Can I be cool with my nurses (and they cool with me)?

When I was a medical student, I was quite envious of the nurses.

It seemed like the nurses, from the RNs to the licensed practical nurses, had the best of everything. Their lounge was big. Their area well stocked with food and drinks. They were always having celebrations...for everyone...for everything. They made late-night Starbucks runs, and had food delivered to the hospital all the time. And even though they were courteous enough to offer me a latte (sometimes), it always felt weird to 'fraternize' with *them*. They, were them...and I was *us.* "You cannot trust 'them,'" I was told. "'They' will throw you under the bus first chance they get!"

So, for years, I had an awkward relationship with the nurses. If I needed them to do something...how do I ask? "Um, excuse me Nurse, did you see my order?" Or, "Ms, I mean, Nurse Smith...can you get room 1 a bedpan?" It just seemed like...I was asking them to do things...like I was in charge. But they are quick to let you know you're not in charge. But, you kinda are in charge. But you cannot 'remind' anyone that you are in charge...or else you belittle their contribution.

What gives?

Then I realized...as I advanced in my education/training...and as I spent more time as an attending...that good nurses are really there to help make your life easier. If they are not doing that...I would argue that perhaps they are not good nurses. And the thing is, I didn't realize this until I had an *awesome* nursing staff to support me!

In residency, the nurses were indeed a little cult...whose primary mission seemed to be to make your life as difficult as possible. Sorta like they were jealous of a young woman doctor...and resented having to take orders from her. They were not polite. They claimed they didn't know how to do much of anything. "Um, I couldn't start the IV on room 3...so I guess you'll have to come do a central line." Or, "we cannot get blood from Ms. Jones...so you'll have to do a femoral stick." Really?! Really, really! Either you're one sorry nurse...or you're just out to get me.

As you progress, it becomes less acceptable for the physician to perform nurse duties...while simultaneously performing doctor duties. Time becomes more valuable, whereby if the physician isn't seeing patients quickly...someone is losing lots of money (and it's usually someone "more important" in the hierarchy than the doctor). And that...is not tolerated. CEO losing money?! So support staff is hired so the physician can continuing 'bringing in the money.' And this extrapolates to nurses who enjoy (or at least don't mind) nursing.

Fast forward to now. I have a great relationship with my nursing staff in general. Some of it is because my nurses are now there to support me (rather than antagonize me). Some of it is because it is the expectation that the nurses do nursing work. But a large part of the equation is me. I am more comfortable with myself, with my skills, and being a doctor. And because I am comfortable with me, and my role as leader...I am less...awkward. I am more willing to "fraternize with nurses because I realize that being friendly with nurses doesn't undermine me or my role. I see myself as team leader...but I give each member of my team the option to critically think and act without me micromanaging their decisions. I ask their opinion...and I don't feel like "they think I'm stupid" if I don't know something.

And in exchange, they bring their kids in to see me for impromptu doctor visits. They save me a piece of baby-shower cake. They "protect" me from the patients and their families (this is a post for a different day). They sneak me a Tylenol or a Reglan out of the Pyxis when I'm not feeling well. They catch my oversights...and they have my back.

Short story:

Last week I had to reduce a patellar dislocation. SUPER easy to do...but I'd never done one before. So, I gathered my nurse and my tech, and confessed. "Hey guys, we have to reduce this...and I've never done one. So I'm going to read up a bit, then we'll do it, okay?" Amazingly, they were even more excited to learn *with* me. We checked out emedicine. We watched a short video. Gave each other encouragement. And went in the room like we knew what we were doing. Like we did this sort of thing everyday. "Don't worry Mr. Johnson, this will be quick and over in less than 10 seconds" (hopefully). We exchanged glances...smiled a little bit. And did exactly what the doctor did in the video. For about 6 seconds, it didn't seem like it was going to work. But then we heard it. The "clunk" of the patella going back into place! We all exchanged glaces again...with big grins on our faces.

We walk out of the room, and into the back, giving each other hi-fives! WE did it!

How fun is that?! This is what makes emergency medicine a team sport.


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olivian said...

There are good nurses who really help make the doctors work easier.
The story which you shared was really nice to read.
Thanks for sharing and keep posting.
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