By Brooks Peck
The U.S. began their campaign for their first Women’s World Cup title
since 1999 on Day 3 of the tournament and they did it in a new kit. The
women are once again in their usual all-white home strip. But the new
design, worn in their opening-match win against North Korea, already has
some fans saying that it looks like a nurse’s uniform. (more…)
On Salon.com, a doctor asks a nurse about tension between doctors and nurses…
By Rahul Parikh
Not long ago, nurse Theresa Brown wrote a provocative Op-Ed
in the New York Times about the tension between nurses and doctors.
“It’s a time-honored tradition,” one doctor sniped at her, “blame the
nurse whenever anything goes wrong!”
Publicly airing this friction opened Brown up to sharp criticism.
“Drawing and quartering your coworkers in the Sunday New York Times
might be run-of-the-mill for politicians. I’d like to see something
better out of doctors and nurses,” wrote one physician over at the Atlantic.
But don’t count me among her detractors. Brown used her story to
advocate for civility in medicine. Mutual respect, she correctly argued,
would improve teamwork and the care of patients. Her essay raised a
question far more important than who was right or wrong: If both nurses
and doctors want to make their patients better, why is there so much
conflict and controversy between them? And how do we do a better job of
working together? To help me answer these questions, I asked Theresa
Brown herself.
Before I get to that, it’s useful to understand the cultural
underpinnings of the doctor-nurse relationship. In one sense, nurses
have spent the last half-century fighting to overcome the stereotype
that they are defanged doctors. It’s a division rooted in education,
income and gender. Doctors — men, affluent, with a professional
education — reigned supreme in the hospital. Nurses — female,
working-class, with a trade school-level education — were their
handmaidens. This stereotype is probably something you would expect to
see on a vintage TV medical drama, though critics point out that it still is the norm on contemporary shows like “Grey’s Anatomy.”
Despite the rigidity of that power structure, nurses smartly honed
their own skills of influence. This was best described in 1967 when a
psychiatrist named Leonard Stein published an essay called “The Doctor-Nurse Game.”
“The nurse is to be bold, have initiative and be responsible for making
significant recommendations, while at the same time be passive. This
must be done in such a manner so as to make her recommendations appear
to be initiated by a physician,” Stein wrote. If a nurse didn’t play
well, she was “a bitch,” or “unconsciously suffering from penis envy.”
What changed between then and now? In 1990, Stein published “The
Doctor-Nurse Game Revisited” to answer that question. The public lost
confidence in doctors and medicine (something I’ve addressed before in this column).
There was a rising demand for nurses, and the profession evolved into
one with specialties (pediatric nurses, ICU nurses, etc)
That’s the context in which I approached Brown. Why, despite all of these changes,
does so much tension fester between doctors and nurses? Brown holds a
Ph.D. in English from the University of Chicago and she also wrote the
book “Critical Care: A New Nurse Faces Death, Life, and Everything in
Between,” recently out in paperback. As you might expect, she is
articulate and smart. She is also warm and introspective and, despite
what her critics say, does not have an ax to grind. She has written just
as strongly about bad behavior between nurses.
Brown answered the question by talking about the way nursing
education has changed. In the past, nursing schools were based in
hospitals, which put students directly under doctors’ influence. While
that no doubt perpetuated the doctor-nurse game, at least it exposed
both groups to each other. But over the past 40 or so years, nursing
schools have become university-based. “Nursing school was now
independent of doctors,” Brown explained. “Yes, we are taught to be
patient advocates, but we are also taught to be a check on the doctor.
The problem with that is we’re only taught to see docs as adversaries,”
she told me. An essay by a nurse in the British Medical Journal
echoes this idea. “Nurses have been indoctrinated with the belief that
doctors are capable of exercising only a cold, scientific medical
model,” she writes. “They treat the disease, not the patient. Nursing
literature is full of anecdotal accounts of the distant approach that
doctors have towards patients and their careers.”As a result, Brown admitted that nurses “never get a good
understanding of the stresses and strains of what it’s like to be a
physician.” I told her that medical school provides next to nothing in
terms of how nurses approach patients either.
“If that’s the case, how do doctors and nurses learn to behave and
negotiate with each other?” she asked. I didn’t have an answer, but in
reflecting on what she said, I realized that over the years, I hadn’t
made much of an effort to understand nurses myself. As a resident, for
example, I never read a single note in a patient chart penned by an R.N.
— a “care plan” as they’re usually called. They seemed extraneous to
me, and doctors have argued that they don’t impact their care of
patients. But had I read them, I may have been able to bridge at least a
small divide between me and the nurses who cared, side by side with me,
for my pediatric patients.We compared other notes. What do nurses want from doctors? I asked.
