Thursday, December 23, 2004

Advancing the profession

I had a conversation about Advancing The Profession two days ago with a friend and colleague at work. Advancing The Profession is, for those of you who aren't nurses, a Big Thing in nursing circles. Nurses who bother to answer surveys report dissatisfaction with their careers, frustration with their practice limitations and paperwork, and anger at how they're perceived and treated by both the public and the other professionals they work with.

There are as many ideas for improvement as there are problems. Many nursing professionals want to change scope of or requirements for practice. Still others want to educate the public. Some want to raise the consciousness of those other professionals with whom nurses work.

Raising Conciousness was the focus of my colleague's and my conversation. I had spent a good part of the morning cleaning up the mess that a group of lazy, ignorant physicians had left and I was frustrated. Being sniped at by everybody and his dog is part of being a nurse, as is cleaning up loose ends that others (usually "too busy" residents) leave lying...but it gets old.

My colleague, who works ICU on the weekends and is an educator during the week, suggested that I devote a little time to Raising The Consciousness of the physicians I'd cleaned up after. And even though it was a good suggestion, I couldn't take it to heart.

Why? Because I was tired. I can see where conciousness-raising would be a brilliant idea: take a resident who's disrespectful aside and talk to him calmly about professionalism and hope for a change. But most of the time, we nurses are so frazzled, we simply don't have the energy to devote to educating the odd Neanderthal who comes in with a medical degree.

I'm lucky on a number of points. The floor where I work is well-staffed. The doctors are, for the most part, good colleagues. My specialty is such that I don't get a lot of jokes or flack about wearing short skirts and a cap. (Say "I'm in neurology" to even the most uncivilized bar patron and they back off.)

But still. Why is it *my* responsibility to educate/lecture/come down on like the crack of Doom somebody who just doesn't get it? If I have the time and the inclination, I will. Otherwise, watch out: if you're an attending physician who hasn't learned to be a decent human being by this time, I am not going to educate you. I'm gonna push back as hard as you push instead.

A group of interns made a video in our nurses' station about how to deal with sexual harassment. It wasn't focused on how to handle the nosy patient if you're a young female doctor, or how to deal with the predatory professor that occasionally crops up. It was on how to deal with a (female) predatory nurse if you're a (male) doctor.

When we (female) nurses all stopped laughing and wiped our eyes, we got into a serious discussion with the instructor of the group. Why, we asked, were the students not being taught lessons that would serve them in good stead? Sexual harassment is covered in our medical school. Being professional and working on a team is not. How not to yell at somebody simply because they're following the rules is not. I'm not implying here that sexual harassment is a chimera or overstated; it's not. What I'm saying is that the curriculum at our facility pays far too much attention to the one problem--often to the exclusion of the other.

I'm a feminist and childfree and a nurse; raising consciousness is not unfamiliar to me. What's unfamiliar is the unwillingness of other professionals with whom I work to police their own. It's left entirely to us to educate/train/police the people who technically are our superiors. At the same time, we're expected to provide good care for sick people and their families, act as gatekeepers and coordinators of care, and keep a smile on.

I once had to report a resident to his attending for being a jerk. I heard the tail end of the lecture the attending gave the resident. Just before Attending turned Resident loose to go back to work, he said, "...and don't let their hysteria get to you, okay? Most of them just aren't that tough." (Enter Crack of Doom Nurse hard on the heels of that statement.) Point being that I'm expected to Educate and Enlighten this person, but his boss will undermine me, then blame nurses for the lack of respect that his students show them.

Honestly, I have no solution for this particular problem. All I can do is keep practicing as professionally as I know how and deal with trouble when it happens. I just hope I'm not completely burned out by the time I retire.

2 comments:

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beth said...

So. Just started reading your blog, so I thought o.would check out the first. I worked as an EMT in a level one trauma center for over seven years, before then in the ER, right next door. I was well known for getting the job done. I loved my job. In the trauma center the attendings knew me, I knew them and their ways, certain doctors want certain things. For example, one attending had his own box of sutures, another well if the doppler and warm blankets were not around she would pitch a fit like a child. These were secrets that I knew that these new residents did not, I was one up and could save them from being yelled at. Many other examples also, point is I KNEW THE ATTENDINGS. I always made a point to spoil the residents, have everything prepaired for their procedure, lac trays set up, irrigation already done, because when it comes down to it it was best for the patient and I know the resident can be short on time also. I would always tell them, clean up your mess... Get rid of your sharps and speak to the family members when you are done. If they were habitual offenders of my rules, their days of getting spoiled were taken away. I would let them know also. (there were always exceptions). Most residents loved me for it, and I learned so much. Some fought me to the end, but they were the ones that suffered. Example, spending 20 mins finding the consult paperwork to fill out, having family members talk to the attending wondering why it took so long to hear news from about their family members procedure. Little tricks of the trade. It even got to the point were I had attendings asking me about how each resident worked under pressure and my personal opinion about them. I'll never forget one resident said " I can't wait till after residency when this white coat actually means something" we are the nurses and staff, we run the ship the attendings direct it, the white coat just means welcome aboard.