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Nurse, Medics, RTs, etc., Heel Thyself

lee parker lee.lardyc7 at dsl.pipex.com
Sun May 15 13:22:48 BST 2011


"jokingly asked his doctor whom he should yell at."

Isn't that the biggest clue?

It's a good job I've never been talked down to/ignored by any nurses or Docs
;0)

And yes I know plenty of Paramedics who are guilty of all the things
mentioned.

lee


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Charles Brault
Sent: 15 May 2011 10:57
To: Trauma-List [TRAUMA.ORG]
Subject: Nurse, Medics, RTs, etc., Heel Thyself

I don't know,
To me
This very example in this article
Is way more telling 
- Of the nurses (Medic, RTs, etc.) persisting inferiority
complexe/Insecurity 
and an indice of their new and evolving affirmation of (professional) 
self-assurance (a good thing)
 
Than 
- The MDs arrogance and old & persistent attitudes
 
   
 
 
________________________________

May 7, 2011
Physician, Heel Thyself
By THERESA BROWN
Pittsburgh 
IT was morning rounds in the hospital and the entire medical team stood in
the 
patient’s room. A test result was late, and the patient, a friendly,
middle-aged 
man, jokingly asked his doctor whom he should yell at. 

Turning and pointing at the patient’s nurse, the doctor replied, “If you
want to 
scream at anyone, scream at her.” 

This vignette is not a scene from the medical drama “House,” nor did it take

place 30 years ago, when nurses were considered subservient to doctors.
Rather, 
it happened just a few months ago, at my hospital, to me. 

As we walked out of the patient’s room I asked the doctor if I could quote
him 
in an article. “Sure,” he answered. “It’s a time-honored tradition — blame
the 
nurse whenever anything goes wrong.” 

I felt stunned and insulted. But my own feelings are one thing; more
important 
is the problem such attitudes pose to patient health. They reinforce the 
stereotype of nurses as little more than candy stripers, creating a hostile
and 
even dangerous environment in a setting where close cooperation can make the

difference between life and death. And while many hospitals have
anti-bullying 
policies on the books, too few see it as a serious issue. 

Today nurses are highly trained professionals, and in the best situations we

form a team with the hospital’s doctors. If doctors are generals, nurses are
a 
combination of infantry and aides-de-camp. 

After all, patients are admitted to hospitals because they need
round-the-clock 
nursing care. We administer medications, prep patients for tests, interpret 
medical jargon for family members and double-check treatment decisions with
the 
patient’s primary team. Nurses are also the hospital’s front line: we sound
the 
alert if a patient takes a serious turn for the worse. 

But while most doctors clearly respect their colleagues on the nursing
staff, 
every nurse knows at least one, if not many, who don’t. 

Indeed, every nurse has a story like mine, and most of us have several. A
nurse 
I know, attempting to clarify an order, was told, “When you have ‘M.D.’
after 
your name, then you can talk to me.” A doctor dismissed another’s complaint
by 
simply saying, “I’m important.” 

When a doctor thoughtlessly dresses down a nurse in front of patients or
their 
families, it’s not just a personal affront, it’s an incredible distraction, 
taking our minds away from our patients, focusing them instead on how
powerless 
we are. 

That said, the most damaging bullying is not flagrant and does not fit the 
stereotype of a surgeon having a tantrum in the operating room. It is
passive, 
like not answering pages or phone calls, and tends toward the subtle: 
condescension rather than outright abuse, and aggressive or sarcastic
remarks 
rather than straightforward insults. 

And because doctors are at the top of the food chain, the bad behavior of
even a 
few of them can set a corrosive tone for the whole organization. Nurses in
turn 
bully other nurses, attending physicians bully doctors-in-training, and 
experienced nurses sometimes bully the newest doctors. 

Such an uncomfortable workplace can have a chilling effect on communication 
among staff. A 2004 survey by the Institute for Safe Medication Practices
found 
that workplace bullying posed a critical problem for patient safety: rather
than 
bring their questions about medication orders to a difficult doctor, almost
half 
the health care personnel surveyed said they would rather keep silent. 
Furthermore, 7 percent of the respondents said that in the past year they
had 
been involved in a medication error in which intimidation was at least
partly 
responsible. 

The result, not surprisingly, is a rise in avoidable medical errors, the
cause 
of perhaps 200,000 deaths a year. 

Concerned about the role of bullying in medical errors, the Joint
Commission, 
the primary accrediting body for American health care organizations, has
warned 
of a distressing decline in trust among hospital employees and, with it, a 
decline in the quality of medical outcomes. 

What can be done to counter hospital bullying? For one thing, hospitals
should 
adopt standards of professional behavior and apply them uniformly, from the 
housekeepers to nurses to the president of the hospital. And nurses and
other 
employees need to know they can report incidents confidentially. 

Offending parties, whether doctors or nurses, would be required to undergo 
civility training, and particularly intransigent doctors might even have
their 
hospital privileges — that is, their right to admit patients — revoked. 

But to be truly effective, such change can’t be simply imposed
bureaucratically. 
It has to start at the top. Because hospitals tend to be extremely
hierarchical, 
even well-meaning doctors tend to respond much better to suggestions and 
criticisms from people they consider their equals or superiors. I’ve noticed

that doctors otherwise prone to bullying will tend to become models of
civility 
when other doctors are around. 

