Sunday, March 24, 2013

Weekend reruns

It's been 3 years since I ran this post. And I still believe every word.


Nurses...

Are AWESOME.

I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Us doctors will see you from 5-30 minutes a day (30 is A LOT), depending on how sick you are. And the rest is the nurses.

They come in all shapes, colors, and sexes. Yes, there are a few idiots out there, that I take shots at in this blog. And there are idiot doctors, too. Idiots are in all fields, but the majority of nurses are damn good.

They're the ones making sure you get your pills, checking that your vital signs aren't dropping (and doing what they can to save your ass initially if they are, of which calling a doctor is only one part). They make sure you don't fall down and break something. If you start barfing, us doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They'll bring you a warm blanket. And clean disgusting things off you. Even if you're drunk. Or delerious. Or mean. And through all of this they try be friendly and positive. Even though you aren't their only sick patient.

I respect nurses A LOT. I learned early on that they're key to being a good doctor. You piss off the nursing staff, and you'll have a miserable career at that hospital. Respect and treat them well, and you'll never regret it. They're as important to being a good doctor as your medical degree. Maybe more.

If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they'll teach you. A good neuro nurse is often a better inpatient neurologist than some doctors I've met.

I remember a guy named Steve, who was an intern with me a long time ago. He had his head up his ass about being a doctor, and saw nurses as lesser scum. We were only a few months out of med school, and as we were writing chart notes one morning a nurse came over and asked if he'd go listen to his patient's heart. With icy contempt, and not even looking up from the chart, he said "I don't have to listen to his heart, because I looked at his EKG." They ain't the same thing, dude. If he'd listened he might have noticed that the patient had developed a loud murmer in the last 24 hours. When the attending caught it a few hours later, Steve got his ass chewed out. If he'd taken the nurse's advice, and listened, he wouldn't have gotten reprimanded by the residency board.

I talk about my Bible a great deal in this blog. Here's a quote from it: "Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom."

Those doctors are also depriving themselves of friends. On a shitty day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn't make the day any less busy, but helps you absorb the punishment better.

What got me started on this?

While I was rounding this weekend, a grateful patient's family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said "Oh, this kind is my favorite, it has cream filling."

And some pig in one of the rooms yelled "Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!"

You say that to a waitress, and you'd likely get your ass kicked out of the restaurant.

You say that to a co-worker, and you'd be fired and/or sued for harassment.

You say that to a lady in a bar, and you'll likely get a black eye.

And what did the nurse do? In spite of the fact that the guy was obviously a detestable jackass, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way.

And I admire the hell out of that.

Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.

While this post isn't about them, there are a lot of other unsung heroes who are part of the hospital team- pharmacists, social workers, nursing assistants, EMT's, respiratory therapists, X-ray techs, lab techs, physical/occupational/speech therapists, housekeeping staff. And many more.

51 comments:

ER's Mom said...

Word. Ten million times over.

Anonymous said...

Between any shade of "bad" nurses and "bad" docs, it's about even, percentage wise. When other docs are "bad" though, it's often famously, grievously, want to reach through the phone and rip out their throat bad. "Bad" nurses are just lazy or something, which is much easier to tolerate. I'll take a bad nurse over a bad doc any day.

We just got a nasty gram for bagging on difficult docs in the chart. Guilty.

C said...

So so true.

Lori said...

I am a 4th year veterinary student in rotations. Every time I have been made to feel like crap by an attending or resident, it's been the nurses (vet techs) who have been there for me. I am getting ready to graduate and I wouldn't have made it through this last year with my sanity intact without the nurses' help and compassion. I am forever grateful to them.

BossNurse said...

Thanks for the awesome shout out!

Anonymous said...

Thank you, Ibee. Thank you. Lori- not to ruin a moment here.. Vet techs are fabulous. But they can't use the title nurse. Must be an RN or LPN to use the title nurse, by law.

Anonymous said...

