Sunday, January 10, 2010

What I Learned About Doctors in Nursing School

 MD Girl* and Liana both were curious as to what we were taught about doctors/med students in nursing school, it was shaping up to be an irritatingly long comment from me so here is a post instead. I used bold so that you could skim through a 3 minute version of my answer the question. For those who are drinking your morning coffee and want a long winded between the bold.

I wish I could offer some very interesting, discussion promoting, insightful answer to that question but I honestly don't have one.

I really had to dig into the recesses of my mind to try and recall specific things that were said about physicians or medical students (formally) in any of my classes. There was a class that was a small group session with pharmacy, nursing, medical, O.T students, which Keet mentioned, but for some reason I had too many electives and they didn't make me take it. It was apparently supposed to highlight the different areas of expertise in the allied health fields, and teach everyone to play nice once they were in the professional sand box together. 

As Keet said in his response in the comments--it really depended on the instructor what was said and what was taught with regard to doctors and medical students. There wasn't what I would call a specific mantra in the curriculum that was repeatedly droned to us.

So instead I'll give you a brief sketch of the types of instructors and the lessons we were meant to learn from them...

Some instructors were from the days of yore when nurses stood up if a doctor entered the room. Those were the ones that implied that we never question anything, we perform our orders even if they seemed inappropriate, and never assume that we had gleaned any information in our extensive interactions with the patient which the doctor might have missed (and therefore not to bother HIM with such trivial matters). Med students also deserved a seat if we were in report together and they were standing. Oh, and we were meant to find all the doctors hilarious, charming, always appropriate, and a fountain of fascinating tales on everything from fly-fishing to changing the oil in their new Mercedes convertible. 

Other instructors were hellbent on providing ample examples of when they were right about something and the doctor/medstudent was wrong. These instructors anecdotes had the central theme of them saving the day with monotonous regularity and I usually mentally rolled my eyes when another health care homily started. These nurses had the clearly visible chip-on-shoulder approach to all physicians (and med students). They were also the ones that gave med students grief, just because they could.

The take home message that was drilled into my brain though was--do not develop a false sense of security just because you are not the one writing the orders. If a doc orders the wrong drug/dose and you give it--YOU are responsible. Ensure you always know what you are giving, the side effects, the intended therapeutic effects and your patients allergies. That nugget was a keeper and I still am very anal about medication administration--especially because so much of what we give in the ED is I.V push (i.e the fastest acting method to give a drug and quickest way to kill someone if you make a mistake).  I am still blown away when I am getting report and the patient is on a med I've never heard of and I ask--"Oh, what is that drug for?  What does it do?" and I get "Oh, I don't know" from the nurse who administered it.


But I digress.

Another type of instructor (and when I say that I mean clinical and/or lecturer) is the type that sees MD's/med students basically as a colleague. They told us that nurses and doctors were each their own profession but that we were supposed to work as a team. They got along with docs/students on the floors and encouraged us to use the medical students/doctors as a resource if we didn't understand something. They encouraged us to ask questions, confirm orders we thought were shaky, and to bring our patient concerns to the PCP/med student as we were the patients advocates.

Which brings me to the final camp--the slightly out of touch academic nurses who were now onto their post-docs in nursing. They were teaching us only because they had to round out their esoteric academic indulgences with some actual student interaction--as per their contract. These nurses hadn't had any clinical experience in over 20 years. They had spent their careers doing things like developing nursing theory and nursing diagnoses. Now usually I get a rash when I think back to those lectures and the subsequent papers I had to write because I think a lot of it is actually *not* clinically relevant and is really self-indulgent navel gazing.  But before I get a flood of comments--especially from you Keet---(hee) I will say that some of the models and theories are very well developed and very applicable: the patient centered care model, Orem's self care model are a couple that immediately spring to mind. But I swear if I hear the words "health as enabling consciousness" or "contrasending with possibles" I still break out in a cold sweat.

