Sorry for correcting you in front of a patient.
I wasn't thinking; it wasn't a very nice thing to do. And it was kind of kicking you when you were down: you had been trying to start that IV for at least twenty minutes, and I waltzed in and got it in one shot. When the patient said, "See? I KNEW she would get it!" I tried to downplay it by telling the story about how when I used to work on the floor I sucked at IVs and I didn't get good at it until I came down to the ED, and that sometimes when I'm having a "bad stick day" I can't get a tiny needle in a vein the size of the Panama Canal.
But then you said, "Great, give this patient sixty milligrams of Toradol IV, please!" and it just popped out of my mouth.
"You mean thirty, right? Sixty is the IM dose." Dude, you should have taken the hint.
"No, sixty IV please."
I should have left it at that. I should have waited until we were out of earshot of the patient and then tactfully suggested you recheck the proper dosage. Instead, I whipped out my Treo with my Davis's Drug Guide on it and looked up the dosage myself. "Nope, says right here the maximum IV dose is 30 mg at a time."
And then the patient yelled, "What, are you trying to KILL ME?!?"
Again, sorry. And when I see you this week, I'll apologize in person.
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83 comments:
Ouch. Poor little intern :)
This is my first job in 15 yrs as an ER nurse that I am working with residents, and OMG, I know they have to learn sometime, but not when my little old lady is actively dying, and I have to explain Dopamine to the Intern
GG that is why you are there. You are not only the patient's advocate, you are the doctor's guardian.
I wouldn't apologize, in fact I think it is he that owes an apology.
TOTWTYTR is completely correct. PGY1 owes you an apology. You hinted. You gently corrected. In spite of this he insisted on relying on his attitude, rather than his brain. This is not something to be encouraged.
I think both PGY1 and GG were wrong.
This wasn't an "on-the-spot" safety issue. Stepping outside and "tactfully suggesting" would have done just fine. Remember, you're building a relationship with these interns. A MUTUAL trust. In most EDs you'd have to leave the room to obtain the med anyhow, why not take that opportunity to "correct" the doctor?
Yes, he's "Just an Intern" but you've broken down that patients trust of their doctor, and unnecessarily "kicked" the intern.
It might be fun to poke at the newbies, but it's not our primary job. That's what seniors are for.
NOW, mid-Code, or a genuine safety concern? Yeah, flog the rookie.
Remember you may know more than the intern this week, but in a couple months, your knowledge base will look like a children's book compared to the learning curve that intern will be on. Making the intern look bad will stick with them forever. At which point your one minute of fame will pale in comparison to that interns ability to order unnecessary tests and procedures on your clock.
Taking it outside the patients room is taking the higher road. I would never bad mouth a nurse in front of a patient, for their complete lack of knowledge in certain situations any more than you should do so for this intern. It's bad policy to get into the I'm better than you are routine, especially since you will soon be on the other end of the stick. And because ultimately, it's the patient that loses faith in the system. A week from now, they won't care if it was the nurse or the doctor, just that the hospital tried to kill them.
GGRN did write that she felt she handled this incorrectly. I wrote that she did not. Suggesting that the intern's brain will grow 3 sizes over the next few months is pure hyperbole. Physicians continue to make mistakes long after board resisency. That the intern will be able to order unnecessary tests to punish a nurse for not handling a mistake by the doctor, in the most deferential manner possible, does nothing to promote respect for physicians. This physician would rather give the wrong dose to a patient, not double check the dose. He needs to learn a lot about risk management.
Rogue:
No one is denying the PGY1 has a lot to learn, about EVERYTHING. That's why he's an Intern.
I go back the mutual respect/trust thing. I didn't like the tone of the "couple month learning curve" and the vengeance.
Trust and Respect. goos-frabba...
Paracynic,
That works for me. I am not interested in encouraging disrespect. Whether attendings abusing interns, nurses abusing interns, or any others disrespect - this is wrong. That it is so commonly accepted says a lot about the problems in all parts of medicine. Too often, we behave as if we are still in diapers.
actually, my comment about ordering unnecessary tests was over the top hyperbole. I, as a resident years ago, have never done so out of spite. I have never seen nor heard of another resident or attending doing so either.
I have however, seen horrible working relationships develop out of a lack of mutual respect between members of a team.
The suggestion that the interns brain will grow three sizes over the next few months is not hyperbole. In fact, it is a truth that no one can understand unless they are put into the position of intern in a medical residency. I have lived it. I know without a doubt my ability to be a doctor grew by leaps and bounds in the first year and even quicker in those first few months. Those first few months were frightening. But the hierarchy of checks and balances from supervising residents to attending, who signed off on all the charts made dang sure that safety was a priority. I also relied on well versed nursing staff for my first few months of training. They are invaluable, only so much as they are willing to work together. Calling out a resident in front of a patient does nothing but damage the relationship of the team and brings doubt into the eyes of the patient.
I would respect a nurse far more for assisting me in private than in front of a patient. In fact, I would chose to avoid suggestions by a spiteful nurse more so than I would one that showed respectful assistance. At some point in the next few month, the resident will not need that type of help. And their lasting memory of you as a nurse will be known for the next 4 yours as that one nurse. Not the one who was helpful in your time of need.
Trust me, I have lived through both types of nurses. The ones I respected the most are the ones that were tactful in their assistance of my training. You should be honored to be able to help the new doctors in training. I certainly felt honored when great nurses helped me at 2 am on my nights of call.
I can say that the first several months of residency are very frightening for the new interns. Their attitude will change quickly, without your spiteful actions. Being known as that nurse or the nice nurse goes a long way in the next 4 years of healthy working relationships.
Rogue medic, there is no way a nurse would give a dose that he/she knows is clearly wrong. Part of being a nurse is to protect the patient and knowingly carrying out an order she knows to be wrong is inappropriate as well. We all know that dose would not be given. The issue is how to educate the new intern. Calling them out in front of a patient is just plain wrong.
happy hospitalist - you're comment about the nurse: "your knowledge base will look like a children's book compared to the learning curve that intern will be on" is disrespectful. You assume you know the knowledge level of the nurse and assume nurses can never have as much knowledge as a doctor. Arrogance.
Further, your implication that you only "relied on well versed nursing staff for my first few months of training" is laughable.
"Doctors save Lives. Nurses save doctors."
...and Paramedics just stir the shit.
If you are telling me that you believe a nurse can ever have the medical knowledge base of a physician, I am here to tell you that is an arrogant statement. Not in a million years would I ever believe I have the knowledge base to be a nurse. That's why I didn't go to nursing school. And that's why I'm not a nurse. Like I've said many times before, if nurses had as much medical knowledge as physicians, all doctors would be going to nursing school, not medical school.
