Honestly: Do you look down on nurses?

Bigredmed
Tue, 19 Feb 2008 22:29:49 +0000

To be bluntly honest, it depends on the nurse. I can also say though that as a group I put ICU and PACU nurses on a pedestal. I’ve always been very impressed with these groups of nurses.

I will readily offer that as a medical student and future physician, I cannot survive without nurses. I need them, I want them, the health/lives of my patients depend on them. Nurses do a lot of the legwork that allows me to do my job. There are also a great many nurses with a lot of experience who know the right thing to do at the right time, and save a lot of work for physicians, and keep a lot of patients progressing through their hospital stay. I also appreciate that nurses take of the things I really don’t want to deal with - like when I’m examining a patient and they poop all over themselves…I’m more than ready to admit, that I’m glad (ecstatic, even) I get to leave the room and move on with my day when that happens.

All that said - I do not like it when nurses cancel, forget, or flat out to refuse the orders I’ve written. They are orders, not suggestions. There have been a few times when patient care has been jeopardized because nurses I’ve worked with didn’t think they needed to do what had been asked for by my team. I also do not like when nurses try to tell me how to care for a patient when they clearly have no idea what’s going on - yet insist that what I’m doing is incorrect. I’ve had a couple occasions in the last 8 months in which nurses have done this, and when I ask them why, they explain a situation that medically impossible or completely backwards. I’m not saying that I have all the answers, but these were so completely wrong it was shocking. On the flip side though, I’ve had some great nurses who have taught me a great deal, often in a very short period. I certainly appreciate when nurses help me through doing things that I’m not very adept at yet like placing an IV.

One example that I think proves a point…
My inpatient medicine team had a patient who was getting tube feedings through a GJ (gastro/jujunal) tube, because he was at risk for aspiration. He had not had a single meal since admission - more than 3 weeks prior. The tube feedings were running at a slow, but constant rate over a 24 hour period (I believe 40 mL’s an hour with no boluses because we were getting a lot of residual liquid backing up into the stomach and we didn’t want him to aspirate). The nurse taking care of him, in her computerized note (the computer system had standardized boxes so she only had to check the right ones to finish her note), marked down that the patient was eating all of his meals and was eating in between meals as well. When my intern read that, he called to talk to the nurse and her explanation was that “well he’s getting tube feeds and they’re running constant through the day!”. Obviously that’s way different than him “eating”. The same nurse also remarked that this patient was getting up out of bed to the chair even though he had been bed ridden for the entire hospital stay. Her lack of attention to detail/laziness meant that she had just clicked the same boxes she always did without really thinking about what she was doing…

The biggest difference that I’ve found between nurses and doctors is that nurse (especially experienced ones) know what to do and when to do it, but they usually don’t know why. Or they can identify a disease but they cannot explain the pathogenesis and the associated conditions. And that’s okay, they’re education is not set up to give them that knowledge.

Now, pretty much all I’ve said, that can easily apply to pretty much anyone - don’t overstep your bounds, do what you’re asked, follow through on your job responsibilities. So it’s not like I’m holding nurses to a different standard.

I do know that many of my female colleagues in medical school do not like to study in public because they get asked if they are studying to be nurses. The fact that it upsets these girls to be asked that upsets a lot of nurses as they seem to take it as a sign of disrespect. I certainly side with my friends, thinking that it’s a shame that any woman with medical related textbooks in front of her is assumed to becoming a nurse. There are fundamental differences in what nurses and doctors do and my friends chose to become doctors because that fit them better.