Listening to nurses is key to being a good doctor

Listening to nurses is key to being a good doctor

I’m a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80′s, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Doctors will see you anywhere from 5 to 30 minutes a day, depending on how sick you are. And the rest is the nurses.

They’re the ones making sure you get your pills and checking that your vital signs aren’t dropping. They make sure you don’t fall down and break something. If you start vomiting, doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They’ll bring you a warm blanket. And clean disgusting things off you. Even if you’re drunk. Or delirious. Or mean. And through all of this they try be friendly and positive. Even though you aren’t their only sick patient.

I respect nurses. I learned early on that they’re key to being a good doctor. You piss off the nursing staff, and you’ll have a miserable career at that hospital. Respect and treat them well, and you’ll never regret it. They’re as important to being a good doctor as your medical degree. Maybe more.

If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they’ll teach you. A good neurology nurse is often a better inpatient neurologist than some doctors I’ve met.

I remember a guy named Steve, who was an intern with me a long time ago. We were only a few months out of medical school, and as we were writing chart notes one morning a nurse came over and asked if he’d go listen to his patient’s heart. With icy contempt, and not even looking up from the chart, he said “I don’t have to listen to his heart, because I looked at his EKG.” They ain’t the same thing, dude. If he’d listened he might have noticed that the patient had developed a loud murmur in the last 24 hours.

When the attending caught it a few hours later, Steve got chewed out. If he’d taken the nurse’s advice, and listened, he wouldn’t have gotten reprimanded by the residency board.

Here’s a quote from “Kill as Few Patients as Possible” by Oscar London, MD: “Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom.”

Those doctors are also depriving themselves of friends. On a difficult day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn’t make the day any less busy, but helps you absorb the punishment better.

What got me started on this?

While I was rounding this weekend, a grateful patient’s family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said, “Oh, this kind is my favorite, it has cream filling.”

And a patient in one of the rooms yelled, “Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!”

You say that to a waitress, and you’d likely get your kicked out of the restaurant.

You say that to a co-worker, and you’d be fired and/or sued for harassment.

You say that to a lady in a bar, and you’ll likely get a black eye.

And what did the nurse do? In spite of the patient said, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way.

And I admire that.

Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.

Doctor Grumpy is a neurologist who blogs at Doctor Grumpy in the House.

Image credit: Shutterstock.com

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  • Tom

    “I’m a doctor. We get all the glory. And credit.”

    And all the blame, which can encompass nursing errors. No question, nurses are a blessing when they’re good, but nothing makes life more miserable than a bad nurse.

  • http://thehappyhospitalist.blogspot.com Happy Hospitalist

    I often say

    Doctors save lives. Nurses save doctors AND lives.

    • http://www.arnp.blogspot.com Jennifer Scott ARNP, FNP-BC

      Thank you Happy Hospitalist! It’s nice to see that you think that we all play a part in health care.

    • Cher

      Now that is a quote worth Facebooking, Happy Hospitalist! Thanks for recognizing us!!

  • jim

    It works both ways. My sister is a nurse at a major academic hospital and she’s told me there’s nothing better than working with a great physician. One who engages the nurses and asks for their opinions, knowing they’re the ones who have been with the patient all day. Making friends with the nurses can only help physicians out, especially since the responsibility always lies with the physician.

  • debra

    Hear , hear! nurses rock

  • Doc99

    My favorite “MD Aware” note involved a disturbed woman who committed suicide by jumping out an 8th floor window in an old hospital ward. “Ms. X jumped out window – Dr. Y aware.”

    • http://www.dcardillo.com Donna Cardillo, RN

      My favorite progress note by a physician when I asked him to document how sick he stated the patient was so we could justify (to outsuide regulators and get paid) keeping her in the hospital, he wrote: “This patient is very, very, very, very sick.” End of note.

  • http://www.fmgportal.com Foreign Medical Graduates

    I agree 100% that nurses will often see things Doctors do not. While I mean no disrespect to Doctors, often a patient will find themselves feel much more one on one time with Nurses than they do with Doctors. The main reason for this is because of the number of patients a doctor may have.

