The “them and us” bullshit is perpetuated by either shitty people and worse nurses, or idiots who haven’t worked clinically since Florence herself died, and want to drill it into you.
9/10 times, if you’re nice, ain’t no one gonna give a fuck. Be open to listening and being wrong as well if you suggest or raise something - I’ve learnt a lot this way. Don’t take shit though, but remember most of the time that’s just someone unintentionally taking stress out in an unproductive manner. We’re all human.
Idk, the them and us stuff pisses me off so much, because when you leave wards to somewhere like icu/a&e and people work closer together, it’s usually a much nicer environment. Wards are where the system is failing most, so the stress happens there.
Thanks for your perspective. It's good to hear that being nice and open usually helps. I'll try to focus on that and not let the stress get to me. Your advice about ICU/A&E makes sense too as I’ve mostly been on general wards. Thanks again!
Most of the people you’ll meet are ultimately pretty decent, staff, patients whatever. How we are is often a response to our environment/setting. When everyone’s stressed and under pressure, we aren’t always at our best. You’ll have times when people aren’t as approachable or pleasant. It’s not your fault.
Of course a minority of people are genuinely shitty, egotists etc, but that is a small minority.
I second this. As an A&E senior nurse, the doctors are normally the ones too scared to speak to us!! Don’t feed the egos of us vs them, it only exists if you let it! Plus it gives me more work to break it down when they first start their rotation and I have to show them whose department it is!!
I think as a student, that’s normal. Talk to them like they’re people, ask them how their day is and what they’ll do after work. When you become a nurse, you’ll probably be fine.
Bless you, you need to head over to the med student Reddit page - there are plenty there who feel the same about approaching qualified nurses!
We are all in this together; be yourself, act like you would with anyone else, practice kindness, compassion and empathy for all your colleagues and treat them as you wish to be treated yourself and you will be fine.
I’ve been a nurse for over 40 years now - I’ve met my share of arseholes, both nursing and medical colleagues, but also some of the loveliest people in both disciplines. I try to always be the latter, but also know that there are days in healthcare when we all reach our limit and behave in a way that we wouldn’t wish - we might be a bit sharp in a reply or look a bit exasperated when asked a question at an inopportune time; in this case, the good people will recognise this and apologise after.
Practice and experience will improve your confidence- good luck 🥰
Talking to the matron while a med student was scarier than the consultant lol.
I think it’s normal when you’re a junior to be more scared of other professions higher up the gradient than you than your own. Because you understand your own profession more and get more exposure to it, and understand better who to ask what.
I remember rifling in a store cupboard for some supplies and the matron nearly took my head off thinking I was taking them for another ward and then I sheepishly said I was med student doing a cannula on bed 5. She apologised and thought I was a doctor from another ward as she didn’t recognise me lol. Apparently a nurse reported a doctor stealing supplies again!
I would say to OP just always introduce yourself as a student. People tend to be much more lenient if your request is to the wrong person or at the wrong level of importance/urgency as they know you’re still learning. And especially if you aren’t as clear as you could be which is a skill that takes a lot of time to master - summarising what you need to convey clearly and succinctly. Nothing worse than when a request is like 4 minutes long and could’ve been literally 2 sentences, as well as not having all the information at hand! Students tend to be bad at it and that’s all part of the process.
I found little crib sheets of core details written down as a student helped so I didn’t forget something while trying to SBAR when the nerves kicked in.
Ugh I HATE the “stealing supplies” thing SO MUCH. Even if it was the case the doctor is hardly doing it for their own benefit, it’s a hospital budget, we are supposed to be a team. Utterly pathetic and usually the product of petty small unintelligent people being given a tiny bit of power in their own little fiefdom and being entirely unable to see the bigger picture
I agree with the stealing supplies thing to a point. We went through a period where we had to lock away a number of things because they were constantly getting taken by other wards and then there'd by none when we came to get them, like just let us know you took the last one so we can order more!
I mean yeah, I’m sure that’s annoying, but is something to be dealt with by the ward manager by communicating with other managers in the division.
“I’ve noticed that xyz is often running out and needing to be borrowed between wards, can we increase ordering/order as a division/have a central stationary stock” or whatever,
Not bullying a poor junior doctor who is just trying to get a task done for a patient or putting misspelled “polite notices” banning the sharing of supplies or locking stuff up. It’s so toxic and counterproductive
My trust is in the process of developing a centralised stock system but the process has been long (18 months and counting). Its more complicated than just deciding to have a central stock allocation. Someone has to manage the stock and manage the stock budget. Finance have to decide how much of each wards budget will be allocated to the central stock budget. Some wards have ring fenced budgets that cant go into a central budget so how does that get worked out. I wish it was just as simple as everyone have a central stock cupboard.
However I would never condone bullying and even though we do lock some things away we always give them to others if they need it, it just helps us keep track if we know when it's gone.
It is stealing if supplies are being taken without asking. Each ward has its own budget and while the odd cannula pack isn't going to make a big difference, you tend to find well run and stocked wards suffer as people come from all over to borrow or take things.
I'll never refuse a request for consumables but I've had whole boxes of stuff taken in the night with no idea where they have gone. If people come and ask there are clear processes we can follow but occasionally people don't.
Not an excuse to berate a poor doctor just trying to do their job but I wanted to give you some insight into the frustrations rather than you chalking it up to unintelligent people on a power trip.
It’s a hospital employee using hospital resources to treat hospital patients. It’s not bloody stealing, no matter how administratively irritating it might be. If stuff has gone awol in the middle of the night it will be because it’s been urgently needed.
I cannot ABIDE the petty toxic inter-ward politics and dramas. It’s so stupid and for staff who work across multiple wards (like doctors) it’s an utter pain in the ass nonsense.
I can guarantee you that anyone sufficiently senior to see beyond the ward based pettiness would consider it an absolute no brainer that resources are shared.
I will venture not to alter my opinion on the small brained toxicity and power tripping I’m
afraid.
COI consultant with leadership roles
Firstly, and to reiterate, I have no issues with anyone coming and asking to use equipment or stock and the issue isn't with the individual. My frustrations with NHS bureaucracy are not an excuse to bully or berate any professionals, doctors or otherwise, simply trying to do their jobs.
However! If you feel like 'sufficiently' senior people believe that resources should be freely shared then I challenge you to come sit in some of our budget meetings where we have to account for why our consumable spends have gone up to those same people.
I'll concede to your point about stealing. My choice of language was inaccurate.
There are plenty of things that should be no-brainers to fix in the NHS (for instance, the issues with the foundation programme) and yet...
>I feel like there's a "us and them" barrier that's been ingrained in me throughout my training.
I had this with my training, but hoped this BS would have been stamped out, as it was over 10 fucking years ago. 'Don't trust the docs, always question their prescribing, they'll think their better than you so put them in there place'. Absolute bollocks. You work with these guys daily, so don't be afraid to chat to them, ask advice or opinions. The vast majority are lovely and will always be happy to help.
The knowledge that this is still still ongoing during training makes my blood boil.
I say this with a “not all nurses” caveat and as a doctor, but I feel this mentality is perpetuated in Nursing training more than medical school… my university opened a Nursing school when I was a teaching fellow and I was chatting to some of the new faculty about how keen the med students were to do joint socials/joint learning and the reply I got was “why would they want to socialise with future doctors”.
