In My Experience...

An hour passed before the timid one came. The student was nervous. She smiled at the woman, "The patient has a lot of swelling. I'm not sure what to do. She's getting a lot of fluid through her IV and her lungs have crackles. I showed the doctor the labs and asked him what to do. He said he had already looked at that patient, but he didn't order anything. I'm worried about her."
The woman smiled at the student. This one had come so far. She wasn't afraid to ask the teacher things anymore. She would go to the teacher first and ask and they would talk about what this could mean, "What do the crackles signify to you?"

"Well, the patient could go into volume overload if she is getting too much fluid."
"Yes, you are right. And how do you know that she's getting too much fluid?"
"The swelling and the lung sounds and these labs are too low." The student chimed back cautiously.
The woman looked at the girl, "Yes, you are right again. That's good thinking. That will save someone a great deal of pain someday, that thinking of yours. Maybe even today. Let's go ask the doctor what to do. We can show him the lab and he'll probably stop the fluid and maybe give her something to make her get rid of the excess swelling or he'll help us understand what we're missing."
The hall was colder than the table. The curved desk hid the medicine machine and four other nurses. A young man sat in the corner, by himself, writing in a chart. The pen was heavy. It dragged over the lines on the page, scribbling away hours worth of sleep. His eyes were mixed red with white and brown. His hair was straight and cut short.
The woman walked over to him. Her eyes crossed his hairline as she asked, "Hello, I'm the instructor for the students here today. One of my students and I are wondering about her patient. We're concerned that her labs are so low. She also has a lot of swelling and her lungs sound wet."
He didn't raise his head from the papers to answer but the words leaked out from between his tight lips, "I'm the doctor, not you. You don't know crap. I see the patients. I've already assessed her and I'll write up the notes when I have time. That's not your job."

"My job is to teach my students how to think about things, how to critically analyze things so that we can provide safe care. It is to teach my students that they can go to doctors and nurses and other team members and discuss the care of a patient as a team. Are we not a team?"
His eyes glazed over. The red over the white of his face was showing. High cheekbones lifted as his teeth grinded behind tight lips, "You're trying to tell me how to do my job. I know how to do my job. I am very meticulous with my patients. I know what's going on with them and I don't need a nurse practitioner who doesn't know anything and who doesn't make crap telling me my job."
The conversation had ended. She turned and walked to the room where the cold table still stood, faithfully. She looked at the student. "Let's ask the primary nurse to call the surgeon." She added with a wasted sigh. Her neck felt tight around her head. The redness swelled on her cheeks.
"But, that's the internists job." The surgeon remarked, "I'm a surgeon. I don't handle volume overload. Stop the fluids and call the internist." The primary nurse heard the phone go dead on the other side.
The woman looked over at the student. They'd have to talk to the man again. They'd have to ask him the same questions over again. The student sank, "I'm sorry, I just thought that I should tell the doctor that the labs were low. I didn't mean to start something. I can't believe he said those things."
"It's not your fault. We'll ask the primary nurse to tell the doctor. You didn't do anything wrong. You saw something that you thought would be a problem and you took action. You wanted to take care of your patient. Even if we get in trouble, ultimately, we need to take care of the patient first and deal with the rest later. When someone reacts to you…you're not responsible for their reaction."
The door opened. Another nurse walked into the room, "I had to tell you, look at this order. That doctor ordered a medicine to make the patient urinate and he ordered some blood too. I just thought I'd tell you."

It was over except she still felt ripped apart and degraded in front of an entire staff of people. She wouldn't be able to teach there and still have the respect of the staff. Her students didn't want any part of that hospital. They all had the smell of the place deeply imbedded within their minds, but more importantly, within their hearts. They were afraid this would happen to them. If their instructor who had helped all over the floor, who had offered information at every request, who rallied when the floor was short staffed could be treated like that then how would they be treated as new graduates? None, they decided, wanted to find out.