Nurses & Doctors: Make Appreciation Reciprocal

artist: jparadisi

artist: jparadisi

Few life-threatening or terminal diseases present themselves in otherwise healthy, alert, and charming hosts the way cancer does.

From the get-go, oncologists are not only captain of the ship; they hoist life preservers in the form of treatment to patients drowning in waves of shock after a cancer diagnosis.

In my opinion, oncologists’ hearts closely resemble those of nurses. This is attributed to the fact that although oncologists do not spend the same quantity of time with patients as nurses do, the quality of the time they spend is intense. They often form relationships with patients over years. It’s common for an oncologist to know close members of their patient’s family, also like nurses.

During my last episode of possible (it wasn’t) recurrence, I experienced this truth.

My oncologist and I share a professional relationship. One of the reasons he’s my oncologist is because I know he’s good at what he does. My husband likes him, too. They share an easy communication, which is another reason for my choice. If/when cancer recurs, I know they will cooperate on my care, freeing me to be the patient, not the nurse. This arrangement brings me peace of mind.

Anyway, I had suspicious symptoms, which landed me face down in an MRI. My appointment to receive the MRI results was scheduled at end of a workday for my oncologist.

David accompanied me. Dr. My Choice entered the exam room holding the films, clipping them to the light box.

“I haven’t looked at these yet,” he explained. “I thought we could see them at the same time.”

It hit me in a flash: Dr. My Choice likes us too. He is about to find out if he will tell a nurse he enjoys working with, and her husband, whether or not her cancer has recurred.

Snap! What have I done to him?

Fortunately, the films revealed I am still cancer free. The look of relief on Dr. My Choice’s face nearly equaled David’s.

Oncologists, (doctors) have feelings, too. This knowledge affects the professional relationships of nursing practice in the following ways:

  • When questioning an order, assume the doctor has good intentions toward his or her patient, same as you.
  • Avoid framing questions to a doctor with your personal inferences, such as opinions of whether or not the physician is “good” or “bad.”
  • Consider that doctors suffer from work overload, and burn out, as do nurses.
  • Remember: Being part of a team is catching one another when we fall. No one is on top of his or her game every time.
  • Protect the Rock Star Doctor (every unit has one) by double-checking their orders the same as you do for any other physician. Don’t let them fall to earth because you were not diligent in providing a safety net for their patients.

Education is the tool of our trade. It is our demeanor, which makes us professionals.

Nurses and Pharmacists: For Valentine’s Day All We Want Is Respect

I’ve written before that I am happily married to a pharmacist. Sometimes when we come home from work, we commiserate together in shorthand about our hospital shifts. When we are grumpy, we play “I work harder than you do,” in which we childishly throw out episodes from our day to prove who had a harder shift and should buy dinner. Usually I win, because as a nurse, I am the one working hands-on with patients. However, I concede that being responsible for every medication calculation, preparation, and drug interaction (and more) is a tough and stressful job. Safe medication administration is a foundation of patient care. I also acknowledge that nurses are occasionally a little difficult to work with (I  was actually once present for a code blue when a stool softener was ordered STAT).

Anyway, for David and all my pharmacist friends, this one’s for you. Special thanks to the friend who brought this video to my attention.

Late Entry: I did have the Pharmacy Respect video here earlier, but I have removed it. Unfortunately, I cannot unlink it from the YouTube playlist that I do not want to post to this site. So, watch the Pharmacy Respect video, click the link or go to YouTube and type Pharmacy Respect into the search bar. It will come right up. Sorry for the inconvenience, but it is a cute video.

How to be Scary with Your Body, Win Games, and Lose Coworkers

     Last Saturday, I sat on a bleacher, watching my favorite 10 year-old play baseball. He is the catcher for his team. He has the proportions and beauty worthy of a Renaissance sculpture, but he is compact and a little small for his age. Looking at him, I guess he weighs in around 60 pounds.

     I was startled watching him play.  He wore bulky black body padding from ankle to neck, and a red metal, helmet-like mask covered his face. In his catcher’s gear, he looks like Iron Man. He chased the players trying to run home back to third base by holding the baseball in his right hand as if it were a weapon, shaking his shoulders back and forth with the ferocity of a miniature Robert Downey Jr.

