December 3, 2006, 1:12 pm

Doctor, May I Have A Word?

shoeNow this is a very cool shoe.

I know, because I wear it.

Or a reasonable facsimile thereof.

But this is a photo of a miniature, collectible nursing shoe.

Yes, apparently people actually collect miniature nursing shoes.

Why on earth someone would want to do that is beyond me. Way beyond me.

But it comes complete with a box and a collector’s card!

Now if I read correctly, because I wear this shoe I am youthful, sleek, trendy and cool.

I am Miss Popularity at work.

And ten of my co-workers just choked on their coffee…

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I have worked with some pretty cool doctors in my time.

In fact, the majority of doctors I have worked with have been nice guys and gals. There is something about the emergency department that lends itself to collegial relationships, although I found the same comeraderie when I worked critical care.

And nothing beats the feeling of having of knowing a particular primary doctor trusts you implicitly, a trust usually earned after years of working with their patients.

The doctors who are the best to work with have an understanding of nurses and nursing and a respect for what nurses actually do. They won’t verbalize it, but a nurse can sense it.

The converse is also true, by the way. A nurse with an understanding of the practice of medicine a respect for doctors will be the best collaborator in the care of their patients.

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Now, having said all that, there are a few things I’d like to ask every emergency physician.

I have worked exclusively ER for the last 16 years and I have run across these issues in every single ER I’ve worked in.

The examples given below are composites of many incidents over the last 16 years.

I do believe these issues are ubiquitous to every emergency department.

*****

Dear Doctor:

  • Please clear your sharps off the mayo stand.
    • It’s a good thing I’m always careful when dealing with any dirty tray, because I have learned from experience to trust no one but myself when it comes to sharps disposal. Still, it was a bit of a shock finding the blood filled syringe with the uncovered needle that was hiding under the disposable tray.
    • I do believe that disposing of your own sharps has been standard operating procedure for the last twenty five years now, no matter how busy the department is.
    • While I am duly innoculated against Hepatitis B, I don’t have that luxury when it comes to HIV. Let me put this delicately, had I been stuck by that particular needle, my life as I knew it would have ended. Be more careful.
  • Please let me push the drugs
    • It’s my job.
    • While I can appreciate the willingness to facilitate the procedure, did you not notice that the saline lock cap had dislodged and that the patient was bleeding back through the opening?
      • You had to have seen it, it was an 18 gauge needle and you stood at the bedside for five minutes.
      • While I would not have expected you to change the patient’s bed or wash all the blood off the patient, I would have expected you to tell me what happened so that I could mitigate the result.
      • Instead, I had a huge bloody mess to clean and the patient required a restart of their IV. I would have caught the dislodgement immediately, because maintainence of the IV is my job and a priority in patient care.
      • IF YOU MAKE A MESS, EITHER CLEAN IT YOURSELF OR TELL THE NURSE IN A TIMELY MANNER. An apology for causing the loss of an IV site would have been nice, too.
  • Please don’t bogart my nursing notes
    • I can appreciate the fact that you find the nursing notes indispensible. I’ve worked with doctors who could not have cared less if I had written haiku all over the front of them, so your appreciation of my documentation is admirable.
    • Your willingness to take my notes from me at any time, regardless of how critical my patient is or how imperative it is for me to chart-as-I-go is NOT admirable.
      • You are able to dictate your notes. I am not.
      • I’m sure you can imagine the frustration if I just walked up to you and took your documentation page anytime I felt I needed it.
    • The pressure to complete increasing amounts of paperwork makes it imperative that I have access to my required paperwork when I need it. Your inability to understand that shows a lack of respect for my responsibilities.
    • A nice compromise would be for you to ask if you can borrow the notes to make a copy and then return them immediately to me. Hell, I’d be happy to take five seconds and make a copy for you next time.
  • Allow me to do my job in triage
    • When a family comes in with five children because they were all involved in a MVA and they all want to be seen, I must do a full triage on every single one of those patients, including documenting the mechanism of injury.
      • I apologize for the fact that it takes me 45 minutes to triage the entire family. That is a little over six minutes per person, including two infants and all the required documentation.
      • I understand you are antsy to get busy on this motely group, but
        I am working as hard and as diligently as I can.
        • Sending in the ER tech and one of my colleagues to hover over my shoulder is not appreciated, nor helpful.
        • Had I been able to send the triaged ones back with one parent, I would have. In between the parents not wanting to separate and three kids needing to go potty, I could not get a single child back!
      • Your sense of urgency does not negate my responsibilities at the triage desk. All your “hurry-up, I’m ready to see the patient” attitude does is
        • Show a lack of respect for my responsibilities as a triage nurse and by extension, I feel disrespected which…
        • …Causes feelings of resentment that I will spend the better part of the next hour trying to overcome.
      • Allowing me to complete the triage/registration process allows me to present the patients in an orderly fashion and with all “i”s dotted ant “t”s crossed.
        • While that may not matter to you in the slightest, I’m required to do it.
        • When all is said and done, you will find your job a lot easier if you let me do my job. Trust me.
  • Please don’t take report from the paramedics until a nurse is at the bedside.
    • It really is important that the nurse hear the report and not fair to the paramedics to have to repeat it, and they will be repeating it if a nurse doesn’t hear it.
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Okay, I’ll be honest.