If you believe a nurse would ever have as much medical knowledge as a physician, even after 50 years of clinical experience, I'm sorry to break the bad news of reality to you. It simply will never happen. The training program of a nurse, both book work and clinical experience is far inferior in breadth and intensity and scope for any rational person to believe that the two professions are interchangeable. I'm sorry you feel they are. You are either not a nurse, or a very dangerous one.
The children's book analogy is not meant to imply disrespect on the basis of the type of knowledge, which is clearly important in the nursing profession. . It was meant instead to imply the lack of volume of knowledge that a nurse gets in their education when compared to a medical residency. A residency is far superior (light years) in intensity, scope, and volume.
If you are a nurse, and you believe your knowledge base is equivalent to a medical resident trained physician, let me know where you practice. I would like to avoid you. Like I have also said many times before. Knowing what you don't know is often far more important than knowing what you know. I am hardly arrogant. I live in reality.
Like I said before, I wouldn't expect myself to practice nursing. I wouldn't have a clue what I was doing. I also wouldn't expect a nurse to do what I do. They aren't trained for it. Not even close. If you want to call me arrogant for speaking in reality, I'm quite all right with that. But know that I'm not.
Whoa! talk about stirring the shit! I didn't mean to start a big controversy or discussion, but I welcome it. I hope everyone involved is aware that I realized that what I did was unnecessary and unprofessional, and I truly intend to apologize to the poor kid.
I agree that by the time the interns reach their second year, they'll be twice or three times the docs they are now.
One thing, though: I'm not sure if the Happy Hospitalist has ever worked in an ED (HH, please correct me if I'm wrong). There, the relationship between docs and nurses is a very close one, working side-by-side rather than in a hierarchy. In the ED (and in the ICU) it's more evident that nursing and medicine are BOTH professional disciplines, each with their own territory and perspective on patient care; and in the ED, BOTH perspectives are necessary to help most patients.
paracynic. "I said I relied on", Not "I only relied on" as you wrote. Obviously, you misunderstood. If you thought I was relying only on nursing staff to get me through I would laugh at that suggestion myself. Of course, it's not what I said. My assistance from nursing was more for things like,
"Doctor, the patients can't poop. what do you want to do?"
My response would be "What would you like?"
At which point I gave the nurse an order for what they wished for.
Or "Doctor, I need something to help my patient sleep"
For which I would ask "What would you like?"
At which point they got what they wanted.
We're talking little stuff. Stuff that you would never know without prescribing it 100 times. We aren't talking about life altering emergencies or million dollar workups. That I looked for help from my supervising resident. A doctor.
If you want to call me laughable for accepting help from nursing staff in my first few months of call, feel free to laugh away. It saved me hours of time and increased my sleep time.
guitar. I have worked through ER's but not continuously for extended periods of time, except for an elective month as a 4th year medical student. As a hospitalist, I am in ERs admitting multiple patients a day. I know how closely nursing and ER docs work. Which is all the reason to make sure the team is coherent from day one instead of creating situations of animosity. I think you know what you did was taking the lower road.
It's those answering with comments like, you did the right thing, you showed him, that clearly don't get it. There is no winner in these power trip type situations. And I have lived through many of them.
psst...no one said the two professions were interchangeable. As a matter fact, my first post was about fostering a mutual respect, and the two working together, not instead of, or against, each other.
That hornet's nest was relatively anticlimatic.
There's an adage that the average medical student forgets 85% of everything they learn in medical school. I'm just glad your 85% wasn't the part that realized nurses know what makes patients poop.
Hehe, good times.
HH: If you think doctors don't order stuff out of spite nor act like a dickweed out of spite, check out my blog. You've never been around when Dr. Busywork orders stuff like UAs on chest pain patients because he can't make up his mind on dispo.
Doctors goof up/miss things all the time DESPITE their vast medical knowledge. In the ER, you're not trying to diagnose Job's syndrome, you're doing a workup to determine if the patient is sick/needs more intervention than can be provided in ER or not sick/can go home with follow-up. Lots of quickfire verbal orders, etc.
I think that if a doctor/intern gives a verbal order in a room for a possible kidney-damaging dose of med, then the nurse should verbally, in the room, explain that it's 30mg just like she did. Who is double-checking that verbal order in the room? Nobody but GG. Why is an intern giving a verbal order for a non-emergency med anyway?
Congrats on embarrassing the doc in front of the pt, not once by twice, I guess. No point in handling it tactfully.
Three observations:
1. Never go to a teaching hospital ER in July.
2. Tact is what you practice when pinching someone's head off and shitting down their neck is what is actually justified, but not politically expedient.
That said, you probably should have taken it outside - but you recognized that. Making him look like an ass only makes you an ass, too.
Keep in mind that he's brand new, defensive and afraid of messing up...and also afraid of looking like he's any of the above.
You recognized that you probably handled the situation indelicately. An apology would go a long way toward calming the ER waters between you, but also make him more likely to rely upon your knowledge and judgment the next time. Tactfully point out that you feel bad about shaming him in front of a patient and that it won't happen again, and also make the point that while he's learning, it would help him to swallow his ego and seed guidance from the experienced nurses.
And if that doesn't work, then he has proven that he isn't just an inexperienced intern, but that he's an arrogant ass who can't admit when he's wrong.
In that case, use one of TOTWTYTR's favorite lines:
"Sorry you feel that way, Junior, but this is a teaching hospital for doctors, not nurses."
3. There are some people with 20 years of experience, and many others with one year of experience, 20 times over. The difference between the two is the theory-based education that allows them to process that experience into applicable knowledge.
As far as depth and breadth of education goes, there is no amount of experience a nurse can accumulate that will equal a physician's theoretical knowledge base. The nursing education curriculum does not prepare them to assimilate and process that experience into meaningful knowledge on a par with a physician's.
The same can be said of medics who think they're as well educated as nurses.
Is my education (at least, the stuff that appears on a transcript) as broad as a nurse's? No.
Is it as broad as a physician's? Laughable.
But there are areas within my own realm of expertise where I possess a far deeper knowledge base than either of them.
There's a big gap between theory and the nuts and bolts practical application of providing care. A wise doctor recognizes his deficiencies in that area, and relies on the nurse's judgment, and likewise the wise nurse should rely on the same from the medics.
