March 24, 2007, 5:19 pm

The Medical Student’s Guide to Nursing

nursessay

Nurse tells, mothers listen?

When was this golden age when words from the mouth of a nurse were heeded?

When a nurse could be accepted as the ultimate authority in an advertisement?

It was before my time, let me tell you!

But Miss Bonner Moore, RN took part in medically supervised trials showing the superiority of Vicks so who am I to question her credibility?

Ah, but you can’t get the Va-Tro-Nol nose drops anymore! At least without showing your ID, getting fingerprinted, reciting the Pledge of Allegiance and putting on a “Just Say No!” pin.

It’s pseudoephedrine!

Sure to make a meth addict out of any child.

Why, just look at how this child willingly places his nose in position for the stimulating high he is sure to get.

All I can tell you is that Vaporub was just a smelly ointment that did nothing to actually cure or relieve anything.

And I’m a nurse, so you have to believe it!

******************************

I googled myself yesterday.

Trust me, I wish it was as racy as it sounds!

I was looking for references on the web to correlate triage time with patient flow and on the third page or so, I saw a title that looked promising and I clicked on it.

It took me to an Emergiblog post…..

Um…I don’t think I’m able to actually cite myself as an authority in a subject I’m taking a class to learn.

Athough it would be sort of cool to see Emergiblog cited in APA format!

******************************

All doctors come into contact with nurses, even if it is only in medical school or residency.

How many of them actually know what nursing is or what nurses do? That nursing, while related, is not medicine.

That nursing has its own science-based foundation.

That nurses do their own assessments, plan, carry out and evaluate their patient care based on those assessments.

That nurses have their own set of diagnoses that are made independently of physicians.

That nurses do not take orders from doctors, but use the orders written by the doctor to incorporate medical aspects of care into a plan that addresses all the needs of the patient. Physical, emotional and spiritual.

Surprised?

*****

I used to joke that there needed to be a class in medical school called “The Nurse Is Your Friend”.

While relationship between medicine and nursing has become more collegial in the last few decades, I believe there is still a dearth of understanding in the medical field about the nursing profession.

I believe this can be rectified by addressing the issue in medical school.

The majority of doctors will spend their entire careers working in tandem with nurses in a variety of environments. Why not set the stage for a deeper understanding and appreciation of nursing at the very beginning?

*****

I’m not talking about an entire semester. I’m talking about a few interactive lectures, by nurses that

  • Give medical students an overview of the nursing profession. The history. The educational background required to be a nurse. An overview of the nursing process. How this affects the student as a future physician.
  • Discuss how medicine and nursing are related. The importance of nursing documentation in preventing malpractice lawsuits.
  • Discuss how medicine and nursing differ, and not just the “Doctors Cure, Nurses Care” schtick. Doctors do care and nurses can cure/resolve and prevent complications.
  • Address nursing stereotypes. Medical students enter their profession with preconceived notions of what nurses are like. Some of those notions may be wrong.
  • Give the medical student an opportunity to ask questions about nursing.

This isn’t fluff, folks. This is solid information about a profession that will have 24/7 responsibility for the care of their future patients.

It would behoove every medical student to understand and appreciate the nurses and the education behind that care.

A collegial relationship between doctors and nurses makes working together a lot easier and much more pleasant.

It also promotes better communication which results in better patient care which results in better patient outcomes.

And isn’t that the goal of both nursing and medicine?

*****

I have to give a hat tip to N=1 over at Universal Health for providing the inspiration for this post (here is her take on medicine and nursing).

I believe the partner to this class should be given in nursing schools in the form of “The Nursing Student’s Guide to Medicine”. Nurses need a strong understanding and appreciation on the medical perspective in order to communicate effectively with physicians.

Who knows? Maybe I’ll teach these classes someday!

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21 Comments

  • #1 Dinosaur
    #1 Dinosaur

    March 24, 2007 at 6:22 pm

    I’d love to take that course. Let me know when/where you’re offering it.


  • Type-B Premed
    Type-B Premed

    March 24, 2007 at 7:17 pm

    Please do speak about nursing and what nursing provides. I agree with you that many, including those in health care, think of nurses as a wait staff instead of the highly trained professionals they are.
    You know, as a pre-med, it’s often hard to know what everyone’s job is. If I wasn’t an EMT, I could get confused about the difference between a tech and a nurse.
    I linked a post I made about my observations of nursing. It sounds like I’m doing alright. :)
    Thanks for another insightful post.