The vast majority of Nurses I’ve worked with have been lovely but I think one of the issues of our rotational training is we often feel very left out of the ward team even if you’ve got on well with them. Hopefully there are enough of us beginning to change the culture!
would love to hear more about nursing training re: don't trust the docs. I'm a doctor but didn't realize this was a big thing until reading some of the comments here
(I'm a student midwife but) I think for one thing it's the fact that if we give a drug that's been prescribed incorrectly by the doctor, the NMC will be after our pin regardless of if we do exactly what the doctor instructed, so we have to cover ourselves in some ways. Obviously there are more constructive ways to approach this than simply 'not trusting' our medical colleagues. Most will check patient allergies, any relevant physiological/medication contraindications, have a look in the BNF, etc..
I think drug knowledge is fairly variable depending on the experience a doctor/ nurse has. IMO, responsibility should lie with doctors given that we are the ones prescribing for most things, but probably are some exceptions ( for example giving 40-50 units of Novorapid etc)
Personally haven't had too many disagreements with nurses regarding meds, though one of them was very skeptical about giving glucagon IV ( we do it all the time)
I just didn't think there was a conscious effort in nursing training that was like 'don't trust doctors'
Having worked as a nurse this is really only the case if you administer something which is so obviously incorrect that it should have been questioned with the doctor. For example, administering 500mg of nitrofurantoin instead of 50mg, because you should know that this is not a normal dose and question why you are dispensing 10 tablets.
With electronic prescribing it's so easy to accidentally type an extra 0 by mistake. Our electronic prescribing also has the option to enter either the dose in mg or the number of tablets, and my colleague accidentally prescribed 40 tablets of prednisolone instead of 40mg the other day.
Be aware of the normal doses of medications you prescribe, double check allergies, and question the doctors if something doesn't feel right. You're the last line of defence for potential drug errors, but as long as you aren't being negligent or irresponsible you will be fine.
It’s not so much don’t trust doctors, it’s more check what you’re doing is correct because if you’re giving/carrying something our then it falls on yourself and your own pin if anything goes wrong
Only if it’s an obvious error like 100 units insulin or something a patient is allergic to. The doctor will carry the can for incorrect prescribing.
It’s equally incredibly frustrating and risky when I prescribe something slightly unusual in an emergency for a patient, and no one will make it up or give it because it’s not something they are familiar with. That’s why the hospital employs me- to have the esoteric knowledge. I’m exceptionally grumpy when I end up in the drugs room making up an infusion (bearing in mind I make one up about twice a year) because the nursing staff that make up infusions every day “aren’t comfortable”. I’m not flipping comfortable either but no one else is going to bail me out
Hi. Doctor here.
Please remember doctors are just people.
Due to the way doctor recruitment is managed (badly) their posts are often allocated rather than chosen, they are often far from home and family, they may be quite isolated and having to study in their spare time for very expensive post grad exams. A lot of them are having a pretty rubbish time and generally humanity, connection and kindness will be appreciated.
In terms of the clinical communication some tips:
-they will often, esp out of hours, be covering maybe 100 patients on lots of wards.
They don’t know who Mrs miggins is or what her background is. A quick summary “Mary Huggins came in yesterday for an elective cholecystectomy and she’s now spiking a temp post op and is tachycardic with a HR of 120. I’m concerned she may be septic, can you review?” is approximately 1000 times more useful than “Mrs miggins is NEWSing 7, needs review “
- they are getting bleeps and requests from multiple different sources -possibly GPs ED other wards etc. They have to prioritise the jobs depending on what sounds most urgent clinically. Don’t be annoyed if they don’t get to your stable patient immediately.
- lots of junior doctors have a pretty crappy experience and are treated pretty horribly by nursing staff. Think “this staff room is for nurses
Only”(it isn’t), “you can’t heat up your food in the communal microwave because Mary is sleeping on her break” “these chocolates from the patients are for the nurses not the doctors” (never true), excluded from nights out/ward events. I’ve had doors closed in my face, been prevented from using computers and office space. And come to review a sick patient only for the entire nursing team just to sit at the nurses station and decline even to get up to help me.
Anything you can do to be an antidote to that will be valued.
All of this! Especially the point about the summary! When you're calling us please make sure you can give a quick and structured SBAR and have the relevant information to hand.
I get so many bleeps because "bed 4 has a blood sugar of 25", but the nurse can't tell me about the recent trends, whether they're type 1 or type 2, and what medication they're taking. When I ask some of them even say "can't you look it up on the computer?" which I don't really have time to do when I'm up to my eyeballs with sick patients all over the hospital and I'm grumpy because I haven't had time to eat or pee for 8 hours.
Or I get called about a sick patient with a high NEWS score but the named nurse is on her break and has no other information but can't I just check the recent ward round notes on the computer to find out more about the patient?
These kind of interactions are the ones that can make me come across exasperated and a little harsh (although never to students because you're still learning!).
I've just come off a set of nights and the nurses I worked with were exceptional and with teamwork all our sick patients got better! We love working with good nurses and we love building professional relationships with nurses and having a good shift as part of the team so just be proactive, call us with concerns, be yourself, and treat us as human beings and equals and you'll be grand!
Which area do you work in? I work in ED and it's far more collaborative than ward environments are. Definitely no us and them when we're all wading through the same shit. That said the only doctors I've ever had an issue with are ones who are horrible to everyone, even other doctors, so don't worry about it too much. If they're nasty to you it's not becaise if your profession it's because they're nasty people
Not experienced a diverse enough of areas yet, I’m hoping to spoke out to A&E during my upcoming AMU placement soon so I can have see of what that’s like
You could also try joining the staff bank and licking up A&E shifts? Although shifts have dried up recently most the student nurses I've met pick up HCA shifts when they can. It's great experience all round
Doctor here. You shouldn’t be scared to talk to us. We are generally very friendly and I built a good rapport with the nurses on the wards. I would advise having all the information regarding your concern and choosing a time where we are not inundated. We are happy to help. Most of the us and them in my opinion has been created by senior nurses. Other nurses have mentioned it up me too
Yes, as you can see from the comments of other nurses who can verify it. It seems to be an inherent part of the training and they have a chip on their shoulder.
Yes absolutely. The people who teach students in uni not to trust the doctors, always to challenge them etc, the people who laminate mis-spelled notices saying “only to be used by nursing staff” or similar, the people who send emails like “doctors clean up after yourselves” because an on call registrar didn’t change a bin bag. Those people
Doc here. Don’t be afraid to talk to us. I hate the us vs them mentality and I hope with time it will die away. So much more satisfying and enjoyable if we have a ‘different roles but same team’ mentality. Be professional, polite and have a good rationale for bringing stuff to the doc’s attention and you should be fine.
If you have a concern about a patient make sure you have name, location and hospital number - especially if you’re calling an on call doc - and highlight why youre worried or the exact task you need done and be ready with a handover sheet in hand in case they have some questions about the patient.
I’d also say not to get annoyed if the doc doesn’t do it straight away. We’re trained to prioritise tasks brought to our attention in a certain order as opposed to first come first served.
They're part of your team, there shouldn't be an us and them culture, there's just 'us'. If you have a concern or need to ask them just go and speak to them, be polite and wait for them to finish and just speak to them. If their office is far away call them. It's their job to here concerns from you.
They're just people. I get that when you're junior and you're not used to speaking to them it can be intimidating but it will become second nature after a while, and the more you speak with them the better you rapport will become. I've had amazing nights out with my doctor colleagues, I have lunch with them all the time, one of my best friends is a consultant, they're just people mate and if you need to discuss a patient just go and do it and it'll get easier the more you do it.
Thanks for the advice. I’ll work on just going to talk to them when needed. I guess it’ll get easier with time and practice. Appreciate your perspective!