I am just a lowly ER tech/unit secretary and humble nursing student. but even I catch mistakes that the doctors and nurses make. HOWEVER, I only correct the doctor/nurse in the relative privacy of the nurses' station, not in the patient room.
for instance, I was discharging a patient from the ER computer, paperwork kind of stuff. I saw that the patient had been prescribed augmentin, and that the patient's medical history showed a penicillin allergy. I asked the doctor if he knew the patient had a PCN allergy, to which he replied that he did. I then asked why he prescribed augmentin, since it has amoxicillin in it. he then said, "it does?" I showed him the drug guide to back myself up.
we immediately called the patient on their home phone number to tell them to not take the medication, to throw it away and the doc called in a new prescription to the pharmacy for the patient to pick up.
shit happens, doctors and nurses make mistakes, we're all humans. in a non-emergency situation, it is more tactful to correct someone in private as opposed to in front of a patient.
As far as depth and breadth of education goes, there is no amount of experience a nurse can accumulate that will equal a physician's theoretical knowledge base. The nursing education curriculum does not prepare them to assimilate and process that experience into meaningful knowledge on a par with a physician's. AD hits it on the head, right here. Having trained nurses and physicians, there's much more reliance on rote knowledge in nursing school. The pathology texts are different. And, bottom line, it's the doctor's knowledge, training, and ultimately, his liability.
It always amazes me, also how much abuse and jerking around the new and transient (medical students and residents) get from the older and unionized. (Ancillary personell).
People have their own areas of expertise. I wouldn't know squat about handling an acute MI. I don't know squat about dealing with contact dermatitis, for that matter. I should get out of the way of the folks who do. Which is AD's last point.
Easy now, boys and girls! This all started with GuitarGirl's acknowledgement that she behaved wrongly. In the middle of her post she says, "I should have waited until we were out of earshot of the patient and then tactfully suggested you recheck the proper dosage" and ends with the sentences, "Again, sorry. And when I see you this week, I'll apologize in person."
What more do you want her to do? GuitarGirl made a mistake at work, a serious mistake (a mistake that none of us perfect professionals have EVER made, right? Yeah, right!). However, she knows it was wrong, she says she was wrong, and she has decided to humble herself with an in-person apology. I’ll ask again, what more do you want from her? Hair shirt? Self flagellation? A week watching reality television? What? Have you ever apologized to an authority figure after misbehaving toward them? Trust one who has; it is humiliating and painful. It takes character and guts; more than most people have. That GuitarGirl would acknowledge her wrong behavior, and face the intern with a sincere apology, tells me that she has plenty of both.
GuitarGirl, we've all messed up like this. That is not to say that it is O.K. to do, it is not O.K., but we have all done it, or something equally bad. (How I wish that my mistakes were all as minor as this one!) The main difference between you and most people is that you have enough honesty to write about it without making cheap excuses, and enough integrity to do the right thing when you have missteped. I salute you. If I were that intern, I would respect you more, not less. But if he or she doesn’t respect you, be brave and do the right thing anyway.
But that’s just my opinion, which is not very valuable because I’m not a very good person. Those who have criticized you are probably much better people than I, giving them the right to take positions of moral superiority. Right boys and girls.
Sorry, I promise to stop after this. GG, delete me if I am being a impolite by posting twice.
HH and William, you are both absolutely right. I am a registered nurse. I am very proud of the knowledge and skill I have acquired and become able to use to help the sick and injured. However, I do not know a fraction of what a physician knows, I never have, and I never will. Equally important, I have never been sufficiently disciplined in my thinking to be capable of diagnosing even simple illnesses, nor am I competent to prescribe medical treatment. Period. End of chapter.
I write this with absolutely no discomfort because, I am actually arrogant enough to believe that what I, a nurse, bring to the patient's bedside is valuable. That it helps patients get well sooner. No, I do not bring medical care to the patient; I am not trained to do that and could not do it if I tried (which I would not do). That is O.K. The patient does not need me to bring him or her medical care; he or she has a physician to do that. The patient needs both a doctor and a nurse (and often, an RT, an EMT, and several other team members). The patient does not need a "junior, assistant, deputy, vice-doctor" attending at the bedside. The patient needs a real doctor to provide real medical care, and a real nurse to provide real nursing care. That is what I do, and I do not need to pretend to be someone that I am not in order to be valuable. What I am, a nurse, is valuable enough.
I have taken up too much room on GG’s blog. Sorry. I will go away now.
I must say that I find HH's comments condescending and arrogant. The truth is that a good ED nurse will know more about treating patients in the real world than any PGY1 and many PGY2s. And some attendings for that matter.
I've been in EMS for almost 30 years. Almost all of my experience in EDs has been in teaching hospitals, so I see a lot of interns and residents. Many, no most, are "wicked smaht" as we say and very well educated. They've learned a lot of medical theory, but med school doesn't teach one how to treat a patient. Internship and residency do. Part of that experience is learning to listen to the people who have spent a lot of time practicing the practical aspects of patient care. Nurses are just that. They might not know the medical theory, but chances are they know how to get things done for the patient. That includes knowing who to call when something that needs doing isn't getting done. That's invaluable to the patient and the medical staff.
Sure, a PGY1 can order all sorts of tests to make a nurse's life miserable. Just remember, there is more than one nurse in that ED and many of them have worked together for more years than PGY1 has been on the planet. "An insult to one is an insult to all" has real meaning.
Maybe I'm spoiled by having years of good relationships with great nurses and EM attendings and the rest of the world isn't like that.
Wow. Interesting conversation.
I agree with totwtytr - maybe GG's comment wasn't the most tactful, but one of the multitude of things that interns have to learn is how to work and communicate as a team.
Regarding knowledge bases, it's unfair to generalize. I know a lot of nurses whose judgment I would trust more than an attending doc. My butt has been saved many a time by a sharp ED nurse.
Treat people with respect and respect their opinions and you'll be a star.
Teamwork wins out every time.
Mon Dieu! Clearly HH has a grasp of language and its wily properties, yes? And so when HH says: "You should be honored to be able to help the new doctors in training." -- does that not say oh-so-very-much?
It's all très bien with Bianca Castafiore, but I must say that you are all overestimating the estime in which *any* of you, acting out in such ways, are held by the patients. And to toss in the occasional "and-what-will-the-patients-think?" crap is just disingenuous.
Salut, les mecs...
HH's comments scream of disrespect and disdain for nurses. HH, I have no doubt that you have been smack in the middle of "horrible working relationships (which) develop out of a lack of mutual respect". Here is a great lesson on how NOT to nurture a working relationship of mutual respect: say things like "your knowledge base will look like a children's book", "your one minute of fame will pale in comparison to that intern's ability..", "you should be honored to be able to help new doctors". HH, I think "honored" is not the truthful term to describe the situation when you were helped by a "great nurse" at 2am on call. Trust me, people do not choose to become nurses to help physicians get a good night's sleep and stroke their egos. People become nurses to care for patients. I believe you would benefit from taking a hefty dose of your own advice: "it's bad policy to get into the I'm better than you situation".
