Tuesday, March 13, 2007


So today I had a rather poor experience with one of the ER nurses. I grabbed a patient's chart from the rack, headed into their room, and had started my history, when the new nurse coming on shift decided that was the best time to perform an assessment on that patient. Nevermind the fact that she had three other patients to see, and could certainly have waited on mine. So, in the middle of my history, this nurse comes in and starts rattling off unrelated questions, listening to the patient's heart and lungs, telling the patient to be quiet right after I asked a question, generally making a nuisance of herself. I finally had to leave, as it was impossible to continue the exam with the nurse in the way.

Now I will grant that I am only a medical student, but in 66 days I will be the doc, and I'm going to ask such interfering persons to kindly permit me to finish my exam before they get in the way. I'm not trying to be mean, we both have jobs to do, but since neither of them are emergencies, is it too much to ask that the nurse wait to perform her assessment until after I've finished with mine? I think not.

On the plus side, I had the opportunity to teach one of the techs a few things today as well. A patient of mine needed an EKG, and as I was in the room reevaluating her when the tech came in, I stayed to see the EKG when it was done. As it turned out, the tech had only done three EKGs before, and so I answered her questions on how to set up the leads, and then showed her some basics of reading the results as they were printed. I realized (again) that I love teaching, and I hope to make that a huge part of my practice in the future.


zhoen said...


That is her job, that she does in a certain way to organize herself. She may have been a jerk, no doubt. But you are in her workplace. You are a student. She does not need you to do her work, and you are an extra responsibility to her. The more you stay out of the nurses' way, the more they will make your life easier. Firm and polite are fine, but charming such a territorial beast as that nurse will get you a long way in a lifetime of such interactions. Teach them, if that seems more natural.

Nathan said...

zhoen - I understand your point of view, but I must disagree slightly. I am not an extra responsibility to the nurse. I am an extra responsibility to the physician. In the main though, you're right, and staying out of her way is what I did.

I realize, in posting this, that the nurse readers of my blog will be varyingly annoyed or incensed. Though I should probably have thought through the situation more before posting on it, I think it's an accurate representation of the way I was thinking at the time, and therefore a valuable insight, for me anyway. Tired, busy people in an environment with a strict power structure are likely to step on one another's toes occasionally, and I doubt this will be the last such instance. The ideal is of course to learn from it, which cannot be done unless it is truthfully understood and described in the first place.

The Angry Medic said...

You're right about the stepping on toes bit, eventually you will cross paths (and possibly swords) with nurses. But that's inevitable - I find that being nice to them gets me a long way. (It's a bonus that most of them around here happen to be hot.)

And I'm glad you like teaching, man. All of the most inspiring teachers I have had were those who genuinely enjoyed and loved teaching. I'm sure you'll make a fantastic educator someday.

Ryann said...

I have to concur with Nathan and The Angry Medic on this one. From the point of view of the patient (i.e., someone outside the medical field with her fair share of random trips to the ER), it’s frustrating to have multiple people poke and prod you at the same time, especially if, as indicated in this case, the nurse was disrupting the flow of the evaluation. She should have waited until Nathan was done – not because it inflates his ego, but because it’s the right thing to do for the patient. Seems like it would be a good reminder to all that it should be about what's best for the patient, not hierarchy or routines or schedules, or even convenience. At least, from my perspective, that's what it should be about.

Anonymous said...

Well, I think you had some valid concerns. I can't render an opinion one way or another without having more facts. Perhaps to the nurse, this was her patient with the highest acuity so she wanted to assess this one first at the start of her shift. (I'm not saying this was so. Just an idea as to perhaps why she interrupted your interview).

I am usually the first to complete my H&P when a new patient comes in. I can get a little annoyed when a PA or doctor interrupts my admission process if I was there first but I also understand that the other has many people to see and admission H&Ps do take a lot of time. Mostly I am just glad if either the PA or doctor shows up within half an hour of the patient's arrival. That way things will get moving with orders and the patient feels like he or she is being cared for and not a number lost in the system.

It does seem rude the way you described the nurse's behavior but again maybe there were a few unknowns the nurse was facing that made her pursue this course of action. Try to give people the benefit of the doubt or render grace to others often as possible. I have to take the same into consideration often for myself. :)

~Anonymous RN

P.S. I have found that as a nurse my favorite aspect of practicing is teaching patients and fellow nurses on a variety of topics. I have considered pursuing my master's degree so that I could be in a dominant teaching role as a nurse. Still contemplating this option. I have heard that the pay for nursing instructors is worse than what floor nurses make even though the nursing instructor has an advanced degree.