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By Kevin Pezzi, MD

Nurses: From empty-headed ones to mass murderers

Note: I will not edit the errors in the following question for reasons that will be eminently clear to all intelligent readers.

Q: Are you nuts??? How can you present nursing as an empty-headed profession? Nurses contribute a great deal to patient care. It is a nurses assessment that a doc is looking for before seeing the patient. When was the last time a doc actually obtained their own vital signs on a patient? We are suffering a sever shortage, and your site with its negative presentation to the nursing profession is not going to help the situation whatsoever.

Answer by , MD: You must not have read through my entire site. In it, I have both critical and complimentary things to say about nurses, but also doctors, paramedics, and politicians. The one group that I almost always bash is hospital administrators. If you don't hate them now, you likely will in a few minutes.

I once had a boss who referred to nurses and other non-physician staff as "the help." He instructed me not to eat with them. I discussed more of this story elsewhere, so I won't repeat all the details now. However, I thought that his opinion was ludicrous.

As I've repeatedly made clear, in healthcare we all work as a team. I think that nurses are an essential part of that team, and I do not view the nursing profession as being "empty-headed," although some individual nurses are (or act as if they are) not very intelligent. Even empty-headed, or worse. For proof of that, see some of the cases I discussed in this site and, such as the male nurse who had a compulsion to touch the sterile surgical instruments on my sterile field with his unwashed, ungloved hands FOR ABSOLUTELY NO REASON, other than whatever malicious ideas were circulating in his brain that seemed to run on booze, not logic. Or if you are in the habit of excusing the mistakes of alcoholics, then perhaps you could explain how another nurse—his boss—chose to look the other way when I reported some of the psycho things he did. What is more important: giving patients the best possible care, or covering up the mistakes of nurses by sweeping them under the rug?

Want to win a Sea-doo (generically, a "Jet-Ski")? I'll give you one if you can find one spot in either this site or in which I criticize a good nurse for doing a good job, or even an average nurse for doing what she should be doing. I will offer the same prize if you can present compelling reasons why it is better to not discuss nursing errors. Incidentally, I discuss them because they affect patient care and the practice of medicine. One of my goals is to give prospective doctors a realistic idea of what it is like to work as a doctor. Most of what I discuss does not pertain to nurses or nursing, but you are part of the team, so if I neglected to mention noteworthy things about nurses, it would be a whitewashed cover-up, not a fair and balanced depiction of the truth.

The more I hear from venomous nurses like you, the more convinced I am that nursing schools teach their students to walk around with a chip on their shoulders, eagerly looking for the slightest provocation to justify the unfurling of your pent-up wrath. In fact, one of my friends who is both a nurse and a psychologist told me that nursing schools encourage nurses to "write up" co-workers; that is, to report alleged mistakes and misconduct to the hospital administration. Some of the write-ups focus on petty, trivial things, not major errors. I've worked in hospitals with great nurses who harmonized with everyone and did a superb job, but I've also worked in hospitals in which nurses seething with rage wrote up everyone they came into contact with: other nurses, doctors, clerks, lab techs, radiology techs, security guards, and even the housekeeping staff. I couldn't find a nurse one day in the ER, so I walked around trying to find them. Eventually I found them in the conference room, sitting around a table, all looking madder than hell, writing up one another for who-knows-what.

> When was the last time a doc actually obtained their own vital signs on a patient?

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I'd do that in the ER whenever possible. If I wasn't busy, I would relieve the triage nurse so he/she could take a break, and I'd triage the incoming patients. This is a bit off-topic, but I found that this greatly expedited patient care. Incidentally, I belong to an emergency medicine discussion group, and some of the ER docs who experimented with this system (a doc working triage) reported similar benefits. This is not intended as a slam against nurses. If you look at the totality of my comments about nurses, I think that you would find that I do more to support the nursing profession than many nurses. For example: You mentioned that nursing is suffering from a severe shortage. That's true, and I have a much better plan to solve that problem than trying to suppress free speech. The solution to the nursing shortage is simple: pay nurses more, and implement other changes that would improve their working conditions (e.g., less patients per nurse). In a free-market economy, shortages are self-correcting because a shortage would (or SHOULD) enable practitioners of that profession to demand more money.

Let's say that nursing salaries were doubled or tripled. That would solve the nursing shortage problem by drawing more people into nursing school, encouraging existing nurses to work more hours, and enticing many nurses who've left nursing to return to that profession. There isn't any law stipulating a ceiling on nursing salaries. Do you know why nursing pay is kept artificially low? It's because of a collusion (tacit or otherwise) amongst hospital administrators. Their avaricious brains have an odd and indefensible fixation: that nurses are not worth more money, and they will be damned if they'll pay more.