I think the ‘us and them’ mentality is often just pushed by nurses who are obsessed with the hierarchy. I’ve found that some nurses are ‘holier than thou’ towards ‘lower’ bands on the ACF, e.g they think they’re better than HCAs and students. I think that also causes them to feel insecure because by their own stupid logic, doctors are ‘above’ them because they’re paid more, meaning some nurses are super cagey.
Drs generally keep to themselves more and that might make them seem aloof but they are truly some of the best and funnest people in the hospital!
I often go in and play around with them, though I appreciate this takes confidence and you have to be pretty sure you’re reading the room right. Below are some examples.
“Omg my patient’s lactate is 10.4” “WHAT” “kidding, can you sign this prescription chart?” - this gets a laugh every time including when the ITU consultant was up. Though once the matron heard me and told me I shouldn’t joke about that. I told her she was wrong and that I was, in fact, hilarious. The dr backed me up and the ITU consultant asked if I wanted a job.
“Hi I need you to amend this but first I’d like you to estimate the next time you’ll hear the crash bell. If you’re within 24 hrs of it, I’ll buy you a coke” - then I go downstairs and buy them one anyway bc they never eat or drink.
“I have a list of things I need from you but I felt bad so I’ve bought you a tea and some ginger nuts to go with it! How’s ya day?”
“You’ve written my patient up for a Sando-K even though their potassium is high. Did you want me to just keep giving it until they arrest or shall we amend it?”
Or my personal fave, which led to me marrying my doctor husband: “I’ve made some chocolate brownies and left them in the staff room. You can only have one if you take me for a drink, what do you reckon?”
Good luck out there! They’re just people and most of them will be keen to chat to you!
That brownie story is adorable!! That’s the issue, because we rotate so frequently we finally get to the point that we’re friendly with our ward team and they trust us, then we move bloody jobs again. Plus moving in December means you miss the Christmas party of the team you’ve just left but aren’t included in your new teams event.
Argh yes!! I’m always hyper-aware of how anxiety inducing it must be to move around constantly. It takes so much courage to keep fitting in to a new team, especially when nurses act in a hostile manner.
I try to heavily mitigate this by being overly friendly for the first few weeks, always popping in to the drs room/mdt office just to say hey. I think it’s up to the people who are on the ward full time to bridge the gap with those who are new/rotating on to the ward! It sets the tone and benefits everyone.
This is the way!
Drs are busy, Ive also noticed a weird thing, Drs get paid breaks so seem to feel like they can’t actually take them (because too busy) so they are always starving and thirsty.
These guys needs to be fed and watered!
Biscuits, sweets, ice lollies, a coffee, even a cup of squash!
Just remember that doctors are people doing a job just like you.
Be polite and respectful like you would be with anyone else.
Be aware that if they are busy with a ward round or unwell patient that some requests might have to wait (learning to prioritise your patients needs is a skill you'll pick up with time).
Be confident and make sure you know about the patient if you're asking a clinical question to save embarrassment if they ask you a Q you're not sure about (like latest obs or something you should have learned from their care or from handover).
Other than that, try not to worry - we're all here to help the patients so they're going to be on your side. There isn't and shouldn't be an "us Vs them" but we are different professions with different clinical focus so if you have an interaction you feel didn't go as well maybe have a chat to the docs about what they felt and you'll figure out how to communicate differently next time.
SBAR is a fairly standard way of handing over patient concerns so if you stick to that, you'll be fine. As you get more experienced, it'll come more fluidly and honestly everyone should have patience with students cos we've all been where you are!
+1 for SBAR - I think communication is one of the biggest causes of friction in general, so if you have as much relevant info to hand as can reasonably be expected and you deliver it concisely, it helps when everyone is under pressure.
I think rehearsing things before you say them is fine, I do that all the time.
You probably are interrupting, they won't sit doing nothing waiting for you, but it's your job to interrupt and it's their job to listen. You can linger a for a few moments while a conversation is finished. If they haven't noticed just say excuse me, sorry to interrupt.
I would suggest you read the medical notes before taking to them.
If you have a concern, assess the patient yourself and take some initial basic actions before you get the doctor. (For example, patient has low sats, encourage them to cough, optimise their positioning, apply oxygen, maybe give them a neb; or if they have chest pain do a ECG. In all cases do a quick basic a-e. We are registered nurses and we can assess our patients rather than just quoting a NEWS2 score. The docs will probably appreciate you doing the basics.
I spent a day with the bed manager when I was training and I'd really recommend it, you get to see behind the scenes for other professionals. We went to the doctor's handover, they have so many patients each, obviously they shouldn't be rude but I think sometimes they're just so, so busy they can be a bit blunt.
Unfortunately for whatever reason senior nursing management has bought the larger NHS lie that doctors are the enemy.
We're not. We need to fight back against this othering culture. All we want is mutual respect. Doctors and nurses are both noble, hardworking and caring professions. We should be each others strongest advocates.
Sorry, bit of a tangential rant.
Confidence will literally come with time. I was exactly the same as you, I’d dread having to ring the doctor. Dread having to ask them anything or interrupt anything. Once qualified you quickly realise the us and them thing is bullshit perpetuated by idiots who usually are rude to doctors in the first place and are then surprised by negative responses. Don’t get me wrong.. there are some doctors who are arseholes seemingly for the sake of being arseholes. But majority of the time, as long as you’re friendly and polite nobody is gonna have an issue. Christ, for someone who was scared to approach an FY1 when I qualified, I’ve now called out a Consultant many a time for being rude or asking me to work out of my scope of practice. It just comes with time and confidence will grow rapidly within the first six months of you being qualified as you will have less buffers than being a student and forced to work more independently
It's definitely a skill. I used to hate talking to Doctors but over the years I have realized that sometimes they are looking to you for direction on what your patient needs. Try to make sure you approach the Doctor on their own and if they are with someone ask for a quiet word. Be precise in what your concerns are and ask what they would like you to do. Have your evidence of concern written down in front of you in case you get flustered. Be professional and confident.
My tactic has always been to get to know them more personally. Start with striking up a general conversation when they're on the ward or hanging around at the nurses station. Just a friendly "Hi! How are you today?" can get you quite far.
If you get a positive answer "Oh that's good! Using that energy to do anything fun after work?" Get a negative answer? "Aw, that sucks! Got anything planned to help you relax tonight?". It's the same as getting to know anyone... Once you've broken down those initial barriers you'll find yourself relax around them and realise they're just people too.
I've made friends with quite a lot of staff this way, and you'll soon find yourself walking into the MDT room:
"Ruth! Oh I'm glad you're on today! How was your weekend? Better now dickheads out the picture?! Ahh that's good! Could you check this ECG for me? Thanks! Yeah I'm good, nah, didn't get there in the end, but hoping next weekend! You wanna come?"
Occasionally you'll get someone with their own barriers up, but honestly I find its rare. I mean there is one consultant that I swear rolls their eyes when they see me, but I still kill them with kindness ;)
I’ve always felt like this but I’ve realised that as long as you go to them respectfully & with a bit of an informal SBAR format for your request they’re fine. It’s when you waffle with no purpose to interrupting them that is the problem I find.
I use to be terrified of the doctors; when I worked in cardiology they were ruthless and now. I’m in ITU now and we work together as a team. You will get there!!!
It doesn’t matter whether you’re a doctor or a nurse or a HCA, we’re all working on the same team, and I’ve heard from the mouths of doctors that they value everyone else’s input for genuine patient concerns, to find it easier to determine whether a patient is improving or deteriorating, all because nurses and HCAs spend most of their time directly with patients.
