January 6, 2008, 3:50 pm

I’m Not Crazy, I’m Just A Little Unwell…


I always feel like I’m going off the deep end, usually around 0300 in a full department.

It passes.

Haven’t had lunch or a break in my last three shifts, and while I know it’s par for the course, and I knew it when I signed up for this profession it doesn’t make me any less grouchy.

I like to think I hide it from co-workers but I’m pretty sure a few of them have wanted to give me an attitude adjustment over the last few weeks.

According to this ad, it’s because I have cholesterol building on the artery walls of my “mental-nervous equipment”.


In that case Lipitor should be an antipsychotic!

Take a hike, Haldol!


I had a chance to catch up with all the docs on my blogroll this weekend.

Very enjoyable!

I found some broken links and some blogs that haven’t been updated, so I did a bit of housecleaning.

If your link is missing and you are still in action, please shoot me an email.


Speaking of Haldol, I ran across a post in my reading that had my jaw on the floor.

Actually, it wasn’t the post that caused mandible-vs-gravity.

It was the comments.


I suppose I should be angry, worked up, hot-under-the-collar, how-dare-you, in-your-face pissed off. (Pardon the language.)

But I’m not.

I’m just sad, and a bit concerned that there are certain antiquated attitudes toward nurses that still persist in the 21st century.

Let me say before I start, that both the post and the comments referenced are from bloggers I enjoy and respect. The post is two weeks old; if I kept up on my reading, I could have given a more timely response. Be that as it may, I really feel the need to say something.

First of all, the original post can be found at Scalpel or Sword? and is entitled “Nursing Ethics”.

If you have not read it, please do so now and then come back. Be sure to read the comments, as the problematic statements reside therein.


So, basically a nurse refused to give a patient a medication, namely Haldol, unless they were able to tell the patient what was in the injection.

Let me state right up front that, given the scenario presented by Scalpel I would have given the injection without reservation, and documented the hell out of the patient’s statements and behaviors to back it up. Been there, done that.

If I had been uncomfortable with the order, I would have talked to Scalpel and asked him to administer the medication himself.

I’ve been uncomfortable with orders before. I have never, in thirty years had to refuse an order. I’ve found errors in orders and brought them to the doctor’s attention at which point the error is rectified.

The emergency department is a very collegial environment. Usually, the doctor will listen to my concerns and either change the order to something I am comfortable with or explain the rationale behind the order, often bringing to light something I did not know.

We work together, in tandem, each approaching the patient in our unique professional capacity.

In other words, the doctor is not the enemy.

But apparently some of them think nurses are.


Scalpel was advised to “obtain nurses who will take orders from physicians”.


Nurses are autonomous practitioners who are wholly responsible for anything they do to or for a patient. If I refuse to carry out an order, I better have a damn good professional reason for doing so. If I question an order, but choose to carry it out, I will document that my concern was discussed with the physician.

Nurses do not refuse to carry out orders on a whim.

And they are not “obtained” by doctors.

One of the comments talked about a nurse being “fired for cause.”


The refusal to carry out an order that the nurse feels will injure the patient, is outside their scope of practice, or against hospital policy or the law will not be fired for cause. And being in a union has nothing to do with it. It is our right, no, it is out obligation as practitioners to not carry out an order that we feel is detrimental to the patient, and we cannot be fired for it. However, we better have a very good reason for not carrying it out

If we do carry the order out that should not have been carried out, and the patient is harmed, it is our career on the line. The buck does not stop with the physician – at least where malpractice is concerned.

One comment brought up the topic of insubordination. Another stated that medicine was a “semi-military heirarchy” and that when an order is written, they “damn well expect it to be carried out.”


Nurses do not work for doctors. Doctors do not have authority over nurses. Doctors cannot punish nurses. Doctors are not responsible for nurses. We are separate, autonomous professions that work side-by-side in caring for the patient. The physicians lay out the medical plan, the nurses carry out that plan, and the nursing care plan that compliments it using the principles of the nursing profession.

Nurses do not salute doctors.

They can, however, respect them for their education and competence.

A little reciprocity in that regard goes a long way.