I have a glowing respect for nurses. My wife is a nurse and I could never do what she does. Guess why. Because I wasn't trained as a nurse. It doesn't matter if I see patients for 30 years as a physician, I will never be as good as a nurse who trained for one year in nursing.
To the comment about not feeling honored to train new doctors, I, as a physician, find it a huge honor to help train new nursing students. To help them understand why I do the things I do. In fact I take great pride in teaching nurses with 20 years of experience about why I do the things I do. They always appreciate any learning experience they get from me as well.
So it wasn't meant to be condescending for nurses to teach the residents. It is an honor that I feel in reverse. If you don't feel that way, then working with residents should not be part of your team effort.
I learned many a thing from the nurses, in the appropriate context. I learned of nursing care and patient care in the context of nursing. If you find that offensive, to bad. It was not condescending nor was it meant to be.
My comments were directed at the arrogant persons who stated that they could practice medicine as good as a doctor, simply by gaining experience as a nurse. My comment was that it simply will never happen, no matter how many years of clinical nursing experience you have. Nor would it be expected.
I don't under stand why some nurses feel such a need to beat their nursing chests and claim superiority in the practice of medicine simply by the wand of of years of nursing experience. I don't have the same desire to tell the nurses I work with that I am much better at nursing than they are because I have more experience as a doctor. Because I know that not to be true.
Feel free to interpret my words how ever you like. I have categorically stated I have full respect for nurses. But for a nurse to claim they can practice medicine above the base of a resident, even the rapidly progressing knowledge base of a first year intern is like me claiming to be an anesthesiologist because I have performed intubations, or claiming to be a cardiologist because I have performed a cardioversion.
Having pockets of experience in what ever field, whether it be nursing, EMT, respiratory therapy etc simply doesn't equate to equal caliber for being a doctor. It's an entirely different thought process that is not experienced to the same degree by non medical physicians. The same goes for doctors in reverse. I would never claim to be as knowledgeable as an EMT, RT or a nurse in the scope of their practice because I am not trained in their scope.
Why is that so hard to understand. Maybe because you chose not to.
The ones who believe I am arrogant simply do not understand my position. Every one has their role in patient care. I don't pretend to be something I'm not, unlike some of the flamers here trying to project their non medical degrees into full fledged medical doctor status.
You should be proud of your degree, what ever it may be and practice that scope of practice to the best of your ability.
"I write this with absolutely no discomfort because, I am actually arrogant enough to believe that what I, a nurse, bring to the patient's bedside is valuable. "
I am not a doctor or a nurse, and have never even been in the medical field (at least not the human medical field). However, over the past 3 years, I have been a patient more times than I'd like to count. What CountryRat said really struck a cord. Each hospital stay I've had, the most recent being just 2 weeks ago, were made tolerable by caring, compassionate nurses.
Of the 4 days I was in hospital most recently, I saw my surgeon twice. It was the nurses who came in and found me huddled in front of the toilet and called the doc and asked for something to make me stop throwing up. It was the nurses who noticed I was still crying in pain after my Toradol and called the doctor and asked about a PCA pump. And, bless his heart, it was a nurse who saw that I was finally sleeping soundly and held off reconnecting my fluids for as long as he could so I could rest.
I'm not discounting what the surgeon could have done to help me but none of it would have happened without the nurses. I would have left 24 hours earlier, AMA, had it not been for the wonderful nurses.
As I said, I've been in the hospital more than I'd like in the past 3 years and will be again, for another surgery, before the end of summer. Not so much in the ER, but once admitted, it always seems there's such an adversarial relationship between nurses and some of the doctors. Who does that benefit? No one. Nurses couldn't nurse without doctors and doctors couldn't fix people without nurses. Neither could function independently of the other.
"We've" come a long way from nurses being a doctor's handmaiden and yet there are still times, as a patient, that I see doctors acting like nurses are there to blindly follow orders, keep patients comfortable and do as they're told. Sadly, a lot of doctors (again, from the view of a patient) don't seem to respect that nurses are professionals and not just maids.
As a patient, I'd like to say "Thank you" to all the nurses who care about their patients and do what they do because they want to be there to help people get better. I know you all deal with a lot of crappy patients but there are still a lot of us out there who appreciate what you do.
I've got to agree that HH's comments were condescending. Even the subsequent posts by HH imply that a physician is better and smarter than a nurse. Our knowledge is just as broad and deep as a MD's - it's just not in the same thing.
Not only is he comparing apples to oranges, he is stating that apples are better.
I've met many a nurse (or ancillary staffer) who could have gone through medical school but didn't for one reason or another. Lots of them never stop learning and will study advanced topics independently.
Every day we learn just by doing our job. We learn during our practice the s/s of different diagnoses, the correct treatment, the risks/benefits of procedures, what test results indicate...and much, much more. Most of the time when a new problem is developing an experienced nurse knows what it is even before the doctor arrives to officially diagnose and she has the treatment already in the works.
As for procedural medicine, if an intern can learn them by "see one, do one, teach one" - then most nurses have "seen one" tens or hundreds of times and could probably "do one" as easily as the interns.
I've also met many Docs who squeaked through med school, internship and residency and then coasted. They are not up to date on meds, treatments or procedures. The nurses have to constantly advocate for the correct care for their patient.
Lastly, no matter how able the Doc they see the patient for a fraction of a day. Almost everything done in a hospital can be done as an outpatient. The only reason to have a someone inpatient is to provide 24 hour nursing care and observation. Without this the patient (and Doc) are up the creek.
Arkie, I feel compelled to resond, as my last, you you bacause what you do not represent what I am saying. No where did I say I am better. I have never felt that way. No where did I say I was smarter, which I'm not even sure how you can quantify when we are talking about different professional fields. I am not claiming that apples are better. That is so far from the truth it warrants rebuttle. You also state that every day you learn just by doing your job. I would agree with that completely. But you aren't learning to be a doctor, you're learning to be a better nurse. If you believe that your experience on the job is making you a better doctor, that would be the equivalent of me stating that every day as a hospitalist makes me a better med-surg nurse, something I know not to be true. You state that you believe your knowledge is just as broad and in depth as physicians, just not the same thing. I agree with that completely because we are dealing with different professional fields of care. Your field of knowledge in nursing is exponentially better than mine because I never went to nursing school and I don't practice nursing every day. Just as your ER doc is far superior in practicing ER doctoring because they are trained to do that. There will, of course, be overlap (considerable) in fields of knowledge. Doctors learn things from nurses. Nurses learn things from doctors. And we both learn things from patients. But 30 years in an ER will never make an ER nurse a doctor, anymore than it will make an ER doctor an ER nurse. The two fields are not the same. And 10,000 patient contacts will not make it so.
