First, I was put in a room with 3^rd-year med students, which was great because I introduced myself and got to chat with them about their program.

Then I waited over an hour for someone to acknowledge me.  (I was escorted to the room, so it was known I was present).  Other nursing students did this same thing through the semester, so it’s not like I was the first one.

Finally, the MD came in. We all stood up, and he introduced himself, shook hands with the med students, and ignored me.  I was very upset by this, so I forced my hand out at him and introduced myself.

Then the MD told some H&P about a patient, mocked them with the door open, called out individually to med students to follow him-and did not provide me directions.  So, I made the best of it and knocked on patients’ doors, introduced myself, and asked if I could observe the visit.  This allowed me time to talk to patients and get information.

Then the docs walked in, did their exams, and left.

I know how to measure a fundus, use a Doppler, and take H&P.  Whoopie!  I was pregnant before, so this was not an educational experience for me.

Also, I was very insulted by the MD’s attitude.  He is supposed to be a professional.  He made it quite clear I was not welcome-even before he met me.  He was also unprepared.  He told every patient he had no idea what labs were drawn, what the results were, or what meds they were taking. I could not imagine this person as my MD!

For the first time since I was in nursing school, I felt out of place, insulted, and even embarrassed to be in the nursing field.  After that clinical visit, I found out that other students were treated this way.  I made a complaint to my instructor and received no feedback.

I am sure not all doctors are like this, but I recommend reading The Intern Blues instead of following some jerk around if you want to know what doctors do.  As for them knowing about what nurses do, they don’t care as long as they don’t have to do it.

It wasn’t until I worked all night with any EXTREMELY agitated RN that I realized how MY bad mood affects everyone I work with.

It was so contagious! I came in to work in the ICU that night in the BEST mood. I was happy and excited about tackling my shift and ready to start the night! Then….she walked in. She came off the elevator griping and complaining. And it continued all night long, accompanied with negative comments directed at co-workers, snide remarks under her breath, and a constant state of negativity on her face.

Pretty soon I found myself being negative. Eventually I talked about this wonderful nurse with other co-workers. Negativity had really sunken its nasty claws into our team that night.

I understand fully that she must have had some underlying problem eating at her inside that she didn’t share. But then I also realized that I had been like this a time or two, too. I have personally apologized (privately of course) to several individual staff members for the negative vibes that I know I have given off in the work environment.

The point I am trying to make is that even when your home life is crashing down, at the point you enter the doors of your job you must pick up the pieces, put your “big girl panties on,” put a little sunshine on your face, and set out to be positive and upbeat for however many hours you have to be there!

It is no one’s fault that your world is collapsing, so don’t make them pay. You’re not only hurting yourself and how others see you, but you are also affecting the attitudes of those around you.

Your attitude is contagious. Make it a good one!

Take a Hard Look at Yourself

When your relationship with your preceptor is a flop, be mature and take a hard look at yourself first. Don’t run and complain to your manager without considering how you are contributing to the negativity in the relationship. After a little soul-searching, you may realize that there are some things you can do to improve the relationship.

Maybe you need to communicate your questions more intelligently and clearly. Maybe you never fully understood your preceptor’s expectations, and you need to ask for clarification. Maybe you’re too beholden to the “this is how we did it in school” attitude and need to embrace your preceptor’s recommendations. Or maybe you need to stop interpreting your preceptor’s critique as a personal attack—and receive it as it is intended: to help you become a better nurse.

The bottom line: You may be part of the problem, and it’s a lot easier to take responsibility for your actions than to harbor expectations that someone else should and will change theirs.

Go Directly To Your Preceptor…with an Open Mind

If you continue to have problems with your preceptor—even after you take an honest look at your behavior and make appropriate adjustments—then take the next brave step of communicating your issues directly to your preceptor.  So you don’t make sweeping generalizations at your meeting with your preceptor, consider documenting specific instances when you experienced negative feedback. And when you do launch your complaints, make sure they are presented in a non-accusatory way. Say, “Can you help me understand so-and-so situation?” or “I feel like I’m not learning when such-and-such happens…”

Your preceptor may not even know that she has offended you or created a bad working environment. And a good preceptor will want to explain her actions and, if necessary, rectify the situation. But go in with an open mind—your preceptor may point out some of your blind spots.  While it might be painful to hear, the critique might help you understand your preceptor’s expectations and help you mature as a professional. It could be one of your greatest learning opportunities.

