When I was in the Air Guard and United States Air Force Reserve, I learned, with great speed, that there was one person in the unit who could make my job, indeed my entire experience, a pleasure. It was the Chief Master Sergeant. He or she was critical to a functional unit. The Chief was the one who made sure I did the right things, signed the right forms, received the right opportunities, and was a successful flight surgeon in each of my several units.
As physicians, we have a Chief Master Sergeant. Actually, we have several. Those persons are nurses. In particular, as a locum tenens physician, traveling to new hospitals with unknown challenges and unfamiliar systems, we can succeed gloriously or fail miserably to the extent that we recognize this inherent power structure. This was an easy realization for me.
First of all, my mother is a nurse. I learned to listen to her opinion from my earliest days. I still recall seeing her nursing cap and white uniform as symbols of authority and professionalism. Later, in college, I worked in a physicians’ office, assisting nurses in any and everything. I saw how things worked. They say in marriage, “happy wife, happy life.” In medicine, it might be “happy nurse…no need to curse.” I’m not suggesting we grovel. But the plain truth is that locum tenens physicians are the “new kids in town.” Many of the nurses we will encounter have been in their emergency departments for years, if not decades. We ignore their experience and wisdom to our own peril. It’s not about who is in charge or who knows more. We do know the facts of our specialty, but we don’t know the referral patterns, who admits, who doesn’t, who wants to be called, and who wants to be paged. We don’t know what medications are in the pharmacy, what the local EMS is capable of doing, how the EMR works, or who the chronic, difficult patients are. We also don’t know how the nurses can help us, with splints or wound care, or even order entry.
If we dismiss nurses or demean them, we’ll have a hard time navigating the complexity of each new hospital where we work. Therefore, one of the best bits of advice I can give any physician is this: make nice with the nurses, and let them help you. Respect their experience and knowledge, and ask for their opinions. Follow their advice when it’s reasonable and appropriate. And if you disagree, even if you do so vigorously, correct politely, and explain your rationale. The old school “because I’m the doctor” reasoning is pretty much gone with the wind.
Furthermore, that sort of behavior can make a night shift into an endless hell of phone calls and order clarifications. So treat the nurses like the colleagues they are. Eat with them now and then or order pizza. Listen respectfully to their troubles. After all, they care for the same patients we do but make a lot less money. Bring candy. It can’t hurt, can it? Sit and share thoughts when things are slow. But most important of all, respect their knowledge, skill and experience. Praise in public. Correct in private. Control your temper and snide remarks…especially when you’re tired. You’ll find that of all the ways to make locums enjoyable, a functional relationship with the nursing staff may be number one.
