of the siteAn ER nurse willing to answer questions pertaining to nursing, because she disagrees with my portrayal of it
Q: I am one of those ER nurses that was offended and intrigued by your www.ERbook.net web site. I have many things that I would like to say but need not bother since from your summary others have said it all. That said, I would love for you to pass my e-mail address to people who have questions for ER nurses. I've been a nurse in the ER since 1992, nursing supervisor and director. I would love to have the chance to tell others what it is that makes this such a special place to work.
I'm not closed minded enough to not see the nice things that you also wrote. I think that in your way you think that you support nurses.
Stacey
Answer by Kevin Pezzi, MD: If you read everything I wrote about nurses, you would probably be thanking me instead of criticizing me. In fact, I doubt that you will ever find a doctor whose writings did so much to support nurses in substantive ways instead of the usual token lip service.
Q: Do you have any idea that we support doctors? All of the time we support you to the patients, other nurses and at times to other physicians. I'm all for free speech and love the opportunity to have the forum to state my opinion back to you and for you to comment back so quickly. I was taken to your site by a teacher that asked us to comment on how your statement made us feel.
A: It sounds to me as if he is looking for discord instead of common ground. The merit of that is questionable, in my opinion. Wouldn't it make more sense to strive for ways to harmonize better? Remember the proverb about walking a mile in the shoes of someone else before you criticize him? As a doctor, I can (and have) done everything that nurses do, so I have a good understanding of what their responsibilities are. However, nurses cannot do everything that doctors do. Sure, they see them working, but they don't know everything going on in their heads, which is where most of the difficult work is done. Thus, I don't think that nurses fully grasp the enormous pressures and responsibilities that doctors face. You may say, "Oh, you're just saying that because you're a doctor." Not true. I've known doctors who were nurses, too, and they gave me an insider's perspective on this matter that reinforced my belief that nurses, despite their proximity to doctors, don't understand doctors and the practice of medicine as well as they think they do.
I was surprised when my best friend (a nurse and a psychologist/therapist) told me that nursing schools teach nurses to be critical of one another. In her opinion, that engenders so much of the corrosive "nurse-versus-nurse" and "nurse-versus-doctor" backbiting and backstabbing that she says is rampant in the nursing world.
While we are on this subject, I may as well reveal what I've heard many doctors say about nurses . . . when nurses are not around, that is. These docs resent the fact that they must often treat nurses with kid gloves. (Want a good example?) They feel that too many nurses are overly sensitive and walk around with a chip on their shoulder, seemingly eager to find offense so they can "write up" someone—that someone could be a doctor, but is often another nurse or co-worker. Those docs opine that nurses' behavior is too often fueled by emotions, not professionalism and logic. Don't believe me? That last link I gave explained how an oversensitive nurse went into an emotional meltdown when I calmly told her not to rely upon a diagnosis rendered by a security guard for a patient with a life-threatening problem . . . yes, she accepted the guard's diagnosis without doing her own assessment. Had I not walked by a few seconds later and intervened, the patient—a woman around the age of 50—would have died. If you read that story, keep reading until you find the nurse who wants us all to just get along and stop talking about such errors. Gee whiz, isn't it a good thing to discuss mistakes that could kill patients?
An intelligent and splendid nurse
Certainly, not all nurses have more concern for their thin skin than they do patient welfare. I have worked with many intelligent, wonderful nurses that I'd hire in a heartbeat without reservations and pay them several times their current wage. However, I've met more than a few immature, whiny nurses who don't have "the right stuff" to work in healthcare—or probably McDonald's, for that matter. In Michigan and other states, nursing as a profession is regulated by nurses. In my opinion, you (in a collective sense) have done an abysmal job weeding out your bad apples, such as nurses who are imbeciles, kooks, or both. Until you (in a collective sense, again) do a better job of weeding out those bad apples, I and other doctors reserve the right to complain about them because we are sick of working with them!
Would you want to work with an ER nurse who comes back from his breaks with a heavy smell of booze on his breath? In True Emergency Room Stories, I described a nurse who (according to other nurses) had been fired by General Motors for repeatedly drinking on the job. Apparently the usual union-mandated "he deserves nine lives" rehab crap did nothing to curb his thirst for boozing it up while building cars (scary thought, isn't it?) so GM, cowered by the militant and shortsighted UAW that is bankrupting them, agreed to pay for the education of this alky so he could find another job. Heaven knows why anyone thought that nursing would be a suitable career for this turkey, but that's exactly where he ended up. In my ER, taking care of my patients. Now I have a big heart (contrary to what nurses think) and am willing to give anyone a second chance, so I don't begrudge giving him the opportunity to transition to another job, but I have no tolerance for someone who thinks he can consume enough alcohol to slur his speech and then work on patients five minutes later. I dutifully reported this to the administrator in charge of the ER, and this person (a nurse) curtly told me that his drinking was none of my business! None of my business?