A lot of these instructors seemed to forget that physicians and medical students existed (or maybe they wanted to forget). You could have entire courses with these people and never hear those words. Partly because these women (yes they were all women so I can say that) were so very very focused on promoting nursing as a profession. Period. Thus their main thrust was expanding nurse theory, nursing diagnosis, nurse practitioner roles and nurse autonomy, so all of this had very little to do with the interaction of nurses and doctors. I don't mean to sound overly glib on this matter--I actually agree that nurses are professionals and should be seen as such. I also agree that many nurses would be amazing in expanded roles with increased autonomy. But that is not what all nurses want. And if we're going to be working in a hospital or clinic (no matter what the scope) I think *some* attention should be paid to what the roles  (R.N, nurse practitioner, L.P.N, medical student, resident, attending) mean and how we can maximize efficiency, patient care, and patient safety by working in harmony.

I hope that answered your question.

I am always happy to be spurned to think about these things, so thank you for the comments and questions.

*I thought that was a better abbreviation than 'Old Girl' because yeah, that isn't an overly apt moniker.   :-)


OMDG said...
This comment has been removed by the author.
OMDG said...

Thanks for writing about this. It was highly educational. It's funny. I really do think that nursing is its own profession and that it would be best for everyone if the medical team played to everyone's strengths. I've worked on some teams with some amazing nurses who I learned an inordinate amount from. I've also worked with some nurses who scared me, and some that seemed to be looking for ways to call me out. The latter two categories have been the minority, however.

Nurses do get treated like crap a lot of the time though. Not just by doctors, but by the hospitals that employ them. It's really a shame.

I remember suggesting nursing as a career to a friend of mine because she wants something that she can study for and then later do part time that won't completely take over her life for all of eternity. She thought I was being condescending to her because *I* wanted to be a doctor. She was such a fool! It would have been -- and still could be -- a wonderful career for her.

Keet said...

It is a fantastic career for anyone who wants to do anything in their lives outside of the day to day career. In North America at least, it is compensated to a level that working part-time, one could pursue another career, or study, or paint, or make music, or whatever floats your proverbial vocational boat. Unfortunately for some nurses, all they have ever wanted to do was care for other people and so like many other workaholic professions that will not be named here, they burn out. And even more unfortunate for everyone, are the ones who are there only for the paycheck, and make bad choices for themselves and the people they are 'caring' for. Oh dear. I am rambling in a comment again. LOL - Asystole - stop me before i start co-transcending the possibles, (Parse's theory of human becoming), but I do have to say, you have hit the nurse education nails on the head here. Way to go! I actually think I got out of INterD 410 as well, because you got out of it, and we'd done the same undergrad courses pre-nursing. or something. Maybe that's why I'm so bad at interdisciplinary working. HA!

lost passerby said...

Unfortunately nurses are still not professionals in some part of this earth.

Liana said...

Wow, I inspired a post. Thanks, ABB.

My mom is a RN and had all these stories about doctors who would throw charts at the nurses and other horrible behaviour.

OMDG, by the same token, I find it very odd when other female doctors are insulted that a patient mistook them for a nurse.

Albinoblackbear said...

OMDG--I am constantly telling my friends that they should go into nursing---it has actually worked for two of them (Keet--case in point). It is a fantastic career; flexible, in demand, well paying, and interesting. It's too bad that someone took offense (because you're in medicine) they are missing out on a great suggestion.

Keet--I am glad you approve of the points and yes...there are some nurses just in it for the money/pension/because they are afraid to try anything else. Many of the older ones had '# of days until retirement' as their screen saver in Victoria.

You are never allowed to co-transcend the possibles around me ever again (NCF 2000?) hee.

LP--It is sad but true. I have worked with many international nurses when I was living in the Arctic and a lot could not believe the respect/responsibility that nurses had in Canada (esp. the north).

Liana--Well thanks for the question! :) It is good to look at it from both sides, after all.