If you claim that your knowledge in doctoring is just as broad and in depth as a physician because you are an expert nurse in your field of practice, I would call you arrogant and dangerous. Pockets of clinical knowledge where " we learn during our practice the s/s of different diagnoses, the correct treatment, the risks/benefits of procedures, what test results indicate...and much, much more." does not equate to being a medical MD. It's the equivalent of a diabetic nurse claiming to be an endocrinologist because they know every thing there is to know about diabetes. It's the equivalent of a respiratory therapist claiming to be a pulmonologist because they can manage COPD like an expert. The fields of overlap across many professional fields does not equate to board certification in all of them. I am not board certified in nursing, nor as an RT because I am not trained for it.
What I believe you are saying is that you can do a doctors job better than the doctor (without a medical license) because you work with doctors in the medical field and have lots of independent personal study and experience in patient care as a nurse. That assumption is the equivalent of me telling you that I can do your job as a nurse because I work with nurses and have a lot of clinical experience.
You appear to be claiming superiority as a nurse and as doctor. I would never even think of disprescting your nursing field by claiming I can do your job as well as you.
I'm sure you can see 100 procedures and feel like you can do it just as well as an intern. Unfortunately, so can a college English professor. The problem is, part of the interns job is to learn how to do those procedures. That's is part of their scope of practice. Certain procedures are not in the scope of practice for nursing.
Your logic could be extended to cath lab nurses believing they can practice interventional cardiology as well as the cardiologist simply because they have seen 1000 caths.
I don't understand your need to tell the world you can practice medicine better than a doctor because of years of clinical experience.
June Cleaver said it better than I ever could. Everyone is great in their own trained way as part of a team that matters. Trying to claim something you are not is arrogant, dangerous.
No more comments. I promise I'm done defending rational thought
I was always nice to the cun..er Nurses, came when they asked, donuts on sunday morning, how else was I gonna get laid during Internship? Seriously, they can make your life miserable. I've always sorta liked watching Nurses try to be Doctors, its like when the Punter trips and has to run with the ball.
I'm not sure the purpose of GG posting this vignette of how she showed up some intern twice in front of a patient, except maybe to add her magnanimous apology. Gads, my olfactory smells disingenuity.
Most of the interaction in hospitals and other professional situations reverts back to stuff we should have learned in kindergarten: treat others with respect, etc.
I'm convinced that some people simply should not work in a teaching hospital... (and that goes as well for doctors being around nursing students, Drackman!)
arkiern, I think you underestimate HH's comments. He obviously thinks he's better than EVERYONE.
He and Dreckman are perfect examples of why many people think most doctors are arrogant.
Arrogant?? Check my blog out sometime, I admit to my fuckups, when the Statue of Limitations has expired, naturally. It's "Frankie's Hideout" the only place on the Web you can read about Whipples, Patty Duke, 44 Magnums, and Back Door Sliders, with Jimi Hendrix playin in the background.
Oh Yeah, GG I know you're a chick, but you just violated one of the Cardinal Rules of Warfare, not considering your enemie's response. Its in Tsung Zu, or Klausewitz. Sure, you embarassed dumbass, but now you've got to worry for the next year. Is he gonna Key your car?(I guaranty yours cost more) Pubic hair in your Mocca? Is that really sugar on the Glazed Donuts? Two words..
STEALTH Its the quiet grasshopper that survives the ..oh whatever..
I'm still a student nurse. There, I've admitted it. But when a resident ordered "5 rectal suppositories PRN for constipation," even I knew something wasn't right. And I wasn't very happy about the resident who ordered a 250 ml *bolus* on his ARF pt. w/o urine output X 8 hours. And another one tried to refuse to discharge his patient on the grounds of, "They always do this do me... do you know how much paperwork I have to do?!?"
After a brief staring contest the resident backed off and told me to get the teaching videos ready, he'll have the patient discharged today.
It stands to reason that at some point in anyone's career the staring contest (or correction, as it were) will eventually happen in the wrong setting.
... I just found your blog, have read all the archives, and can't wait to hear more!
All I have to say, is thank goodness I work in rehab.
No baby docs, but plenty of tests going round...the docs order them from the comfort of their desks without even telling a nurse if they're contemplating them while they're on the floor. Electronic health records are great, aren't they?
I like to ask the docs aside if something looks weird. "Hey, doc, can I check something to make sure I've got it right." Those JCAHO people love readback, so this usually keeps them quiet...unless they're in a rush to go back to their desks.
I just remember that my job is to a)do the job and b)not kill the patient. If there's any chance of b), this RN ain't doin' it and you better be ready to deal with my posse on the chain of command, 'cause I ain't fightin' you all by myself.
That's why those managers get paid the big bucks...to be heavies.
All I have to say, is thank goodness I work in rehab.
No baby docs, but plenty of tests going round...the docs order them from the comfort of their desks without even telling a nurse if they're contemplating them while they're on the floor. Electronic health records are great, aren't they?
I like to ask the docs aside if something looks weird. "Hey, doc, can I check something to make sure I've got it right." Those JCAHO people love readback, so this usually keeps them quiet...unless they're in a rush to go back to their desks.
I just remember that my job is to a)do the job and b)not kill the patient. If there's any chance of b), this RN ain't doin' it and you better be ready to deal with my posse on the chain of command, 'cause I ain't fightin' you all by myself.
That's why those managers get paid the big bucks...to be heavies.
All I have to say, is thank goodness I work in rehab.
No baby docs, but plenty of tests going round...the docs order them from the comfort of their desks without even telling a nurse if they're contemplating them while they're on the floor. Electronic health records are great, aren't they?
I like to ask the docs aside if something looks weird. "Hey, doc, can I check something to make sure I've got it right." Those JCAHO people love readback, so this usually keeps them quiet...unless they're in a rush to go back to their desks.
I just remember that my job is to a)do the job and b)not kill the patient. If there's any chance of b), this RN ain't doin' it and you better be ready to deal with my posse on the chain of command, 'cause I ain't fightin' you all by myself.
That's why those managers get paid the big bucks...to be heavies.
Ha Ha, you said "Nurse" and "Heavies" in the same post. Maybe those Docs are just pissed at you sending them stuff in triplicate. And you're right Thora, fluid for a patient in Renal Failure? Anyone whos watched ER knows you give Lasix,and make it Stat! Jeez. Lets talk about it in the Call Room...
Drackman is a MD troll who likes to stir it up in the comment section of other people's blogs to increase his blog traffic.
Happy Hospitalist isn't arrogant, he's right.
I'm pretty damn smart, and I've picked up a lot of stuff clinically, but even the dumbest ER Doc that I work with is still a better doc than I am. Oh wait, because I'm NOT A DOCTOR.
