Just recently, someone I know entered medical school with
great hopes, expectations and vision for a future in medicine, and what I'm
hearing about his initial experiences brings me great joy and
hope.
Showing posts with label nurse-doctor relations. Show all posts
Showing posts with label nurse-doctor relations. Show all posts
Wednesday, August 01, 2012
Saturday, July 14, 2012
Doctors and Nurses: We All Can Win
Interactions between nurses and doctors can be entertaining, frustrating, enlightening, symbiotic, neutral, competitive, or otherwise charged with emotion or energy. Just recently, I've had several interactions that were all interesting in their own way.
Tuesday, March 13, 2012
Gender, Healthcare and Communication
Last night on RN.FM Radio during a discussion with Beth Boynton, the nurse author of "Confident Voices: The Nurses' Guide to Improving Communication and Creating Positive Workplaces", we touched on the subject of gender and its effects on communication. Countless books on communication between the sexes have been written---the ones most readily coming to mind being those by Deborah Tannen, including "You Just Don't Understand" and "That's Not What I Meant"---and I am keen to point out that there is currently no book on the market of which I am aware that specifically discusses the gender aspects of communication within healthcare.
Wednesday, January 11, 2012
Book Review: "Confident Voices" by Beth Boynton
A note to the reader: As always, I have received no remuneration for
posting this book review. As a point of disclosure, I did, however,
receive a free copy of the book from the author in order to facilitate
the review process.
"Confident Voices: The Nurse's Guide to Improving Communication and Creating Positive Workplaces", was published in 2009 by Beth Boynton, RN, MS and edited by Bonnie Kerrick, RN, BSN.
Summary
In Confident Voices, Boynton strives to give nurses the understanding and skills to navigate the workplace in a way that fosters improved communication, healthier workplaces and a more supportive and safe environment for them and their colleagues. Boynton achieves her goal, and delivers information that is useful, well-organized, easy to digest, and potentially possible to put into practice immediately.
The book walks the reader through three distinct sections covering various topics of interest to the nurse who wishes to work in an environment that supports positive relationships and respectful communication.
Part I addresses workplace dynamics, and identifies the characteristics of toxic workplaces, and delves into theories that explain human behavior, especially in the context of the workplace. Organizational culture is explained and dissected, and workplace violence---be it physical, verbal or emotional---is also addressed.
Part II is focused on "building assertiveness and respectful listening skills" and explores "strategies for creating organizational cultures where effective communication and respectful relationships can thrive".
Part III integrates the theories, insights and skills covered in Parts I and II in the context of nurses' experiences which were gleaned from interviews with nurses in the field. Common toxic behaviors are described and various revisions of the encounters in question are offered as examples of improved communication and healthier outcomes for all involved.
Discussion
Toxicity in the workplace is an important subject rarely given its due, and Boynton succeeds in communicating her mission clearly in this very useful book. We all know that the health care system is suffering from various forms of overload and dysfunction, and the result for nurses is that we often feel powerless in the face of old patriarchal systems of organization, entrenched methods of communication, and hierarchical relationships that apparently strip us of our power and leave us literally speechless in the face of workplace violence, bullying, top-down management, and organizational failure.
Boynton gives nurses concrete examples of common situations wherein nurses can practice their assertiveness and respectful communication skills. She also provides practical tools for nurses within a theoretical framework that takes into consideration the characteristics of toxic workplaces, the ways in which workplace violence impacts nurses, and how effective communication can cut through the static to a place of greater clarity, personal empowerment, and professional satisfaction.
In a future edition of "Confident Voices", I would like to see the author make use of a more diverse selection of real-life scenarios in order to address potential gender and power issues that her examples fail to take into consideration.
Suggestions
The nurse interviews used in the book to illustrate Boynton's thesis all feature female nurses who are interacting with male physicians in the hospital setting. While this gender dynamic may be common (and may be a deeply and culturally embedded knee-jerk reaction when we think of "nurse and doctor") there are now a plethora of female physicians working alongside male nurses, and male nurses working alongside male physicians.
Additionally, it would be interesting to explore workplace dynamics when we consider male and female nurses working together, as well as combinations of male nurses alongside male nurses, and female nurses collaborating with female doctors. It could also be enlightening to explore the dynamics of workplace violence, bullying and communication when considering comparisons between male and female supervisors and administrators, and the ways in which gender differences impact communication in health care. Several books have been written about the effects of feminism on the nursing profession, most notably "Daring to Care: American Nursing and Second-Wave Feminism" by Susan Gelfand Malka. Perhaps an exploration combining the effects of feminism on nursing and changes in communication would be an interesting follow up to "Confident Voices".