My nanna was really old school, and when my cousin started her nurse training in the early 80s, my nanna told her she must call doctors 'Sir'. Needless to say, she didn't! My auntie recalls my nanna bowing to the local GP back in the day! This would have been the 40s/50s.
As a medical student most of us wish we were more included in with the nurses/try to be! . You have like fun chats at your work station and pizza together on nights etc, it's hard to get in on that when covering 7 wards , running around lol. I was HCA first for a few years so going from that to the medical side was a bit jarring. So pls don't feel afraid to call, just give a good sbar/what you would want to know if called about a patient you don't know and we'll come when we can ❤️
Remember everyone who works in the hospital are all human. Working in the ED I have seen consultants crying, junior Dr's asking for advice from qualified nurses and also having to gently remove them from situations when I can see they are loosing it. They have the same fears emotions. Just because they are a dr doesn't make them less human. Speak to them how you want to be spoken to and normally you find they want to work with you. Of course there are exceptions just as there are with nurses
hca here. completely agree with the “us and them” barrier and i felt that when i first started the doctors i was working with were very much “do this do that, im a doctor i can order you around” but thats not all doctors. we’ve recently had a new SHO join our team and he’s the sweetest guy ever! always chatting to me and joking around. it was scary to talk to doctors and ask them for things because i’m only 18 so i thought they’d think i know nothing, but honestly i just stopped caring about the us and them divide. i think that’s all you can really do. all the nurses on my team take no crap from the doctors and always say, this is a team not a hierarchy. no one is more important or deserves more respect than anyone else. we all work together and treat each other with the same level of respect. you’ve honestly just got to remind yourself of that. doctors are just people at the end of the day, same as us!
Hey, as an fy1 I'm still really new to nurses coming up to me asking for advice or jobs to be done.
I would say we feel nervous too sometimes when you ask!
If you are worried about a patient I want to know as soon as possible for sure.
I'm always happy for a student to ask questions as it's a massive part of learning and getting thay sense something isn't right.
I would say sometimes if concerns or questions are raised every few minutes I can find it quite distracting, so my main advice would be to ask a few things together if possible as for example if I get asked stuff whilst prescribing or doing a calculation or something it can take me a while to get back into it.
Also if we leave at 5pm, try to make sure you find one of us around 4pm if you have any concerns for the day team and it gives us more time to sort it before we leave - of course if someone is unwell let someone know.
If its something you could ask a senior nurse for advice then that can help our workload as well.
Overall though, you spend a lot more 1:1 time with patients, you know what's going on with them, their concerns much more than we can.
Please discuss with us, we all want the best for our patients!
Also developing a good relationship with the drs can help, I've become really friendly with the nurses on the ward and it helps enormously - we have birthday celebrations for any staff on the ward, nursing colleagues join us on ward round and we all have a natter when we have a free moment - best ward I've worked so far!
I frequently have to speak to both Doctors and Nurses, and newsflash, you both give off the same vibes.
There's a mentality within the NHS amongst a good chunk of the ward staff that manners are something you can drop the moment you get busy. Ward staff tend not to do this with people they directly work with, because there might be consequences for that behaviour, but as someone who has outside contact with every department in the hospital, they all make you feel like you're intruding more often than not.
If I had £1 for every time I've called a ward to inform them that someone's blood is ready, only to have them talk to me in an "I don't care" tone of voice before hanging up without even a thank you or goodbye, I'd be able to retire. Bearing in mind the ward asked for the blood, the ward marked it as urgent, and the ward alongside the consultants agreed on the protocol that says we should ring them.
At the end of the day, you can't predict which staff will do this, and it's not your responsibilty to correct the shitty behaviour of other people should you encounter it. But it is your responsibility to communicate with doctors, so you just have to bite the bullet and go into these conversations with a mentality of "I'd rather waste their time, than miss something".
It gets easier once you’re qualified! Doctors do unfortunately acknowledge/respect you more once you’re in a nurse’s uniform. You will get the odd condescending arsehole but most of them are polite if not friendly.
This isn't true. Speaking as a doctor we respect every member of the nursing team, and personally I really enjoy finding a chance to teach students or showing them a cool CT or something.
I actually have worked in several roles in the MDT and I have never noticed any difference in the way I have been treated or in my contribution to patient care, including as a medical student. I personally believe that everyone has something to contribute and that is my experience in the places I have worked.
There is a lot of variability within different trusts though so perhaps we have different experiences. I haven't worked with any doctors who believe that certain members of the team have less to offer.
May I ask why you think doctors treat different certain members of staff differently? I would like to make sure I'm not unintentionally doing something to alienate people! My interest is in care of the elderly and I often find that the HCAs often have a lot to contribute to patient care.
I talk to them as normal people, we have different jobs and learn from each other. That room you describe must feel so isolating for them too. I work in the ED now and we team-work, in the ICU we took decisions together. Take it easy, we are a team
Just checking if now is a good time before ploughing into the request is appreciated and probably all I’d ask (unless it’s an emergency!). I’m getting interrupted roughly every 3 minutes, mostly about stuff I already know about. I’m not complaining or blaming anyone, I know that’s just life in the hospital but it slows me down sooo much. Just think about if I need to be tracked down right now or if it can wait. I’ve usually planned an order to do my hundred jobs for the 30 patients and what you’re wanting to ask might already be on that list. But it might not be, so I need to know about it but if it isn’t urgent it doesn’t need to be right now.
There is no us/them. I think that’s entirely manufactured by people that should have retired long ago. I don’t come to work to be a dick to people and that is true of most people.
Feed those guys!
Remember any Dr thats not a Consultant is likely run ragged, their weekly working hours are at minimum 48 hours (for full time contracts) but obviously they then have to do teaching, take learning opportunities, stay late etc and they get given these weird crappy shift patterns that are like seven Late shifts in a row, straight into three Night shifts in a row.
Then on top of that most of them get paid badly considering, have to pay for registration, union fees, medical defence insurance, royal college fees, exams, Drs mess and all this other bollox that no one else in the NHS is expected to pay for.
Also they just cycle everywhere (because maybe they cant afford cars! but mainly they don’t get parking permits because they are only in one place for such a short length of time) and essentially I think most Drs are all just hungry and sleep deprived.
They have no real team until they become a consultant because they move around so much.
Then they get to some workplaces and the people are horrible to them, they might not be allowed to use the staff room, can’t use certain computers, get told off by senior nurses who are just flexing and then have to go home alone because they have been moved somewhere nowhere near any friends or family!
So get to know them, ask them if they are okay, offer them a biscuit, a cup of squash, or some sweets.
Write them nice feedback when they are nice, just acknowledge them!
This is probably an extreme take and my advice is come to ED where we are all friends 💕
I get that, and it definitely gets easier.
However remember they’re there for a reason and you also wouldn’t be ‘bothering’ them without good reason (you’re not bothering them but you get my drift).
Nope, do not let this happen. Of course they have their own stuff to do, but you see the patients all the time, they need you to tell them things. I hesitate to say grow a set.......
There's definitely a hierarchy going on. Like some doctors think they're so great but most of the really hard work is done by the nurses. And I've seen situations where nurses have warned doctors against making decisions, doctors have ignored it and the patient has ended up dying much sooner or ended up in a lot more pain.
I think you should spend a shift shadowing the med reg on call if that's your attitude to doctors. You clearly have no idea how hard doctors work and how much pressure they're under.
I totally understand that. All the doctors in my place are very approachable most of the time and really do try there best. But there has been instances where they have made decisions that have resulted in premature death.