Hey GuitarGirl, where'd you get your shit-stirring stick? I need to pick one up. It's fantastic.
Wow - what a comment roll. I personally have no problem being corrected by RN's on things like dosages of meds - in fact I am glad for it (and I am sure the patients are too). However, I have to agree that correcting someone in a manner such as pulling it of a book is best not done in front of patients - and that goes for MD's correcting RN's as well - it does not engender any feelings of confidence in the patient as to the effectiveness or safety of the treatment they are receiving. It breeds distrust of the system - and god forbid something goes wrong (usually totally unrelated) they will latch onto the experience and think "wow, no wonder something bad happened, they don't even know medication doses". People easily misconstrue everything and that is a set up for a lawsuit. Arrogance needs to be put aside and ANY disagreement RN's and MD's have (no matter who is right or wrong) should not be had in front of patients - also, 60 mg IV of Toradol is the wrong dose but if you gave it to a healthy person, nothing bad would have happened (OD's of NSAIDS are usually no bid deal at all unlike ASA and Tylenol). Now, if he were demanding you push 50mg of Morphine instead of 5, that is a different story.
GuitarGirl RN has got to be the most annoying co-worker in the world, correcting people that way in front of patients. Great way to build up patient mistrust and dissolve coworker comraderie, Ms. Thang.
Wowie zowie. MG, why is it always the little, anecdotal posts that get the shit stirred up? I honestly don't know.
P.S. everyone: when I apologized, he didn't even remember the incident. He thanked me for being so nice and asked if we could review angiocath insertion techniques. And then he must have told all the other residents, because they're all telling me how sweet I am AND they're all coming to my show tomorrow night. (Hmmmm...if I had known this would bring people out to the bar to see us, I would have done it long ago...)
Two more things. 1. There's no "I" in team unless you're GuitarGirl RN. 2. The only fair ending for this story is for the doc to make Ms. Thang look stupid in front of patients from this point on.
"He thanked me for being so nice"
Now that's what I'm talking about.
Guitar Girl, hate to tell you this, but that Intern clearly has read Sun Zu. The part where it says deception can be as deadly as a well placed dagger thrust. He didn't remember the incident?? At best he's got Alzheimers,at worst, a Versed habit. Lucky guy though, last time I talked to a Nurse about Insertion techniques I got slapped.
As a guitar player who knows how hard it is drag anyone over 30 with kids out to see my band play, I have to agree that whatever it takes to bring 'em out, you gotta do what you gotta do. I was considering writing some medical marijuana Rx's ;-)
"Frank Drackman said...
Arrogant?? Check my blog out sometime, I admit to my fuckups, when the Statue of Limitations has expired, naturally. It's "Frankie's Hideout" the only place on the Web you can read about Whipples, Patty Duke, 44 Magnums, and Back Door Sliders, with Jimi Hendrix playin in the background."
Well, you got me on the guns and Back Door Sliders. Not to mention your artistic use of the Three Stooges. I guess I have to recant on that part.
Patty Duke? What's up with that?
HH, if I misunderstood your post - you definitely misunderstood yours.
After stating practicing medicine and nursing are apples and oranges, I was certainly NOT stating we are the equivalent of doctors.
I was trying to respond not to the actual words of your posts but the attitude. It came across that you think MDs are better and smarter. I was trying to explain that we are intelligent enough and capable enough to learn what physicians learn. But our career paths are different and we didn't choose medicine and we don't want your job. The physicians are necessary and I'm grateful they are there because they can do things I can't - not through lack of intelligence or ability but because they have a different knowledge base and training.
Many people(even MDs) seem to have the idea that nurses are just people who couldn't make it into medical school or are working their way up to going to med school. We don't want to be doctors! Nurses are vital to the health-care field. We are intelligent and capable and we choose nursing. We love being nurses and it's a very important job that requires a lot of intelligence and skill.
Just wanted to make my position clearer. Thanks to GG for the opportunity and sorry for hi-jacking your post.
I have just one question: would we be having/reading this discussion if the DOCTOR had embarrassed the NURSE by correcting him/her in front of a patient?????
I know the answer, and the answer is: hahahahahahahahaha!!!! No.
Frank: I don't like you anymore. :oP
Well played, well played, mes amis! Bianca Castafiore cries tears of joy as you come together, encore une fois, united against your common foe: the litigious junkie assholes who are your patients. Bianca sees, oui, elle le voit de bien près!
The ERP, I think it was, wove an especially dense fabric of disingenuity (c'est le mot du jour!), although I am almost convinced, through readings at his website, that he is not a false sort of person... oops, a false sort of *doctor* (Je m'excuse! Je m'excuse! How dare I confound the two, a doctor or a nurse, with "people"/person! I am, how do you say, febrile?).
The ERP, he writes:
<<...[correction of zee health care professionals devant le public] does not engender any feelings of confidence in the patient as to the effectiveness or safety of the treatment they are receiving. It breeds distrust of the system - and god forbid something goes wrong (usually totally unrelated) they will latch onto the experience and think "wow, no wonder something bad happened, they don't even know medication doses". People easily misconstrue everything and that is a set up for a lawsuit. Arrogance needs to be put aside and ANY disagreement RN's and MD's have (no matter who is right or wrong) should not be had in front of patients - also, 60 mg IV of Toradol is the wrong dose but if you gave it to a healthy person, nothing bad would have happened (OD's of NSAIDS are usually no bid deal at all unlike ASA and Tylenol). Now, if he were demanding you push 50mg of Morphine instead of 5, that is a different story.>>
Bof! Bianca does not want you all to be so immersed in your potential liabilities that you cease to share the important je-ne-sais-quoi-s of patient care! She does not want to be the one who unknowingly gets the 60 of Toradol, especially now that she knows you would never tell her that it happened...
People, vous savez, they easily misconstrue EVERYTHING.
Bon soir, mes petits choux, mes petits égoistes! Do not do differently than the Bianca!
GuitarGirl, like the ERP, your blog has a very honest and healthy air to it -- not well served by this comment thread. To that end, the Bianca again says "merci" for the chance to mingle with the important people (Zut! the ERP, there I go again. Person v. Doctor v. Nurse v. Litigious Asshole v. Drug Seeker. It is so confusing!).
The sources I use say Toradol - like most drugs - has a range of appropriate doses, IV or otherwise.
Did it occur to anyone that maybe the nursing-centric pharm book was not actually infallible?
M.D. training has so much depth precisely because there are so many variables to consider - including dose ranges. "This is THE dose" is easier to claim intellectually, but it isn't always the best thing for the patient's clinical condition with their particular medical history.
Seems to me that a discussion with this focus would have been the most productive for everyone.