  • NCurse
    NCurse

    March 25, 2007 at 12:09 am

    Why don’t we have nurses like you? :)


  • DrDork
    DrDork

    March 25, 2007 at 1:13 am

    The medical school I attended has for *many* years required med students on their initial clinical placement to spend a week or so shadowing and assisting nurses.

    Very useful process, to my mind – our respective professions are enmeshed and intertwined as to be symbiotic.


  • Annemiek
    Annemiek

    March 25, 2007 at 5:09 am

    Another great post, I would love you to teach that class! I had a pharmacy student who was in his last semester shadow me once. He had no idea what we do as nurses, and they too get to work with them later on. It should be a requirement for med students too.


  • punchberry
    punchberry

    March 25, 2007 at 5:53 am

    I agree that this would be very useful. My medical school has (so far) offered no formal instruction in health care roles, or who does what (but I am only in second year). Clinical attending do address this to a degree. When we were shadowing a trauma surgeon, a nurse reminded him to give a patient pain meds, and he went into a little lecture on how we should listen to nurses because they are the patient’s advocate. It was nice, but I agree that it is not the same as making med students learn the roles and differences early on. Many have only been exposed to nurses on TV, so there are a lot of misconceptions to correct.


  • Candy
    Candy

    March 25, 2007 at 8:12 am

    I think the reversew would be helpful, too, for those nurses who (unfortuantely) think they are pseudo-physicians. This would be an eye-opener for the nurse who believes her diagnosis trumps that of the physicians, who “just won’t listen to me!”

    Or for people like me, who insist on telling their PCP just what’s wrong and what med I need and expect the doc to do what I tell her to do…(this affliction affects doctor’s daughters at a high level)


  • Jen
    Jen

    March 25, 2007 at 9:02 am

    Whoa! I just saw the pic and the words “nurse” and “mother” and got chills–that pic looks exactly like my mum in her grad photos (ca 1952). Eerie. For me the caption would be “Nurse says… Listen to your mother…” Uncanny. I’m sending her the link.

    Jen


  • Liana
    Liana

    March 25, 2007 at 8:21 pm

    Sigh… I don’t think I should bring up the travesty that occurred at the University of Alberta a few years ago, but if you’re interested, you could google it. I definitely agree that it would be helpful in med school to learn about what a nurse does.

    My residents’ association just did a study on nurse/resident interaction but has not published the results yet as far as I know. I’ll keep you posted!


  • jen
    jen

    March 25, 2007 at 10:14 pm

    I’ve actually had 2 med students “shadow” me, as they were writing a paper about how nurses spend their time. Uh, i guess it was sorta cool. I actually feel bad for the med students that get to come to the ED though……..I mean just looking at them makes me cringe like I was back in school or something, they just look like fish out of water.

    Also, I would have NO problem citing emergiblog in APA format because Kim you ARE legit girl!


  • A Bohemian Road Nurse...
    A Bohemian Road Nurse...

    March 26, 2007 at 5:27 am

    I totally agree.


  • Deacon Barry
    Deacon Barry

    March 26, 2007 at 7:48 am

    Don’t be surprised about appearing so prominently in Google listings. It’s a reflection of your blog’s authority.


  • Shannon
    Shannon

    March 26, 2007 at 6:59 pm

    I am a senior nursing student and my school does a couple of interdisciplinary activities with medical students. The first was with senior nursing students and 4th year med students and centered around the SBAR communication technique. The second was a very well developed small group seminar that incorporates all of the health affairs disciplines that my university offers – Nursing, Medicine, Dental, PT, OT, Rehab Psych, Social Work, Public Health, and Pharmacy. Each group has at least one of each student and an advisor from one of the schools. They are presented a “real” patient (role player) and then work together to determine an interdisciplinary plan of care. It was a good experience, however the nurses were much more experienced with patients than any of the other specialties. The med students were 2nd years without much clinical experience so it was a great opportunity for them to see what the rest of us do! It was interesting for all of us to see who focused on what with the patients!


