Collaboration With Other Specialties
When I was a student, I noticed that my preceptors seemed stuck in a rut. “We don’t really mess with that,” they would say when I asked about some out-there thing involving another specialty. I felt judgmental. For heaven’s sake, I thought. Hadn’t these nurses been to nursing school? Didn’t they pay attention in all these classes I was in right then? My nursing school (a rogerian institution) emphasized integration and cross-specialty, whole-person emphasis. Were these nurses serious that they didn’t really DO that? (“That” being, for example, psychiatry, cardiology, nephrology, neurology, or anything that wasn’t emphasized on that particular floor.)
No one explained to me that this is what “specialty area” means. Integration is optimal and desired but probably unrealistic. Medicine and the healthcare system have become so complicated that perhaps the best nurses can do is have a healthy respect for our colleagues in other specialties. Do we have that type of respect, though? We can do better. Practicing nurses, raise your hands. Who has heard something like this:
- Floor nurses work the floor because they just aren’t smart enough to do anything else.
- ICU nurses are snotty.
- ER nurses are sloppy.
- OR nurses do nothing but pass instruments and meds.
- Psychiatric nurses aren’t real nurses.
I could go on, but the stereotypes would fill an entire post. They are not productive. We are all nurses, and we are all needed. Snapping at each other’s heels with these pejorative putdowns helps no one—least of all us.
I have theories about why we do this, but the worst one is the least flattering: it makes us feel better to put others down. I have worked the floor as a CNA, the ICU as an RN, and the ER as an RN. I have close friends who work psych and OB.
- Floor nurses work in the trenches and are wizards of patience, time management, complaint triage (“I need more juice!”), and sheer hands-down knowledge of nearly any disease process you throw at them. If you need 194 things done in 2 hours, you want to enlist a floor nurse.
- ICU nurses look snotty, if they do, only because they are sitting in front of a bank of monitors and lab values pondering which drip to change. Is titrating that dopamine drip up to increase the patient’s blood pressure going to send him into V-tach? These are the things ICU nurses are busy with. Not being snotty.
- The “sloppy” ER nurse has delivered you a dirty, bloody patient. Whom she has received in…what shape you do not know, started usually multiple difficult IVs on, inserted a Foley catheter, and in general stabilized, possibly with multiple complicating factors. She isn’t sloppy; she’s stabilizing and transferring.
- OR nurses, apparently, have ESP. I’ve seen this. The surgeon barks out “svarzolorean clamp!” or some such thing and the nurse already has it waiting there. I am convinced that surgeons speak out loud only for show, because OR nurses anticipate every single thing they are about to need. It’s impressive.
- Psychiatric nurses have the patience of saints. I do psych nursing in the ER, and that’s enough for me. Nursing involves treating the whole person, and you can never convince me that psychiatric illness is not “real.” Nurses who can treat these diseases effectively have my undying respect.
I wrote this post because I responded to a code recently on the floor. The floor nurses were not doing much, and initially I was annoyed, but why should they? They’re geniuses at hanging 143 meds an hour, troubleshooting stuff that would make me want to bang my head against the wall, and managing a few CNAs. I did the code stuff because that’s what I’m a genius at. I was glad, at the end of it, that we (all of us with different skills and specialties) are able to do our thing. But we need more mutual respect. We’re all needed and appreciated.
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