When Doctor/ Nurse interactions escalate

When it comes to doctor/ nurse interactions, when is enough, enough?

Last week, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened). She is very smart and savvy when it comes to nursing. She constantly gets feedback from the patients as being one of the kindest, most thorough nurses. I look up to her in many ways.

The physician, also notable, one of the few physicians in this specific program. I always say if I ever need a doctor in this specialty, I would go to him. He is unbelievably thorough and great with patients.

She was approached by a physician wondering why the blood pressure medications of a certain patient were being held over the past few days and he was not notified. This nurse, being very diplomatic, offered a response to the physcian, “I’m not sure, I didn’t even know that happened, let me look into it for you and get back to you.”

Unrelenting, the physician pressed farther: “There’s no need for you to look into it further, I’ve been sitting her for 20 minutes looking at the blood pressures and medications given–and it makes no sense.” Getting louder with each word.

Knowing she could offer nothing useful in this conversation with it escalating, she simply walked away saying, “I don’t know, I’ve literally taken care of this patient for 4 hours.”

The nurse pulled me aside to talk it out–she was worried she had done something wrong. At this point, we are both thinking, honestly, we do not get paid enough to deal with this type of interaction.

Physicians come with a full picture of the patient that they’ve known over months to years. Nurses come in and get a snap shot of the patient that the previous nurse discloses. Over the first four hours of our shift, while we are running around attempting to maintain sanity, we may not get a chance to look back over specific details for individual patients.

I think bigger questions come to light in the midst of these types of interactions:

  • Where is the mutual respect among colleagues here?
  • Where is the team work? If we continue to treat each other (and this goes both ways–not just physician to nurse) in this way, it undoubtedly will be to the detriment of patient care.
I understand this occurs both ways, and my intention here is not to bash physicians. I simply want to shed light on a problem that needs addressing.
Thoughts?

 

8 Comments on “When Doctor/ Nurse interactions escalate

  1. I have no specific medical knowledge or background, so what I’m saying comes purely from personal observations.

    First, you’re often dealing with male doctors and female nurses, so there’s that dynamic. (No need to elaborate. .. )

    Second, doctors are used to being top dog on the totem pole and are valued for their analytical and decision-making abilities (in addition to other characteristics, of course), while nursing is still viewed by many as the “caring” profession. So a doctor is going to have a thicker skin and be accustomed to throwing his weight around, while a nurse is more likely to second guess her/himself.

    Basically, you’ve got all the dynamics of power inequality mixed in with sexual role expectations and a disparity in mutual respect. I would bet that in situations where a doctor and nurse worked closely together over time and grew to respect each other’s strengths, there would be less of what you describe, but in a passing encounter–like a hospital situation–I wouldn’t be surprised if what you describe is the norm.

    • D- I appreciate your perspective. “Basically, you’ve got all the dynamics of power inequality mixed in with sexual role expectations and a disparity in mutual respect.” Worded much better than I could have put it. Thanks for reading!

  2. I think there might be another factor too, and that is the rushed nature (at times) of “report”–it can fall victim to the “minimize unproductive time” sort of logic that some places deal with. When you have nurses having to both give and receive report in a piecemeal manner from/to multiple others, in a distracted environment, then it seems to me inevitable that transmission of vital information suffers.

  3. Terri makes a good point. I recently left a nursing position for a less stressful ( if you can believe it) IT&S position with the same company. What is most troubling is not the interaction, but the environment that breeds it. Like Terri said. It seems beyond belief that administration could not be aware of these problems. Or worse, they’re possible incompetent to remedy them.

  4. Sara, you sound like me, or as I would have sounded a few years back before retireing. There simply aren’t enough nurses on hospital floors. The patients are almost always at risk. There is an exurberance to being competent and responding lightening fast but it shouldn’t be the norm.

    I shudder to remember the suffering patients waiting too long for intervention. The U.S. system is wrong because it is based on profit and cost cutting is done routinely on the backs of nurses and other support people. Doctors work hard, but at least they get rich. The patients suffer one way or the other.

    Sally

    • Well said, Sally. I worked only a week into my short career before I realized the same– it is based on profit, not pts. If we were primarily interested in solving the problem at hand (whatever condition the pt has), we would never organize healthcare this way. And someday, each of us will be a pt.

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