The economic value of nurses should be decided by the economy, not administrators who are hell-bent on limiting what nurses make and maximizing their workloads. Although I could cite many facts in support of this, one way to illustrate the veracity of my sentiment about administrators is to look at what they've done to the nurses at Northern Michigan Hospital (NMH) in Petoskey, Michigan (not too far from where I live). The nurses there have been on strike for years. It's the longest nursing strike in Michigan history, and (I think) also in the world. The strike drags on because the NMH administrators have dug in their heels and resolved to vehemently fight their nurses even if that battle costs them far more than what the nurses wanted (and it has, because NMH had to pay astronomical wages to attract other nurses to fill in). Therefore, this is more than a monetary battle; it gives a glimpse into how some classist administrators loathe nurses and are obsessed with triumphing over them.

Some people might say that there isn't enough money to pay nurses more. Baloney. There is plenty of money, but it is being diverted to overpaid administrators, useless bureaucrats, lawyers (especially lawyers!), and even drug reps (pharmaceutical representatives). The latter can make far more money than doctors . . . for what? For using their pulchritude to get in the door, give the docs free pizza and pens, and deliver spiels on the two drugs they know inside and out?

It isn't easy to quantitate job difficulty, but I'd estimate that what drug reps do is over ten times less important and difficult than what doctors do. I've known several drug reps, and their biggest headache seemed to be the annoyance of getting past the doctors' office staff (incidentally, they were so bitter about this that they referred to them as "window witches"). Compared with what I did in the ER, and compared with what nurses do, that was a walk in the park. It shouldn't come as a surprise that drug companies actively recruit ex-cheerleaders, not brainiacs.

One way to judge the value of an occupation is to think of the consequences that might result if those workers went on strike. Imagine that every drug rep went on strike for the next year. What might happen? Would you ever hear a doctor say, "Oh, no, I have a critically ill patient, and I don't know what drug to treat her with! I need a drug rep to tell me what to do!" That's never happened, nor will it. Doctors do not need the advice of drug reps. Nor do patients, quite frankly. The real function of drug reps is to persuade doctors to use the most expensive drugs. Does that help patients? If pharmaceutical manufacturers were as concerned about patients as they profess to be, they wouldn't spend billions of dollars on drug reps; they would instead use that money to make drugs more affordable, or they would invest it in research for truly new and useful drugs (instead of the "me too" copycat drugs that passes for innovation these days).

Based on this method of assessing occupational worth, nurses are indeed very valuable—precisely why I believe their pay should be doubled or tripled, instead of getting the meager raises they now receive that barely keep up with inflation. I've never met any doctor who trivialized the importance of what nurses do, and that includes the docs, like my boss mentioned above, who personally felt superior to nurses. (He'd never eat with them, but he sure as heck wanted nurses to help take care of patients!)

In and this site, I made it clear that I am not anti-nurse; I am against bad nurses. If you insist that there are no bad apples in your profession, you are—to use your crudely unprofessional manner of expression—nuts. By attacking me personally as you did ("Are you nuts???"), you are engaging in what is termed an ad hominem argument (see the Wikipedia for a good definition). People often resort to such arguments when they cannot think of any valid way to address the substantive merits of the matter, so they use shenanigans such as name-calling or insults to attack or belittle the person who presents the issue rather than dealing logically with the issue itself.

If I were to reciprocate and assail you with an ad hominem argument, I could say something such as, "Where did you learn your manners? From the same place that you learned to spell and punctuate? You neglected to include an apostrophe in "nurses assessment" and you used the word "sever" (to separate into more than one part; divide, detach, disconnect) when you should have used "severe" (Very serious or dire; grave, grievous). You also erred by writing "presentation to the nursing profession" when you should have said "presentation of the nursing profession." If I wanted to nitpick further, I could mention a few more errors you committed, all made in the space of a short paragraph.

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I'm going to let you in on a little secret about what doctors think of nurses: We know that some of you are smart or even very smart, but more than a few of you are so stupid that we wonder how you made it through nursing school. I once wondered the same thing myself, but after volunteering my services to help teach students in nursing school (see this page for a discussion of that), I saw how people with subnormal IQs can squeak through nursing school, thanks to overly lax policies in which just about everyone with a pulse graduated. One of the cardiologists at our local hospital threw up his arms in disgust while reading the nursing notes on a patient. "I can't understand anything she wrote," he lamented. "It doesn't make any sense!" The notes were typewritten on a computer, so the issue wasn't legibility; the issue was that this nurse was so scatterbrained that she could not compose a lucid sentence, even if a patient's life depended on it . . . and it might. What sort of brainpower does it take to write something such as, "The patient complained of chest pain" or "The patient had an uneventful day without any complaints"? An elementary school student should be able to compose such a narrative, so doctors are alarmed and frightened when we find nurses who manifest their stupidity in this or other ways. If you're that dumb, we wonder, how can we trust you to do more demanding things with patients?

