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I read an interesting NY Times Opinionator article the other day.  It was written by an oncology nurse, Theresa Brown (author or “Critical Care: A New Nurse Faces Death, Life and Everything in Between“) and was titled “Healing the Hospital Hierarchy.”

Ms. Brown details her unprofessional experience with a particular doctor who, in front of the entire hospital staff and patients, became aggravated with her and “twisted down to put his face close to [hers] and yelled…”  The situation arose after Ms. Brown suspected the patient was suffering from a heart attack and asked the attending physician to delay a transplant until the cardiologist could review the EKG.

Jeanne Detallante

Jeanne Detallante

This kind of “intimidation” doctor’s impose on other medical team members exists everywhere in the clinical hierarchy, especially between doctors and nurses and ESPECIALLY when the nurse seemingly questions a doctor’s authority or expertise.  Ms. Brown makes very intelligent, and in my opinion accurate, statements regarding this issue:

  • “Doctors and nurses are trained differently, and our sense of priorities can conflict.  When that happens, the lack of an established, neutral way of resolving such clashes works to everyone’s detriment.”  For instance, many doctors operate under the “poof factor”: they order the medicine and then POOF it’s done (with no input from nursing needed and little knowledge of nurses’ importance to patient care).  To doctors, that reflects a solid, good working team.  Nurses, however, are more likely to define good teamwork as a relationship in which everyone’s input is considered.
  • “The lack of “communication along the medical hierarchy can be deadly.  Indeed preventable medical errors kill 100,000 patients a year…”
  • “Nurses cannot give orders but they are considered the final check on all care decisions that doctors make, and we catch mistakes all the time… Unfortunately there is no established way for a nurse to resolve [an error a doctor makes].”
  • “Some nurses reject the whole idea of doctor’s orders; they think the term makes nursing sound subservient.  As a working clinical nurse, I don’t find that a practicable approach: someone has to be ultimately responsible for clinical decisions, and MD’s have that authority.”
  • “Because successful health care needs to be interdependent, the silencing of nurses inevitably creates more opportunities for error.  In a system that is already error-prone and enormously complicated, where health care workers are responsible not just for people’s well-being, but their lives, behavior that in any way increases dangers to patients is intolerable.”

There are institutions out there who are working hard to break this trend in the medical hierarchy.  The University of Virginia requires “inter-professional education for its nursing and medical school curriculum.  Courses, training modules and even faculty members are shared across both disciplines.”  In this way, medical and nursing students come to understand and respect the roles that they each play in patient care.  I tip my hat to the administrators who are supporting this program because I think it’s truly a great (and much needed) endeavor.  I only hope more academic settings will follow this example because I do not think this issue will be solved in the work setting; it must start at the beginning where future medical professionals are educated.

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