In the United States, we tend to subscribe to the belief that medicine is a hierarchy in which doctors call all of the shots. Nurses, in contrast, simply do as they are told. This assumption is deeply rooted in the patriarchal history of medicine, which has largely been rejected by modern practitioners in favor of a more progressive, team-based approach. However, tradition runs deep – many of our future patients will enter the hospital with the assumption that, because we are the doctor, we know best. And while we may spend hours upon hours during medical school discussing and disproving this fallacy, is this truly enough to break the status quo?
I entered our nurse shadowing experience acutely aware of this power dynamic that unquestionably still exists on the wards. The irony of the situation was not lost on me: What did it mean for me, as a future doctor, to rely heavily on education from nurses to whom I may one day give orders? Freshly showered and clad in a dress and my crisp white coat, I felt conspicuous and downright prim. It was painfully obvious that I was dressed to watch, and not to help.
Christine, the nurse with whom I was assigned to work, was on the ninth hour of her shift (I, on the other hand, had just woken up from a nap). She was extremely welcoming, and apologized for the fact that many of the patients were asleep, so it would be a quiet evening. However, as I told her, after a long day of lectures, the opportunity to see patients for two hours was still quite exciting.
I was surprised to see that Christine was only assigned to four patients, but as I glanced at her “cheat sheet,” I immediately understood why. She had written down extensive information about each patient—recent changes in condition, medications, names of family members, and doctors involved in their case. I watched, impressed, as she moved from room to room, monitoring blood sugar levels and dispensing pain medication. She gracefully changed the bedding underneath a half-asleep woman in her nineties who was suffering from pneumonia and dementia. She, equally as gracefully, spoke with the patient’s family members about their concerns and potential next steps in care. When we finally got a chance to sit down, Christine immediately logged into her computer and charted, from memory, everything that she had just spent the last hour doing.
I came into the nurse shadowing experience with full knowledge of how busy nurses are, and how hard they work. It dawned on me that, in splitting her 12-hour shift among four patients, Christine probably spent roughly three hours that day with each of her patients. And while the doctors were undoubtedly behind the scenes, working hard to determine diagnoses and treatment plans for their patients, the time that they had spent interfacing with these patients was on the order of minutes, not hours. Nurses and doctors play complementary roles as part of a healthcare team, both performing very different but essential duties.
It is crucial for us to continue to interface with other healthcare providers during our time in medical school. Furthermore, we must challenge ourselves to actively dispel the false “hierarchy” of medicine. The reality of being medical students, and eventually doctors, is that we are constantly steeped in a culture of entitlement and perceived superiority. Shadowing nurses was a reminder of how much they do, and how much they know, and how integral they are to providing patient care. The nurses with whom we will one day work will constantly be teaching us things. It is in our patient’s best interest, and is our duty as medical providers, to listen and to learn.