Vacation is going well. I am sleeping a lot. Catching up on the backlog of TV shows on my DVR. Explaining to friends that even though I have officially been a doctor for six months, I still can't write them prescriptions until I pass Step 3 of the boards, and even then, I'm going to require an actual doctor's visit.
It's kind of nice to go a week without being called "doctor," without having to ask anyone if they moved their bowels today, without having to find a vein, and without having to check lab results. So much of what we do is tedious, dull, mindless work. Interrupted only occasionally by moments of excitement or reward. I guess that's any job though.
I don't think I've talked about this before, but the doctor/nurse divide is weird. One of my intern friends called me the other night and said there's a nurse he likes, and in theory wants to ask her out, but doesn't think he should. It would be awkward, he's like her superior... he doesn't feel comfortable doing anything. And maybe he's right. But the whole dynamic is weird. They call us doctor, and we call them by their names-- and sometimes not even. At one of the hospitals, there's this strange custom where the nurses all go by Miss or Mister and their first names. So I'm Dr. Lastname and they're Miss Jenny or Mister Steve. It's bizarre. Miss Jenny sounds like a kindergarten teacher. Maybe. And some of the residents use these names when they talk about the nurses to each other, like-- "did you give the order to Miss Amber?" "did you tell Miss Jeanette?" Are we children? I feel like we're colleagues, and we should all just call each other by our first names. Like colleagues do. Patients can call us Dr. Whatever, but I don't feel like I need the nurses to treat me like a superior, and I also don't want to treat them like they're my nursery school teacher.
Back to my DVR.
Friday, January 15, 2010
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There's something infantilized about nurses. Not sure if it stems from them or is put upon them (and they don't protest). I've known a few people who have gone to nursing school and they seem to have a sort of "calling" to go into it, almost in a religious way (of course, the roots of nursing are with nuns, etc.). But I also sense that they go into nursing because they are desperate for a ready-made role in society and I think that this contributes to expectations that they be subordinate, docile, obedient, and junior. Years ago I worked at Genentech as a clinical research associate (managing clinical trials) and I was the first non-RN that they hired for the job. All the other CRAs were RNs -- not because of any special knowledge or skills they had, but because the bosses (all MDs) could easily leverage that physicial-nurse dynamic, to their advantage, of course (i.e., just follow orders). Then I came along and not being an RN, naturally developed a collegial relationship with my MD-bosses. I didn't know any different. My arrival did cause quite a stir (this was 25 years ago) but the bottom line was that, not being hindered by expectations in the doctor-nurse relationship, I did a far better job than my RN colleagues in managing these studies. I could question things, bring errors to the MDs' attention, and really do my job creatively and insightfully to the benefit of everyone. Rigid roles carry rigid expectations. But there are people who like rigid, infantilized roles. And there are plenty of opportunities for those people in careers like nursing. Miss__Tina
ReplyDeleteI'm slightly offended at the person above's comment. I'm an ER nurse, and I call our doctors by their first names. It's Barb, or Steve, or Chris. A few of them that I haven't worked with before, I will call Dr. So-And-So until I get to know them, as I would with anyone who is my mom's age (I'm 24, these doctors are in their 40s, 50s...). I don't just "follow orders" and I don't consider myself to be docile or subordinate to my co-workers. I question orders I don't think are appropriate, and when I'm the one spending 3 hours with a patient where the doctor has spent 10 minutes with them, I come to the doctor not only with the patient's new symptoms, but with suggestions (i.e. "Mrs. Smith says the nubain didn't help her headache and she feels like she is trembling; I see that she is on steroids at home and her glucose is only 90. Since steroids tend to increase blood glucose, she probably feels hypoglycemic. Can I try feeding her to see if her headache and shakiness go away?")
ReplyDeleteThe role of a nurse is not rigid NOR is it infantile, and I'd like to see "Miss Tina" try nursing for one day. Or even try making it through a nursing school BSN program. I highly doubt she could pass with that attitude.