Accept That Your Preceptor Isn’t Going to Be Your Best Friend

In the professional world, you’re not always going to work with people whom you’d choose to be friends with outside of work. Nevertheless, some new nurses look for a warm-fuzzy friendship with their preceptor. And when there is a personality clash, they immediately want to request a change.

The fact is you and your preceptor might be opposites. You might be vivacious; she might be insipid. You might be intuitive; she might be imperceptive. You might be passive; she might be confrontational. You might like routine; she might like variety. You might be cautious in your speech; she might be blunt.

The case may be that you and your preceptor won’t ever be BFFs (best friends forever), but you can still maintain a professional rapport. And you can improve the relationship simply by being receptive to your preceptor’s strengths. Sure, she might be blunt, but she is a fount of knowledge.  As your focus shifts from your preceptor’s shortcomings to strengths, your first weeks on the job won’t be completely unbearable. In fact, by the end of the precepting experience, you may even come to understand—and respect—your preceptor, despite your differences.

If All Else Fails…

If you make every possible attempt to rectify the relationship but still find it is not conducive to learning, then take your complaints to your nurse manager/educator. Let him/her know the steps you’ve taken to improve the relationship, demonstrating you’re professionalism and commitment. Then be prepared to give specific examples of what you need in a preceptor and why your current precepting relationship is failing you. Ultimately, the hospital needs you to gain confidence and knowledge during this period so that you will be an effective member of the team—and with a “bad” preceptor, you certainly won’t. With the right information, your nurse manger/educator can get you the coach you need to be a success your first year.

I took care of her for two days in a row. At first she seemed pleasant, and we got along well. We have daughters the same age and live in the same city.

At the end of the first day, however, she started to become somewhat needy. There were frequent calls. Things were seemingly going wrong every hour or so: an IV pump would mysteriously be on hold and alarming, or her pain medicine wasn’t working.

The second day started off fine, and she shared with me some of the issues she was having with members of her family–specifically problems surrounding a hurtful letter that had been sent to her by a family member, which made terrible assumptions about her health condition.

For 20 minutes I listened and reassured the patient. However, the same needy behavior occurred and increased (pain, nausea, pressure, nausea, pain, fatigue, nausea, reflux, pain, pain, nausea).

Don’t get me wrong: I take my patients very seriously, and I do what I can to make them comfortable. But she needed me for every little thing. By the end of my shift, I had become so frustrated by what seemed to be attention-seeking behavior that I decided to set limits in a firm but professional way.

Thankfully, a few days later when I returned to work, she was not in my assignment.

Recently, I found out that this patient complained about me, not only to the other nurses but also to the hospital’s patient relations department. It got filtered down to me through my manager, who rallied behind me.

In her two-page complaint, the patient stated that after she showed me this “letter” I began to treat her differently. She said her pump was alarming and I was talking in the hall to another nurse and ignored it. She also said, on a day I wasn’t her nurse, I walked into her room, looked at her PCA pain pump, and then walked out. (It is hospital policy that two nurses check the settings of a PCA, and that is EXACTLY what I did.)

Her complaints were vague, to say the least, and in no way reflected the CARE I gave her. She seemed like someone scorned or rejected.

At first I was angry because I had been nothing but caring, kind, and compassionate to her. But I began to wonder if maybe somewhere I had crossed a line with her and she saw me as more than just her nurse.

Now I feel like I need to be cautious when dealing with my patients. I never know what they’re really thinking or capable of saying about me–even if I give the very best care.

I was wondering if anyone had any feedback on this or had similar experiences and how they dealt with it.

Why, then, is there so much bitching going on? We’re a bunch of nice people in the world’s greatest profession, yet whining often takes a prominent role in our conversations.

