Nurses/Doctors: Sweet/Sour Relationship
When I was a medical student I vaguely became aware of the underlying currents that exist between nurses and doctors. I was at a ward round during my outside posting as a student when my senior registrar was giving the matron an instruction to have a patient with a thoracolumbar fracture log rolled every two hours. Just as he had finished speaking a thin piped voice was heard to say “We will not move him, we were told not to move patients who can move themselves”. In shock we all swiveled to the direction the voice had come from and saw that it was a student nurse that had spoken, of course my senior registrar was incensed and turned the full wrath of his anger on her she also gave him the full edge of her tongue. The matron that had a few seconds ago been with us on the ward round had quietly moved a few feet away and asked us very innocently what the trouble was even though she had been a witness to the way the student had behaved.
To cut a long story short, the student was asked to go to wait for her in her office and the round continued as though nothing had happened; my impression that day was that nursing students sure got away with plenty. If as a medical student i had tried an ounce of what the student nurse had done I may as well have been bidding my mates goodbye from school! That was my first induction into the sweet/bitter world of nurses and doctors.
Of course the full baptism into this sweet/bitter world came when I became a house officer. I was luckier than most of my colleagues who had their immersion in the same pond they had been in as students. It was not unusual there for a nurse to tell you pointedly that she knew when you started medical school so your protestations did not cut any clout with her. One of the first things I realized was that the nurses expected you to write down whatever instructions you wanted them to carry out (this is only reasonable) and they also expected you to tell them whenever you had an order changed (only fair).
My argument (internal most of the time) is that first of all when I walk into their wards for a round I do not expect to have to meander my way alone through the maze of patients, I expect to have a nurse (after all they are in charge of the wards) go with me to see my patients so that whatever instruction I give to the patient or write down in the order sheet does not come as a surprise to them and they don’t keep calling me back to clarify issues after I am through with the round as is their usual practice. I also don’t like being called to set a line and get to the ward only to realize that no tray has been set and I have to go round collecting the cannula, cotton wool, tourniquet and other things I need wasting precious time.
Another of their favorites is sending for you to see a patient in the middle of the night and getting there to see them all sleeping, if you have the audacity to wake them up or disturb their somnolent state you can be sure that you will have the most disagreeable company during the time you spend on the ward. The last time this happened was in the maternity ward, I had been sent for to see a patient who had a Caesarean section two days before, on getting to the ward the door was locked and it took some time before the nurses opened the door, it was obvious they were asleep, they immediately went back to their sleeping positions, my attempts at eliciting a history and wondering why I had been sent for yielded a scowl from the sister on duty I insisted that she go with me to see the patient. I learnt more with her by my side than if I had allowed her the pleasure of continuing her nap. My resolution is obvious: no more naps allowed night nurses when I am called out from my bed at night!
Of course not all the nurses behave this way but those that do make up the majority. One other argument I have heard from the nurses is that the job I do as a doctor is one they can do just as well after all they studied the same anatomy, physiology and biochemistry as we did, I have no problem with that but ill add that after they attend medical school for six years in contrast to the three years they spend as student nurses their argument will be valid. One of my seniors in response to their play at similarities to the two professions asked why it was they did not treat their illnesses and that of their relations but yet they keep coming to the clinics to see the doctor?
In the bid to be what they are not they make a very bad job of being what they are supposed to be. I have met nurses who do such a good job that the propel me to do a much better job, if I may add these nurses are those who have been in the profession for much longer periods than those who do not inspire me. (Both as a medical student and as a house officer nurses have on several occasions taught me things and given me hints that made my work much easier and I certainly would have been in a quandary if they had not helped.) Has there been an addition to the curriculum of younger nurses that teaches them that the doctor is the villain and their job is to oppose him at every opportunity? I sincerely hope not. I just finished reading comments/responses of general practitioners to an article by a nurse practitioner in the BMJ suggesting that they are giving more responsibilities which are being tackled by the GP’s. The problem is a global one don’t you think.
All the examples I have given are real life examples, what set me off writing this article? Your guess is very good – a clash with a nurse. I look forward to the day when I can comfortably work with (all) nurses who are secure in their jobs, when I don’t have to tip toe round them trying to avoid the ‘inevitable’ conflict, when they are as proud of being nurses as we are of being doctors.
To cut a long story short, the student was asked to go to wait for her in her office and the round continued as though nothing had happened; my impression that day was that nursing students sure got away with plenty. If as a medical student i had tried an ounce of what the student nurse had done I may as well have been bidding my mates goodbye from school! That was my first induction into the sweet/bitter world of nurses and doctors.