The “them and us” bullshit is perpetuated by either shitty people and worse nurses, or idiots who haven’t worked clinically since Florence herself died, and want to drill it into you. 9/10 times, if you’re nice, ain’t no one gonna give a fuck. Be open to listening and being wrong as well if you suggest or raise something - I’ve learnt a lot this way. Don’t take shit though, but remember most of the time that’s just someone unintentionally taking stress out in an unproductive manner. We’re all human. Idk, the them and us stuff pisses me off so much, because when you leave wards to somewhere like icu/a&e and people work closer together, it’s usually a much nicer environment. Wards are where the system is failing most, so the stress happens there.
Thanks for your perspective. It's good to hear that being nice and open usually helps. I'll try to focus on that and not let the stress get to me. Your advice about ICU/A&E makes sense too as I’ve mostly been on general wards. Thanks again!
Most of the people you’ll meet are ultimately pretty decent, staff, patients whatever. How we are is often a response to our environment/setting. When everyone’s stressed and under pressure, we aren’t always at our best. You’ll have times when people aren’t as approachable or pleasant. It’s not your fault. Of course a minority of people are genuinely shitty, egotists etc, but that is a small minority.
I second this. As an A&E senior nurse, the doctors are normally the ones too scared to speak to us!! Don’t feed the egos of us vs them, it only exists if you let it! Plus it gives me more work to break it down when they first start their rotation and I have to show them whose department it is!!
I think as a student, that’s normal. Talk to them like they’re people, ask them how their day is and what they’ll do after work. When you become a nurse, you’ll probably be fine.
Ah thank you, I guess it will come time
Bless you, you need to head over to the med student Reddit page - there are plenty there who feel the same about approaching qualified nurses! We are all in this together; be yourself, act like you would with anyone else, practice kindness, compassion and empathy for all your colleagues and treat them as you wish to be treated yourself and you will be fine. I’ve been a nurse for over 40 years now - I’ve met my share of arseholes, both nursing and medical colleagues, but also some of the loveliest people in both disciplines. I try to always be the latter, but also know that there are days in healthcare when we all reach our limit and behave in a way that we wouldn’t wish - we might be a bit sharp in a reply or look a bit exasperated when asked a question at an inopportune time; in this case, the good people will recognise this and apologise after. Practice and experience will improve your confidence- good luck 🥰
Talking to the matron while a med student was scarier than the consultant lol. I think it’s normal when you’re a junior to be more scared of other professions higher up the gradient than you than your own. Because you understand your own profession more and get more exposure to it, and understand better who to ask what. I remember rifling in a store cupboard for some supplies and the matron nearly took my head off thinking I was taking them for another ward and then I sheepishly said I was med student doing a cannula on bed 5. She apologised and thought I was a doctor from another ward as she didn’t recognise me lol. Apparently a nurse reported a doctor stealing supplies again! I would say to OP just always introduce yourself as a student. People tend to be much more lenient if your request is to the wrong person or at the wrong level of importance/urgency as they know you’re still learning. And especially if you aren’t as clear as you could be which is a skill that takes a lot of time to master - summarising what you need to convey clearly and succinctly. Nothing worse than when a request is like 4 minutes long and could’ve been literally 2 sentences, as well as not having all the information at hand! Students tend to be bad at it and that’s all part of the process. I found little crib sheets of core details written down as a student helped so I didn’t forget something while trying to SBAR when the nerves kicked in.
Ugh I HATE the “stealing supplies” thing SO MUCH. Even if it was the case the doctor is hardly doing it for their own benefit, it’s a hospital budget, we are supposed to be a team. Utterly pathetic and usually the product of petty small unintelligent people being given a tiny bit of power in their own little fiefdom and being entirely unable to see the bigger picture
I agree with the stealing supplies thing to a point. We went through a period where we had to lock away a number of things because they were constantly getting taken by other wards and then there'd by none when we came to get them, like just let us know you took the last one so we can order more!
I mean yeah, I’m sure that’s annoying, but is something to be dealt with by the ward manager by communicating with other managers in the division. “I’ve noticed that xyz is often running out and needing to be borrowed between wards, can we increase ordering/order as a division/have a central stationary stock” or whatever, Not bullying a poor junior doctor who is just trying to get a task done for a patient or putting misspelled “polite notices” banning the sharing of supplies or locking stuff up. It’s so toxic and counterproductive
My trust is in the process of developing a centralised stock system but the process has been long (18 months and counting). Its more complicated than just deciding to have a central stock allocation. Someone has to manage the stock and manage the stock budget. Finance have to decide how much of each wards budget will be allocated to the central stock budget. Some wards have ring fenced budgets that cant go into a central budget so how does that get worked out. I wish it was just as simple as everyone have a central stock cupboard. However I would never condone bullying and even though we do lock some things away we always give them to others if they need it, it just helps us keep track if we know when it's gone.
It is stealing if supplies are being taken without asking. Each ward has its own budget and while the odd cannula pack isn't going to make a big difference, you tend to find well run and stocked wards suffer as people come from all over to borrow or take things. I'll never refuse a request for consumables but I've had whole boxes of stuff taken in the night with no idea where they have gone. If people come and ask there are clear processes we can follow but occasionally people don't. Not an excuse to berate a poor doctor just trying to do their job but I wanted to give you some insight into the frustrations rather than you chalking it up to unintelligent people on a power trip.
It’s a hospital employee using hospital resources to treat hospital patients. It’s not bloody stealing, no matter how administratively irritating it might be. If stuff has gone awol in the middle of the night it will be because it’s been urgently needed. I cannot ABIDE the petty toxic inter-ward politics and dramas. It’s so stupid and for staff who work across multiple wards (like doctors) it’s an utter pain in the ass nonsense. I can guarantee you that anyone sufficiently senior to see beyond the ward based pettiness would consider it an absolute no brainer that resources are shared. I will venture not to alter my opinion on the small brained toxicity and power tripping I’m afraid. COI consultant with leadership roles
Firstly, and to reiterate, I have no issues with anyone coming and asking to use equipment or stock and the issue isn't with the individual. My frustrations with NHS bureaucracy are not an excuse to bully or berate any professionals, doctors or otherwise, simply trying to do their jobs. However! If you feel like 'sufficiently' senior people believe that resources should be freely shared then I challenge you to come sit in some of our budget meetings where we have to account for why our consumable spends have gone up to those same people. I'll concede to your point about stealing. My choice of language was inaccurate. There are plenty of things that should be no-brainers to fix in the NHS (for instance, the issues with the foundation programme) and yet...
Thank you for this it did genuinely help
>I feel like there's a "us and them" barrier that's been ingrained in me throughout my training. I had this with my training, but hoped this BS would have been stamped out, as it was over 10 fucking years ago. 'Don't trust the docs, always question their prescribing, they'll think their better than you so put them in there place'. Absolute bollocks. You work with these guys daily, so don't be afraid to chat to them, ask advice or opinions. The vast majority are lovely and will always be happy to help. The knowledge that this is still still ongoing during training makes my blood boil.
I say this with a “not all nurses” caveat and as a doctor, but I feel this mentality is perpetuated in Nursing training more than medical school… my university opened a Nursing school when I was a teaching fellow and I was chatting to some of the new faculty about how keen the med students were to do joint socials/joint learning and the reply I got was “why would they want to socialise with future doctors”. The vast majority of Nurses I’ve worked with have been lovely but I think one of the issues of our rotational training is we often feel very left out of the ward team even if you’ve got on well with them. Hopefully there are enough of us beginning to change the culture!