  • http://www.drjohnm.blogspot.com DrJohnM

    The nurse, who is also a dear friend, bandages me after the cyclocross race.

    The nurse on third shift untangles me from the IV tubing, and gives me a pain shot after a chest tube is inserted.

    The nurse changes the sheets on my bed after I soak them from a pneumonia-induced fever.

    The nurse points out that the patient in whom you ordered heparin, is already on lovenox.

    In the EP lab, the nurse sedates your patient with skill and compassion.

    Great post.

    Masters of the obvious know the value of nurses.

    JMM

  • http://www.dcardillo.com Donna Cardillo, RN

    Great post – thanks. Nurses and physicians are part of the same team – both members of the primary healthcare team. We have the same goals and wishes for the people we serve. We compliment each other and enhance each other’s practice. We are collaborators of care. I have always regarded physicians as colleagues and believe they have regarded me as same.

    I teach new nurses to treat physicians with honesty and respect and to expect the same in return. This is to everyone’s benefit but especially our clients. We can, and we do, continue to learn from and support one another.

  • jsmith

    Nurses do rock and have saved my bacon many times. BTW: that pt obviously does not belong in the ICU anyway if he is able to speak.

  • http://glasshospital.com GlassHospital

    Dr. Grumpy he speaketh the truth.

    I will cut this out and show it to my fellow docs–the unwise ones, that is.

    -GH

  • Sheila

    The best thing ever is when nurses and doctors listen and respect each other, work together for the sake of the patient. I have been a nurse for 28 years, I have worked with some great docs and some who won’t listen because it wasn’t their idea. We have to get over that in order to better care for our patients (the younger docs seem to be getting this a little in school they will listen to the nurse a little better, wise decision)

  • http://www.linkedin.com/in/achievementstrategies Marie

    Wow. Thank you. Just…thank you. :)

  • Lyn

    At the end of the day, there is nothing more satisfying than a team effort between a physician and nurse. Having worked with and for doctors for 30 years, I have experienced great joy in working with a doctor who sees me as a partner, and great frustration in working with a doctor who uses me as his instrument, and nothing more.

    Great article Dr. Grumpy!

  • Molly Ciliberti, RN

    Thank you and the feeling is mutual. Good nurses appreciate good doctors; we are a team. As for insults and unbelievably filthy language, patients are pros. Sometimes it is really difficult not to laugh when the recipient. Had an ICU patient have a large loose stool in his bed. When two of us went to clean him up and change the bed, he said, “See this shit?” pointing to the you-know-what. “We men have been taking it from you women forever, now here’s some back!” We struggled to not howl with laughter and could barely get him cleaned up due to the tears of laughter in our eyes. He was having DT’s and not responsible for his words. The night shift and we nearly died laughing about it at shift change.

  • Craig MD

    I have to chime in here. This is not rocket science. It’s not about treating nurses right so they’ll make our lives better. It’s about basic respect for another human being. Treat the nurse (and the housekeeper, and the patient care tech, etc) like you would want to be treated. With empathy, respect, and compassion. How you treat a restaurant server says a lot about you view others. The same could be said of nurses. You can bet those physicians with haughty cruel attitudes towards nurses are the same at home. Unhappy. All that said, now I will say I feel nurses do deserve special respect. They’re the ones with the patients and their families all day. They’re the ones who correct our orders when we make mistakes. Cruel docs have never taken management courses. Belittling or degrading someone never helps the situation. Good managers know this. Cheers!!

  • ERnurse

    Stating the obvious, I’m an ER nurse. No where are good doctors more appreciated by the staff that supports them. Good MD’s ROCK!! and again stating the obvious bad docs just plain out suck. We can tell how our shift will be by which docs are working with us. We’re about to change ER doc groups, scary times for us.

  • Deborah Garibay

    I was an ED nurse for 20 years then went to law school and into Risk management. I cannot tell you the number of errors and subsequent claims/lawsuits that result from MD’s unwilling to listen to nurses, through arrogance or stupidity. Or, they have insulted the nurse so often the nurse is afraid to call when they need to. Either way, the patient suffers. Happens all the time!

  • Susan

    Excellent post. Now someone please find me a lawyer who will say the same things about the paralegal profession . . .