Nurses Speak Out, About Doctors

Published: October 27, 2008

In our transparency-seeking, report-card-issuing, memoir-happy climate, not much about medicine goes unexamined these days. One exception, oddly, is an aspect that used to be at the center of attention: the ever-titillating relationship between doctors and nurses.

From Cherry Ames to Dr. Kildare, the folks in the stiff, white uniforms once waltzed around providing vicarious fun for all. A few serious academic analyses from those days confirmed the intensely stereotypic sexual gamesmanship and complicated power plays underlying even trivial doctor/nurse interactions.

Now, of course, all that has changed, with nursing established as a powerful and educated profession, with gender stereotypes erased, salary disparities shrinking and job descriptions overlapping.

But has it really changed? Do we know for sure? In theory, doctors and nurses are now heading for a happy paradise of equality, collaboration and mutual respect. Human nature being what it is, though, one wonders if we are not first condemned to weather a Reconstruction-type era of confusion and ongoing mutual abuse, as all parties struggle to regain their footing.

In the meantime, not many bulletins are coming in from the field. You can bet that no doctor out there is planning to publish a manuscript entitled “Reflections on Nurses” any time soon. I am assuming my colleagues concur that such a project would be best left for retirement incommunicado somewhere on a distant Pacific atoll, where the mailman never calls.

It is hard to say which would prompt more angry letters: outlining some of the bad nursing care the present system enables, or searching for exactly the right words to describe the miraculous best. “Saintly,” “selfless” and “devoted” all have condescending paternalistic overtones. “Professional” is just too cold. There is a limit to how many times you can use “fabulous” in one piece of writing. Better to keep quiet, we say, cowards all.

But nurses are made of sterner stuff. In “Reflections on Doctors,” they have produced something quite extraordinary in recent medical writings: a compilation of 19 brief essays musing on the current relationship between the species. The book comes from Kaplan Publishing, whose guides take aspiring professionals from SAT preparation to licensure, and it is apparently intended to prepare incoming nurses for the terrain.

It does so not by theory but by anecdote: these contributors hail from the trenches rather than the executive offices or classrooms, and while some are writers by avocation, few can muster anything in the way of literary style. Still, their casual stories deliver a remarkably wide perspective on their subject.

Karen Klein recounts the two occasions in the course of a career when she refused to take a doctor’s orders. The first time netted her a heartfelt apology when her judgment proved correct; the second time, for an equally correct judgment call, she got only a bloody handprint on the back of her uniform as the irritated doctor gave her a shove in the direction of the job she refused to do.

A heavily symbolic handprint, that, and in self-consciously literary hands it could have been fashioned into quite the metaphor. This nurse only hopes the doctor “got the help he needed.”

Other stories are similarly matter of fact. Cara Muhlhahn, a nurse-midwife in New York City, describes a complicated cord-around-the-neck home delivery: “Yay! One more unnecessary Caesarean avoided because of excellent clinical management and great collaboration with doctors.” Paula Sergi, a public health nurse, writes about the workaholic doctor she wound up marrying, “the person behind the woman who attends social functions alone.”

Anna Gregory, an occupational health nurse, ruefully reflects on her looping career arc: as a nurse she increasingly took on “the doctor’s job”; now, training as a doctor, she worries that when she finishes “all the docs will have been replaced by nurses.”

In war-torn Kosovo, a team of hip young female women’s health doctors and nurses groan when an elderly Albanian pediatrician joins their team, only to become captivated despite themselves by the old crone’s clinical prowess.

Each story represents a step in understanding the inherent differences that separate the professions. While working as a rehabilitation nurse, Mindy Owen stumbles on a big one in caring for a quadriplegic teenager, the victim of a car accident. She becomes transfixed by a picture of the boy with his old basketball team, and shows the photograph to the boy’s doctor. “Never do that again,” he snaps. Only then does she realize that the doctor takes the photograph as a reproof, a message that because he cannot “fix” the patient, he has failed.

Nursing is intensely reality-based; medicine, often, not so much. “It was the first time I really understood the philosophy of some physicians,” the nurse writes, “and the definition of failure to a doctor.”

These nurses despise the lazy and arrogant doctors they come across (one wonders if the modern empowered nurse elicits worse behavior from these characters than did the old subservient model). They adore the paragons who spend endless hours with chronically ill patients and then happily play Santa Claus at the Christmas party.

Mostly, though, they write in shades of gray, describing interactions and relationships that are colorless, courteous, businesslike. You might actually call them dull. You wouldn’t get a minute of good television out of them. You might, however, get some good medical care.

Get Over the Wall as a First-Year Nurse

Surviving your first year as a nurse will likely be one of the biggest challenges you will face in your career. Almost universally, first-year nurses have days, weeks or months when they feel overwhelmed, inadequate, disillusioned, stressed out or all of the above. If you're thinking, "Was I really cut out for this job?" these tips can help you get through your first year as a nurse with your sanity, confidence and love of the profession intact.

Accept Your Limitations (and Keep Your Ego in Check)

Nursing school can often leave new nurses with unrealistic expectations. "A lot of us nurses are Type A, brainy people who were used to getting good grades in nursing school," says Ashley Flynn, who has been an RN in a surgical unit at Children's Hospital Boston since late 2006. "Nursing school is so hard that when you graduate, you think you know what you're doing." However, you won't know everything all the time, but that doesn't make you a bad nurse, she says.

Don't Try to Do It All

Likewise, new nurses must come to terms with the fact that they may not be able to accomplish everything on their to-do lists everyday. "There were days I ran rampant and didn't eat lunch until 3 in the afternoon, and I left crazy and felt like I wasn't doing a good job," Flynn says. That's when her preceptor would have her write out what she needed to do herself, what she could delegate and what she could leave to the next shift. "You have to learn to accept that nursing is a 24/7 job, and you're only there for 12 hours at a time," Flynn says. "There's always going to be something that you can't be there for or that you can't get done. You have to rely on a lot of other people."