P.S. Your friend should ask her out. My good friend (another nurse) has been dating a 3rd year resident for a year and half now, and has a great relationship. It helps both parties to see the jobs of the other for what they really are, and helps nurse-doctor relations, I think. Plus, they know what each other is going through for the most part, and can educate each other on the parts they don't get.
-Andrea
How old is your friend how old is the nurse that matters young people dont really care about politics in the work place and it could work. plus the amount of hours you spend at work when do you have the time to meet other people who have you intrest so your advice should be yes why not you only live once
ReplyDeleteBe adults about this if you introduce your self as ben i will call you that if you say hi my name is dr whatever that is what i will call you so what
ReplyDeleteI KNOW scrubs is not real......but Carla and Turk had a very sweet relationship. He should totally ask her out!
ReplyDeleteMe molesta que nos digan doctores ,cuando en realidad somos médicos.
ReplyDeleteClaramente debemos personalizar las relaciones con nuestros pacientes
Interesting take on the ever enigmatic Doctor-Nurse equation at work. Here's my two cents' worth...
ReplyDeleteRelationships you forge at work depend a lot on your attitude towards your colleagues. I agree with Andrea in that if you introduce yourself to a nurse as say, Dr. Anon, you deprive her the right to address you by your first name, at least until you have had the time to get better acquainted. Would you introduce yourself to a fellow intern as Dr. Anon?
I have always found nurses and indeed doctors easier to work with if you just see them as members of your team with their separate roles. They help you with your job, you help them with theirs. It will be worth it to remember that everybody on the hospital floor is doing an important job, from the attending to the janitor.
I have worked in hospitals in India, England, Scotland and Russia, and have the advantage of having a surname that's not too easy on the "foreign" (non-Indian) tongue! But kidding aside, here's my take on what Miss_Tina had to say about an almost religious kind of "calling" to go into the nursing profession...
Nurses' pay in India has to be among the lowest in the world, yet so many bright, intelligent young women enroll in nursing courses every year. I personally know quite a few from affluent families - that could well afford the rather prohibitive costs of medical education in the country - opting for a career in nursing. Parents, especially devout Christian ones, still see nursing as a service rather than a profession, if I am getting my point across! And there is this inherent subservience, for want of a better word, that I suppose goes along with that kind of attitude, evident among nurses in India.
I am not so sure about nurses in the UK or Russia. I have felt, and this is purely my opinion, that the nurses in these countries have it a lot easier than their counterparts in India. But then, that's the case with doctors as well, because of the huge volumes of patients we have to content with in our hospitals. If my consultant (or attending physician, as you would call him in the US) has seen 10 patients in his clinic, he's had a "rough day". And I know of Indian consultants who go through a 100 of them a day! So you can well imagine the plight of the poor nurses. (And the battered interns, of course!) They are the ones that have to follow up on instructions, send the 'labs' and check reports, write up treatment schedules and case notes, liaise with specialists whose consultations have been requested, update relatives daily... The list never ends.
Unless you have a "calling", as the nurses surely must have, or are seriously mentally deficient, as most of our interns are, you never ever want to work in a hospital in India!
So there you have it, in spite of what we doctors think, the nurses are the ones in the forefront of our interaction with patients, and spend a lot more time with them than we do. Andrea is surely right that "Mrs. Smith's" hypoglycemia will first be noticed by, or reported to, the ward nurse. But if she thinks that all nurses would make the effort to find out about the steroids as the cause, I'm not so sure about that.
Remember, there are certain specific roles that all of us play at work. The goal should be to "play the game" as a team, in sync with your team mates. For what's medicine if not an infernally complicated, immensely engrossing, ultimately rewarding game. Of cat and mouse with death, did I hear?
Keep up the great work, Anon, and Save Some Lives! :)
http://ajnoffthecharts.wordpress.com/2010/01/15/they-call-us-doctor-and-we-call-them-by-their-names/
ReplyDeleteSorry, Anonymous! We (here at the American Journal of Nursing blog, Off the Charts) quoted you in the above post several days ago, but somehow dropped the link back to your original post. That has just been corrected.