     After the game, I asked him about his aggressive style. He told me that wearing a mask makes it impossible to use his facial expressions to intimidate his opponents, so he learned how to be scary with his body. 

     It reminded me of a story told by a friend about a performance between two nurses discussing a clinical matter. One nurse pointed her finger like a gun at her coworker. She did not let the other nurse get in a sentence, blocking her attempts to speak without listening.  All hope of productive communication was lost, and the other nurse sulked back to third base. My friend said that watching the bullying nurse use her body to be scary reminded her of this Pink Floyd lyric:

And it’s too late to lose the weight you used to need to throw around.

     Little Leaguers and nurses are not the only people who use their bodies to be scary. I’ve had fingers shaken at me by doctors too. I’ve been threatened with rolling eyes, words launched in tones of sarcasm, even yelling, at work. While it’s unpleasant, these behaviors send up a red flag signaling to me this person is probably telling me to do something that is against policy or unsafe. Or, they might be covering up a mistake they made. They may be afraid of revealing something they don’t know. Whatever, I stay focused on the issue, while directing the conversation towards policy and scope of practice. Sometimes it works. 

     The thing is no one wins when communication at work breaks down to this level. At its worst, patient care suffers. Who hasn’t seen the code from hell when a team leader lost control of the situation by intimidating the rest of the code team? How many errors occur because someone says, “just do it”, when you know the “it” is against policy or safe practice, and no one effectively stands up to him or her?  

     Aggressive body language is a strength on a sports field, where it assists in winning games. In the workplace, there is not an opposing team. We are all there to take care of patients. Chasing coworkers away by intimidation might make you feel good in the moment, but you won’t have a team covering the other bases when you need them.

Consensus and Majority Rule are Siblings not Twins

     Just because you are not in charge, it doesn’t mean you are not a leader.

Anonymous

         I’ve thought a lot about working in groups and leadership lately. I think it’s important for nurses to respect the skills necessary to do either. In a perfect world, all nurses, or at least all the ones I work with would.  In my dream team-nursing unit, every nurse communicates his or her needs and patient care concerns clearly and concisely. Every nurse stays focused on the present situation, without bringing past history or personal issues to work. My first-rank draft pick teammates respect each other and never say anything hurtful about a coworker. In my dream team unit, passive aggressive behavior doesn’t exist, because nurses speak openly about their feelings and concerns. My dream team colleagues and I would never have a lapse in judgment or make a mistake.

     Anyone out there know where I can find a job like that? Anybody? Bueller?

     I was speaking with someone about leadership in the workplace. She says she goes along with the majority’s decisions, even if it’s not what she believes in, because that’s consensus.  That feels wrong to me. While I admire this person’s willingness to put her own beliefs aside to move her department’s work forward, I have concerns. First, what if the majority is wrong? Second, why would a group lack concern for the feelings of one of its members, if the goal were to develop a team working effectively together? Lastly, what are the effects on a team member’s performance and psyche that regularly has their needs and concerns ignored? At what point will habitual sacrifice transform a willing team player into a nurse whining, “No one ever listens to me”?    

     News Flash: No one will ever listen to you if you don’t speak up. You have to speak your mind. I know it isn’t easy for everyone, but like learning to start IV’s, it gets easier with each attempt. It’s tempting to go to your “nice” coworkers for help with uncomfortable staff dynamics instead, but eventually you will wear out these people too.

      As for leaders, if you say things like, “The problem with you…” or “This is your problem, not mine…”, you are promoting passive-aggressive behavior. Eventually, this coworker who appears weak, will consciously or unconsciously create a situation that may sabotage positive clinical outcomes. No one wants that.

    Majority rule says, “This is how we’re going to do it, and you will do it this way or else we will __________ (fill in the blank). Common nursing punishments for peers who don’t comply are shunning, refusing to help them (leaving patients at risk), rudeness, and belittling them to other coworkers.

         In comparison, consensus is the voice of reconciliation achieved through sincerity. Consensus says, to the minority, “This is how most of us want to do it, but we don’t want to alienate anyone on our team. What can we do to make the way we are going to do things easier for you? What concessions can we give you to make the work flow well for you too?” 

     I do not work with my dream team, and neither do my colleagues. Our patients depend on us, so we work together as a team to move each shift forward. Some shifts move easier than others do. Each morning we start the clock over, leaving the past where it belongs, and play a new game.