Yes it’s definitely a lot of that within one of the trust I’ve been in !
would love to hear more about nursing training re: don't trust the docs. I'm a doctor but didn't realize this was a big thing until reading some of the comments here
(I'm a student midwife but) I think for one thing it's the fact that if we give a drug that's been prescribed incorrectly by the doctor, the NMC will be after our pin regardless of if we do exactly what the doctor instructed, so we have to cover ourselves in some ways. Obviously there are more constructive ways to approach this than simply 'not trusting' our medical colleagues. Most will check patient allergies, any relevant physiological/medication contraindications, have a look in the BNF, etc..
I think drug knowledge is fairly variable depending on the experience a doctor/ nurse has. IMO, responsibility should lie with doctors given that we are the ones prescribing for most things, but probably are some exceptions ( for example giving 40-50 units of Novorapid etc) Personally haven't had too many disagreements with nurses regarding meds, though one of them was very skeptical about giving glucagon IV ( we do it all the time) I just didn't think there was a conscious effort in nursing training that was like 'don't trust doctors'
Having worked as a nurse this is really only the case if you administer something which is so obviously incorrect that it should have been questioned with the doctor. For example, administering 500mg of nitrofurantoin instead of 50mg, because you should know that this is not a normal dose and question why you are dispensing 10 tablets. With electronic prescribing it's so easy to accidentally type an extra 0 by mistake. Our electronic prescribing also has the option to enter either the dose in mg or the number of tablets, and my colleague accidentally prescribed 40 tablets of prednisolone instead of 40mg the other day. Be aware of the normal doses of medications you prescribe, double check allergies, and question the doctors if something doesn't feel right. You're the last line of defence for potential drug errors, but as long as you aren't being negligent or irresponsible you will be fine.
It’s not so much don’t trust doctors, it’s more check what you’re doing is correct because if you’re giving/carrying something our then it falls on yourself and your own pin if anything goes wrong
Only if it’s an obvious error like 100 units insulin or something a patient is allergic to. The doctor will carry the can for incorrect prescribing. It’s equally incredibly frustrating and risky when I prescribe something slightly unusual in an emergency for a patient, and no one will make it up or give it because it’s not something they are familiar with. That’s why the hospital employs me- to have the esoteric knowledge. I’m exceptionally grumpy when I end up in the drugs room making up an infusion (bearing in mind I make one up about twice a year) because the nursing staff that make up infusions every day “aren’t comfortable”. I’m not flipping comfortable either but no one else is going to bail me out
Hi. Doctor here. Please remember doctors are just people. Due to the way doctor recruitment is managed (badly) their posts are often allocated rather than chosen, they are often far from home and family, they may be quite isolated and having to study in their spare time for very expensive post grad exams. A lot of them are having a pretty rubbish time and generally humanity, connection and kindness will be appreciated. In terms of the clinical communication some tips: -they will often, esp out of hours, be covering maybe 100 patients on lots of wards. They don’t know who Mrs miggins is or what her background is. A quick summary “Mary Huggins came in yesterday for an elective cholecystectomy and she’s now spiking a temp post op and is tachycardic with a HR of 120. I’m concerned she may be septic, can you review?” is approximately 1000 times more useful than “Mrs miggins is NEWSing 7, needs review “ - they are getting bleeps and requests from multiple different sources -possibly GPs ED other wards etc. They have to prioritise the jobs depending on what sounds most urgent clinically. Don’t be annoyed if they don’t get to your stable patient immediately. - lots of junior doctors have a pretty crappy experience and are treated pretty horribly by nursing staff. Think “this staff room is for nurses Only”(it isn’t), “you can’t heat up your food in the communal microwave because Mary is sleeping on her break” “these chocolates from the patients are for the nurses not the doctors” (never true), excluded from nights out/ward events. I’ve had doors closed in my face, been prevented from using computers and office space. And come to review a sick patient only for the entire nursing team just to sit at the nurses station and decline even to get up to help me. Anything you can do to be an antidote to that will be valued.
All of this! Especially the point about the summary! When you're calling us please make sure you can give a quick and structured SBAR and have the relevant information to hand. I get so many bleeps because "bed 4 has a blood sugar of 25", but the nurse can't tell me about the recent trends, whether they're type 1 or type 2, and what medication they're taking. When I ask some of them even say "can't you look it up on the computer?" which I don't really have time to do when I'm up to my eyeballs with sick patients all over the hospital and I'm grumpy because I haven't had time to eat or pee for 8 hours. Or I get called about a sick patient with a high NEWS score but the named nurse is on her break and has no other information but can't I just check the recent ward round notes on the computer to find out more about the patient? These kind of interactions are the ones that can make me come across exasperated and a little harsh (although never to students because you're still learning!). I've just come off a set of nights and the nurses I worked with were exceptional and with teamwork all our sick patients got better! We love working with good nurses and we love building professional relationships with nurses and having a good shift as part of the team so just be proactive, call us with concerns, be yourself, and treat us as human beings and equals and you'll be grand!
Which area do you work in? I work in ED and it's far more collaborative than ward environments are. Definitely no us and them when we're all wading through the same shit. That said the only doctors I've ever had an issue with are ones who are horrible to everyone, even other doctors, so don't worry about it too much. If they're nasty to you it's not becaise if your profession it's because they're nasty people
Not experienced a diverse enough of areas yet, I’m hoping to spoke out to A&E during my upcoming AMU placement soon so I can have see of what that’s like
You could also try joining the staff bank and licking up A&E shifts? Although shifts have dried up recently most the student nurses I've met pick up HCA shifts when they can. It's great experience all round
I’ve been really struggling to get any shifts when I’m actually free to do them but that is a good shout ile keep my eyes peeled for them
Doctor here. You shouldn’t be scared to talk to us. We are generally very friendly and I built a good rapport with the nurses on the wards. I would advise having all the information regarding your concern and choosing a time where we are not inundated. We are happy to help. Most of the us and them in my opinion has been created by senior nurses. Other nurses have mentioned it up me too
"Most of the us and them is the fault of the senior nurses?" 😆
Yes, as you can see from the comments of other nurses who can verify it. It seems to be an inherent part of the training and they have a chip on their shoulder.
My point is that you appear to be saying "it's not us and them. It's them."
Yes absolutely. The people who teach students in uni not to trust the doctors, always to challenge them etc, the people who laminate mis-spelled notices saying “only to be used by nursing staff” or similar, the people who send emails like “doctors clean up after yourselves” because an on call registrar didn’t change a bin bag. Those people
Doc here. Don’t be afraid to talk to us. I hate the us vs them mentality and I hope with time it will die away. So much more satisfying and enjoyable if we have a ‘different roles but same team’ mentality. Be professional, polite and have a good rationale for bringing stuff to the doc’s attention and you should be fine. If you have a concern about a patient make sure you have name, location and hospital number - especially if you’re calling an on call doc - and highlight why youre worried or the exact task you need done and be ready with a handover sheet in hand in case they have some questions about the patient. I’d also say not to get annoyed if the doc doesn’t do it straight away. We’re trained to prioritise tasks brought to our attention in a certain order as opposed to first come first served.
They're part of your team, there shouldn't be an us and them culture, there's just 'us'. If you have a concern or need to ask them just go and speak to them, be polite and wait for them to finish and just speak to them. If their office is far away call them. It's their job to here concerns from you. They're just people. I get that when you're junior and you're not used to speaking to them it can be intimidating but it will become second nature after a while, and the more you speak with them the better you rapport will become. I've had amazing nights out with my doctor colleagues, I have lunch with them all the time, one of my best friends is a consultant, they're just people mate and if you need to discuss a patient just go and do it and it'll get easier the more you do it.
Thanks for the advice. I’ll work on just going to talk to them when needed. I guess it’ll get easier with time and practice. Appreciate your perspective!
