What do nurses think of doctors? What do doctors think of nurses? More to the point, what do they admire about one another, what do they do to irritate one another, and what can they do to improve their working relationship?
Memphis Medical News posed these questions to experienced doctors and nurses in the Memphis area, and we hope their candid answers in these two stories help to promote a better understanding between the disciplines.
In order to receive the most frank and honest comments, we made an exception to our policy of not using unnamed sources. We offered the nurses and doctors anonymity so that they could talk most freely.
Some of the opinions expressed here may sting, but they also may open some eyes and elicit productive discussion.
Doctors Say:
Ask Memphis physicians about interactions with nurses and how the work environment might be improved, and they all agree with the nurses: communication and respect are primary. However, responses differ about how much autonomy the nurse should have in this relationship.
A recurring topic was questioning a doctor in front of the patient.
“Some patients get the impression by the nurse’s body language or interaction with me that they are questioning my decision,” said a neurosurgeon with decades of service. “That causes a crisis with patient confidence. Nurses should respect the physician and understand that carrying out orders instills patient confidence. They don’t need to imply they know better.”
This same physician had great respect for a nurse’s intuition and wanted them to “take more ownership” with patients. It seemed the input would be welcomed had there not been an audience.
This theme continued in the feedback gleaned from a seasoned dermatologist, who advised questioning the doctor in front of the patient produces confusion on the part of the patient and causes them to second guess everything. He said this advice also goes for physicians of other specialties.
“Double checking work and discussing opinions are fine if the issue is worked out respectfully privately and then presented to the patient,” he said.
One general practitioner of 30-plus years explained, “There will always be some bumping of heads, and everyone has to remember they all have the patient’s best interests at heart.
“I know there are doctors that tend to be know-it-alls, and I know a lot feel threatened when questioned. Nurses are afraid to speak up and feel they will get in trouble. If they complain, they could be let go or get bad shifts, and I think that’s a shame,” he said.
Another doctor interviewed said, “Like we could get nurses in trouble. The hospital is always going to take the nurse’s side.” He cited the nursing shortage and ways hospitals can discipline doctors as reasons for his statements.
Over and over there was a call for nurses to use their training and clinical skills. A six-year veteran in inpatient rehabilitation encouraged nurses not to be afraid to use their clinical judgment to problem-solve before calling a doctor, she said. “Have a proposed solution when you call me. Think it out and present it to me so we can intervene.”
One hospitalist with experience in a variety of areas expressed displeasure over the content of his messages while taking call.
“Sometimes I will get a call at 5 a.m. over whether to administer an over-the-counter medication. If they were at home, they could do that. If a patient gets transferred to another room, they will call me—and I ordered the transfer. It gets to the point of harassment,” he said. “They have six patients, and I have 60.”
He said the way the hospital uses nurses can put stress on the physician-nurse relationship, and that nurses should not feel that they have to call for every little thing. He encourages nurses to use their training, but he believes they are constrained by hospital policies.
Other doctors blame electronic charting for communication problems between nurses and doctors. An internal medicine physician for 36 years pined for the days of written records.
“I used to be able to ask if a patient had a problem in the night, if they pooped, if they slept—I defy anyone to find that in electronic charts now,” he said. “Nurses need to be able to present a simple history sex, age, presents with these symptoms, appearance, here is pertinent history, here are labs being done—like in the ER. Now we are shotgunning people with 50 types of labs to see what falls out.”
The role of the nurse practitioner was a hot topic. Repeatedly, it was expressed that supervising NPs should not imply to doctors they know all that doctors do. Also said was that the accountability of nurse practitioners was not there. One 30-plus-year anesthesiologist recounted a story he heard from a colleague about a patient who accessed a freestanding clinic in a drugstore with severe abdominal pain. The NP administered antibiotics for a UTI. The next day the patient was near death in the ED with a ruptured diverticulum.
“A physician in that spot would be in jeopardy of losing his license. The Board of Medical Examiners has a lot of criteria and a long, arduous process for licensure but the nursing board feels a nurse can do anything a doctor can do by taking a weekend course,” he said.
An internist echoed his opinion, comparing 2500 nursing training hours with what he cited as 25,000 training hours for the standard beginning intern. Speaking of statewide legislation proposed to allow NPs to function without doctor oversight, he said, “It is foolhardy to think nurse practitioners can function without physician supervision.”
Citing the need for nurse practitioners due to primary physician shortages, he continued, “We need to have a more symbiotic relationship. As a whole, my peers respect NPs.”