I'm a nurse and appreciate this! I wish more docs felt this way! Can I come work for you!

Pandora said...

Thank you :) Warms my ED nurse heart

Anonymous said...

Tell it, Doctor Grumpy! The more time I spend as a patient the less I respect doctors (present company excluded of course) and the more I respect nurses.

bobbie said...

Thank you, Sir ~

bobbie, R.N.

Anonymous said...

three years to repost this is too long a time. You should repost this at least once a year.

As a volunteer, I train all the new volunteers that come work in the ED. One of the first things I tell the new volunteers is to treat the nurses well, and all will be good on that shift. Keep the coffee fresh, be polite when you talk to them, and always smile when they ask you to do something. :)

I hope that I can remember this advice as I complete my medical school training.

Theresa said...

You just made me cry. Thank you from this nurse

Anonymous said...

Enormous thank you to Dr Grumpy! As a charge nurse in a ghetto ER with a few very ungrateful doctors it is sometimes easy to feel beat down and defeated. One nice sentiment like this and I am recharged for months. It is nice to know we are appreciated. Thank you again.

Kate said...

I worked the floors for several years as an NA and developed a huge respect for and learned a great deal from the amazing nurses I worked with; it was by far the most valuable pre-med experience I had. My med school has organized nurse-shadowing experiences for M1s & M2s- something I think should be mandatory all aspiring docs.

Ms. Donna said...

My Mom, the now retired ADON thanks you. (And her daughter does as well)

This belongs on KevinMD

RehabRN said...

Thank you Grumpy. I gotta take care of the patients, but if you/they are nice to me, I also take care of my providers (no matter MD, DO, NP, PA, etc.) and everyone else (therapists, pharmacists, IT people, etc.)

Because I know if I do that, when I need them, they'll take care of me, too.

And you never know when we'll score some pizza, fancy chocolates, coffee or lots of Diet Coke, that I just may hang on to some for my "friends" if I know they are on the unit or on call.

Anonymous said...

As a lab tech, I agree with this 100%. Nurses do EVERYTHIHG, and they'll do it even if the patient isn't cooperating, being nasty to them, etc. They're also pretty much the only human contact you get if you work night shift for an ER.

Now if only we could figure out what doctors do other than order tests and look at all the labs once they print off. :)

Jen said...

Thanks for the short shout-out to the clinical laboratory scientists and medical technologists at the end. We "lab techs" like to be noticed sometimes. Just because they keep us in the basement doesn't mean we're not an important part of the healthcare team.

Jessie said...

My son was a preemie (10 weeks early 2lbs 2 oz) and the NICU nurses were wonderful. I used to bring in brownies and muffins for them when ever he reached a new milestone.

He is 8, in second grade and completely normal. They were his guardian angles.

Shannon said...

This same holds true for the veterinary profession-as a DVM i know that my support staff is indispensable. Treat them well and your day will go well. Treat them poorly, and you'll likely get bit by your patients. Thank you to the hard working LVT's and VA's.

Laura K said...

You are SPOT ON. And all it takes is one stay in the hospital to learn this. I knew I liked you.

burnttoast said...

Amen! I worked as a Candy Striper in High School (volunteer in hospital) for two summers, mainly functioned as nursing aide. Worked as a real nurse's aide for one summer, and as a nurse's aide in newborn nursery (best job I have ever had). Then I went to medical school. Already knew that the RNs knew way more than I did, and knew how to listen. They humanize medicine for both the patients and us docs.

gin4407 said...

As a young teacher, many decades ago, I learned to make sure I addressed every secretary, custodian and cafeteria staff member by name. This lesson made my career in education wonderful!

gloria p said...

That is a lovely tribute. Thanks for your attitude toward your medical co-workers.

danielle said...

Thank you

Anonymous said...

Thank you for your support. We, the nurses, and the doctors, need to remember and be reminded, that we are the doctors eyes and ears.

Probie To Practitioner said...

