Saturday, September 24, 2005

Let's get one thing straight right the hell now.

Oh, holy hell.

Can I just say this? I've figured out over the course of a short and misspent life that if a doctor is an asshole to you, she or he would be an asshole whether he was holding a stethoscope or a plumber's wrench. Some people are just plain assholes, and they end up in careers that allow them to make the most of their assholishness.

Same for nurses. If you work at a hospital (whether as a resident or nurse) where the nurses resent female residents, or residents of either sex as a group, then I feel sorry for you. That's known as a combination of assholery on the nurses' parts and a bad work environment.

I do not resent residents as a group. I resent the hell out of certain residents; namely, those who tell me that they're sick of reading X-rays on a particular patient, or that I should ignore the fact that said patient is breathing 32 times a minute and satting 76% on ten liters with a nonrebreather mask.

It's a focused, specific resentment.

And it's a resentment that's easily dealt with; namely, you have to be straight with the assholes you work with. If Doctor Assholian tells me he's tired of dealing with the above patient, I say to him (as I've said before), "Look, Fred, part of my job is to make your job easier. Would you rather write for Mucomyst now or code this patient later?"

If you're a nurse who gets peevish when an attending or resident goes against your recommendations, think of this: they might just know more than you. I'm not talking, of course, about times when somebody who's too tired or too frazzled orders something ridiculous, but about times when there's a judgement call to be made on a *medical* basis. We can't call all the medical stuff; there's simply too much that we don't know, okay? Okay.

If you're a resident who dislikes being called "Nurse" by mistake, suck it up. Mistaken identity is part of the business of dealing with people who are not all there. If you've got nurses who woo you in the station and diss you in the breakroom, you might examine your own behavior. If your behavior comes out clean--and I'm saying here, loud and clear, that there are lots of times when it will--you might have to chalk the whole backstabbing thing up to assholishness.

And for the residents who pull the "ten years of training" card, think of this:

Three hundred years ago, or even less, medical school was a short-term thing. Doctors had a few years of courses, followed (sometimes) by informal apprenticeships.

Nursing is where doctoring was in its infancy. As a profession--not just a dumping ground for retired whores and drunks--we're less than two hundred years old. We've still got the relatively-short-formal-education thing followed by what's essentially a working apprenticeship. Nurses who have been practicing in high-acuity settings for three to five years are referred to as "new" nurses. The idea of nursing diagnoses is less than fifty years old, and the reality of nurses as people who synthesize a large amount of scientific data and decide on treatments based on that data is even younger.

You're an expert in your field. Do me the credit of assuming (until I pull one of my spectacularly original fuckups) that I'm an expert, or at least an expert-in-training, in mine.

I will bust ass to make sure that your job is as easy as possible. If you let me round with you, you'll know all your patients' lab values for the last thirty-six hours without having to refer to an index card. If you let me make a suggestion, I will keep your patient from having to have a wound-vac installed on the stage IV decub. on their butt.

Likewise, I know that you will bust ass to make sure that my patients are as healthy as possible; that they don't end up getting conflicting medications or unnecessary treatments. I know that you won't cuss at me if I call you at 2 a.m. because something is *just not right*.

And let's drop the whole notion of whether scrub jackets or print scrubs make you look more or less like a nurse, shall we? I already have enough trouble with residents who don't wear undies.

1 comment:

beajerry said...

Nice rant!

Here's my thorn from the past week:
Me: blah, blah, blah..."so can this patient have something to calm down?"
MD: (irritated voice)"Yeah, sure, give him Ativan 2mg's IV Q6hrs. And he can have Haldol 1mg IV Q8hrs."
Me: "Ok, that's Ativan 2mg's IV Q6hrs-"
MD: "2mg's!? Who said anything about 2mg's!? I said Ativan POINT 5 mgs!"
Me: "Uh...ok...Ativan 0.5mg's..."