After working with nurses for a couple of decades, I know that one thing they want is respect. They often don't receive it from hospital administrators, who routinely treat nurses as dispensable peons. Nurses receive respect from some patients and family members, but others treat nurses as servants who should be at their beck and call (that is, ready to immediately comply with any wish or command). Nurses often don't obtain respect from lab techs, x-ray techs, pharmacy techs, and clerks, all of whom are often mired in their own problems. Doctors could (and should) do more to express respect and sincere appreciation for nurses. I did that to some extent by giving nurses cards, baking cookies for them, and buying them pizza on so many occasions that I couldn't begin to remember them all. I would also give them free medications and free medical care as tokens of my gratitude. I even performed free plastic surgery on a few nurses! Could I have done more? Yes, but you could say the same about almost anyone. For example, how many spouses routinely compliment and show respect for their partners?

However, respect is a two-way street, and you broke the first rule of respect by opening your diatribe with a vitriolic ad hominem denunciation that has no basis in fact. If you want to be taken seriously as a healthcare practitioner and receive due respect, you shouldn't go around making half-baked allegations. Is someone nuts because his opinions are not identical with yours? I've been to medical school, and I have a license that empowers me to determine who is insane (or "nuts," to use your pejorative terminology). Nowhere in the diagnostic criteria for judging insanity is any mention of dissimilar opinions.

Like people who resort to profanity or racial epithets because they aren't smart enough to present more cogent arguments, you could not assail the merits of what I said, so in desperation you chose a vituperative way to vent your malicious rage. Immature elementary school students often engage in such attacks, but adults with healthcare degrees and presumably a tad more self-control should be more circumspect if they wish to be treated with respect. If I were as boorish as you, I could assail your inept writing ability and openly wonder if you can truly master nursing if you cannot master basic English. But then, I am genuinely nice, not a boor. My best friend is a psychologist, and she says that I am one of the happiest and most well-adjusted persons she has ever known. In fact, she is somewhat amazed that I turned out as well as I did, considering that my life was hardly a bed of roses. You and I don't see eye-to-eye on whether nurses should be sacrosanct; you seemingly believe that all nurses are wonderful and beyond reproach. Now that is nutty! Like people in other occupations, there is no one level of competency in nursing. Some nurses are stellar, and some are incompetent. While I strongly support a substantial increase in nursing wages, I would (if I could) give that not as a gift without strings, but as a quid pro quo in which good nurses would receive doctor-level salaries but bad nurses would be fired or forced to receive more education, counseling, or whatever it took to make them good nurses.

Unlike some webmasters, I am willing to post messages from people with dissenting opinions, even when their flaming attacks are uncivil, as in the insulting message above from the nurse. I realize that people would be more civil if they could not hide behind a veil of anonymity, as she and others have done. I've been interviewed by magazines, newspapers, radio and television stations across North America, so I do not have the luxury of hiding behind a meaningless e-mail address or screen name.

After writing this response, I took a lunch break. I asked one of my friends, a nurse, for her opinion of other nurses. She said that many of them are unhappy and crabby. To illustrate this, she recounted how she once called her doctor's office to obtain a lab test result when "the nurse got on the phone with me and immediately became belligerent, going on a tirade for no reason at all."

After that, I turned on the TV to watch one of the true crime channels. Coincidentally, this episode focused on Dana Sue Gray, a nurse who killed many elderly women and then stole their credit cards to go on shopping sprees. Although there have not been many female serial killers, it seems to me that a strikingly large percentage of them have worked in the nursing profession. Is this just a coincidence? After seeing how their anger often boils over inappropriately, I am beginning to wonder about that. Most nurses are nice, decent people, but the nursing profession is plagued by some bad apples with bad attitudes, poor education, and thuggish responses to resolving conflict.

Shocked by what some nurses did
Those nurses did WHAT???????

UPDATE: In the next few days, I heard about a few more instances of nurses who were serial killers. One case involved a group of four nurses who felt stressed by having too many patients to care for. Rather than quitting, or complaining to their administration, or even sending a message to me to blow off steam, they instead chose to kill the patients who monopolized their time by being too demanding (pressing the "I need help" button too often, for example). If you think that is shocking, just wait until you hear HOW they killed their victims: drowning them by pouring water down their throats over the course of an hour, or however long it took. This manner of asphyxiation is particularly cruel, but those agonizing deaths didn't seem to bother the nurses involved, who were caught only after they bragged to other co-workers about what they were doing! The police suspected them of killing over 300 people, but ultimately they were found guilty of various charges in "only" 30-some deaths, because their drowning method left little evidence.

UPDATE: A nurse friend told me about a student nurse she recently supervised who didn't know a blood pressure drug from one that lowers cholesterol. The scary part? She is two weeks away from graduation!

If I become rich (and I might), I will do an experiment: increase nursing (etc.) wages at a hospital and a nursing home, substantially boosting what they are paid and increasing staffing but demanding more education and less of the overly negative attitudes I've witnessed in more than a few nurses. Nurses are human and most are overworked (for example, see Most Ward Nurses Say Time Pressures Force Them to 'Ration' Care). By unburdening them and paying what they're truly worth, I think patients will receive much better care.

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