  • Michelle
    Michelle

    March 27, 2007 at 12:05 pm

    I find it funny the huge disparity between Nurses and physicians. I have one ER doctor that likes to “teach” me how to think like a Physician. As if Nursing is a lesser profession. I like to think of Nurses as the Back-bone of the medical world. With out us they would slump over and fail to accomplish anything. I enjoy reading your blog BTW.


  • shadowfax
    shadowfax

    March 27, 2007 at 4:34 pm

    Too true, in more way than one. The main point that many doctors need to get is that the nurses will make or break you. I hire doctors for our group, and I insist on a nurse reference for each candidate. Sometimes I call the applicant’s ER cold at 2AM and ask to talk to the night charge nurse. If the applicant doesn’t get on well with the nurses, if they don’t work well as a TEAM with the nurses, I do not hire them. Also, nurses are more willing to divulge problem behaviors or personality traits.

    One other thing is that when I got out of med school, I had no clue how to do 90% of basic nursing procedures. Sure, I had been shown how to put in an IV or NG tube of foley. But really, I had no idea how to draw up or mix meds, connect an IV tubing set, operate a pleurevac, or any of a hundred other common tasks that nurses do. Which is a problem when I am in the pit and have to figure it out on the spot.

    It makes patients very uneasy when they see the doctor peer quizzically at some gadget or device and say “now how does this work?”


  • Rob
    Rob

    March 27, 2007 at 6:25 pm

    I agree with you, but also think everyone in healthcare should get a course like that for all the other major jobs. For instance, I’m a paramedic and a nursing student, and most of the other students in my classes have no idea what I do. When I run into floor nurses they think I’m nothing more than an ambulance driver. I have a basic understanding of the job of RTs, X-ray techs, and lab techs, but by no means could I list even 4 or 5 of their job responsibilities. That’s a bad thing, because I know I could learn so much from them, and in a team setting everyone in the room would have a better understanding of who does what best.

    But, alas, it seems most of our understanding of other people’s jobs is based mostly on second hand he-said, she-said information.


  • LungMan
    LungMan

    March 28, 2007 at 8:51 am

    Kim,

    I have been an avid reader of your blog for some time now, and I have never had an occasion to disagree with you more than I do now.

    I was really impressed with your idea to teach “nursing 101″ to med-students. It is a good idea to help the new guys understand what it is that nurses do in the care of their patients.

    My disagreement comes from your assertion that nurses do not take orders: they use them to form plans of care. This is where a problem has crept into the practice of medicine. Nursing plans of care are great, a fine addition AS LONG AS THEY ARE CONGRUENT WITH THE PHYSICIAN’S PLAN OF CARE. RNs for all of their knowledge and experience are not the “makers of the plan”. They are those that “carry out the plan”.

    I’m not diminishing the role of the RN in any way. I like to use an analogy to describe the healthcare process: it is like an orchestra. Every instrument makes a part of the music that will be missed if it is absent but there is only one person at the front with the baton. I have never been to a performance where the orchestra has had a meeting at the beginning to deside who was going to lead. It is always the conductor.

    The conductor coordinates the rest of the orchestra making sure that everyone comes in to play their part at the right time. The percussionist and the bassist and the oboist and violinist all have their jobs and roles. Those role are important and deserving of respect but they are not the conductor and should not pretend to be.

    As in healthcare: RNs, RTs, CNAs, PT, OT, etc all have their roles. All are good and important. But none has the responsibility to the big picture as does the physician. Your experience as a nurse is important to the physician as you have a unique role that no one else can play. Certainly the only way nursing care can be done is by the nurse.

    Please, focus your energy in the place where it is most important. The physician has a plan and she needs you to help carry that plan to fruition for the good of the patient.

    It is not my intent to flame you in any way, Kim. I have nothing but the utmost respect and admiration for you and your profession, but please consider what I have written here. It may be utopian in nature but it is right.

    Respectfully,

    LM


  • Kim
    Kim

    March 28, 2007 at 12:20 pm

    Hey Eexcell!

    No flame or disrespect noted! Comments are for just that! Comments and opinions, and yours is welcome!

