One of the benefits of being an ER doctor
by Kevin Pezzi, MD
One of the best things about being an ER doctor is the opportunity to closely work with nurses and other ER personnel. That statement might surprise you if you've read my books or website postings in which I complained about various nurses. However, bad news is generally more newsworthy than good news. If a family heads to McDonald's for a meal and returns home safely, it isn't newsworthy, but if they are incinerated after being struck by a truck carrying thousands of gallons of gasoline, it is newsworthy. Similarly, if I mentioned what nurses and other ER personnel do well or just correctly, my readers would fall asleep. Imagine how boring the news would be if newscasters mentioned everything that went OK.
Not all doctors work so closely with nurses and other medical personnel. For example, one of my friends who works as a cardiology nurse from 7 AM to 7:30 PM said she typically interacts with doctors for 5 to 10 minutes per day, if that. Incidentally, she is grateful for that sparse contact, since she says most of them are abrasive egomaniacs dumb enough to think the path to health is paved with pills.
Reflecting on my ER career, what especially amazes me is how nurses and other workers invariably performed flawlessly at one hospital, while at another, they made enough mistakes to generate plenty of news. Of course, even the latter nurses usually did most things OK, but in a busy emergency department, “usually” and “most” aren't good enough.
I don't have time to study this phenomenon, but someone should. We need to nail down exactly what separates the hospitals filled with nurses who routinely manage to do everything right versus hospitals with more than a few bad apples. Intelligence and knowledge may partially explain this performance gap, yet there is more to it. There seems to be a certain level-headed maturity that gives some nurses the ability to solve problems in a common-sense way, while some other nurses evidently take a juvenile delight in creating conflict and making mountains out of molehills.
For example, I previously mentioned the wet-behind-the-ears (having just graduated from nursing school and hadn't yet taken the RN exam) nurse who did an EKG incorrectly and then refused to redo it, wasting more of her time and mine arguing about whether the first EKG was performed correctly (it certainly was not) than it would have taken to repeat the EKG.
Oh, I think I partially answered my question. I met the CEO of the good hospital early one morning in the parking lot. I didn't know who she was, but she recognized me and warmly introduced herself, letting me know that if I had any problems, I could contact her directly. In contrast, at the hospital with bad apples, the brass would hide out in their offices, leaving us to deal with an incompetent ER head nurse (she employed a nurse for years despite us repeatedly warning her that nurse had Alzheimer's disease) and an incompetent nursing supervisor in charge of the critical care units (ICU, CCU, and ER). Even when we brought obvious problems to her, such as a drunk nurse, she'd tell us to buzz off. One might think that her method was to invariably side with nurses, right or wrong, yet she was so inept that even the nurses loathed her. To put it in shirtsleeve English, the nurses hated her guts, and so did the ER doctors. Rather than solve problems, she had a malignant way of perpetuating and magnifying them.
In the case of the recent nursing grad deficient in EKG skills and—worse yet—an inability to know the limits of her knowledge coupled with a pit bull fight-to-the-death attitude that compelled her to argue with me even though I clearly knew much more, the critical care nurse administrator should have called Nurse Conflict into her office, showing her the EKG she swore up and down was done correctly and the EKG done on the same patient afterward, with the leads correctly positioned. After pointing out the night-and-day difference, the administrator should have said something such as:
“Dr. Pezzi told you the EKG you did was not performed correctly. He was right, as you can see by looking at the second EKG. If you are going to dig your heels in and fight doctors, you had better have good reason for doing that. Dr. Pezzi is an experienced ER doctor and he knows how to read EKGs. Not even the most experienced ER nurses can read EKGs like he can, so for you—just weeks out of nursing school and before passing your RN exam—to argue with him over this matter is inexcusable.
Unfortunately, this is not the only problem you've had with doctors; it seems that you derive some sort of malicious joy from fighting with them instead of cooperating and doing your job as you should. We don't want troublemakers working here, so you are fired. We cannot give you a favorable recommendation if you apply at another hospital, and since your behavior poses a risk to patients, we will notify the State Board of Nursing, recommending that they investigate your psychological fitness to serve as a nurse anywhere.
Your behavior ended your employment here and may jeopardize your license and therefore your career. Since you are no longer employed here, I cannot compel you to do anything except leave, yet I suggest that you see a psychiatrist or psychologist to gain insight into why you either revel in conflict or act as if you do.”
Nurse Conflict was impossibly gorgeous, so I surmised that she had the beautiful woman syndrome and wasn't accustomed to being told that she was anything less than perfect, yet I've worked with equally hot nurses who were easy to get along with and always performed superbly, never creating any problems. In my opinion, Nurse Conflict was one of those people who have venom flowing through their veins, a stack of chips on their shoulders, and go around looking for flimsy excuses to vent their anger. In a busy, high-acuity ER (such as the one I worked in), there wasn't time to deal with such staff. By not properly doing their jobs and by wasting their time and mine, they were endangering patients. Therefore, this was a clear-cut case in which the ER head nurse or the critical care administrator should have intervened, but since they blew off our concerns about Nurse Alzheimer's, it isn't surprising they did not cooperate in this case or similar ones.
After I moved to another area and tired of driving back there to work, I resigned a few months later but heard through the grapevine that the hospital board wised up and fired the critical care administrator and the CEO who hired her. Rumor had it that he was sleeping with her, which may have given her some false assurance that she could behave like an irresponsible petulant teenager and get away with it. The critical care administrator was also hot, with a body that models would envy, and a willingness to flaunt her luscious legs by wearing skirts that were inappropriately short for any business, especially a hospital. I suspected the critical care administrator also had the beautiful woman syndrome in addition to her own psychological issues, so expecting professional maturity and wisdom from her was asking too much. The board evidently tired of her shenanigans and gave her what she deserved: a pink slip. Had they done that years before, the message sent by firing her and Nurse Conflict would have engendered a spirit of cooperation that made the troublemaker nurses more willing to work with the doctors, not against them. Leaders set the tone, for better or for worse.