In other words, alongside uniform, well-enforced rules, doctors themselves
need 
to set a new tone in the hospital corridors, policing their colleagues and 
letting new doctors know what kind of behavior is expected of them. 

This shouldn’t be hard: most doctors are kind, well-intentioned
professionals, 
and I rarely have a problem talking openly with them. But unless we can
change 
the overall tone of the workplace, doctors like the one who insulted me in
front 
of my patient will continue to act with impunity. 

I wish I could say otherwise, but after being publicly slapped down, I will 
think twice before speaking up around him again. Whether that was his
intention, 
or whether he was just being thoughtlessly callous, it’s definitely not in
my 
patients’ best interest. 

Theresa Brown, an oncology nurse, is a contributor to The Times’s Well blog
and 
the author of “Critical Care: A New Nurse Faces Death, Life and Everything
in 
Between.”http://www.nytimes.com/2011/05/08/opinion/08Brown.html?pagewanted=p
rint


 
________________________________

May 14, 2011
When Doctors Humiliate Nurses
To the Editor: 
Re “Physician, Heel Thyself” (Op-Ed, May 8): 
As a nurse for more than 25 years and the author of a book to teach nurses
how 
to combat bullying from physicians and others in health care, I applaud
Theresa 
Brown’s first-person account of her experience. 

Beyond humiliating nurses, physicians who abuse nurses endanger the very 
patients they profess to protect. Leadership from health care
administrators, 
medical staff and policy makers is needed to change this appalling practice.

What other profession would tolerate such abuse? 

Nurses, too, can rally around an abused nurse in a practice called “code
pink.” 
The word is passed nurse to nurse, and colleagues gather around the
beleaguered 
nurse. Few physicians can stand the scrutiny of neutral-faced nurses
standing 
silent beside one of their own. 

At more than three million strong, nurses are the largest group of health
care 
professionals. They, and their patients, deserve better. 

ELEANOR J. SULLIVAN
St. Louis, May 8, 2011 
The writer is the author of the forthcoming book “Becoming Influential: A
Guide 
for Nurses” (second edition). 

To the Editor: 
There are some medical issues I wish we could end once and for all. As
Theresa 
Brown wrote, doctor superiority, especially at the expense of nurses and
other 
staff, is one of them. 

The best doctors I know consider themselves part of a team and use the
team’s 
knowledge to the advantage of the patient. They think “patient first” and
draw 
on the experience of nurses, laboratory technicians and other medical 
professionals. The patient receives the doctor’s best treatment advice based
on 
the collective knowledge of the team. 

Doctors who accept only their own counsel are putting ego before medicine, 
possibly at the expense of the patient. Hospital care should be based on 
collective wisdom to reach the best treatment plan. Nurses, doctors and all 
highly trained medical professionals each have a role to play, each of which
is 
invaluable to the patient. 

HERBERT PARDES
President and Chief Executive
NewYork-Presbyterian Hospital
New York, May 9, 2011 
To the Editor: 
Today, hospitals pride themselves on providing patient-centered care by a 
multidisciplinary team, a hallmark of their quality. When one team member 
bullies another, patient care suffers. As a nurse, I would not want my
family 
member or my nursing students in a hospital where physicians demean and
insult 
their nurse colleagues, thus hampering their ability to care. 

A culture of civility and a climate of respect and dignity not only win the
day 
but also ensure patient safety and quality care. 

It’s time physicians learned that nurses are on their team, poised to manage

complex critical decisions and care for their patients. Please, no bullying
— it 
hurts. 

DONNA M. NICKITAS
Old Greenwich, Conn., May 8, 2011 
The writer is a nursing professor at Hunter College, Hunter-Bellevue School
of 
Nursing. 

To the Editor: 
I cry out from the absolute bottom of the health care totem pole, a
desperate 
plea from a lowly third-year medical student. The unprofessional behavior
cited 
by Theresa Brown is sent on down the line from the top doctors to the house 
staff to the nurses and eventually to students like me. 

Ms. Brown is right: institutionalized standards of professional behavior and
a 
way to submit confidential incident reports should be in place, but is it
really 
too much to ask health care professionals just to take a stance and pledge
to 
treat one another right, regardless of this arbitrary hierarchy we’ve
created? 

In the meantime, I’ll pass along some advice I got from my seventh-grade 
guidance counselor about bullying: “Annie, just kill ’em with kindness.” 

ANNIE ONISHI
New York, May 8, 2011 
To the Editor: 
Of course nurses aren’t the only target of doctor-bullying. Patients, too, 
cannot guarantee that their doctors will treat them as equals. And sometimes

they can be patronized in front of strangers. 

During my stint as a linguistic researcher at a rather famous Northeastern 
hospital, I attended daily rounds for new doctors. One (memorable) morning,
the 
attending physician was proudly displaying to his audience all the skills
that 
had been lost by an elderly man who had recently suffered a stroke. Look at
how 
he cannot repeat after me, how he has trouble holding up two fingers, now
three 
fingers and so on. 

The doctor then filled a small cup with water and asked the patient to
slowly 
raise it and drink from it, all the time winking at us that he wouldn’t be
able 
to do so. The cup got halfway to the patient’s mouth, at which point revenge
was 
had: he tossed the water all over the physician. 

SUSAN J. BEHRENS
Brooklyn, May 8, 2011 

http://www.nytimes.com/2011/05/15/opinion/l15nurse.html?hpw
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