I feel better having written this post.

My blood pressure is back within normal limits.

I can face my next shift with enthusiasm.

I may even turn over my nurse’s notes with a smile the next time I’m asked.

Or at least make the doctor a copy.

I really am attached to those notes…….

13 Comments


  • jen

    December 3, 2006 at 6:50 pm

    haha, amazing, i’ve seen all of those things, but not all at the same facility….and all of those things get on my nerves. I hate it when they do an aspiration of a wound, with a safety needle, and don’t even close the safety cap, then leave it on the mayo stand. DUH!!!



  • Sid Schwab

    December 3, 2006 at 8:19 pm

    I’m sure I’m guilty of lots of oversights along the way, but I ALWAYS disposed of my own sharps. In fact, I usually changed the paper sheet/roll on the exam table, too. Semi-related: it has always bugged me that so many of my fellow docs leave their scrubs on the floor in the locker room. I once left a note on a board in there, saying “unless your wife/mother will be coming, put your damn scrubs in the hamper.” Didn’t have the balls to sign it, howeve.



  • NPs Save Lives

    December 4, 2006 at 6:04 am

    Kim, I deal with this in up on the floor as well. Especially the sharps issue! I play secretary sometimes too. I don’t mind getting something for the docs if I’m not in the middle of taking care of my own patients. I make a concerted effort to round with my docs in order to make sure the patient’s needs are being taken care of. Respect is expected on both sides!



  • apgaRN

    December 4, 2006 at 7:12 am

    Shame on that doc for leaving the sharp exposed! Holy crow. Do they not get how dangerous that is? Not something to be taken lightly.
    I’ve also found that we have good working relationships with the docs on L&D, but again, I think it’s because we tend to work in collaboration, and we HAVE to be able to function well together in a crisis. It seems to be more prevalent, as you say, on acute care units like ED, CCU and L&D.



  • Shauna

    December 4, 2006 at 8:21 am

    Hey Kim!
    Those little shoes are cute….I know people who collect such items as they relate to advertising or a specific profession or just because they’re so cute. Quite often, sales people would have these to show prospective customers. I’ve also seen little stetsons and other hats and rubbers(the ones men wear over their shoes in winter).
    Shauna



  • Dr. Gwenn

    December 4, 2006 at 10:05 am

    I worked in the ER for years and could have used a few more nurses with your attitude! I totally agree that respect is a two way street. Unfortunately, I think too many docs and nurses don’t give each other the chance to get to know each other and learn to work well together. The job is stressful enough – it would be a lot better if everyone just lost the attitudes and tried to deal with each other as people – equal people in fact.

    Great post!



  • Airway Control

    December 4, 2006 at 10:08 am

    excellent points. i always make it a poiint to lecture the doctor (ussally a resident) on proper sharps disposal.

    btw, your site redesign is [in my best Borat voice] “very nice, I like.”



  • Andrew

    December 4, 2006 at 4:14 pm

    AMEN!!! Kim has given all us lowly techs a voice again… just dont use WNL (with in normal limits)…. in the field we used to call this “we never looked.”



  • ITNurse

    December 5, 2006 at 1:50 pm

    This post is every place I ever worked. not every physician, but at least half.
    I even left for a few years and re-entered hoping for change, alas, none. I think they must teach a whole semester on this in Medical School. it is taken right after the “I didn’t go to medical school to enter orders/be a secretary” class. 8^)



  • Sara

    December 5, 2006 at 3:26 pm

    You know the solution, of course, is to train the new impressionable medical students when you can. I’ve had several very kind nurses of various flavors show me the “right way” to do things – they always make sure to emphasize things like what you’ve mentioned here.
    Oh, except I already knew about the respecting the nursing notes thing, and I’m only a 3rd year med student. Hmm, maybe that course is a 4th year one…



  • Liana

    December 5, 2006 at 9:23 pm

    Airway tech, you made a pun. Point. Sharps. Ha! Ha…

    Erm, getting back to the post at hand, mutual respect. I like the concept.



  • V

    December 7, 2006 at 7:13 pm

    Good point Sara. I was trained by several good nurses back in the day. I was trained to put down a chux when drawing blood or starting a line. Many other things. And magically, my patients’ lines didn’t fall out with the regularity of my friends’. And I didn’t get the 3am Tylenol order calls. Respect is a 2 way street. When I was a resident, I always had a good relationship with the nurses. I had an easier time of it & my patients got better care. I always tried to impress that upon the houseofficers I trained.



  • Mick

    December 19, 2006 at 10:25 am

    Thanks for the excellent post. I get along well with the nurses in my ER but had never had it pointed out to me that they needed to be there to hear the paramedic handover. It wasnt until my partner (who happens to be a nurse) nearly bit my head off over it that I realised. Why dont you people tell us these things more often?!?!

    Oh and another thing I’ve learnt- never EVER question why someone has been triaged as they have. It’s a sure way to make you an unpopular resident for the day


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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