I'm sitting here, drowning in nursing school homework, with half an ear to the radio for our 911 tone (Also proudly working as an EMT), and trying to convince myself to keep at it...

And this post made me supremely happy and proud. That was just the most perfect little boost to keep me at it tonight. :) Thank you, and to all of you doctors out there who realize that medicine is a team sport. You rock.

FireCap5 said...

On behalf of all the EMT-B's and Paramedics out here, thank you for the nod at the end.

Now if we can just get the medical community to realize Pre-Hospital care is a profession, and that we are professionals in the same sense that Doctors and Nurses are...

Maitri said...

Amen. Nurses delivered my second child because the doctor didn't get there within 2 hours. Whenever I've needed medical care, the nurses have been amazing and wonderful. When my son was in the ICU for 2 weeks, and his stuffed Tigger accidentally got thrown away, the nurse felt so bad that she gave us a gift card to Target to get him a new one. Nurses CARE, often more than the doctors. Nurses rock.

Anonymous said...

This RN has HUGE respect for EMS. You guys start turning the patient around- by flashlight, in smooshed cars, in the rain, on dangerous corners- with no labs or imaging and by the seat of your pants. Hats off.

Medic2RN said...

Thank you Dr. Grumpy, this means more to me than you'll ever know.

Packer said...

Our daughter is a Nurse, she just moved over to an ICU month, she is young, the work is hard. You got me teared up. Thanks.

Anonymous said...

Wow. Thanks Doc.

bobbie said...

I agree with Anon @ 1138 (3/24) ~ this should be repeated once a year, perhaps on May 6th (National Nurses Day)

Anonymous said...

Anonymous at 10:10- vet techs can and should absolutely be called nurses! As a veterinarian in a busy emergency room I can tell you without a doubt that our veterinary nurses are extremely well trained and way more knowledgeable that my husband who happens to be an RN (no offense meant to him of course). They need to know every specialty and every species except humans. There is no such law that says a vet tech cannot be called a nurse and on behalf of all my awesome techs I am offended by your comment.

Anonymous said...

Please don't take offense, Anon at 1:26. I respect and admire my vets techs. But the title Nurse *is* legally restricted in all 50 states- just like the title Doctor is. . Calling oneself a nurse without an RN or LPN license is a misdemeanor is some states, a felony in others. I can't use your title or theirs, they can't use mine or yours, etc.

Shannon said...

So I'm currently in nursing school. I'm 22 and literally just starting my pre-reqs because I didn't figure out until recently that my unending desire/need to help people was my brain going 'Nurse. Be a nurse. BE A NURSE YOU DUMMY'
anyway I figured it out, and I'm so excited and motivated and I know that I want to be the kind of nurse that makes people love nurses.

I told my friend Michael (just in remission from leukemia) that I was going in to nursing, and he hugged me.

Last year a nurse saved my life by noticing that the two medications I had been prescribed would have stopped my heart.

Nurses man.

They rock.

Patho Nurse said...

This brought tears to my eyes after an especially rough week at work. Thank you.

Ali D said...

Nurses are AWESOME. I'm in my final year of pharmacy school and have done two rotations in the ICU. The nurses were all really cool and willing to help a poor overwhelmed student. They really are wonderful.

k!nkyNurse said...

After a rough night in critical care, this was a much needed post to read. Sending a BIG thank you and virtual hug your way.

Anonymous said...

At the risk of earning everyone's ire, I'm going to go the other way for a moment. I'm a NYC surgery resident on outside rotation in Rhode Island. I think there are many incredible nurses, and I've met far more than I ever could have hoped for on this outside rotation. But I do have to say that, in New York, the nurses generally make up about 80% of the awful experiences that your typical med student, intern and resident experience in the course of medical training. For no good reason, the nurses in that area (and I can say this as a born and raised New Yorker) truly do not care about teaching, helping or being part of the medical community. I have seen nurses refuse to do basic parts of their jobs, give unnecessary hassle for tasks that had implications for direct patient care. I have seen nurses torture medical students whom they have never met (and therefore did not earn the torture), just because they could. I have seen nurses refuse to help during codes because they were "on break".