Within "Confident Voices", Boynton also does not address cultural, ethnic and racial differences in communication that could greatly impact nurses and those who work in health care institutions. Asians, Native Americans, Hispanics and other groups may have cultural practices and norms vis-a-vis communication that differ widely from white American culture. From eye contact to body language, communication in the workplace also needs to take these differences into consideration.
My Recommendation
Overall, I would highly recommend "Confident Voices" to any nurse who wishes to improve his or her own communication skills, share those skills with colleagues, and attempt to understand organizational culture with an eye towards creating positive workplaces for all concerned.
On the Radio
Beth Boynton will be appearing as a guest on RN.FM Radio: Nursing Unleashed on March 12th, 2012 at 9pm EST. Please tune in and you will be able to call into the show and ask Beth questions about her work as a nurse, writer, and workplace communication expert.
--------------
"Confident Voices: The Nurse's Guide to Improving Communication and Creating Positive Workplaces", was published in 2009 by Beth Boynton, RN, MS and edited by Bonnie Kerrick, RN, BSN.
Summary
In Confident Voices, Boynton strives to give nurses the understanding and skills to navigate the workplace in a way that fosters improved communication, healthier workplaces and a more supportive and safe environment for them and their colleagues. Boynton achieves her goal, and delivers information that is useful, well-organized, easy to digest, and potentially possible to put into practice immediately.
The book walks the reader through three distinct sections covering various topics of interest to the nurse who wishes to work in an environment that supports positive relationships and respectful communication.
Part I addresses workplace dynamics, and identifies the characteristics of toxic workplaces, and delves into theories that explain human behavior, especially in the context of the workplace. Organizational culture is explained and dissected, and workplace violence---be it physical, verbal or emotional---is also addressed.
Part II is focused on "building assertiveness and respectful listening skills" and explores "strategies for creating organizational cultures where effective communication and respectful relationships can thrive".
Part III integrates the theories, insights and skills covered in Parts I and II in the context of nurses' experiences which were gleaned from interviews with nurses in the field. Common toxic behaviors are described and various revisions of the encounters in question are offered as examples of improved communication and healthier outcomes for all involved.
Discussion
Toxicity in the workplace is an important subject rarely given its due, and Boynton succeeds in communicating her mission clearly in this very useful book. We all know that the health care system is suffering from various forms of overload and dysfunction, and the result for nurses is that we often feel powerless in the face of old patriarchal systems of organization, entrenched methods of communication, and hierarchical relationships that apparently strip us of our power and leave us literally speechless in the face of workplace violence, bullying, top-down management, and organizational failure.
Boynton gives nurses concrete examples of common situations wherein nurses can practice their assertiveness and respectful communication skills. She also provides practical tools for nurses within a theoretical framework that takes into consideration the characteristics of toxic workplaces, the ways in which workplace violence impacts nurses, and how effective communication can cut through the static to a place of greater clarity, personal empowerment, and professional satisfaction.
In a future edition of "Confident Voices", I would like to see the author make use of a more diverse selection of real-life scenarios in order to address potential gender and power issues that her examples fail to take into consideration.
Suggestions
The nurse interviews used in the book to illustrate Boynton's thesis all feature female nurses who are interacting with male physicians in the hospital setting. While this gender dynamic may be common (and may be a deeply and culturally embedded knee-jerk reaction when we think of "nurse and doctor") there are now a plethora of female physicians working alongside male nurses, and male nurses working alongside male physicians.
Additionally, it would be interesting to explore workplace dynamics when we consider male and female nurses working together, as well as combinations of male nurses alongside male nurses, and female nurses collaborating with female doctors. It could also be enlightening to explore the dynamics of workplace violence, bullying and communication when considering comparisons between male and female supervisors and administrators, and the ways in which gender differences impact communication in health care. Several books have been written about the effects of feminism on the nursing profession, most notably "Daring to Care: American Nursing and Second-Wave Feminism" by Susan Gelfand Malka. Perhaps an exploration combining the effects of feminism on nursing and changes in communication would be an interesting follow up to "Confident Voices".