GGRN Husband here -
For a bunch of smarty pants edumucated types a whole lotta ya sound awfully dumb, and reeeaally thin skinned. I don't think I'm filling in the blanks by knowing my wife and reading into her post more than is actually written. I think if you all read and try not to add YOUR prejudices and orientations you'll see that she was sharing a simple workplace anecdote that's easily analogous to others. Essentially, she corrected an impressionable but potentially powerful or influential trainee in front of a client. (As a spanking guitarist but novice bass player she gets to hear me shout, "play pentatonic. Pentatonic!" in front of our buddies. I could certainly be more politic. But with a background in ass kicking classical training she takes my criticism firmly on a high held chin and leaves it in the practice room.) As a co-worker, as a HUMAN, she reflected upon her words and actions, decided she wasn't happy with her behavior and set about correcting it. In the meantime, she posted the anecdote. Some of you emotional midgets took the non-regulation ball and ran with it, seeing fit to digress and spew about doctor/nurse relations and compare educations.
So.... Have any of you EVER been wrong? Can you admit it? Would you set about correcting it or at least making amends? "Tony" even went so far as to accuse GGRN of disingenuous self-congratulation. Frankly, why the fuck would she create such a post unless she simply wanted to share the little event in evidence of her sure imperfection balance by an ability to learn and change. Most of you blowhards don't sound like you've changed your mind since you were ten and decided on blue instead of green.
And some of these "kids" are gonna come to the gig and get their fill of some twisted weirdo Soft Boys/Beefheart/Television melody saturated rock n' roll. More learnin' shoved down their ears.
PS to Frank and anonymous 1:20am - I dig the clichés! Way to go referencing Sun Zu (sic), and I love that "miss thang" thing. So original!
secretwave101 said...
"The sources I use say Toradol - like most drugs - has a range of appropriate doses, IV or otherwise."
Right you are, secretwave. Doctors do not prescribe medication by following a rulebook. The do it by exercising judgment based on extensive knowlledge. Sometimes a higher than usual dose is best for the patient, and when it is, the doctor should order, and the nurse should administer, that higher dose. However, the nurse is responsible for the results of her care, and "I was just obeying orders" does not cut it, ethically or legally. (licensing boards take our licenses away from us for that kind of thing, and tort lawyers take our bank accounts and houses away, if our actions hurt someone badly enough.)
When a physician gives an order that differs from what is usually safe, the nurse MUST contact the doctor and make sure everything is kosher. In my experience, a fifteen-second conversation usually resolves the matter, and life goes on. However, if the nurse still believes that obeying the order will harm the patient, she MUST not follow the order, must inform the doctor of her decision, must document it up the wahoo and do all kinds of other unpleasant administrative medico legal stuff. As you would expect, situations in which the nurse is ethically and legally required to refuse to take a doctor's order are extremely rare, even extraordinary. However, it is a big world, and weird things do happen occasionally.
In any case, GG did not refuse to follow the doctor's order, nor, I suspect, is she ignorant of how individual differences justify off label pharmacology in selected cases. She conferred with the doctor regarding the correct way to carry out his order, which was exactly the right thing for her to do. Unfortunately, she did the right thing in the wrong place, using less than the best words, as have we all, sad to say.
I'd like to offer a slightly different perspective here. Most of you are assuming that the intern didn't listen to GG because he was arrogant. Instead, perhaps it was because he was scared s--tless. (Hell, I know I was terrified when I was an intern, although that may have had something to do with the crutches I was on at the time. But I digress...) Scared people want to be in control, and maybe the intern felt that the only thing he could control was his memory of the "right" dose of toradol. Let's cut him a little slack in that regard.
Congratulations on getting the house staff to come see your performance. :-)
Oh, yes, and I forgot to add: July 1st is the day that I get down on my knees and thank God that I'll never have to be a resident again. :-)
With nurses as friends and family I know better than to pick fights with the nurses. I was expecting to read a story of you smacking down an intern who was rude or disrespectful...I have no tolerance for that and intend to never do that to a nurse or any other staff at a hospital, and to correct any of my colleagues who I see doing that.
However your situation and the ensuing rabblerousing was a bit different... it didn't seem to me like the intern was trying to diss you. So, to you I say, good on you for correcting the intern. They will never, ever forget the IV dose of Toradol. In fact, I probably won't either.
As well, good on you for admitting it here, and encouraging a lively and hopefully beneficial discussion.
And even more good on you for being willing to apologize for the method of fact delivery, even though as far as the fact went, you were right.
In response to the hospitalist... "The suggestion that the interns brain will grow three sizes over the next few months is not hyperbole. "
Even in second-year med school we already realize that nobody truly understands what they are putting us through unless they have lived it... and we haven't even made it to internship yet.
ps. Bianca, what are you on??
It's funny. Yesterday I had to correct something a nurse was saying to another nurse about - medication dosages. I made sure no patients were around!
Vitum Medicinus asks himself outloud to me:
Bianca, what are you on??
We bat the eyes at you, we laugh, toujours la coquette!
We know that if we are ever sur zee Toradol, we want GuitarGirl on the other end of the tubing, giving us not more goutte than our alloted due...
http://prof-de-rien.blogspot.com/2008/07/nepeta-cataria.html
All of this flinging about makes us all look bad. There's a reason we practice medicine as a team. The team includes (in no particular order) RNs, MDs, PAs, pharmacists, LPNs, and probably a few more I'm missing. None of us is perfect and the checks and balances are what makes us able to provide good patient care. Everyone has a story of a doctor/nurse/pharmacist who made a med error. Every one of us undoubtedly has a story of a serious med error that was caught by someone with different letters behind their name than we have.
By the way, I also consider the medical assistants, phlebotomy techs, and housekeepers to be important parts of the team. Someone needs to keep my patient clean and change her position to prevent decub ulcers. Someone needs to draw 6AM labs because I sure don't have time to do it on all my patients. And someone needs to disinfect the rooms after a patient with MRSA or C Diff is discharged, because I sure don't want my next patient to get it.
Enough mudslinging. We all have our important roles.
interns need to learn and it matters not from whom they learn. you were right to correct him. in fact, i give thirty IM and 15 IV. as to how the interaction took place and whether you 'overstepped your bounds' i think we all have more important things to worry about don't we? old school medicine... i miss it, the nurses in white hats and hats etc... but we aren't in kansas anymore.
The Happy Hospitalist went wrong in his first sentence. "Remember you may know more than the intern this week, but in a couple months, your knowledge base will look like a children's book compared to the learning curve that intern will be on." Well, no. Compared to the intern's knowledge base, the nurse's knowledge base will be, well a nurse's knowledge base. I think that everyone here agrees that nurses and physicians bring different things to the table, and that both are necessary. In the grand scheme of things, physicians probably "know" more than nurses. (A nurses training is two to four years, a physician's is much longer.) Comparing a nurses knowledge base to a children's book, even as an act of hyperbole, is going to piss off a lot of nurses.