    You also make some good points, for instance if a doc writes for early ambulation on a post-op patient, the nurse can’t “plan” to keep the patient on bedrest and has to work the ambulation into the routine while making sure the patient has enough pain relief to allow them to move early and well, while evaluating their tolerance for the activity and noting any progress (or lack of progress) made and encouraging the patient to actually do the moving by educating them on the dangers of inactivity after a surgery and providing the motivation to actually do what the doctor feels is in their best interest. Any deviation from what is expected post op is documented and communicated to the doctor who may have to increase the pain medication or re-evaluate the patient to find out why they are unable/unwilling to do what is asked.

    One “order” written by the MD, an entire aspect of the nursing care plan in congruence with it!

    And let’s not forget the patient’s part in all this.

    Nurses plan their nursing care so that their plan is congruent with the medical plan, but should there be a discrepancy in what is written by the doctor and what the patient can/does or does not do or exhibit, then the plan becomes incongruent and it is the nurse that will inform the doctor and obtain a variation in the medical plan that returns it to congruency.

    A doctor can write a medical plan, but rarely do they carry it out alone.

    A nurse can write a patient care plan and carry out the nursing functions without a doctor ever involved, and use their assessments as needed to request certain “orders”, as needed, to help the patient respond to that plan. The doctor may disagree at which point a dialog takes place so that both the nurse and the patient understand the medical reason behind the “order” and possibly come to the best answer for that particular patient.

    So, I think we agree to a point. The care plans must be congruent and they have to take into account the individuality of the patient’s entire physical, emotional and spiritual health. The doctor is instrumental in the physical aspect, but for the health of the patient every aspect has to be considered and that is what the nursing care plan is. The medical plan is just part of the nursing plan, but it is up to the nurse to incorporate it as written and obtain changes in that plan as needed.

    I am posting this in my comments and sending it to you as email! I appreciate your viewpoint and taking time to comment. Don’t ever hesitate to do so! : )


  • UK Doc
    UK Doc

    March 31, 2007 at 1:18 am

    At my old UK Med School we had to undertake at least 1 day every placement (4 weeks) with the nurses. Generally these were used as ‘beat the med student by wiping bottoms’ but occasionally they were useful. This job I’ve taken the student nurses and have them shadow me. They were amazed at what we do, as they thought that when we weren’t on their ward we were just sat drinking coffee. They hadn’t seen the other 2 wards we look after, the reviewing sick patients, and A&E (ER) consultations that take up the majority of our time.
    In this job the nurses are short-staffed and so I routinely do my own dressings, IV fluids and drugs, set up pumps and do basic obs, because if I want my plan carried out I’d better do it myself.


  • enrico
    enrico

    April 3, 2007 at 2:58 pm

    When I was shadowing various physicians in the US, I saw a very confrontational and “I know just as much as you do” attitude from many floor nurses towards doctors. The badge of knowledge wielded was the time spent w/the patient, which for many of them, trumped all. (ie, “*I* know what patient needs; I’m with him/her all day.”) Plans and orders made by a doctor for one patient within a few minutes’ time as said doctor writes them for another dozen patients throughout the morning can be scrutinized, picked apart, second-guessed, ad-infinitum by several shifts of nurses until the next day. That doesn’t really help matters, either. I’m not suggesting that nurses get similar “sensitivity training” towards physicians, since they get the short end of the stick on a day-to-day basis by neanderthal physicians, but I thought I’d add a small footnote of devil’s advocacy to an otherwise awesome post.

    In support of what you said, I picked up a digital copy (we won’t say where ;) ) of a pathophysiology text that was geared towards nursing students. Instead of the typical “clinical correlate” boxes med books have in the margins about the standard progression of dz, the text was peppered all throughout with all sorts of PRACTICAL tips, actual procedural approaches, and very “hands on” data that are often sorely missing from standard medical school basic science textbooks. It was great to see another facet of the same subject, and I think that kind of exposure makes for a better understanding of patient management. Helping collegiality between nurses and physicians can only be improved by this as well.


  • Teresa
    Teresa

    December 17, 2007 at 8:19 pm

    I am a RN and want to say that I hold the upmost respect for physicians and will give them that respect as long as I get the respect I deserve. I have attended college for 4 years, continuing on for 4 more for my Masters. Nurses do have years of education as aa physician does. I do beleive Med students need at least one week of nursing to gain a better insight into what we do and that it takes some education to be a RN.


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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