What can nurses learn from doctors?

There’s a lot nurses can learn from doctors.

There I said it.

But I’m not talking about clinical ability or medical knowledge. I’m talking about expectations. I’m talking about basic behaviors that dictate a predictable response.

Nurses don’t feel valued. Much of this is warranted, but I argue that some of it is self-inflicted. I said this once to a colleague and she responded, “But that places the blame on the nurse.”

I disagree. Rather than placing blame on the nurse, it empowers any nurse to realize that in each of us lies an opportunity to behave in a way that allows us to receive the respect we deserve. Stop fighting for it and start expecting it. Close the gap between doctor and nurse without offending or confusing anyone.

There are ways that we nurses can be more like doctors that don’t require additional degrees, institutional approval or even money.

Doctors use medical words

Real life nurses actually already do this. It’s just that nursing education hasn’t caught on yet. Which is unfortunate because it takes new nurses so many steps back from where they should be when entering the profession. If you don’t know what nursing diagnoses are, they are an attempt to distinguish nursing language from doctor speak when describing the very same clinical scenario. For instance, when I have a patient who’s hypoxic, I say, “This patient’s hypoxic.” I do not say, “This patient has altered tissue perfusion.” That would be silly. Every time nursing students are taught to use nursing diagnoses, the profession is shooting itself in the foot again.

Doctors quote the literature

You don’t need M.D. after your name to stay abreast of cutting edge research in the medical field. There’s plenty of clinically relevant research in nursing journals (and hey, go crazy with a medical journal once in a while—you might even understand the big words). Then tell your patients what you know. I guarantee you they’ll respect it.

Doctors use the “C” words: Consult and colleague

Doctors consult with colleagues; they discuss clinical ambiguities and tough decisions. Nurses consult with each other, too. We’re just not taught to use those words. Let’s start.

Doctors don’t apologize for doing their jobs

How many times have I heard a nurse say to a physician, “Sorry to bother you”? Saying “Sorry to bother you,” when addressing a clinical matter to a doctor who is vested in the outcome is like the President apologizing to the Senate for calling a meeting to address national policy. These are our jobs. We share a unified goal called optimal patient care. Don’t start out by providing a reason to ask for forgiveness for a crime not committed. Rather than come from a place of “Sorry.” Why not come from a place of “Thanks.” As in, “Hey, thanks for getting back to me.” Try it just once—it feels good.

Doctors expect respect

Doctors expect to be respected and are surprised when they aren’t, not the other way around. That’s not a criticism, it’s a compliment. They’ve worked hard for many years and can prove it with their school loans. Nurses come into the workforce already expecting to be snubbed, brushed off, and undervalued. We’re afraid of getting yelled at, afraid of being blamed for something, afraid of being mistreated with no recourse. And we feel pleasantly surprised when that doesn’t happen. Let’s turn our expectations around.

Meaghan O’Keeffe is a nurse who blogs at Nurse.com and Healthy Offspring

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  • Tom

    Nurses should be empowered and feel like the integral members of a
    healthcare team that they are, but they should also accept the same
    level of responsibility and consequence for patient outcomes as physicians. Nursing education is focused on process measures (which unfortunately translates to documentation instead of achieving results) instead of real patient outcomes. Additionally, because nursing is oriented around shift-work, there is a reduced sense of ownership of both bad as well as good outcomes.

    In our current system, doctors are ultimately responsible for patient outcomes and quality and are subject to financial risk through pay-for-performance incentives, yet so much of front-line-care is determined by nursing and out of the control of the physician.

    If we want to truly improve healthcare all the incentives around patient-care need to be similarly aligned. You can’t penalize doctors financially for poor quality, but pay nurses the same salary regardless of quality of care delivered. Everyone in healthcare–physicians, nurses, allied health staff–should be blamed for bad outcomes, but everyone should also be equally rewarded for good outcomes.

    • Mike C.

      Compensations is a complex measure weighing, risk, responsibility, education, time vested, and in many ways outcome already. After all you are certainly not compensated if you lose whatever license you have. By increasing the compensation based upon outcome, professionals simply won’t want to take high risk patients, they will move to fields where there is little risk as so many are already doing so now. Furthermore, it is likely to hinder care for patients with low outcome expectations creating another layer of bias.