Incidentally, this is the same hospital in which it took multiple complaints by ER doctors over a period of years to get an ER nurse fired. Why didn't we want her working on our patients? Because she had Alzheimer's disease! Shouldn't that constitute grounds for immediate dismissal? Why did we, as doctors, have to fight that battle? Why didn't the nurses in charge do the right thing and fire that person? Because the nurses were so blinded by their desire to fight doctors every chance they could that they adamantly refused to agree with what we wanted even though it was the only logical thing to do! Consequently, when I hear nurses speak of "supporting doctors," I think of that case and others like it.
Q: This was what I wrote about how your statement made us feel:
Now, I realize that he's writing it from a "get the doctors interested in ER medicine" point of view, but wow, here is a guy that doesn't think highly of nurses time spent on each patient. We do independently think, all of the time. I don't just take the doctors orders as given, thank goodness I have caught many errors over the years. If a critical patient, lets say an AMI, comes in the door and the doctor is in another room, he better hope that by the time he arrives that I've done the triage, started the IV, done the EKG, drawn the labs, put them on oxygen, have them on the heart monitor and have someone getting me the nitro for when he orders it. What I just did took me about 20 minutes if working by myself. His walking into the patient's room and doing assessment and then orders takes an average of 5 minutes/patient. We have done a time study at our facility. Now there may be only one doctor but he can see three patients and do a workup on each one, it will take one hour of my nursing time. He still has over 30 to 45 minutes left of his hour. There is a reason that there are so many ER nurses per physician. What we do takes more time.
A: That is not always true, of course. ER docs do plenty of things that take lots of time, from talking with psychiatric patients, or patients who are hard of hearing, or ones who have a difficult time answering simple questions like, "How long have you been sick?" (Such as this patient who told me virtually nothing useful after 20 minutes of questioning.) We also repair complex lacerations, start central lines, perform lumbar punctures, review old records, consult with other physicians, write orders, etc. What you said IS generally true of some patients, such as cardiac patients and drug overdoses.
However, I have a feeling that you work with ER doctors who are not very thorough, as many of my colleagues are (see, I criticize doctors, too). I know that after both working with them and reviewing countless ER charts when I was on the Quality Assurance Committee.
I rarely had much free time in the ER because I would devote whatever "free" time I had to doing a more comprehensive evaluation on patients and spending more time educating them and their families. To squeeze in as much care as possible, I would walk, talk, write, and dictate as fast as I could, almost every minute of every day, for 12-hour shifts that often turned into 15-hour nonstop marathons. I did everything possible to improve my time efficiency, but that can be improved only so much, especially when dealing with some patients who need five minutes to answer basic questions or who give circumlocutions even to "yes or no" inquiries.
Yes, nurses would hustle when the ER was busy, but I've never worked with anyone—nurse or doctor—who would be in overdrive mode as often as I was. Instead of taking even two minutes for lunch, I'd often suck down a can of Ensure through a straw in 7 seconds or less and resume working. I had many patients tell me that I examined them more thoroughly than any doctor ever did, even their family doctors who should have performed regular head-to-toe physical examinations. If I was not busy and the nurses were, I would chip in and help them start IVs, make beds, feed patients, clean bedpans, gives meds, do triage, discharge patients, etc. So, with rare exceptions, I was usually the busiest person in the ER. I was the best educated and best paid, too. I could do it all, and I did, day after day. Some ER docs take superficial histories and do woefully incomplete exams, and then sit on their butt reading Sports Illustrated while the nurses run around, but I wasn't one of those half-ass doctors.
If anyone has a question for Stacey (regarding her offer to field ER nursing questions), please DO NOT WRITE TO ME AND ASK FOR HER E-MAIL ADDRESS. I suggested a much better alternative to Stacey; namely, that she register for my free MySpamSponge service. If she does that (I haven't yet heard back from her), you can click her personal hyperlink to contact her without the need for either of you to reveal your e-mail address. For example, if you want to contact me, you can click my personal hyperlink:
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I hope that Stacey follows through on her offer to answer ER nursing questions. Several nurses (including one president of a nursing organization) previously contacted me and offered to answer questions, but none ever did. Nice offers, but hollow.
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