Can a doctor and a nurse be friends in the OR?

One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven’t seen her since I was in school, we’re still in touch and expect to be seeing each other at last in a couple of months.

By some coincidence one of my best friends now is also an O.B. nurse. I’ll call her Ziva (yes, I watch a lot of NCIS). Ziva is from Israel. She is smart and funny, a lover of books and movies and good music and good food, talented and competent, and above all a great and generous person I would entrust with my children’s lives. Ziva and I can talk about just about anything – silly “girl stuff,” deep intellectual stuff, spiritual questions, moral/ethical dilemmas, work stress, kids, comic moments from day-to-day life, worries about tough problems, faults and failings, embarrassing secrets, cultural differences, things that inspire us or bring us joy.

For some reason, her colleagues are very uncomfortable with our friendship and underhandedly persecute her for it with snide comments and not-so-veiled criticisms. One time I arrived to provide a spinal for a C-section. Ziva was already in the room counting instruments, and one of the other nurses said, “Oh, are you happy now – your friend’s here.” Another time she happened to mention that she and I had recently discussed the mechanics of intubation, and in front of all the other nurses one of her other colleagues made some critical remark about her being friends with me. When Ziva called her on it, saying “What’s wrong with that? T. is SO nice! She’s totally adorable,” the other nurse said, “I have no desire to be friends with T. I have my OWN friends.” Ziva found this nurse’s comments and the tone in which she said them disrespectful and hurtful. Many of the other nurses can barely conceal the clouds of disapproval and resentment that darken their looks when Ziva and I greet each other cheerfully at the nurses’ station.

“They feel threatened,” my husband said.

“But if I were a single, tall, good-looking male doctor it would be fine for a nurse to be close to me, right? Isn’t that totally self-demeaning of these women? Sure, it’s ok to befriend a man in a position of authority, but it’s somehow wrong if it’s a woman?” I was totally frustrated and irritated that the culture in this workplace wouldn’t tolerate a genuine close friendship between a female doctor and a nurse.

Ziva and I do not flaunt our relationship in professional situations. I feel I am just as business-like with Ziva while delivering patient care as I am with any other team member, and conversely, just as nice with the other team members as I am with her and with the patients and with any colleague. But there’s a lot going on here. Gender issues. Cultural issues. Xenophobia, or, even worse, maybe some anti-Semitism. And perhaps status issues. Maybe they think nurses and doctors can’t or shouldn’t be friends (unless, of course, it’s a dating situation between a male doctor and a female nurse). Or maybe they feel Ziva’s smarter and more highly trained and better educated than they are and they just can’t stand it.

I am feeling exasperated and a little angry. This type of collective attitude is completely stupid and unnecessary. I don’t know that there’s much I can do about it. I’m certainly not going to change this blessed friendship for the sake of a few small-minded harpies who aren’t comfortable enough in their own skin to show some tolerance, respect, and support.

Anesthesioboist T is an anesthesiologist who blogs at Notes of an Anesthesioboist.