There were lots of compliments about “good” nurses, described as those who used their intuition and clinical skills, took ownership in their jobs, went the extra mile and were friendly and approachable. A rehab physician said, “The ones who are not just clocking in, passing meds and going home are the best to work with. It’s usually very obvious who those nurses are that take extra steps with their patients.”
A hospitalist said, “I am usually around nurses who are bright, funny, good to be around and good at what they do.”
Nurses Say
When the Memphis Medical News asked nurses what physicians could do to improve their working relationship, good lines of communication was one of the factors most mentioned.
“I like the doctors the patients like – the ones who have some savvy or charisma in dealing with people,” was the response from one nurse. “The ones who communicate well with patients, patient families, nurses, everyone,” said a 25-year veteran ICU and recovery nurse and nurse educator. She said this goes for physicians, regardless of age and gender.
Indeed, communication and respect were key issues mentioned in every interview. The nurse quoted in the above paragraph said she has prayed for doctors to ask her opinion. “I am at the bedside 24/7. I know the specialty patients I take care of well. We could take much better care of the patient if doctors would just ask me my opinion, listen and communicate.”
As for most of the nurses interviewed, internists and family practice physicians were preferred to specialists because of the respect they have for nurses and their people skills. The most temperamental specialty described was surgery.
“One highly respected doctor has called us ‘nothing more than trained monkeys,’” said an almost 30-year nursing veteran currently working in an ambulatory surgery center. “If you would not talk to your wife, daughter or mother in the rude manner you find yourself talking to me, then do not talk to me in that manner.”
One hospital surgeon was described as “berating nurses and residents over pretty much everything. He is intentionally intimidating and downright mean to everyone he deems not as important as himself,” said a 16-year pre-op nurse with 33 years cumulative hospital experience. She described instances of whining, complaining and temper tantrums from many doctors, resulting in a real lack of respect for the doctor and decrease in productivity by the staff.
“I have definitely had some doctors who have had a sense of entitlement, and are rude or arrogant,” said a nurse practitioner with 10 years’ experience. “Or, they don’t see the value of nurses and nurse practitioners. NPs are there for the benefit of the patient. It’s not that we want to be a physician. If that was the case we would have gone to medical school.”
A MED/SURG nurse of 16 years said she knows all specialties are busy, but she would like more physician communication with patient families. She has been on both sides, recently losing a family member after several months-long hospital stays. She said at first, she would keep her profession a secret from her loved one’s doctors, but eventually her nursing experience would be found out. Communication would improve after that, and she thinks that openness in communication should be the same for everyone.
Communication between physician colleagues is important to the hospital nurse, said a 27-year nursing veteran. There can be conflicting discharge orders, different medication choices, or one doctor may start one thing and another physician discontinue it. In these cases her concern is consistency.
Blanket concerns have to do with the stressed health care system, such as nurse shortages, new reporting practices and increases in policies and procedures. Nurses say it is always helpful if doctors understand the limited staff and limitations put on nurses by competing demands.
“I realize there are not enough experienced nurses anymore. I know the newer ones will call a lot in the middle of the night and we are using less supervisory docs in my area,” one NICU nurse said. “But I have 25 years’ experience. If I call you in the middle of the night because I have a concern, it is something. It’s not my call whether we save this baby or not. You are the professional. It’s your call.”
A growing number of physicians and nurses are becoming efficient at new electronic charting and reporting systems. One nurse said that new computerized charting systems, although a learning curve at first, will help streamline healthcare – making treating patients safer and interpreting orders easier. Another explained that verbal orders are hard to do with new computer systems, and said she wishes that physicians would adhere to the new electronic guidelines.
Nurses also pointed out they also have their physician heroes. A nurse practitioner in psychiatry had a difficult patient threaten her and then file a grievance against her and threaten to kill her. The psychiatrist told her to walk away from the situation and let him handle it, telling her he had her covered and it was ultimately his responsibility as the attending. It meant a lot to her and she felt much safer.
A 24-year oncology nurse explained she was extremely happy where she worked.
“I work with some of the most intelligent people in the world, world-renowned, and they are not too big to talk to patients, patient families, or nurses,” she said. “They are very respectful of everyone and it facilitates the best patient care possible.”
Self-sufficient, kind, friendly, quick to thank those who help him and very complimentary is the way one pre-op nurse described her favorite anesthesiologist.
“Typically, the doctors who get the best work from nurses are the ones who treat them with kindness and respect,” she said. “They show occasional appreciation or interest in you as a person or your life outside work. It’s validation.”