20 June 2010

RN vs MD

There is a lot of literature and there are many studies assessing the relationship between doctors and nurses. As a medical student you are told often and early, "don't piss of the nurses." This is sound advice because honestly, you learn a lot from your nurses and they can make your life very frustrating if they so choose. On the other hand, I can already understand some of the frustration that doctors feel. There are those nurses who, for some reason or another, think their accumulated wisdom is more valuable and correct than what goes into the education of an MD. Two recent examples:

1. I was reviewing a rhythm strip on a patient who has an AV nodal arrhythmia. We were concerned the patient was intermittantly having 3rd degree heart block - a rhythm in which the atria no longer communicate with the ventricles, who begin to generate their own "escape/junctional" rhythm. The nurse told me that he couldn't possibly be having an arrhythmia because the interval between the beats was constant. I tried to explain that a junctional rhythm would, in fact, be regular, but would still be an arrhythmia. She proceeded to tell me that after all these years here she knew that, but it still couldn't be an arrhythmia. Um, yes, it could. She insisted it couldn't. I gave up because she clearly wasn't going to change her mind. But honestly... what does she think I've been studying for these last few years? Proper bleaching technique for my white coat?

2. Another patient of mine has been on the floor for two solid weeks getting antibiotics. He's going a little stir crazy and I wanted to let him walk around the hospital courtyard for some fresh air and sunshine. My attending agreed that he was safe to be off telemetry for an hour or so and a walk would be good for him. The nurses overruled us. Apparently, they decided he was too sick to be off telemetry. Excuse me? Since when did nurses get the right to veto physician orders?

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