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Comments

http://www.chrisjohnsonmd.com Chris Johnson
he issue may primarily reflect a cultural difference between the OR and other medical settings. I’ve done pediatric critical care for 25 years. Over half of pediatric residents are now women. As a result, many PICU trainees and attendings are also women. All around me I see many perfectly ordinary friendships among women nurses, residents, fellows, and even attendings. It’s no big deal, and I’ve certainly heard no snide comments about it. Perhaps this reflects that the OR has traditionally been a more hierarchical place than the pediatric floors.
Jane
I doubt it’s semitism or xenophobia. I think nurses could care less about the religion or color of their doctors – they have too much professional respect and veneration for the higher ups. In my opinion, I think the nurses’ response is more an ingroup-outgroup bias.
I’m only a premed, but as a volunteer at the hospital I’ve spent a lot of time just sitting at the front desk, observing the social dynamics, and listening for hours to the nurses chatting with each other.
I noticed that it’s okay to befriend someone below you, but not above you. The nurses are very friendly when I am on the floor volunteer (I am only a volunteer), but when I walk in with a suit on as the director of the volunteer program, the tone completely changes, even though our friendship hasn’t.
If you befriend someone clearly below you, you’re just being generous – the elementary school equivalent would be a big sister helping out a little sister. The tone of this interaction is “oh, hello there little darling how can I help you?” It’s, “I am so nice for talking to you.” Befriending someone higher up on the ladder counts as brown-nosing or somehow sticking out from the mainstream. You have friends that are outside ‘the group’, you are now different. (Why are you friends with that other person anyway?) The elementary school equivalent would be the teacher’s pet.
I would guess that the nurses’ response is probably one of jealousy. I noticed a hyper-sensitivity among the nurses to what the doctors say to them. The nurses are always bragging to each other about things like, “Dr. X complimented such and such,” “Dr. X is always so nice to me,” “Dr. X is so nice because she always brings us food.” They will dwell on small sporadic negative comments from the doctors for weeks, complaining to each other and going through the incident over and over “Dr. Y said I wasn’t working fast enough during the operation. I hate him.”
The nurses respond strongly to how the doctors make them feel (perhaps it has something to do with how tiring the job is), though most of the time this has nothing to do with who the doctors really in fact are as people (since the nurses usually don’t know the doctors personally). If the doctor criticizes them, they will cut him, if the doctor praises them, they will love him, and there is rarely a middle ground.
When you want approval from someone, you tend to be more extreme in your reaction to them. The same goes with the nurses’ response to your friendship. It’s, “she thinks she’s so cool, she’s on the up and up with the higher ups.” Perhaps your friendship makes the others feel slightly excluded, perhaps a little jealous, perhaps suspicious. If I were you I would start by befriending the other nurses, or at least making them feel cared for and accepted (it’s what every human being wants anyway). Compliment them, express your deep appreciation of them, show that you value their work and think highly of them, emphasize the individual and build connections. Their envy/judgmentalism will likely lighten up.
What you write about is the quintessential trademark of a female clique. Think back to high school: you were either in the in-crowd, or out of it, and there was little mixing. If a girl from one clique makes friends with someone outside the clique, one of two things will happen: either the entire clique will quickly embrace the new person, or the entire clique will quickly turn against that person as an outsider. There is no middle ground, in high school, you are either in the “in group” or completely out of it. It’s the ingroup-outgroup bias. You make make yourself an ‘ingroup’ member by showing others you care for them. Everyone wants to feel appreciated, and will be jealous of someone who is somehow better appreciated.
Tischelle
Speaking as an RN, I agree with Jane in that I doubt its anti-Semitism, xenophobia or gender-related. If you were a man, they’d probably still have a problem with your friendship, albeit an altogether different one. They’d still have a problem with your friendship because it sounds, honestly, as if they have a problem with Ziva. What you have here is a case of resentment & since they can’t knock you/her down on the playground during recess, childish behavior otherwise known as pettiness.
I disagree with Jane in that you should make some extra effort to befriend, compliment, etc., the other nurses. Frankly, I think that would come off as disingenuous & only make things worse all around. Besides, this isn’t high school. Just because they’re acting like a bunch of juveniles, doesn’t mean you have to. I’ve been in your situation many times before & speak from experience. I do not now, nor have I ever concerned myself with trying to ingratiate myself to any clique. I like, speak to, associate or socialize with whom I want, when I want, because I want. I always ‘mix’ freely & am frequently sought out by others. But I digress…the point is neither you nor Ziva owe any of these petty women any explanations or justifications for your friendship. It is what it is & if they cannot handle it, it’s their problem, not yours.
I do, however, think that the next time one of them has the audacity to make such a snide remark in your presence/within earshot or in front of a patient (your retelling of the C-section incident didn’t note whether or not the patient was present), YOU should also call them on it. You could ask the same innocuous question Ziva did: What’s wrong with that [my being friends with Ziva]? You’ll likely be met with the surprised silence that frequently accompanies a dropped jaw.
I also think you shouldn’t let them get away with such a passive aggressive non-response either. Either at that same moment/during that same incident, sometime later that day or on a different day even, you should single out the ringleader & very casually call her on it. Something along the lines of “You seem to have a problem with Ziva & I’s friendship & I’ve been meaning to ask you why” should do nicely.
On the other hand, you could always take an ‘I need your help with this’ approach & tell her that you think (or you’ve noticed) that some of the other nurses seem to have a problem with Ziva & yours’ friendship but you don’t know why & ask her if she knows. If you decide on the latter approach, do make sure that when she asks you questions (& she will) that your answers include ONLY things that YOU yourself have seen or overheard & not things that you & Ziva may have talked about privately. That way, you won’t inadvertently make things worse for her. Is this last bit of rigamarole annoying? Highly, but it has its uses. (OB nurses are a whole different animal).
On a parting note, I just remembered you mentioned that you don’t ‘flaunt’ your relationship in professional situations, however, is it possible that when in close proximity (situation or no) that the two of you, being good friends, start talking & get a teensy bit carried away in your conversation so it’s as if there isn’t anyone else in the room? Do you sometimes talk in a sort of short hand as good friends are sometimes apt to do? Or do you sometimes maybe talk in pseudo-hushed tones because what you’re talking about though completely unrelated to anyone in the room (or building even) is being spoken to the person you’re having the conversation with & not the entire room? While none of those behaviors warrant the level of nastiness or vilification going on here, they can be annoying to others & unfortunately for the more paranoid among us (meaning us people, not us nurses); it can make them think you’re talking about them behind their backs.
Just my two (or maybe four) cents.
YokelRidesAgain
I’m a physician as well as the husband and son of female physicians; it has been my experience that there is a certain percentage of female nurses who manifest hostility (usually in a passive-aggressive fashion) toward female physicians in a manner that would not be adopted with me or other male colleagues. I don’t know why this is. Do female physicians have, on average, more abrasive personalities than male physicians for one reason or other and this tends to inspire reactions in kind? Do some female nurses resent their position in the medical hierarchy in general, yet are able to reconcile that position vis a vis male doctors by blaming traditional gender roles/patriarchy, but lose that defense mechanism when working with female doctors? Or is it that the persistence influence of those traditional roles make them less likely to engage a male doctor in a hostile fashion?
Doubt that, in any but rare instances, any of the above thoughts are actually formulated on a rational level, but is interesting to speculate.

Can a doctor and a nurse be friends in the OR?

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