To put it in terms a kid would use: Doctor, you are not the boss of me.


Somebody help me out here.

Docs, do you really see nurses like this? Even in this day and age?

Do you really look at a nurse and think “you better damn well carry out my order?”

Do you really see nurses as subordinate to you? Particularly in the ER? Anywhere?

What are you taught in medical school?

I guess I’m shocked that these attitudes are still floating out there. I work in a great ER where the docs and the nurses have good communication. They trust each other but have no problems confronting or questioning when necessary.

It’s called team work, and to read the opinions expressed in response to Scalpel’s post was like getting slapped upside the head.

I would have expected those comments twenty years ago, but not today.

Can I be that naive after thirty years of nursing?



  • Nathan

    January 6, 2008 at 4:13 pm

    It’s an interesting relationship, of course, and I don’t want to get too caught up in the highly charged emotional fray around it, but I will answer some of your questions. As far as the “damn well” bit goes, I try not to think in such terms, because anger and condescension doesn’t really get you far with anyone. But it plays into the next question you asked, about subordination, and on that count, yes, in a sense we do. Nurses don’t write orders for doctors, it’s the other way around. Now I respect and value the input and perspective of nurses, but in the last analysis, it is the physician who is making the treatment plan and ordering it. I’ve certainly been confronted about errors in orders, and I’m always grateful to and respectful of the nurses who confront me, but it is still me writing the orders. Respect goes both ways in any hierarchy.

    Thanks for your comments on my blog. I sincerely hope I don’t alienate you with any of the above.

  • scalpel

    January 6, 2008 at 5:58 pm

    I sort of cringed when I read some of those comments too. The nurse in question is also a friend of mine, and I would never have made an issue of our disagreement. I just thought it was an interesting philosophical issue, and I wanted to hear some other reactions to it.

  • My Own Woman

    January 6, 2008 at 6:32 pm

    This has absolutely noting to do with your post today, but I’m feeling very left out. I don’t have a blog display on Code Blog…..and I don’t have your email address. I’m pouting…..can you see me?

  • Sandy

    January 6, 2008 at 8:38 pm

    Wonderful post. Good reminder that nurses hold the ultimate legal responsibility when carrying out orders. Actually, nurses write plenty of orders for doctors [who sign off on them] — after decades in ICU, each fresh crop of new interns regularly went to the experienced nurses to do that for them. 😉

    As to your question about if condescending attitudes still prevail, sadly, yes. Being in a research specialty for the past ten+ years I encounter it from doctors (not the experts in my field) too often. Nurses are dismissed as lowly nurses and they have MDs. Sometimes it can seem like an expression of insecurity. But the most brilliant and wonderful doctors, and the ones I hold the most respect for, also happen to be the same ones who see nurses as colleagues, not subordinants.

  • icu rn

    January 6, 2008 at 8:55 pm

    I read that post, but chose not to comment because quite frankly, we don’t get those patients in my unit. They are gone well before being transferred to the unit/floors. Therefore, I cannot say what I would have done not having experienced that specific situation before. As far as the docs go that I work with? Old school, for sure. “Yes, sir. No, sir.” That kind of stuff is expected by them. I personally find that the hospitalists are more involved than any of the other admitting mds, and subsequently, are the ones who tend to have the best relationships with the nursing staff, at least where I work.

  • lna

    January 6, 2008 at 10:18 pm

    My mom is a nurse, and when I was a kid, she told me stories about the doctors she had to work with. Gave me the impression that all doctors are assholes to nurses. They’re the favorite children of the hospital family, spoiled rotten and fussy. They’re poweraholics.

  • Rita Schwab

    January 7, 2008 at 4:40 am

    “We can respect [doctors]for their education and competence. A little reciprocity in that regard goes a long way.”

    That statement sums it up.

    Medicine, especially emergency medicine, is an environment fraught with emotional land mines, and as such the occasional explosion seems inevitable. However, a foundation of respect will keep the team functional through it all.

    When I’m the patient I hate being able to detect tension among the care-givers, very scary.