Ask for Help

Good nurses -- whether newcomers or seasoned veterans -- know when to call in reinforcements. For Andrea Kuehn, who has been an RN in the hematology-oncology unit at Cardinal Glennon Children's Medical Center in St. Louis since March 2007, that means asking doctors and more experienced nurses lots of questions. "I'm never scared to ask questions, and I don't care if I'm getting on someone's nerves," she says. "[My] patients' quality of care [is] at stake."

Anticipate Reality Shock

Many first-year nurses participate in structured orientation programs and enjoy low patient loads and lots of help from preceptors and mentors for their first few months on the job. Then reality shock hits when the first-year nurse starts working more independently. "It's common for nurses to go through a slump of discouragement and to feel inadequate and overwhelmed, starting anywhere from their fourth to sixth month on the job," says Stacy Thomson, RN, MSN, a nurse educator/intern coordinator at Wake Forest University Baptist Medical Center. "If they hang in there, they'll feel a greater sense of satisfaction and accomplishment around the nine-month mark."

Separate the Personal from the Professional

One of the biggest mistakes new nurses make is taking things personally instead of professionally, Thomson says. "Family members can be very challenging, and patients in pain can be very irritable," she says. "Professionally, you have to step back and pull out your psychosocial skills and realize that people are in stress, and it's not personal."

Seek Support

Socializing and sharing stories with your former nursing classmates or other new nurses at your facility will help put your struggles into perspective. Hearing a nurse who is a few months further along say, "Hang on, it will get better" or "I've done the same thing you just did" can validate your experiences and provide support, Thomson says.

Remember Why You Became a Nurse

In the end, Flynn and Kuehn both say the wonderful aspects of nursing outweigh the challenges. "There are days you argue or get your feelings hurt or get screamed at, and you go home and don't feel great," Flynn says. But then the next day, a child may draw you a picture or a parent will thank you, making you feel good about that part of the job, she says. "Whether or not we're happy all the time in what we're doing, most of us feel like we were meant to do it," she says.

Adds Kuehn: "I always thought it would be magical, saving lives every day. In fact, it is a very stressful job when you're first starting out. Just remember that everyone has to start somewhere."

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Best of the best

Best of the best
For the first time, we rank Best Places to Work


Welcome to Modern Healthcare's first Best Places to Work in Healthcare supplement. In this issue, readers will learn the rank order of the Best Places to Work in Healthcare.

Our new awards and honors program, which we announced in January, recognizes workplaces in healthcare that enable employees to perform at their optimum level to provide patients and customers with the best possible care and services. To determine those workplaces, Modern Healthcare entered into a partnership with the Best Companies Group, a firm that conducts regional "best places to work" programs across the country. Organizations and companies from all segments of the healthcare industry with a minimum of 25 full-time employees were eligible.

On behalf of Modern Healthcare, the Best Companies Group conducted two surveys of healthcare organizations and companies that volunteered to participate. The deadline to sign up for the program was June 20, and the two surveys were administered in July and August. The first survey was a questionnaire for a participating employer. The second was a satisfaction survey of a participating company's employees.

Participation was free to those that completed the questionnaire and survey electronically. There was a nominal fee for those that submitted their entry on paper. Healthcare employers that participated will receive a free summary report on the results of the questionnaire and survey. Some 238 healthcare organizations and companies participated in the survey. On Sept. 8, Modern Healthcare announced an alphabetical listing of the 100 healthcare companies that made the cut. And in this supplement, we reveal for the first time the ranking of those 100. We congratulate them for their achievement.

The Studer Group sponsored Modern Healthcare's Best Places to Work in Healthcare program. Per editorial policy, sponsors are not involved in the design, administration, tabulation or interpretation of the survey or the judging or determination of award recipients.

Modern Healthcare would like to thank frequent contributor Ed Finkel for writing the main story and three employer profiles that appear in this supplement. You can reach Finkel at

Most importantly, we'd like to thank all of the 238 healthcare organizations and companies that participated in this year's Best Places to Work in Healthcare program. Watch for an announcement of next year's program early next year.

Thank you.

David Burda, editor

Cytomegalovirus (CMV)

Q: I have heard that CMV can be a serious problem when contracted by a pregnant woman. What is it and how can it be prevented?

A: Cytomegalovirus (CMV) is a virus contracted by contact with infected body fluids like saliva, urine and blood. Most adults and children who get CMV may not even know they have been infected because the symptoms are often mild or vague, like fever, fatigue, sore throat or a mononucleosis-type illness. However, babies born with CMV (about 1 in 150 live births) may have a more serious illness.

Health problems occur most often in babies born to women who get their first CMV infection during pregnancy. In the United States, about half of expectant mothers have never been infected with CMV. Fewer than 4 percent of uninfected pregnant women will get a first CMV infection during their pregnancy. Only about 30 percent of those pregnant women will pass the virus to their unborn baby. Although most babies born with CMV never develop problems, the infection may cause hearing loss, vision loss and developmental disabilities in affected newborns.

CMV is most frequently found in day care and pre-school age children. Most infections among pregnant women are caused by contact with infected saliva or urine; therefore, mothers and child care workers are at high risk for contracting the infection.

Recommendations for pregnant women to help prevent contracting CMV:

• Wash hands often with soap and water, especially after contact with saliva or with diapers of young children.

• Do not kiss children under 6 years on the mouth or cheek.

• Do not share food, drinks or silverware with young children.

If you are pregnant and think you may have contracted CMV, talk to your doctor.

Daniel R. Lattanzi, M.D.
Obstetrics and Gynecology