Within "Confident Voices", Boynton also does not address cultural, ethnic and racial differences in communication that could greatly impact nurses and those who work in health care institutions. Asians, Native Americans, Hispanics and other groups may have cultural practices and norms vis-a-vis communication that differ widely from white American culture. From eye contact to body language, communication in the workplace also needs to take these differences into consideration.
My Recommendation
Overall, I would highly recommend "Confident Voices" to any nurse who wishes to improve his or her own communication skills, share those skills with colleagues, and attempt to understand organizational culture with an eye towards creating positive workplaces for all concerned.
On the Radio
Beth Boynton will be appearing as a guest on RN.FM Radio: Nursing Unleashed on March 12th, 2012 at 9pm EST. Please tune in and you will be able to call into the show and ask Beth questions about her work as a nurse, writer, and workplace communication expert.
Wednesday, July 14, 2010
A Visit to the Doctor
The case manager and I have brought our client to see his new doctor, who enters the room smiling, his gray lab coat worn over a white shirt and tie decorated with multicolored stethoscopes and faux ECG readouts. He shakes each of our hands, in turn.
"So, you're Mr. __________. Very nice to meet you. I believe your son is my patient, as well."
My client is solicitous, friendly and smiling as the doctor greets him. "That's right. Nice to meet you."
"You seem very healthy for a man of your age," the doctor says. "We should all be so lucky."
As we talk, review our client's history and relate our concerns and needs, the soft-spoken doctor listens----really listens----and reflects back to us what he hears. Performing a cursory yet thorough exam, he listens to our client's heart and lungs, prods his belly, inspects his limbs, checks his eyes, and otherwise gives him the once over with gentle and learned dexterity.
"I think you're all doing an excellent job caring for Mr. _________. He's a lucky man to have such a team looking after him 24 hours a day." He leans over and speaks very loudly into our client's ear. "You're a lucky man!"
Our client smiles broadly.
After the exam, the doctor recommends a tetanus booster and a pneumonia vaccine, and we're stunned when he comes back into the exam room to prepare and administer the vaccines himself.
"I'm sorry," I say, "but I've never seen a doctor give an immunization before. Do you always do this?"
He looks up at me as he flicks one of the syringes with his finger to remove any errant air bubbles. "Oh, when the nurses are busy I like to help out. It's no big deal, really." He leans down and administers the two injections deftly, one in either deltoid. Mr. _______ never flinches.
"Well, it's a big deal to us. Most doctors would never dream of doing such a thing," my colleague says to him as he places the used syringes in a sharps container. "You've been very kind and attentive."
"It's my pleasure, truly." The doctor shakes each of our hands once again, hands us prescriptions, referrals and a signed application for a handicap placard, and slips quietly out the door.
"That is one fine doctor," my colleague says to me, shaking her head. "What a positive experience."
We wheel our patient to the elevator, all of us quiet, knowing that we have just had what might be seen by some as a very unusual experience. The doctor was efficient, kind, thoughtful, thorough, paid great attention to detail, and listened to everything we had to say. As nurses, being really listened to by a doctor is simply a coup d'etat, and we left that office beaming with our collective good fortune.
A fine doctor, indeed.
"So, you're Mr. __________. Very nice to meet you. I believe your son is my patient, as well."
My client is solicitous, friendly and smiling as the doctor greets him. "That's right. Nice to meet you."
"You seem very healthy for a man of your age," the doctor says. "We should all be so lucky."
As we talk, review our client's history and relate our concerns and needs, the soft-spoken doctor listens----really listens----and reflects back to us what he hears. Performing a cursory yet thorough exam, he listens to our client's heart and lungs, prods his belly, inspects his limbs, checks his eyes, and otherwise gives him the once over with gentle and learned dexterity.
"I think you're all doing an excellent job caring for Mr. _________. He's a lucky man to have such a team looking after him 24 hours a day." He leans over and speaks very loudly into our client's ear. "You're a lucky man!"
Our client smiles broadly.
After the exam, the doctor recommends a tetanus booster and a pneumonia vaccine, and we're stunned when he comes back into the exam room to prepare and administer the vaccines himself.
"I'm sorry," I say, "but I've never seen a doctor give an immunization before. Do you always do this?"
