Post 29 My battle with the nursing sister. Round One

I have the greatest admiration for nurses.  They are wonderful, caring, hard working people who do a great job, often in difficult circumstances.   So I wasn't surprised  when I started my first job as a resident doctor, that I was advised by my consultant to heed the immense experience and wisdom of the ward
sisters and to seek their guidance at every opportunity.    Sound advice indeed; and advice that later, as a consultant, I had no hesitation in passing on to others.

It was therefore, my grave misfortunate that the very first ward sister I encountered was the exception that proves the rule; an exception that provides the basis of this next story.       

                                      -----------------------------------

With hesitant steps, sweat on my brow and fear in my heart, I approached the surgical ward.  I had walked this way many times before, but only as a student.    Now I approached for my first day as a newly qualified doctor.   Although proud that I had managed to fool my medical examiners and qualify, I was nervous; acutely aware of my lack of experience.   The challenge I faced was daunting.   Could I handle the long hours and the stress that the job entailed?   Would I cope when faced with my first medical emergency; perhaps a major haemorrhage, a sudden collapse or, heaven forbid, a cardiac arrest?

Reaching the ward I paused and took a deep breath.   Through the glazed portion of the door, I could see the nurses’ handover  in progress.   This is the ritual  repeated morning and night, on every ward in every hospital in the land on a daily basis.  The nurse who had cared for the patients through the night was informing sister and the oncoming day staff of the progress of each patient.    I knocked quietly on the office door and entered the room.
“Good morning, Sister,” I said politely.   “If you don’t mind I’ll just take a few sets of notes so I can and familiarise myself with some of the patients." 

Sister looked up for a second but then, without acknowledging my presence, indicated to the nurse to resume the handover.  
Obediently she did so.

 “In bed one, we have Dennis Needham.   He’s due to go home today.   A district nurse has been arranged to ........”
Having completed her report on Dennis, she paused inviting questions but none were forthcoming so she continued.

“In bed two, we have Stuart Taylor, yesterday’s gastric operation.  There was a bit of blood oozing from ..........”
I saw a couple of the nurses look in my direction as I waited by the door but Sister continued to ignore me.   It seemed I was invisible to her.

“In bed 3, we have the young lad, Peter Thompson.  Aged 16, he had ...…"
The notes trolley was on the far side of the group of nurses and I couldn’t reach them without disturbing them.    I coughed softly and tried again.

“Excuse me, Sister.”

She looked up angrily.
“Shhh, don’t interrupt.    Can’t you see we’re busy?”

By this time, some of the nurses were looking apprehensive, aware no doubt, that an argument might ensue if Sister continued to ignore me.   But ignore me, she did.
After an apologetic glance in my direction, the nurse continued yet again.

“In bed 4, we have Max Quigley, admitted yesterday with GI bleeding.   He’s only 42 years old and he’s being transfused.   He’s a long history of indigestion and the bleeding is thought to be coming from a gastric ulcer." 
“How many units has he had?”  Sister asked.

“Three so far.”
“And how much more blood is available for him?”

“Three further units but the transfusion is running a little behind schedule at the moment.    He’s unstable and needs careful monitoring.”

I decided that I’d been ignored long enough.   Sister was being obstructive and provocative; my patience was at an end.
  I couldn’t familiarise myself with the patients without their case notes and I couldn’t get the case notes because they were out of reach beyond the group of nurses.

“Sister,” I said, making a move in the direction of the trolley, “if you don’t mind, I’ll just get a few notes and then be out of your way”.
Sister was sitting at her desk facing the door with the nurses from both night shift and day shift in a semicircle around her, mainly with their backs to me;  a mother hen with her brood.  As I spoke, all heads turned in my direction.     I was faced with a sea of 8-10 faces.  Sister’s was red and angry.

“Stay exactly where you are,” she said, her voice crisp and cold.  “Surely you know that medical students are not allowed in my office until 9 am”.   There was just the slightest emphasis on the word ‘students’.  It was clearly an instruction to leave forthwith.
Had she not seen the white doctor’s name badge that I was wearing proudly on my lapel in place of my dark blue student badge?   Or was this a further deliberate snub; an early opportunity to put a nervous new house officer in his place?

“I do apologise, Sister,” I said, desperately trying to remain cool, though my heart was pounding wildly.  “I should have introduced myself.   I have been appointed as the new surgical house officer.   My name is Doctor Lambert.”   I gave a slight but definite emphasis to the word ‘Doctor’.
“Then Doctor”, again the slight emphasis on the word, “if you are new, you need to learn that it is quite inappropriate to burst into my office and interrupt a nursing meeting in this manner.  Please leave and return when the meeting is over.   We shouldn’t be more than 20 minutes.”

I looked at the group of nurses; all faces turned to face me.   Sister’s expression was stern and uncompromising.   Clearly she had decided that she would have her way in this little battle.  A couple of the nurses  obviously found the situation amusing - only managing to conceal their smiles with difficulty.  The more junior nurses looked anxious and I was certain there was sympathy in their expressions. 

This was clearly a watershed moment in my relationship with the Nursing Sister with whom I would be working  for the next six months. I knew that this was not her office.    It was the clinical office shared by all the clinical staff.    I was entitled to have access to the clinical records - it would be impossible for me to do my job without them.  

But why she was behaving in this way?  Was it possible that she had made an innocent mistake, had not noticed my doctor’s badge and had forgotten it was the 1st of August, the day when the new resident doctors arrived?

No, that wasn’t possible!   It was pure bloody mindedness; a desire to show me who was the boss from the very start but it put me in a very difficult position.

Rightly or wrongly and many will think me a wimp, I decided to withdraw.   Head down, I left the room and closed the door quietly behind me.
                                                                             ----------------------------------------------------------------

I had been publicly humiliated but it wasn’t long before the tables were turned.   How Sister was put in her place will be revealed in the next post!


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Comment

I am pleased to say that this proved to be an isolated incident and it has been a pleasure for me to work alongside numerous warm, friendly and supportive nurses during my medical career.

This story is adapted from ‘THE FIRST CUT’ which tells the story of a young doctor's first 6 months on a surgical ward. It is available from Amazon as a paperback or ebook.

Quotation of the day
I’ve never won an argument with her; and the only times I thought I had, I found out the argument wasn’t over.
Jimmy Carter  (of his wife Rosalynn)   1924 …

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This is a copy of a hospital discharge letter to GP:  ‘The patient was admitted. Many tests were performed. Then we sent him home to come again.’

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