Thursday, May 28, 2009

An excellent question

we are not so dissimilar, new nurses and new doctors. so why the disconnect? if we can all acknowledge that we're all here for the same reason - to learn how to do our jobs, and to do as much good as possible, with as little harm - can't we meet in the middle? with the greater good as our goal?

That particular question came from the comments on the post before last, and it's a hell of a poser. Why can't we, in the immortal words of R. King, all just get along?

Ego. Fear. Exhaustion. Territorialness (well, it's a word *now*). Bad examples set by other people. 

I have heard, oh my friends, horror stories from residents and nurses alike about how they're treated by each other. I read once, on another blog, of how an older nurse told the new nurses in her charge to treat residents badly so they'd know their place. I once witnessed an attending telling a resident that nurses tended to get hysterical over nothing. That was the same guy who swept an entire counter full of charts off into the face of a charge nurse, so consider the source--but it goes to show you that there are bad, bad examples on both sides.

There's also the issue of turfing, or of being territorial. We all want what's best for the people in our care, and sometimes we disagree on how to accomplish what's best for those people. If two people have equally compelling arguments on two sides of an issue, and they're both convinced they're right, you tend to get discord. Sometimes it's hard to admit that, even though you have a good plan, somebody else might have a *better* one. We tend to fall a little in love with both our patients and our treatment ideas; getting over that posessiveness can be difficult. So we fight.

And exhaustion. Imagine, if you're a new nurse, doing everything you're doing now, but with increased power and no sleep for the last 48 hours. (Yeah, yeah, I know there are work-week limits now, but they're honored more in the breach.) Imagine that everything that you do will be gone over with a fine-toothed comb by people whose job it is to teach you hard lessons quickly and sharply. Imagine that, if you screw up, it could easily kill somebody--and you feel like there's nobody checking your work.

Contrariwise, residents, imagine being a new nurse: you're dropped onto the floor after a couple of years of school and told--and it's really true--that you are ultimately responsible for every single thing that happens to your patient. Doc writes a bad order? Pharmacy doesn't catch it? Charge nurse and second nurse go ahead and sign it off, and you give that drug or perform that treatment and it hurts that patient? That is, ultimately, the nurse's responsibility. You're also expected to supervise other people, play peacemaker with family members, coordinate getting the person to radiology/ultrasound/CT/whatever, and still find time to make sure they're not lying in their own shit.

Ego and fear go hand in hand. Everybody's afraid of screwing up and looking stupid. Everybody's afraid of losing some perceived power they have in any situation. And that tends to make people jerky at best and assholish at worst. 

The thing is, though, that doctors and nurses have the same feelings and the same reactions to situations. We all get frustrated, we all remind ourselves that you can't medicate crazy, and sometimes we all just need a cup of caffeine and a shower. 

My advice? If you want to work with people who aren't jerks, find a facility that fosters respect among colleagues. If you're unlucky enough to have an attending who shoves charts off of counters and yells at his residents and nurses in common areas, try to be the opposite of that person. Likewise, if you're a new nurse with a preceptor or mentor who views residents and interns with disdain, ask for another preceptor or find another person to hang out with.

Most of all, when you get angry or frustrated, try to remember that the other person is likely just as angry, frustrated, and frightened as you are. If you yell, apologize. If you break down in tears of frustration, that's okay. If you need to, you can take a deep breath, give the issue a rest for two minutes, and return to it in a calmer state of mind.

All of us are in the same boat. Rather than smacking each other with the oars, we ought to dig in and start rowing. Forgiveness, a sense of humor, and keeping hold of your self-respect helps a lot.


Reality Rounds said...

Nicely written. It is usually insecurities that make people treat others like jerks. I have been in this game for 16 years, so no one will get away with throwing a chart at me. I once worked with an OB who threw an instrument at a nurse in the OR. That is not just stupidity, it is assault. Don't cha' wish everyone would just do unto others.....?

One Nurse said...

Love this post! I see this ALL the time amoung new residents and old nurses. I think it is a mixture of many things just as you stated. And sometimes it just needs to be said. . . thanks for saying it! We are all here to work toward the same outcome. For the better of the patient. Sometimes you just gotta get along.

AzRN said...

i work w/an older nurse who loves to be mean to the nursing students (who i happen to adore b/c they are so interested and eager). i have had to go to the students defense and speak w/my colleague. some folks just don't get it...when you're nice to the students, they want to help you. i have found the same w/residents and fellows. *shakes head*

shrimplate said...

It is illegal to shove charts at people. It's assault.I would have had a lot of fun with that guy. His balls would be on a very tight leash with a pretty little pink rhinestone-studded choke collar that I could pull anytime.

Crazed Nitwit said...

Slightly off topic, but nonetheless, Nurse Jackie to begin soon on Showtime is an interesting and brutal satire that addresses your topic as well. Try and catch an episode.