[ak217]

Yeah, this whole discussion cracks me up. I have a number of direct experiences with Kaiser nurses. They repeatedly got into arguments with doctors in front of me, tried to countermand doctors' instructions, ignored their patients, and complained to each other about their patients while they were right there.

Repeated unprofessional behavior with no discernible change after trying to address it. My take is that the Kaiser nursing org has a serious discipline and customer (patient) focus problem.

[drknownuffin]

To one degree or another, this is endemic among nurses. It's part of a broader cultural element: nursing programs have entrenched a culture of nurses vs. doctors. There are literally questions on their licensing exam to the effect of "which of these orders from a doctor should you refuse to enact?" (rather than, say, "which of these orders should you contact the doctor to seek clarification on?" or some other collaborative take). Nurses are taught their job is to protect patients from physicians. Given they don't have the expertise to do that , the general result is more broadly a power struggle in the guise of patient care.

[fn-mote]

I think this is an unfair take.

The necessity of teaching nurses that doctors orders are not sacrosanct comes from the bitter experience of doctors giving orders that are wrong.

Asking for clarification is great, but doctors can be very reluctant to hear. The bottom line is that the nurse must not do certain things and the certification exam is there to make sure they know it.

Think of it in relation to the “anybody can stop the assembly line” part of quality control.

[ak217]

I agree (with the obvious qualification that there are excellent nurses out there who do a great job and don't let this stuff get in the way of helping their patients, some Kaiser nurses included). But I also see a marked difference in behavior and outcomes in other hospitals I've been to. Yes, there are still some unprofessional nurses in those networks as well, but judging by the outcomes, the hospitals don't let them do damage.