Of course the full baptism into this sweet/bitter world came when I became a house officer. I was luckier than most of my colleagues who had their immersion in the same pond they had been in as students. It was not unusual there for a nurse to tell you pointedly that she knew when you started medical school so your protestations did not cut any clout with her. One of the first things I realized was that the nurses expected you to write down whatever instructions you wanted them to carry out (this is only reasonable) and they also expected you to tell them whenever you had an order changed (only fair).
My argument (internal most of the time) is that first of all when I walk into their wards for a round I do not expect to have to meander my way alone through the maze of patients, I expect to have a nurse (after all they are in charge of the wards) go with me to see my patients so that whatever instruction I give to the patient or write down in the order sheet does not come as a surprise to them and they don’t keep calling me back to clarify issues after I am through with the round as is their usual practice. I also don’t like being called to set a line and get to the ward only to realize that no tray has been set and I have to go round collecting the cannula, cotton wool, tourniquet and other things I need wasting precious time.
Another of their favorites is sending for you to see a patient in the middle of the night and getting there to see them all sleeping, if you have the audacity to wake them up or disturb their somnolent state you can be sure that you will have the most disagreeable company during the time you spend on the ward. The last time this happened was in the maternity ward, I had been sent for to see a patient who had a Caesarean section two days before, on getting to the ward the door was locked and it took some time before the nurses opened the door, it was obvious they were asleep, they immediately went back to their sleeping positions, my attempts at eliciting a history and wondering why I had been sent for yielded a scowl from the sister on duty I insisted that she go with me to see the patient. I learnt more with her by my side than if I had allowed her the pleasure of continuing her nap. My resolution is obvious: no more naps allowed night nurses when I am called out from my bed at night!
Of course not all the nurses behave this way but those that do make up the majority. One other argument I have heard from the nurses is that the job I do as a doctor is one they can do just as well after all they studied the same anatomy, physiology and biochemistry as we did, I have no problem with that but ill add that after they attend medical school for six years in contrast to the three years they spend as student nurses their argument will be valid. One of my seniors in response to their play at similarities to the two professions asked why it was they did not treat their illnesses and that of their relations but yet they keep coming to the clinics to see the doctor?
In the bid to be what they are not they make a very bad job of being what they are supposed to be. I have met nurses who do such a good job that the propel me to do a much better job, if I may add these nurses are those who have been in the profession for much longer periods than those who do not inspire me. (Both as a medical student and as a house officer nurses have on several occasions taught me things and given me hints that made my work much easier and I certainly would have been in a quandary if they had not helped.) Has there been an addition to the curriculum of younger nurses that teaches them that the doctor is the villain and their job is to oppose him at every opportunity? I sincerely hope not. I just finished reading comments/responses of general practitioners to an article by a nurse practitioner in the BMJ suggesting that they are giving more responsibilities which are being tackled by the GP’s. The problem is a global one don’t you think.
All the examples I have given are real life examples, what set me off writing this article? Your guess is very good – a clash with a nurse. I look forward to the day when I can comfortably work with (all) nurses who are secure in their jobs, when I don’t have to tip toe round them trying to avoid the ‘inevitable’ conflict, when they are as proud of being nurses as we are of being doctors.
Yeah I guess so! There are now Advanced nurse practitioners (ANPs) in the UK, who are assigned to do tasks similar to those of junior doctors - set lines, clerk and examine etc. The way most of them handle it with so much relish, its obvious they seemingly want to take over!!!! So much for techniques without good foundational knowledge.
ReplyDelete"My argument (internal most of the time) is that first of all when I walk into their wards for a round I do not expect to have to meander my way alone through the maze of patients, I expect to have a nurse (after all they are in charge of the wards) go with me to see my patients so that whatever instruction I give to the patient or write down in the order sheet does not come as a surprise to them and they don’t keep calling me back to clarify issues after I am through with the round as is their usual practice."
ReplyDeleteYou just verified what most nurses hate, a doctor expecting a nurse to be a maid. Does you facility have the duties of your nurses spelt out or do you expect them to add catering to doctor x & y to their job description. It is bad enough that nurses have to take crap from doctors in additon to the patient. I am not trying to justify nurses especially the ones that give the proffession a bad name but sometimes but youself in their shoes.
I admire doctors, i think you guys have a tough job to do but certainly not the hardest. Yes you went to medical school for ten years but that should not stand in the way of having a proffesional relationship with other healthcare proffesionals.
As for the nurses sleeping on duty, they should be fired.