He looks up at me as he flicks one of the syringes with his finger to remove any errant air bubbles. "Oh, when the nurses are busy I like to help out. It's no big deal, really." He leans down and administers the two injections deftly, one in either deltoid. Mr. _______ never flinches.
"Well, it's a big deal to us. Most doctors would never dream of doing such a thing," my colleague says to him as he places the used syringes in a sharps container. "You've been very kind and attentive."
"It's my pleasure, truly." The doctor shakes each of our hands once again, hands us prescriptions, referrals and a signed application for a handicap placard, and slips quietly out the door.
"That is one fine doctor," my colleague says to me, shaking her head. "What a positive experience."
We wheel our patient to the elevator, all of us quiet, knowing that we have just had what might be seen by some as a very unusual experience. The doctor was efficient, kind, thoughtful, thorough, paid great attention to detail, and listened to everything we had to say. As nurses, being really listened to by a doctor is simply a coup d'etat, and we left that office beaming with our collective good fortune.
A fine doctor, indeed.
Thursday, October 30, 2008
Reflections on Doctors Reviewed in the NY Times
Reflections on Doctors, the recently-published book of non-fiction by nurses for which I was one of many contributors, has been reviewed for the New York Times by Dr. Abigail Zuger, M.D.
While Dr. Zuger is admittedly underwhelmed by the lack of "literary style" demonstrated by the book's contributors, she states that "each story represents a step in understanding the inherent differences that separate the professions".
Even as the reviewer points out that the relationships described would not elicit "a minute of good television" (an assertion which I reject out of hand), and that the authors "write in shades of gray, describing interactions and relationships that are colorless, courteous, [and] businesslike", the Dr. Zuger seems to conclude that good, thoughtful medical care is, on balance, the end result of nurses' thoughtful reflections on the care that they and their medical colleagues provide.
In the course of her review, Dr. Zuger does indeed bemoan the fact that "no doctor out there is planning to publish a manuscript entitled 'Reflections on Nurses' any time soon", stating that "I am assuming my colleagues concur that such a project would be best left for retirement incommunicado somewhere on a distant Pacific atoll, where the mailman never calls." Sadly, this statement belies the fact that many doctors simply do not take the time to consider the crucial role that nurses play in the delivery of medical care, or, as the reviewer asserts, are potentially concerned that angry letters would ensue whether praise or criticism were duly proffered.
As a nurse blogger, I can attest that some of the best interdisciplinary writing does indeed occur in the medical/nursing blogosphere, and perhaps it is in that venue where the one-way conversation begun in "Reflections on Doctors" can be openly and honestly continued.
However, I can attest that "Reflections on Doctors" is one more step in further elucidating the multifaceted relationships between nurses, doctors and surgeons. Such literary excursions can only serve to inform the public, empower nurses and doctors to communicate, and to open additional avenues for future discussion.
While Dr. Zuger is admittedly underwhelmed by the lack of "literary style" demonstrated by the book's contributors, she states that "each story represents a step in understanding the inherent differences that separate the professions".
Even as the reviewer points out that the relationships described would not elicit "a minute of good television" (an assertion which I reject out of hand), and that the authors "write in shades of gray, describing interactions and relationships that are colorless, courteous, [and] businesslike", the Dr. Zuger seems to conclude that good, thoughtful medical care is, on balance, the end result of nurses' thoughtful reflections on the care that they and their medical colleagues provide.
In the course of her review, Dr. Zuger does indeed bemoan the fact that "no doctor out there is planning to publish a manuscript entitled 'Reflections on Nurses' any time soon", stating that "I am assuming my colleagues concur that such a project would be best left for retirement incommunicado somewhere on a distant Pacific atoll, where the mailman never calls." Sadly, this statement belies the fact that many doctors simply do not take the time to consider the crucial role that nurses play in the delivery of medical care, or, as the reviewer asserts, are potentially concerned that angry letters would ensue whether praise or criticism were duly proffered.
As a nurse blogger, I can attest that some of the best interdisciplinary writing does indeed occur in the medical/nursing blogosphere, and perhaps it is in that venue where the one-way conversation begun in "Reflections on Doctors" can be openly and honestly continued.
However, I can attest that "Reflections on Doctors" is one more step in further elucidating the multifaceted relationships between nurses, doctors and surgeons. Such literary excursions can only serve to inform the public, empower nurses and doctors to communicate, and to open additional avenues for future discussion.