  • unsinkablemb

    January 7, 2008 at 5:22 am

    In our OR, you can a little bit of the Us versus Them attitudes between doctors and nurses – especially from “Old School” professionals. However, I happy to report that is not the majority. From what I’ve seen, it’s a matter of building trust. In surgery, it can be difficult because you can literally be stuck in room with someone for an entire day – no escape. It’s in the best interest of all parties to try and get along!

  • Labor Nurse

    January 7, 2008 at 6:47 am

    I didn’t read the original post that you are referring to here in your post, mostly because I find this argument tiresome and distracting. This whole “we’re better than them” attitude (from either side) really gets me down.

    One thing I want to add is that nursing and medicine are two very different scopes of practice. Our approach is different, and both is very much needed for excellent patient care.

    An obstetrician I work with said that she wished more people realized that nursing and medicine were two totally different beings, but stand to learn a lot from each other. Her mother was a nurse, and she has always been respectful of the nurses she works with. Having seen this positive, collegiate attitude, I chose her as my gynecologist.

    Most of the doctors I have worked with have been respectful. Of course there is always a few bad apples, but the same is true with nurses.

    Thanks for asking those questions, Kim, I’m just as curious.

  • Katie Bee

    January 7, 2008 at 7:38 am

    This has turned into a great conversation. I don’t think it’s shocking or unfair to think of the nurse vs. doctor paradigm as completely hopeless. It was only 4 years ago nurses were instructed to give up their chairs for a doc that entered the room, no?

    We’ve come a long way in just the 150 or so years that we’ve been an established profession. And since nursing is a traditional woman’s job and one of servitude and submission, I think it’s definitely improving.

    I find most doctors my age (Gen Yers) are learning to treat medical care as a team effort, and are much more receptive to nurses as teammates, not subordinates. We just have to try to get along and not be as angry and resentful all the time.

  • Katie Bee

    January 7, 2008 at 7:39 am

    Oops, that’s supposed to say 40 years, not 4. Bet I’d get some interesting comments from that!

  • Onehealthpro

    January 7, 2008 at 9:44 am

    Sad to say, but there are bad apples in every profession and those bad apples create a bushel load of trouble for everyone else.

  • Julie

    January 7, 2008 at 2:26 pm

    Interesting debate both here and over on the original post. One of the amazing things that we see in the blogsphere is the evidence of this attitude of what Drs think nurses are and do.

    This is often no different in the UK, remember the debates / rows many of us have had with Dr Crippen and his colleagues (He’s another disappeared medic blogger). However in the UK there is no such thing as ‘Dr’s Orders’. A Doctor cannot order us as nurses to do anything. If he or she wants us to give a drug to a patient, it is prescribed on a chart and then it is administered. Our code of conduct would also prevent us from willingly withholding the identity of the drug we are giving to a patient, however psychotic, who was able to understand what was going on.

  • […] McAllister at Emergiblog remind doctors that nurses are beholden to their own code of ethics, not the doctors they support. […]

  • […] After reading the comments, go read the reactions and subsequent comments at ERNursey and Emergiblog. […]

  • Disappearingjohn

    January 7, 2008 at 9:15 pm

    I have been very lucky in that I work in en ER where we are able to talk freely with the Doc’s. While I have far less experience than you, Kim, I have told a doctor I was uncomfortable giving the quantity of a medication a doctor had ordered, and he explained his rationale, and then offered to give it if I was still uncomfortable. I gave the med, as I understood where he was coming from, but it felt good that we could have that conversation as professionals and adults, with no “attitude” to get in the way…

  • Georgia

    January 8, 2008 at 11:49 am

    “We can respect [doctors]for their education and competence. A little reciprocity in that regard goes a long way.”

    So well-put.

    I think some of the nurse-doctor tension also comes from a real lack of education as to what nursing entails. I think that a lot of physicians see nursing as waitress-like. We take orders and carry-out millions of tasks, but do they see the critical thinking, assessment, and incredible physical labor we do while managing sometimes 12-15 different cases (at least in the ER)?

    As a profession, I think nursing fails to articulate to our colleagues (doctors, in particular) exactly what makes nursing MORE than just picking up doctor’s orders.