      • ninguem

        Under the Code of Hammurabi, physicians were held responsible for outcome in ancient Babylonia. Punishment for failure was so severe, when Herodotus visited the land centuries later:

        “They have no physicians, but when a man is ill, they lay him in
        the public square, and the passers-by come up to him, and if they have ever had his disease themselves or have known any one who has suffered from it, they give him advice,recommending him to do whatever they found good in their own case, or in the case known to them; and no one is allowed to pass the sick man in silence without asking him what his ailment is.”

        I don’t think I would want to practice medicine under Hammurabian law; definitely would not take high-risk cases.

  • fcirone12@yahoo.ca

    I think the fact that it is a unionized profession takes away from the professionalism of nursing. Doctors are not unionized. Again, that atmosphere of demanding respect, rather than simply working hard and earning it.

    • http://www.facebook.com/meaghan.okeeffe Meaghan O’Keeffe

      Not all nurses are unionized. That’s institution specific. And to suggest that nurses haven’t worked hard to “earn” respect seems ignorant at best. I agree that demanding respect can often be counterproductive in the end. Anyway, unions came about to protect workers. Whether they’ve turned into something else over time is another discussion for another day. The point I’m making above is that nurses can learn from their physician colleagues in a positive way. And that by changing the way we, ourselves, think about how we’d like to be treated, we can perhaps change the culture of healthcare just a little bit.

      • Mike C.

        Everyone has to earn respect, it isn’t something that can just be assumed. Courtesy, however, should be given regardless of position.

    • http://www.facebook.com/caspear Carole Ann Spear

      Many doctors are unionized. Check out the UAPD. Why would this take away from professionalism of anyone? People should be respected for the job they do, that is what they need to work hard at.
      If you want to know how respected anyone is just listen to your co-worker private conversation. That is where you will see respect or not. I have been embarrassed by the way some of my colleagues speak to doctors and each other, not to mention about them.

  • Pratap Chavan

    If you understand that nursing is separate and an independent profession then no need to compare with other profession. I think respect should be not be demanded it should be commended through your work, knowledge and united strength. Tell me how often we as nurses meet for nursing discussion?

  • Sandra

    Very interesting. Its 2013. To be sustainable our system requires signficant transformation. Not only do we need to look to evolving where we deliver care, we must also explore how and when we deliver care and how we can leverage the full scope of all providers. Amid all this emerges a commentary on what nurses can learn from doctors. Its intent is not focused on clinical ability or medical knowledge but about expectations and basic behaviour. Is the author suggesting the expectations and basic behaviour of physicians is superior to that of nurses? Several years ago the Canadian Nurses Association did a survey that showed nurses as one of the most trusted professions in this country. If I thought a comparison of professions would actually help evolve our health system I would suggest a parallel commentary be written entitled what doctors can learn from nurses. This commentary speaks to the importance of citing literature yet none is cited. This commentary speaks to expecting respect yet the content and title do little to respect the nursing profession. The author may be a RN but does little to advance or promote the nursing profession in writing such a commentary. The time has come to: focus on building the relationship between “colleagues”; appreciate the contributions all providers make to the health system, remembering that ‘different’ is good; and spend more time providing commentary on issues that will better the health of and well-being of our citizens.

  • Juliet

    Obviously, the author intended the title to be provocative, and the idea of nurses learning from doctors seems offensive, but CLEARLY, the content of this piece is intended to support and empower nurses. Anyone who thinks otherwise is not completely understanding what is being said here.

  • Tammie, RN ICU/Dialysis

    Okay, I want to comment on one point that the author brings up, because I so strongly agree with it. The writer makes a point of contrasting a nursing diagnosis; with medical jargon and how silly it is…it IS silly, and somewhat embarrassing to the nursing profession.

    I have read medical text/reference books that are laying around the nursing
    station and have been enlightened and educated in ways that have improved my understanding of what was going on with my patient. 

In my opinion, nursing education has too much of the “touchy-feely fluff stuff” when compared to the science of the medical text that really helps nurses understand how to provide the best care for their patient.

    I am not saying that patients don’t benefit from the parts of our nursing education that are touchy-feely,but I would like to see it shift focus to be more scientific, and more in line with what physicians could respect.

