they don't really need an IV or tube of blood.

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

The great thing about the med/surg floors 'round these parts is that the patients are so close to a hospital.

 

[Faebinder]

I'm an anesthesia resident, and it's been my (limited) experience that nurses get upset when I touch "their" pumps. The worst though, are the respiratory therapists who have hypertensive crises when I touch "their" ventilators.



The bane of anesthesia residents is the page to start an IV, or worse, to draw blood. Most of the time, no one's even tried, either because of past troubles or just the rumor that a patient is a tough stick.

It got to be so bad last year that if I was walking through a ward to do a pre/post op visit, I'd be accosted by nurses who'd ask me to stick their patients. These days, when I get paged for an IV, I tell them that when I have time, I'll give it one stick, and then the patient's getting a neck line (or a femoral stick for their labs). And if the home team's not OK with that, then they don't really need an IV or tube of blood.



The great thing about the med/surg floors 'round these parts is that the patients are so close to a hospital.

Classic...

Anyway... I do fume when they have not even attempted the peripheral access and want a central line. I feel like I need to do their job when i have to come do a peripheral myself as well. This seems to be happening a lot of late on our service, so i feel your pain.

 

[fineline]

Dude, what's your problem? Don't tell me if you're one of those obnoxious docs...

I'm extremely obnoxious and the people I look down on most are the ones who act like they're not as obnoxious as me. Everyone's obnoxious, the only question is how much B.S. you want us to buy in addition to that.

 

[Josh L.Ac.]

OP, if you want to start in ICU and you have some descent skills, then depending on location you can probably find a position. I got hired with three other new grads in the ICU.






Why would the nurses call a physician to put in a peripheral without even trying, especially if there are graduate nurses on the floor? Seems like a waste of an opportunity.



Oh, and I'm not really sure why nurses sleeping on the floor at night is acceptable. Would it be acceptable during day shift?

Prolly not.

 

[caroladybelle]

Oh, and I'm not really sure why nurses sleeping on the floor at night is acceptable. Would it be acceptable during day shift?

I was freaked when I was in NYC - because of the one hour break issue, there were some night nurses that actually did sleep on the break.

Down South, break or no break, you would have been kicked to the curb.

------------------------------------------------------------------------

I was working evenings and had someone getting chemo late, followed by Q2H - IV mannitols, some of which would run into the night shift. The night nurse pitched a fit about having to run the mannitols and complained to the unit manager, who raked me (as agency) over the coals for running chemo so late. This despite the fact that the ratios were the same on nights as on evenings.

A few weeks later, a night nurse called in and a staff member with kids was going to be "mandated OT". I offered to take the mandated double. Come to find the nightshifter that complained about having to do mannitols ....asleep. I made a point of tripping over him several times.

Later when they tried to get me to renew my contract, I declined and went uptown for my next assignment.

 

[Josh L.Ac.]

I was freaked when I was in NYC - because of the one hour break issue, there were some night nurses that actually did sleep on the break.

Down South, break or no break, you would have been kicked to the curb.

I'm not so concerned with nurses sleeping on the mandatory 1-hour break since it is their time to do whatever they want - eat, sleep, run the halls, gamble online, whatever.


I'm talking about nurses sleeping on the floor when their breaks are over. Wow.

 

[deleted109597]

Only the nurses who do stuff like this.
http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=486673&in_page_id=1770&in_a_source=

 

[justmanda]

Get off your high horse. I'm the one who busts on nurses and EM physicians the most around here and I don't prejudge them. I let them do their thing and treat them accordingly. If you're that conscientious and dedicated and hard-working, then nobody's going to have an issue with you. However, if you're waiting for us to say that, based on you, we changed our minds and nurses are awesome and not lazy at all, you're going to be waiting a long time.

I'm a lazy human. A perfect day for me would consist of napping and lounging. I would've been a great cat. But as a nurse, there just isn't any time to be lazy. Every nurse on my unit runs around like a maniac until quitting time. Granted, some get more accomplished than others, but I think that is more of a problem with being organized than it is with being lazy. All the nurses I know try their hardest to get everything done so they don't have to hand it off to the next shift. You've never seen vicious until you tell an oncoming nurse that you couldn't get an IV on someone. I know I won't change your mind about nurses in general, but the lazy thing just isn't true in most cases. Bitchy, grumpy, backstabbing and judgmental, I'll grant you that. I've been a nurse for ten years and most of my un-lazy colleagues would throw a fellow nurse under the proverbial bus in the blink of an eye.

 

[jennyboo]

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.

hehe I'm glad you've had good encounters with residents in your clinical experience. That's really as it should be. To be honest, we were all students at one point and we totally understand that as a student, you're like a third leg -- low on the totem pole, uncertain of yourself, and not sure of everything that's going on. I would feel bad for giving crap to any student, medical or nursing, because I know -- and I think most residents ought to know, but unfortunately some of the worst of us really do not -- that students are in general powerless and usually harmless, and thus ought to be treated well.

As for this forum -- residents do gripe. Part of the reason we gripe is that, to be honest, in the best of situations our interactions with nurses and with everyone else is 85% good/professional and 15% ****. What you're reading on the forum is the 15% ****. We just don't talk about the 85% good, so it makes the forum look like we think all nurses are 100% ****. But it's not true. Don't be discouraged -- just realize that when things go well, we don't spend time complaining about them.

 

[yaah]

Why oh why did you bump this thread?

Timeless reminder in advance of what is sure to come: Please keep things civil.

 

[AmoryBlaine]

I have 95% love for RNs. Most of them rock my world.

In my experience most of the bad ones cluster in the OR and too a lesser extent the ER. I have seen so many ER nurses go WAY outside their boundaries based on a misguided belief in their own experience/seniority. Scrub nurses routinely berate and belittle medical students for trivial "infractions" that do not even hint at a violation of sterility.

 

[danielmd06]

I didn't read all three preceeding pages, but to answer the original titled question:

"No."

 

[telenurse]

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.

Lords no...in nursing school we were told stories of a nurse left alone in a 4 bed country ED where the MD had stepped out, the nurse recieved a walk in trauma, needed IV access stat, couldn't place IV x numerous attempts, couldn't find the MD x numerous pages,pt crashing anyways, attempted EJ access failed. Pt died...nurse lost license. Moral of story...for a nurse it would have been better to let the pt die than try something out of your scope of practice in an attempt to save a life. Needless to say, that's why I only work in places that always has a doc in house.

One little accessed vein to go for is the basilic in the forearm...it requires an awkward approach, so it's highly underused...I've stuck a lot of "difficult" pt's there. I tend to avoid hands, wrists, and ac's unless necessary, I go for the basilic, cephalic and median veins. Of course my biggest complaint is, if you know the pt is a hard stick, just come and get me before you blow all the veins forcing me to stick them in the axillary vein or the thumb.

 

[ForbiddenComma]

Moral of story...for a nurse it would have been better to let the pt die than try something out of your scope of practice in an attempt to save a life.

Sadly enough, this is true for docs as well. So most won't address issues outside their scope of practice, no matter how screamingly obvious or deadly, lest they wind up at the wrong end of some litigation.

Thank you, lawyers!