There may be a couple things going on. One is that we, by nature, are martyrs. The other is that we don’t like change. Those two characteristics cause us to stay in jobs we don’t like. After a while, our inward martyr becomes outward bitchiness. Our desire for stability makes us resentful of feeling “stuck”. More bitchiness.

The truth is lots of nursing jobs out there suck. There are too few nurses, too many patients, too little budget, an over-abundance of lazy or mean supervisors, and a few narcissistic docs.

Here’s the bigger truth: There are millions of nursing jobs–and most of them don’t suck. Most of them are in caring environments with great staff and management.

I propose if you’re reading this and are in a job you don’t like, quit bitching and just quit. You’ll have another job in no time. Have you not read about the nursing shortage? You’re in high demand, for crying out loud. Go find a job you love.

As a new surgical nurse, I’ve noticed that the nurses who have been around for a while don’t want to let me do some of the procedures. I’m nudged out of the way. I’ve talked with other nurses, and they say that they’re afraid of getting into trouble if the new nurse blunders, or they don’t want to slow down the pace by teaching the new nurse.

A lot of the times, new nurses don’t even get a chance to learn because they have to be so fast from the get-go. When I say I don’t know how to do something, I often am ignored instead of being told, “I know you haven’t done this. I know you don’t know how to, so let’s go through it together.”

But if something does go wrong they say, “Oh, it wasn’t me. It was the new girl!”—even if you haven’t participated in the procedure.

Once I was working with two other nurses—one who was significantly more experienced and a newer nurse than I was at the time (she was still in training). When I came into the operating room, after working with the nurse-in-training, I noticed the seasoned nurse’s laps were off. I counted and recounted. The numbers she wrote down didn’t match the actual count.

The doctor came in, and of course, he started flipping out. When the nurse-in-training left the operating room, the seasoned nurse turned and said to the doctor, “That’s why I hate working with her.”

She didn’t want to get in trouble. She wanted to look good. And who’s a better scapegoat than the new nurse?

So writes Suzanne Gordon, author of Nursing Against the Odds (Cornell UP, 2006). And while this has historical roots, it is particularly dysfunctional today. In this RealityRN interview, Gordon describes the complicated relationship between nurses and doctors—and gives practical advice for nurses to help remedy the situation.

RealityRN:  Describe the history of nurse/doctor relationships.

Suzanne Gordon: The perception of nurses has long been influenced by men. According to historical, patriarchal views on society’s structure, men were able to define our roles—first as women, then as nurses. Women only received knowledge men thought they should have.

Hospitals became hierarchal systems. Doctors were at the top and nurses followed in descending levels of importance. Hospitals developed into job-specific, gender-specific environments—males were doctors and females were nurses.

How does this affect health care today?

Nurses and doctors have been socialized to believe they are not each other’s healthcare partners. They are taught they belong to opposing teams; they view the other team as somehow messing with their goals, mission, or skills. Doctors sometimes think nurses don’t know anything, and nurses sometimes think doctors know the wrong thing.

Do nurses perpetuate this?

You can’t have a bad relationship without the participation of two or more parties. Whenever there’s a failed nurse/physician relationship, there’s potential for something bad happening to the patient downstream.

I don’t think nurses, any more than doctors, know how to negotiate or resolve conflict. Physicians and nurses are taught dyadic communication. They’re taught to focus on nurse/patient or doctor/patient communication—not nurse/doctor/patient communication or team relationships. There are good, historical reasons for this model, but it’s proven to be quite dysfunctional now; nurses are very critical of it.

So what should they be focusing on?

I think people have to focus on being a team—and recognizing what the concept of “team” actually means. A team is not a bunch of people doing different things in the same room. It’s not a bunch of different people engaged in power-plays around the patient’s bed. Nurses often confuse venting and communicating. Venting isn’t communicating. It’s really important for nurses to learn how to communicate well with physicians and other nurses.

Often, complaints go to the nurse manager and the nurse manager goes to the doctor.

Absolutely. And the nurse manager and the doctor, whom the nurse talks to, often have equally poor skills in negotiation, communication, and conflict resolution.

It seems like a problem of the entire work environment.