    • Student EEN

      I am currently a nursing student and we are all struggling with the nursing diagnosis. Have a patient with hypertension and I have to say patient has raised BP etc. I don’t understand the reasoning for this. Our lecturer tell us that is because that is a medical diagnosis but do doctors really want us to communicate that way?

      • Leisa

        A nursing diagnosis is worded specifically with the understanding that we are concerned with real, at risk, and perceived conditions. If a patient has sepsis as the medical diagnosis, the nurse is supposed to look at the rest of the picture. That patient could be put in an induced coma that puts the patient at risk for skin conditions that are not part of the sepsis protocol. Acute rashes could be herpes exacerbated from the rubbing of oropharyngeal tube plus the acute stress of the situation.
        The nursing diagnosis is not supposed to be used for communication, it is to put the nursing science in perspective for documentation and care planning. I’m sorry that your lecturer could not communicate this to you in a way that clarifies its purpose. Just remember, for every nursing diagnosis there is a nursing intervention.
        Keep at it and please stay positive and non-judgemental. Nurses are going to be your peers–that includes your lecturer.

  • liz59

    This is very true. I would take it further and include medical secretaries and admin staff. We are even more undervalued despite the fact that we are the backbone of the organisation.

  • Leisa

    Right on Meaghan!! It took four years into practice before I developed my nursing backbone. This was because I was raised as a baby nurse by subservient professors and then preceptors who continued to apologize and say “yes sir” as they were attacked during physician encounters.
    Nursing is an esoteric body of science, so we need to be proud of our knowledge and act accordingly. That means we need to be competent in our fields and communicate with the language of our experience. I work the night shift and will not apologize for bothering a physician unless it is necessary for my patient advocacy. Everyone is part of this healthcare team–the doctor is the planner and I am the manager.
    The only apology someone gets from me is if I make a mistake, and I offer that without hesitation. However, respect is expected from all. I will take it a step further—nurses are supposed to expect their patients to respect them as well. Educate patients who say stupid stuff like–you work for the doctor, or do you think you’re a doctor? Answers should be respectful but firm about your role in overseeing the patient’s care.

    • http://www.facebook.com/meaghan.okeeffe Meaghan O’Keeffe

      Leisa, thank you. I couldn’t agree more. I’ve worked with exceptional, smart and autonomous nurses who recall having to stand when a physician entered the room! And this was in the 80s! It’s important for nurses to know that it’s OKAY to challenge those ideas if they come across them.

  • http://twitter.com/Clinician1 Dave Mittman, PA

    Meaghan:

    Every profession can learn from each other-especially in medicine/healthcare.

    The article was awesome. Should be required reading. Out of the box thinking is evident and wonderful.

    Thanks for writing it.

    Dave

    Dave Mittman, PA, DFAAPA

  • Anne, FNP

    Well said! I will be forwarding this on to some of my nursing colleagues. It’s a valid reminder to thank and not apologize for consults –we are in this together with the goal of optimal patient care. Very thoughtful commentary!

  • http://www.facebook.com/robert.molyneaux.79 Robert Molyneaux

    Well said. That and the “I’m *just* a nurse.” is further demeaning and
    self-defeating. Non-medical folks hold nurses in high regard until they have
    the answers to their questions prefaced with that phrase. It’s fine to say
    “This is what I think. However, there may be other things involved that another
    clinician can add to what I’ve said.” That gives the patient info they need and
    if necessary, incentive for further consultation. And doesn’t demean the nurse…

    When I hear the “Just a nurse…” phrase, I make a point to stop the nurse
    and remind them they are not “just” something, they are something.

  • NPFriendLynn

    I couldn’t agree more with the author. I sometimes feel nurses are their own worst enemy. I LOVE my profession. I’ve been a nurse for almost 30 years and an NP for the last 18 years. I have always felt that we do a disservice to our profession w/ the concept of “nursing diagnosis.” (Please tell me they don’t to “Care Plans” in nursing school anymore!) We want to be respected by physicians but don’t teach the same language. When you get out into the real world of medicine, no one talks nursing diagnosis. Nurses are special and different because we look at the whole picture and not just a medical diagnosis, but there must be a way to incorporate that better. On the subject of colleagues, I love to consult w/ my colleagues: NP’s, PA’s, MD’s- we all have our strengths and talents and it’s best to share. After all, isn’t that in the patient’s best interest?