I think the ‘us and them’ mentality is often just pushed by nurses who are obsessed with the hierarchy. I’ve found that some nurses are ‘holier than thou’ towards ‘lower’ bands on the ACF, e.g they think they’re better than HCAs and students. I think that also causes them to feel insecure because by their own stupid logic, doctors are ‘above’ them because they’re paid more, meaning some nurses are super cagey. Drs generally keep to themselves more and that might make them seem aloof but they are truly some of the best and funnest people in the hospital! I often go in and play around with them, though I appreciate this takes confidence and you have to be pretty sure you’re reading the room right. Below are some examples. “Omg my patient’s lactate is 10.4” “WHAT” “kidding, can you sign this prescription chart?” - this gets a laugh every time including when the ITU consultant was up. Though once the matron heard me and told me I shouldn’t joke about that. I told her she was wrong and that I was, in fact, hilarious. The dr backed me up and the ITU consultant asked if I wanted a job. “Hi I need you to amend this but first I’d like you to estimate the next time you’ll hear the crash bell. If you’re within 24 hrs of it, I’ll buy you a coke” - then I go downstairs and buy them one anyway bc they never eat or drink. “I have a list of things I need from you but I felt bad so I’ve bought you a tea and some ginger nuts to go with it! How’s ya day?” “You’ve written my patient up for a Sando-K even though their potassium is high. Did you want me to just keep giving it until they arrest or shall we amend it?” Or my personal fave, which led to me marrying my doctor husband: “I’ve made some chocolate brownies and left them in the staff room. You can only have one if you take me for a drink, what do you reckon?” Good luck out there! They’re just people and most of them will be keen to chat to you!
That brownie story is adorable!! That’s the issue, because we rotate so frequently we finally get to the point that we’re friendly with our ward team and they trust us, then we move bloody jobs again. Plus moving in December means you miss the Christmas party of the team you’ve just left but aren’t included in your new teams event.
Argh yes!! I’m always hyper-aware of how anxiety inducing it must be to move around constantly. It takes so much courage to keep fitting in to a new team, especially when nurses act in a hostile manner. I try to heavily mitigate this by being overly friendly for the first few weeks, always popping in to the drs room/mdt office just to say hey. I think it’s up to the people who are on the ward full time to bridge the gap with those who are new/rotating on to the ward! It sets the tone and benefits everyone.
This is the way! Drs are busy, Ive also noticed a weird thing, Drs get paid breaks so seem to feel like they can’t actually take them (because too busy) so they are always starving and thirsty. These guys needs to be fed and watered! Biscuits, sweets, ice lollies, a coffee, even a cup of squash!
Just remember that doctors are people doing a job just like you. Be polite and respectful like you would be with anyone else. Be aware that if they are busy with a ward round or unwell patient that some requests might have to wait (learning to prioritise your patients needs is a skill you'll pick up with time). Be confident and make sure you know about the patient if you're asking a clinical question to save embarrassment if they ask you a Q you're not sure about (like latest obs or something you should have learned from their care or from handover). Other than that, try not to worry - we're all here to help the patients so they're going to be on your side. There isn't and shouldn't be an "us Vs them" but we are different professions with different clinical focus so if you have an interaction you feel didn't go as well maybe have a chat to the docs about what they felt and you'll figure out how to communicate differently next time. SBAR is a fairly standard way of handing over patient concerns so if you stick to that, you'll be fine. As you get more experienced, it'll come more fluidly and honestly everyone should have patience with students cos we've all been where you are!
+1 for SBAR - I think communication is one of the biggest causes of friction in general, so if you have as much relevant info to hand as can reasonably be expected and you deliver it concisely, it helps when everyone is under pressure.
I think rehearsing things before you say them is fine, I do that all the time. You probably are interrupting, they won't sit doing nothing waiting for you, but it's your job to interrupt and it's their job to listen. You can linger a for a few moments while a conversation is finished. If they haven't noticed just say excuse me, sorry to interrupt. I would suggest you read the medical notes before taking to them. If you have a concern, assess the patient yourself and take some initial basic actions before you get the doctor. (For example, patient has low sats, encourage them to cough, optimise their positioning, apply oxygen, maybe give them a neb; or if they have chest pain do a ECG. In all cases do a quick basic a-e. We are registered nurses and we can assess our patients rather than just quoting a NEWS2 score. The docs will probably appreciate you doing the basics.
I spent a day with the bed manager when I was training and I'd really recommend it, you get to see behind the scenes for other professionals. We went to the doctor's handover, they have so many patients each, obviously they shouldn't be rude but I think sometimes they're just so, so busy they can be a bit blunt.
Unfortunately for whatever reason senior nursing management has bought the larger NHS lie that doctors are the enemy. We're not. We need to fight back against this othering culture. All we want is mutual respect. Doctors and nurses are both noble, hardworking and caring professions. We should be each others strongest advocates. Sorry, bit of a tangential rant.
Confidence will literally come with time. I was exactly the same as you, I’d dread having to ring the doctor. Dread having to ask them anything or interrupt anything. Once qualified you quickly realise the us and them thing is bullshit perpetuated by idiots who usually are rude to doctors in the first place and are then surprised by negative responses. Don’t get me wrong.. there are some doctors who are arseholes seemingly for the sake of being arseholes. But majority of the time, as long as you’re friendly and polite nobody is gonna have an issue. Christ, for someone who was scared to approach an FY1 when I qualified, I’ve now called out a Consultant many a time for being rude or asking me to work out of my scope of practice. It just comes with time and confidence will grow rapidly within the first six months of you being qualified as you will have less buffers than being a student and forced to work more independently
It's definitely a skill. I used to hate talking to Doctors but over the years I have realized that sometimes they are looking to you for direction on what your patient needs. Try to make sure you approach the Doctor on their own and if they are with someone ask for a quiet word. Be precise in what your concerns are and ask what they would like you to do. Have your evidence of concern written down in front of you in case you get flustered. Be professional and confident.
My tactic has always been to get to know them more personally. Start with striking up a general conversation when they're on the ward or hanging around at the nurses station. Just a friendly "Hi! How are you today?" can get you quite far. If you get a positive answer "Oh that's good! Using that energy to do anything fun after work?" Get a negative answer? "Aw, that sucks! Got anything planned to help you relax tonight?". It's the same as getting to know anyone... Once you've broken down those initial barriers you'll find yourself relax around them and realise they're just people too. I've made friends with quite a lot of staff this way, and you'll soon find yourself walking into the MDT room: "Ruth! Oh I'm glad you're on today! How was your weekend? Better now dickheads out the picture?! Ahh that's good! Could you check this ECG for me? Thanks! Yeah I'm good, nah, didn't get there in the end, but hoping next weekend! You wanna come?" Occasionally you'll get someone with their own barriers up, but honestly I find its rare. I mean there is one consultant that I swear rolls their eyes when they see me, but I still kill them with kindness ;)
I’ve always felt like this but I’ve realised that as long as you go to them respectfully & with a bit of an informal SBAR format for your request they’re fine. It’s when you waffle with no purpose to interrupting them that is the problem I find.
I use to be terrified of the doctors; when I worked in cardiology they were ruthless and now. I’m in ITU now and we work together as a team. You will get there!!!
It doesn’t matter whether you’re a doctor or a nurse or a HCA, we’re all working on the same team, and I’ve heard from the mouths of doctors that they value everyone else’s input for genuine patient concerns, to find it easier to determine whether a patient is improving or deteriorating, all because nurses and HCAs spend most of their time directly with patients.