“Respect, a willingness to listen even when we’re bringing up something
stupid, a sense that we’re on the same team,” Brown replied. Doctors
demonstrate a great deal of variability in all of those things. Again,
though, we agreed that this variability goes both ways. I’ve worked
with, and continue to work with, amazing, caring and competent nurses.
These are the R.N.s who would be my first-round draft picks, even over
other doctors. On the other hand, I’ve been driven nuts by nurses who
consistently botch a patient’s care plan, misinform parents about their
child’s health, or simply refuse to do what’s needed of them.
That brought up the next question: Can doctors and nurses hold one
another accountable without picking the scabs off old emotional wounds?
Her suggestion was that if there’s conflict or a mistake made, debrief
together. “Be honest, say what happened, work together to solve a
problem.” One way doctors do this is by having regular “morbidity and
mortality meetings,” where individual cases are discussed and the
physicians involved are asked to explain why a patient was hurt or
another bad outcome occurred. Nurses are not part of that process, and
the tendency among them is to “just say something bad happened, not talk
about it again.””If we really want parity and respect we also need to be held
accountable,” she said. In principle, Brown has a point. In practice,
the jury is out on how doctors and nurses can hold each other
accountable when their skill sets are complementary but still very
different.
Brown and I both agreed that bad behavior between health professionals (be it between doctors and nurses or even between doctors and other doctors) is bad for business. In her case, it’s unforgivable that the doctor who
chastised her didn’t have the decency to confront her privately about
any concerns. His goal wasn’t to figure out what happened but, like a
hot teakettle, merely to blow off steam. A recent survey
suggests that this abusive behavior really is disturbingly common among
physicians. That kind of behavior undermines the patient’s confidence
in his or her medical team, and we absolutely need teams to be
successful in an era of medicine as complex as ours.If there’s one hope for both of us, it’s our patients. As one
observer points out, “for decades we understood the professions as a
conventional nuclear family, with doctor-father, nurse-mother, and
patient-child. But our hope for total wisdom and protection from father
is forlorn, our wish for total comfort and protection from mother
unachievable, and the patient has grown up. A new three-way partnership
should displace this vanishing family.”
Finally, I asked Brown which fictional character she might give
credit to for being a more realistic portrayal of a nurse. “Nurse
Jackie,” she said.A foul-mouthed, grouchy drug addict as an iconic nurse for the
masses? Yes, she confirmed. Because Jackie is flawed, fallible and
therefore as human as a nurse can be. I suspect that if all of us,
doctors and nurses, embraced our own flaws, admitted our own fallibility
and realized that we need each other every single day, we would take
yet another step forward at getting better together.
Some nurses are able to 
move past their history of an arrest or conviction to become licensed registered nurses. Getting through the licensing process with a criminal record takes exceptional honesty, patience, and usually the assistance of a lawyer.
RNs often care for people who are vulnerable to abuse and maltreatment, which makes it especially important for state boards of nursing to screen those with a history of violence. Also, registered nurses often handle powerful medications that can be tempting for those with substance abuse problems. A study by the National Council of State Boards of Nursing and published in the March 2009 issue of the American Journal of Nursing found that nurses with a prior criminal history were almost twice as likely to require future disciplinary action as those without a history of criminal conviction.
Nursing schools and state boards of nursing perform background checks on all prospective students and applicants for licensure. This usually includes both a state and federal background check through the FBI. The FBI returns a report with the individual’s history of prior arrests or convictions, if any exist. If the report shows a criminal history, the board of nursing contacts the applicant for more information. The board then makes a decision whether to license the individual, based on her risk to the safety of future patients.
The best way to overcome a criminal history when applying for RN licensure is to be prepared. Request a criminal background check from the FBI at least three months before applying for a nursing license. According to the FBI’s website, the FBI requires the person requesting a background check to submit a signed cover letter, his fingerprints on an approved fingerprint card and the required fee.
If an arrest or conviction appears on the FBI background check, obtain documentation of the case’s outcome, especially if the charges were dismissed or expunged. State boards of nursing generally require applicants to disclose any criminal history on their initial application and will require these documents as proof of the case’s status.
Some applicants find it helpful to retain a lawyer during the process, to ensure that the licensing process goes smoothly. This can be expensive, and not all attorneys accept payments over time. Start saving for legal expenses in advance if you anticipate a problem, and be patient. Boards of nursing decide on these cases individually, and the decision may take some time. A criminal history does not mean that a person cannot become a nurse, but it may mean extra work and extra expenses.
Read more: Can Someone With a Criminal Background Become an RN?
eHow.com http://www.ehow.com/about_5584237_can-criminal-background-become-rn_.html
A Word from Access Nursing 