911 doc - I'll only where the white hat if you have to too...
this story rocks.
thank you gg!
Dafydd has it right. Of course doctors know more than nurses. (Full disclosure: I am a nurse, if that matters to you.) So what? What matters is that we each know what we need to know in order to provide the care we are there to provide. We know diffent things in different amounts because we bring different services to the patient. This is not a problem.
I think that I understand what HH was trying to say, and if I read him correctly, I agree with him. I regrett HH's choice of metaphore (you know, the children's book thing), but it is just a metaphore. I am pretty thin skinned, sad to say, but I was not offended. A little taken aback for a second by his (in my opinion) unfortunate choice of words, but still able to appreciate the value of his main point.
It is interesting, I think, that much of the back and forth between HH and other posters is about saying something true in a less-than-the-best way. GG and HH have something in common there, as do I, and everyone else reading this blog. We all "fail to engage brain before opening mouth" sometimes. Appologize when appropriate, figure out a way to do better next time, and, for goodness sakes, learn to laugh at yourself a little!
I supposed I should have clarified when I said "your knowledge base" I was referring to a medical knoweldge base of doctor stuff, as opposed to a nurses knowledge base, which is completely different, but none the less just as important. I've already explained my analogy to the children's book and it needs no further explanation.
Sure has made for some interesting reading though.
Like I said before, I wouldn't expect myself to practice nursing. I wouldn't have a clue what I was doing. I also wouldn't expect a nurse to do what I do. They aren't trained for it. Not even close. If you want to call me arrogant for speaking in reality, I'm quite all right with that. But know that I'm not.
Oooo, I'm jumping into the fray here! : D I guess because I came into the discussion late, I am not hearing arrogance in HH's statements. The above statement shows it. HH realizes that while our professions overlap somewhat, they are not the same.
I would however, say that dogs are trained - doctors and nurses are educated! : D
PS - My one time working in a teaching hospital I had an intern tell me to give 60 mg of Toradol PO.
(What is it with Toradol?).
Now, I knew that Toradol (at the time) came in 10 mg tablets and to make up the dose would be SIX tablets. Hmmm...
So, outside the patient's room I asked if she (the intern) really meant 60 mg PO. She was adamant that it was PO. I looked it up to make sure there wasn't something new I had missed and called the pharmacy to double check that there were no new guidelines I was unaware of.
No, the pharmacist said that 60 mg was not the usual PO dose.
I went back to the intern and said, "I think I see the issue here, would you prefer this dose IM?"
She told me, "Oh geeze, yes, I wanted it IM!" and thanked me.
GG - if you take that intern aside in person and apologize, it will go a long way in helping to restore/prevent problems in your working relationship. Who hasn't made a comment in the heat of the moment that they've regretted later?
HH - I get the gist of your argument. Medicine is a different profession than nursing. One is not better than the other, they are symbiotic in the benefit of the patient. And I have an very deep respect for the responsibilities and education needed to put that MD after your name!
Many thanks to Vitum Medicinus for mentioning this very interesting discussion!
I think for the most part doctors and nurses overlap in a large part of their duties... the difference in the two is that a nurse is usually more capable with the floor work and the doc can usually make the off-the-wall diagnoses better.
But honestly, when a patient rolls in to the ED with an evolving Mi, everyone from the docs down to the janitors know what lab tests to order and who to call :-)
Clotbusters? ;-)
First and most important you protected the patient from a drug error. I say, better a near miss at the intern's expense then a sentinal event and all the BS that goes with it.
Did the intern get his little feelings hurt/did you make him look like a boob? Too bad, it's the a business of protecting THE PATIENT first, not the sensitive intern's feelings. (regardless of what learning curve he's facing).
1: I would never throw a co-worker under the bus in front of a patient. Behind closed doors, all bets are off.
2: Why are so many people butt hurt by HH. He makes many valid points.
3: Thora- I have no problem giving an ARF patient a 250cc fluid challenge. It is all dependent on the situation. And do not be surprised when a renal patient only makes urine once a day.
4: GG- Kudos for you. You made a whoops and did what most people never do, you owned up to it. That is what makes you a better person.
Well done, GG. You are a class act. We should all be so gracious. Now let's move on.
I have been done with Happy Hospitalist's blog for some time now. It's comments like his here that make me glad I don't read it anymore.
He's FOS if he thinks he's not being condescending or arrogant.
I am both - R.N. and M.D.
I think you should have just told the intern in private. I know as an M.D. that's what I'd like, and as an R.N., that's what I'd do.
:)
A little late on this but read about it from Physician Executive. Posted the following on their blog too:
(for the record, I agree with you & phys. exec., HH's original comment was, as he states, perhaps not meant to sound as it did (though it did sound disrespectful, his rebuttle was rather dignified)
Anyway, sounds like anyone in medicine could benefit from this book:
A great read in this (whether one agrees with it or not) is Nursing Against the Odds, by Suzanne Gordon. A somewhat feminist approach on nursing and the doctor-nurse relationship, she does bring up a lot of good points. My favorite was her analogy to a barge coming into port. "When a large freighter or passenger liner approaches a major port,
until it is safely out into the sea lanes. This sensible procedure, designed to avoid accidents, reflects the fact that navigation on the open sea (think doctor) is the more general skill, while piloting a ship through traffic in a particular port is a highly contextual skill (think nurse). What the (local) pilot knows are local tides and currents along the coast and esbars, unmarked reefs, seasonal changes in microcurrents, local traffic conditions, the daily vagaries of wind patterns off headlands and along straits, how to pilot in these waters at night, not to mention how to bring many different ships safely to berth under variable conditions."
I agree with Guitar Girl RN. I also agree with you. I also think someone who is willing to admit mistakes wherever they land on the pecking order, is pretty cool. I mean, we're here for the patient, bottom line right? It's easy to forget sometimes. I wonder if any of your other readers have read this book? I'd be interested to know.
[I don't have a medical blog but I am an RN in a peds ed]
I just finished my residency a few weeks ago, and what I want to know is why in the hell was an intern in the ER putting in an IV? That is a nursing job. Doctors tell nurses to put in IVs. Unless he is going to be an anesthesiologist, then I don't see the point. Who cares if she corrected the intern in front of the patient? He'll get over it. Sounds like the patient was an asshole. Probably some jerk who isn't going to pay his bill anyway.
Good on you! Someone has to advocate for the patient. It doesn't matter what the label is Nurse or Doctor you both have medical training,and you actually saved his butt. Their is no hierarchy any more its called teamwork. You saved a patients life you should be thanked.:)
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