Thursday, June 28, 2007
....And Then It All Came Crashing Down....
It was just one of those things. Our office is being rewired, with workmen on ladders, standing on my desk intermittently, the computers and phones periodically down for the count. Most of us tried to work outside the office throughout the day, but there are just some things that can't be done from the outside, at least without sufficient wireless technology.
My day went fine while I was working away from the office. Emails and phone calls came in waves, and I performed basic triage in order to take care of the most pressing issues as others waited in the wings.
Once I set my foot in the office door, the tumult began, and what seemed to have been a breezy day transformed into one which seemed to pummel me from all sides at once. For better or worse, several of my colleagues were experiencing the same intensity, and we held onto the rails of our tossing ship together, life-jackets at the ready. Tears, smiles, laughter, sarcastic surrender----it all melded into one miasma of reaction to stress. Laughter relieved my stress the most as I fumbled through the afternoon.
Moments of merriment and lightness were balanced by other moments of utter exasperation. Answering my phone around 3:00, I was on the receiving end of the angry outburst of a plastic surgeon who was unhappy with my "interference" in the care of "her" patient.
"I don't even know who's managing this patient's care," she said sarcastically. "Can you tell me, by any chance, what is happening and why I was not informed?"
I grimaced into the phone. "I am a nurse care manager for my patient, and I see my role as a patient advocate. Since the surgery which you performed, she has had increasing pain and what seems to be an untreated infection," I replied. "Your office has been slow to respond, her primary doctor just left the area, and I was left holding the ball. So I ran with it to the best of my ability."
She seemed disarmed as we discussed the plans for the patient further before she hung up the phone rather abruptly, but not before she let me know that I would be held responsible if the patient no-showed to tomorrow's scheduled procedure. I'm sure she shared choice words about me with her colleagues, as I did with my own coworkers about her unnecessarily harsh demeanor. Surgeons.
Anyway, the day eventually came to a lukewarm conclusion as I moved my attention to my 3-hour evening shift as a clinic nurse. As I began the latter portion of my workday, the frantic energy of the previous hours began to dissipate, resulting in a body like a dish-rag and a brain made of nothing more than oatmeal.
Coming home to loving family, loyal canine, and the warm embrace of home, the crashing stress of the previous ten hours melts into what it should be---a memory and nothing more. And now for rest, and the forgetfulness of sleep.
My day went fine while I was working away from the office. Emails and phone calls came in waves, and I performed basic triage in order to take care of the most pressing issues as others waited in the wings.
Once I set my foot in the office door, the tumult began, and what seemed to have been a breezy day transformed into one which seemed to pummel me from all sides at once. For better or worse, several of my colleagues were experiencing the same intensity, and we held onto the rails of our tossing ship together, life-jackets at the ready. Tears, smiles, laughter, sarcastic surrender----it all melded into one miasma of reaction to stress. Laughter relieved my stress the most as I fumbled through the afternoon.
Moments of merriment and lightness were balanced by other moments of utter exasperation. Answering my phone around 3:00, I was on the receiving end of the angry outburst of a plastic surgeon who was unhappy with my "interference" in the care of "her" patient.
"I don't even know who's managing this patient's care," she said sarcastically. "Can you tell me, by any chance, what is happening and why I was not informed?"
I grimaced into the phone. "I am a nurse care manager for my patient, and I see my role as a patient advocate. Since the surgery which you performed, she has had increasing pain and what seems to be an untreated infection," I replied. "Your office has been slow to respond, her primary doctor just left the area, and I was left holding the ball. So I ran with it to the best of my ability."
She seemed disarmed as we discussed the plans for the patient further before she hung up the phone rather abruptly, but not before she let me know that I would be held responsible if the patient no-showed to tomorrow's scheduled procedure. I'm sure she shared choice words about me with her colleagues, as I did with my own coworkers about her unnecessarily harsh demeanor. Surgeons.
Anyway, the day eventually came to a lukewarm conclusion as I moved my attention to my 3-hour evening shift as a clinic nurse. As I began the latter portion of my workday, the frantic energy of the previous hours began to dissipate, resulting in a body like a dish-rag and a brain made of nothing more than oatmeal.
Coming home to loving family, loyal canine, and the warm embrace of home, the crashing stress of the previous ten hours melts into what it should be---a memory and nothing more. And now for rest, and the forgetfulness of sleep.
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