There are of course many wonderful nurses in the NYC area including at my hospital (especially in the ICU) but they are sadly too rare. On arriving at this outside rotation, I was shocked at how much work these wonderful nurses were willing to do, and they were shocked with my tales of nurses refusing to attempt IV lines, blood draws, foleys on male patients and generally being completely unaware of the patient's condition.

My point is this: I am all for singing the praises of anybody who works hard. But where I come from, residents save the asses of nurses just as much as the nurses save the asses of residents.

Anonymous said...

Another clinical lab scientist from the dark unknown basement thanks you for the mention. Too many people have no idea what we do and think it's a high school diploma and throwing stuff on an analyzer hitting the send button with the results. On the rare occasions we do get noticed/thanked, it's always greatly appreciated. There are so many people that make a hospital/patient care run smoothly. It's great if they all get a little thanks once in awhile. Definitely agree that a good nurse can make or break your hospital stay.

Angela said...

I'm an oncology RN and love my job. There is a lot of dirty work, literally, that goes unnoticed so to get recognition for what we do as a profession is awesome. I particularly like the line about the docs running out as nurses run in when the vomit starts.

I also love the MDs, PAs and NPs I work with. They went to way more school than I did and truly know their stuff, as I'm sure you do. I wouldn't want that job for the world. When collaboration happens between these worlds it is such a beautiful thing.

Anonymous said...

Thanks, Dr. Grumpy, as a L&D RN who got her ass chewed out this week by an OB, I appreciated so much what you said. Now if I can just post this in her call room all would be good.

lorenzo said...

Dr. Grumpy,
I work as a nurse on a tele/stroke/medical/detox/you name it floor. I really admire how you always know that the nurses are looking out for you and your patients. I have a few physicians who don't care to listen to my suggestions, and the patient usually winds up having a problem in some way. good tip for all doctors is that the nurses are the ones who are the front line to the beginning of a problem. Thanks for a well meant post.

kevel88 said...

Grumpy, you are so sweet. As an OBGYN RN for 40 years and most of that at a teaching hospital, I learned to dread July when the new interns and residents showed up. . . Some knew what they were doing and many did not. But then, that's why they are there. . . to learn. With a little prodding and encouragement, or even verbally ordering a verbal order. . . they get the experience they need to move on. Most of the MD's I work with in my department now, I have known since they were students. We have a great time and good laughs about "the good old days" when they were just babes in training. . .

Anonymous said...

If only there were some way that you could make every med student and resident read this post.

The g/f is an ICU nurse and I always say...some of these residents who think they're a god because they have M.D. behind their name better hope that I'm never watching a relative in the hospital and hear them say some of the things they do.

Why would you not listen to a nurse that has a hell of a lot more experience than you when someone's life is at stake? Every story I've heard basically ends with the nurse being right and the resident being wrong. Are some of them really that egotistical?

Aesop said...

Even if this were nothing more than blatant sucking up, we'd still appreciate it.

But it's much more than that.

Preach it, brother.

Anonymous said...

From a student clinical cardiac technologist - thanks for the shout out Doctor G !

Jo said...

Thank you for the props, Grumpy!

I'd like, too, to direct everybody's attention to the nurse aides, lab techs, phlebotomists, EEG and EKG majordomos, the superheros who run the echo and sono machines, and the housekeeping staff (ESPECIALLY the housekeeping staffs) of every hospital everywhere.

We're all cogs in a big, cool machine, and sometimes the hardest-working, most-dealing-with-gross-stuff cogs get forgotten.

Thanks, y'all.

awesomesauciness said...

Doc, from the many, many folks in my family who have chosen to be nurses I say a heartfelt thank you and add my own - damn straight!

 
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