Recently a nurse from another unit and I were talking. He is a good work friend to me. We get lunch sometimes; hang out in the hall and chit-chat. We talk about relationships, bad managers, and gripe about the political bull that we have to endure at our lovely hospital. ‘I’m going to go to the yellow team room and ask out one of the residents.’ He announces. ‘Which one?’ I ask. ‘The R2, I think her name is (blank)’. He replies with a glint in his eye. I flashback to my previous week with her and cringe. In the ICU you get to know your residents very well. ‘Oh God, not her’ I say rolling my eyes. He gets a worried look on his face and asks ‘What’s wrong with her?’ I go over some of my recent experiences with her and the team she is supposed to be overseeing, ‘Frankly my friend, she is incompetent’. He lets out a sigh and looks down. This is the worst insult of all.
I feel bad as I write this. If someone called me incompetent, I would be horrified. This is a label that cuts to your very foundation if you have a Type A personality like I do. Most professions are important enough that to be incompetent would be unacceptable. You want your mechanic to be qualified, childcare to be safe, a bartender who takes care of you, and an accountant who will keep the IRS away. Some professions only require adequacy, where there isn’t much to loose. Depending on how well the job is done, you may or may not get called on again. Healthcare is different. You don’t get to choose your doctor or nurse in a hospital. You are at the mercy of people you hope to God won’t forget about you. People you pray will optimize care for you, working tirelessly to get you better faster, and let you go on with your life in the real world.
Not all healthcare workers have the same philosophies. Some strive for excellence, some adequacy, and the others just try to stay under the grid, not really caring, hoping no one notices. It seems that many nurses and doctors are satisfied if their patient is alive at the end of the day. I guess that this would be adequate performance by some standards, but for me is not quite enough. The far side of the spectrum is the resident (or nurse for that matter), who looks good from the outside in the morning during rounds, saying the right things, nodding emphatically and writing down the plan for the day, and then walks away as if all patient care has been completed. They don’t check on the patient, respond assertively when a nurse calls with issues and questions, nor do they make measurable goals with solid outcomes, change care plans, call for back-up when the patient is circling the drain, and then they are surprised when they get reprimanded the next day. They are children who have no sense of obligation or duty it seems. Maybe they are intimidated by critically ill patients and use denial and rose-colored glasses to camouflage the true nature of the patient’s condition. Whatever the reasoning, there is no excuse for letting your patient crumple in front of you and then failing to respond. That is when I call the fellow. Too late, unfortunately in this case. But, of course the doctor still fails to take any responsibility the next morning, instead blames nursing for not putting in IVs, or relaying patient condition information, when really, they were on call all that night, and failed to make plans for your patient before midnight and it was too late for such and such procedure. So my friends, I did what any assertive ICU nurse would do, I got even with her for trying to make me look bad. Yes, vindictive I know, but it felt really good.
The attending who has known me for over three years became very informed of all the team’s shortcomings, and how the inability to have any accountability was an affront to the nursing staff which has shown repeatedly to have excellent patient care skills and intuition. He nodded in agreement with me, and with his jaw set, said he would have a talk with her/them.
The best residents and nurses who can see a holistic vision of their patient. They see beyond the hospital stay. They see the patient before he came, and what it might be like when they leave. They work for the benefit of the patient everyday, not just keeping them alive, but making their lives better. Getting them stronger physically and emotionally, giving dignity and understanding throughout the patient’s stay.
Incompetence for me is a four letter word, and I hope that I never have to be a patient of someone who doesn’t understand this. However, you can try to date and screw one who is apparently. As my friend so succinctly put: ‘Well whatever, she’s hot’.