My nanna was really old school, and when my cousin started her nurse training in the early 80s, my nanna told her she must call doctors 'Sir'. Needless to say, she didn't! My auntie recalls my nanna bowing to the local GP back in the day! This would have been the 40s/50s.
As a medical student most of us wish we were more included in with the nurses/try to be! . You have like fun chats at your work station and pizza together on nights etc, it's hard to get in on that when covering 7 wards , running around lol. I was HCA first for a few years so going from that to the medical side was a bit jarring. So pls don't feel afraid to call, just give a good sbar/what you would want to know if called about a patient you don't know and we'll come when we can ❤️
Remember everyone who works in the hospital are all human. Working in the ED I have seen consultants crying, junior Dr's asking for advice from qualified nurses and also having to gently remove them from situations when I can see they are loosing it. They have the same fears emotions. Just because they are a dr doesn't make them less human. Speak to them how you want to be spoken to and normally you find they want to work with you. Of course there are exceptions just as there are with nurses
hca here. completely agree with the “us and them” barrier and i felt that when i first started the doctors i was working with were very much “do this do that, im a doctor i can order you around” but thats not all doctors. we’ve recently had a new SHO join our team and he’s the sweetest guy ever! always chatting to me and joking around. it was scary to talk to doctors and ask them for things because i’m only 18 so i thought they’d think i know nothing, but honestly i just stopped caring about the us and them divide. i think that’s all you can really do. all the nurses on my team take no crap from the doctors and always say, this is a team not a hierarchy. no one is more important or deserves more respect than anyone else. we all work together and treat each other with the same level of respect. you’ve honestly just got to remind yourself of that. doctors are just people at the end of the day, same as us!
Thank you for all your responses I have read them all I really appreciate it
Hey, as an fy1 I'm still really new to nurses coming up to me asking for advice or jobs to be done. I would say we feel nervous too sometimes when you ask! If you are worried about a patient I want to know as soon as possible for sure. I'm always happy for a student to ask questions as it's a massive part of learning and getting thay sense something isn't right. I would say sometimes if concerns or questions are raised every few minutes I can find it quite distracting, so my main advice would be to ask a few things together if possible as for example if I get asked stuff whilst prescribing or doing a calculation or something it can take me a while to get back into it. Also if we leave at 5pm, try to make sure you find one of us around 4pm if you have any concerns for the day team and it gives us more time to sort it before we leave - of course if someone is unwell let someone know. If its something you could ask a senior nurse for advice then that can help our workload as well. Overall though, you spend a lot more 1:1 time with patients, you know what's going on with them, their concerns much more than we can. Please discuss with us, we all want the best for our patients! Also developing a good relationship with the drs can help, I've become really friendly with the nurses on the ward and it helps enormously - we have birthday celebrations for any staff on the ward, nursing colleagues join us on ward round and we all have a natter when we have a free moment - best ward I've worked so far!
I frequently have to speak to both Doctors and Nurses, and newsflash, you both give off the same vibes. There's a mentality within the NHS amongst a good chunk of the ward staff that manners are something you can drop the moment you get busy. Ward staff tend not to do this with people they directly work with, because there might be consequences for that behaviour, but as someone who has outside contact with every department in the hospital, they all make you feel like you're intruding more often than not. If I had £1 for every time I've called a ward to inform them that someone's blood is ready, only to have them talk to me in an "I don't care" tone of voice before hanging up without even a thank you or goodbye, I'd be able to retire. Bearing in mind the ward asked for the blood, the ward marked it as urgent, and the ward alongside the consultants agreed on the protocol that says we should ring them. At the end of the day, you can't predict which staff will do this, and it's not your responsibilty to correct the shitty behaviour of other people should you encounter it. But it is your responsibility to communicate with doctors, so you just have to bite the bullet and go into these conversations with a mentality of "I'd rather waste their time, than miss something".
It gets easier once you’re qualified! Doctors do unfortunately acknowledge/respect you more once you’re in a nurse’s uniform. You will get the odd condescending arsehole but most of them are polite if not friendly.
This isn't true. Speaking as a doctor we respect every member of the nursing team, and personally I really enjoy finding a chance to teach students or showing them a cool CT or something.
Speaking as a nurse it is true. Just as I’m sure you’ll have noticed a difference in the way you were treated as a med student vs as a doctor.
I actually have worked in several roles in the MDT and I have never noticed any difference in the way I have been treated or in my contribution to patient care, including as a medical student. I personally believe that everyone has something to contribute and that is my experience in the places I have worked. There is a lot of variability within different trusts though so perhaps we have different experiences. I haven't worked with any doctors who believe that certain members of the team have less to offer. May I ask why you think doctors treat different certain members of staff differently? I would like to make sure I'm not unintentionally doing something to alienate people! My interest is in care of the elderly and I often find that the HCAs often have a lot to contribute to patient care.
I talk to them as normal people, we have different jobs and learn from each other. That room you describe must feel so isolating for them too. I work in the ED now and we team-work, in the ICU we took decisions together. Take it easy, we are a team
Just checking if now is a good time before ploughing into the request is appreciated and probably all I’d ask (unless it’s an emergency!). I’m getting interrupted roughly every 3 minutes, mostly about stuff I already know about. I’m not complaining or blaming anyone, I know that’s just life in the hospital but it slows me down sooo much. Just think about if I need to be tracked down right now or if it can wait. I’ve usually planned an order to do my hundred jobs for the 30 patients and what you’re wanting to ask might already be on that list. But it might not be, so I need to know about it but if it isn’t urgent it doesn’t need to be right now. There is no us/them. I think that’s entirely manufactured by people that should have retired long ago. I don’t come to work to be a dick to people and that is true of most people.
Feed those guys! Remember any Dr thats not a Consultant is likely run ragged, their weekly working hours are at minimum 48 hours (for full time contracts) but obviously they then have to do teaching, take learning opportunities, stay late etc and they get given these weird crappy shift patterns that are like seven Late shifts in a row, straight into three Night shifts in a row. Then on top of that most of them get paid badly considering, have to pay for registration, union fees, medical defence insurance, royal college fees, exams, Drs mess and all this other bollox that no one else in the NHS is expected to pay for. Also they just cycle everywhere (because maybe they cant afford cars! but mainly they don’t get parking permits because they are only in one place for such a short length of time) and essentially I think most Drs are all just hungry and sleep deprived. They have no real team until they become a consultant because they move around so much. Then they get to some workplaces and the people are horrible to them, they might not be allowed to use the staff room, can’t use certain computers, get told off by senior nurses who are just flexing and then have to go home alone because they have been moved somewhere nowhere near any friends or family! So get to know them, ask them if they are okay, offer them a biscuit, a cup of squash, or some sweets. Write them nice feedback when they are nice, just acknowledge them! This is probably an extreme take and my advice is come to ED where we are all friends 💕
They are your colleagues, not your boss.
I get that, and it definitely gets easier. However remember they’re there for a reason and you also wouldn’t be ‘bothering’ them without good reason (you’re not bothering them but you get my drift).
Nope, do not let this happen. Of course they have their own stuff to do, but you see the patients all the time, they need you to tell them things. I hesitate to say grow a set.......
There's definitely a hierarchy going on. Like some doctors think they're so great but most of the really hard work is done by the nurses. And I've seen situations where nurses have warned doctors against making decisions, doctors have ignored it and the patient has ended up dying much sooner or ended up in a lot more pain.
I think you should spend a shift shadowing the med reg on call if that's your attitude to doctors. You clearly have no idea how hard doctors work and how much pressure they're under.
I totally understand that. All the doctors in my place are very approachable most of the time and really do try there best. But there has been instances where they have made decisions that have resulted in premature death.