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What are the Rules?

January 15, 2012

In nursing school, or at least in mine we were always taught to respect doctors and there was always an unspoken hierarchy that was vaguely referred to in lecture, at clinical and in lab. My professors would speak of their experiences and encourage us to stick up for ourselves as nurses and for our patients, but there was still a strange fear present. Our professors would imply that many doctors were intimidating and not respectful to the nurses.

In one of my first clinical rotations in pediatrics I was waiting for a resident to change the written order for a dose of a child’s asthma medication that was due. As I waited for the order to be changed and the resident didn’t answer my page, I felt frustrated. This child needed his asthma medication and it had been decided during rounds that the dose prescribed to him was not working properly. When I saw the attending physician down the hall I thought, “I’ll just take initiative and ask him to please change the order in the computer since he is the one who dictated the order change to the resident.” I approached the attending physician and politely reminded him that the order hadn’t been changed and asked if he wouldn’t mind fixing it so I could give the medication. The attending physician looked at me with a blank look in his face and said, “I’m an attending, I don’t write orders. Residents write orders” as he walked away from me. At the time I thought, “since when are there rules stating who I can and can’t talk to? And if there are rules, what are they and why haven’t I learned them?”

I remember feeling dumbfounded. First of all, at that point in nursing school no one had ever explained to me that attending physicians are not the “go to” person to get orders changed, and also I thought to myself,  he’s a physician, he has an MD, he technically can change the order so why won’t he do it? The anger I felt in that situation made me want to yell at this doctor. What ever happened to the patient coming first? Anyway, as my professor learned of this incident she told me, “I understand you’re frustrated, but that is how things are. You can’t ask an attending physician to do a resident’s job.” Ever since that incident I was nervous about starting work as an RN. While I do respect the chain of command and of protocols, I believe more in what is right for my patient. I would never go out of my way to contact an attending physician, but if he or she is right in front of me when a resident is no where to be found, you better believe I’m going to ask him or her to do exactly what is within their scope of practice as an MD.

Now that I am working as a nurse, I have run into similar situations, but for the most part the attending physicians that work on our unit are pretty receptive of nurses, especially us new graduate nurses. I think the communication between doctors and nurses still needs to be revamped and improved. I don’t think it’s right for a nurse to feel intimidated by a physician, and at the same time I don’t think it’s right to assume a physician is going to be a jerk who won’t work well with the nurses. It seems as though both physicians and nurses could benefit from taking communication courses together to hopefully get rid of some of those stereotypes that some physicians believe to be true of nurses and vice versa.

Stay tuned for my next entry, “Aha! Doctors Are Real People Too?!”

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