Right. It’s a systems problem. Doctors don’t communicate well with each other, so why would we expect them to communicate well with nurses? Nurses don’t communicate well with other nurses, so why would we expect them to communicate well with doctors? Between 75 and 80 percent of medical errors and injuries are caused by human error, often from shortcomings in communication.

This is not just about “being nice to each other.” This is not charm school. Patients are dying—they’re experiencing preventable complications because of errors in communication. It’s a systemic problem and it has to be solved systemically.

How can an individual nurse fix a systems problem?

A friend who’s a PT thinks that, on the first day of nursing school, every nurse is told that she’s the only one who cares about the patients. The PT felt most nurses conveyed this attitude: “I’m the patient advocate. I’m the only one who communicates with that patient. I have to protect the patient from you.”

The nurse thinks she’s working for patient advocacy, but inadvertently she’s suggesting that everyone else is the patient’s enemy.

Nurses have to admit they need help and find ways to learn better communication skills. Systems don’t change because the people who run them suddenly notice they’re flawed. Systems change because human beings in those systems force them to change.

So, really, a new mindset needs to be developed.

Yes.  A team is a group of people who help each other work efficiently and effectively to fulfill a shared mission.

A new nurse, for example, should ask physicians for briefings. If a new nurse sees a doctor in a patient’s room, she shouldn’t wait for the doctor to approach her. She should go up to him/her and ask questions. She should clearly state her concerns, and not hold them in.

What about the fear of being put down by the doctor?

The nurse should always stick to the facts. For example, “I’m concerned about the patient’s blood pressure,” “The patient looks clammy,” or “The patient was acting one way and now he’s acting another.” State the reason you’re concerned and say it over and over again. If the doctor says he or she is really busy and can’t talk, you say, “I’m really concerned about this—I think you need to come now.”

In teamwork training, I teach what we call the “Two Challenge Rule.” You challenge the presenting issue twice, and if it’s serious, you go to someone else and say, “Help.”

Isn’t this good old-fashioned patient advocacy?

Yes. But advocacy is not simply having the best interest of the patient at heart. If the doctor blows you off and you do nothing, you are no longer that patient’s advocate. Advocacy means inquiry and persistent assertion for your patient and your profession. It means speaking clearly.

A new nurse recently wrote, “I tend to spend a lot of time addressing patients’ emotional needs prior to their operations (calming them, answering questions, or just being with them during the transition). I find other nurses resent me for not spending more time prepping in the operating room.

“How do I meet my patients’ emotional needs without feeling like I’m letting my co-nurses down? Should I spend more time prepping with the other nurses (who have it under control), or should I continue to make my patient my primary concern?”

My first thought is the obvious: the day you stop making the patient your primary concern is the day you need to find another profession. But how should she approach the issue with the other nurses? How would you advise her?

Jana Goetz

Managing Editor

RealityRN

Most nurses avoided him, busying themselves with pre-op. Even the anesthesiologist warned Mallory, a second year surgical nurse, “Watch out for this one.”

Earlier, Mallory had picked up that he was in the military, so she asked him about his service.  As Mr. Grumpafagus began talking, he lightened up, his crankiness tapering. When the anesthesiologist returned, he couldn’t believe the change. “Who is this guy?” the doctor asked.

Mallory calls her approach with Mr. Grumpafagus the “I care” mentality. Certainly, most nurses care about their patients. But when it comes to difficult patients—the ones who really try your patience—sometimes caring is replaced with irritation, brusqueness, and hurried, impersonal care.

Tongue-in-cheek, Mallory often advises new nurses who are dealing with difficult patients to “Kill ‘em with kindness.” This is, of course, the opposite of what you feel like doing, as if you have nothing else to do on your shift and no other patients.

Mallory says she tries to anticipate the needs of the Grumpafagus-types before they voice them; discreetly touch their hand or shoulder to show her concern; sit down for a few minutes and ask them about their dog, children, grandchildren, likes and dislikes; or, empathize with their pain and fear.

Mallory says she also asks herself, “Is this the treatment I’d want my father, who’s dying of cancer, to receive?” While a patient may be Mr. Grumpafagus to her, he is also someone’s father.