    Medical education schools future doctors extensively in the science of human health and illness, but it does very little to prepare students to work cooperatively with other healthcare professionals in the hospital environment. Nursing education is not much better. The two professions are kept separate from Day One of our training and are then, unrealistically expected to understand one another and cooperate in the work environment.

    For anyone looking for a good read, there is a great chapter on nurse-physician relationships in Suzanne Gordon’s book “Nursing against the Odds.”

    Keep asking great questions Emergiblog!

  • sean

    January 8, 2008 at 2:22 pm

    VERY well said!

  • Deb

    January 8, 2008 at 5:39 pm

    Though I am not a nurse, I can hear your passion and found this post so powerful!

  • ArkieRN

    January 10, 2008 at 10:32 am

    I think the language may be reinforcing these MD delusions.

    Perhaps if instead of writing “orders” the physician wrote out the patient “plan” and subsequent “updates” to the plan.

    It really sounds more team focused. Which good health-care should be. It also does not feed into the myth that MDs have any authority over nurses.

  • Rachel

    January 10, 2008 at 1:44 pm

    I saw a comment on the Student Doctor Network forums recently in which a medstudent worried that the nurses hated him, and another commenter essentially said, “You wouldn’t care if the janitor hated you, so why do you care if a nurse does?” So, yeah, apparently some folks still do have this attitude, and some of them are brand spankin’ new to medicine. Ooph.

  • Karen Johnson

    January 13, 2008 at 6:12 am

    Right up front, I’ll say I’m neither a nurse or doctor. But I was a police officer for 18 years, and am now a Certified Music Practitioner.
    What all of that has to do with making a comment about Scalpel’s post, and the many responses is this: Power hierarchies. As a former police officer, I daily/hourly/by the minute, saw a similar attitude toward the general public/suspects,and anyone else who wasn’t a police officer. You (the non-police officer) were expected to do EXACTLY what you were told to do by the officer. There was to be no questioning of power.
    Unfortunately, I detect the same thinking in the post in question.
    The problem with all this, is that each of us is a human being, and we deserve to be treated with kindness, and even a sense of humour. Whether I’m old, young, poor, rich, a convict or an upstanding citizen, I do have some life experience, some intelligence, and deserve to be able to talk about what’s being done to or *for me* in situations that effect my quality of life.
    And you’d be surprised at how many times that happens during the day…
    An odd phenomena.. so often those who ‘take care of’ others begin to despise them. The care-taking professions (and really, every other profession) could benefit from walking a mile in someone else’s shoes.

  • Peggy

    January 16, 2008 at 3:34 pm

    My mother and several of her sisters were RNs. Some of them wanted to go to medical school but their parents forbade it; nursing was barely an acceptable occupation for young women, but medical school definitely was not. They were in nursing school (took turns, working to put each other through), an excellent one, in the early 1920s. I admired and adored these women, all very strong and self-confident and they loved their profession.

    I don’t think many people realize how new the nursing profession is. Florence Nightingale in the mid-1800s basically created the profession as a profession and in the process established life-saving medical care practices that doctors learned to value. When my mother and her sisters were attending nursing school the profession was intensely focused on professional ethics and standards of behavior, not only professonally but personally for nurses.

    My mother and aunts had no doubts about their value to medical care (and participated in continuing nursing education their entire careers). They very likely dealt daily (but I never heard that discussed) with ‘old school’ docs of the time who saw nurses as little more than poorly educated cleaners and low-class women off the streets, which was exactly what they had been before Nightingale. Since doctors consider themselves (rightly) to be highly intelligent, it’s a mystery how they could not value the nurses on whom clearly they depend. I think most of them do. Providing medical care, figuring out diagnoses, prescribing treatment, etc, is a chancy business, even more so today with a lawsuit-happy society. The stresses can be tremendous. Nurses and doctors really are the most natural allies of any of the professions! Thanks for letting me go on a bit.

  • Hansa student nurse final year

    February 5, 2008 at 7:14 am

    At present and in the future, teamwork and recognition of all members, not only nurses and doctors will be essential for improving patient experience and learning from each other. Sooner or later, we are going to be a patient and will benefit all, from improving attitudes and communication.

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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