On Your Feet, Nurse, the Doctor’s Here!

Should nurses give up their chairs for physicians? A nursing professor named Susan Kieffer writing at NurseTogether.com thinks so:

If you have been a nurse for any length of time, you know how precious the seats at the nurses’ station really are. These seats are a rare commodity; one to be cherished and guarded once you snag one. It is also true that the coveted chair can be very revealing regarding the professionalism of the person occupying it.

Uh-huh. Kieffer goes on:

I will pose to you a question that I recently asked a class of students: registered nurses who are taking their first course in their journey to their bachelor’s degree and are studying the art of professional nursing. Many of them have been practicing nurses for 20 years or more. Here is my question to them: “As a professional courtesy, would you willingly and gladly give up your chair at the nurses’ station to a… to a… wait for it… a doctor?”

The old is new again

Really?

Kieffer goes on to argue that nurses are bigger than their ownership of their chairs by a mile. In other words, we’re better than those nasty physicians, even when they are nasty to us. I call Kieffer’s argument The Chair Strategy for Recalcitrant Physicians:

So, here is the point that I wanted to make with my students and will do so here as well: I believe that giving up that chair to the doctor shows the utmost in professionalism, courtesy, and confidence.

[SNIP]

Can we not be confident enough in our abilities and our practices that we do not feel like we have to prove ourselves by remaining seated while the physician stands? If a nurse gives up his or her chair at the nursing station to a physician, maybe even the very doctor who was disrespectful a few minutes ago, I believe that it shows that the nurse’s professionalism is a notch above the norm. It’s like taking the high road in the midst of mistreatment. Such professionalism could go a very long way in increasing the respect given to us in the health care community. Who knows… maybe our example will eventually lead to a physician offering his or her chair to US!

I know many of you are now rolling around on the floor in a display of unrestrained mirth. But stop it. Right now. This is a serious question, posed by one of our nursing betters leaders. And I will offer a serious and considered response.

My short answer is not only No, but Hell, No.

Two reasons: first, though I do have a streak of unreconstructed idealism a mile wide, I am not so naïve to believe that the Chair Strategy will ever cause physicians to respect us more. There is not enough Pollyanna in the world to make this possible. It isn’t as though physicians spend their sleepless nights agonizing over the burning question of Disrespectful Nurses. In any case, why (insert eye-rolling here) are we obsessing over what physicians think of nurses anyway?

And the Chair Strategy as the cure for bullying physicians? Please. Good physicians treat nurses professionally, with dignity and respect. Their opposite numbers are only going to be encouraged by subservience. Such physicians need to be called on their behaviour by assertive and confident nurses and if necessary reported to higher authorities, not coddled and enabled to be bullies.

My second reason has to do with the paternalism implicit in Kieffer’s article. I am not old enough to remember those halcyon days when nurses rose to their feet when the physician (in all of his god-like powers) entered the nurses’ station — no nurse would ever sit in the presence of a physician, God forbid — and when the charge nurse followed him on rounds, to open the door to ward rooms and take orders. But I am old enough to to have been educated by nurses who did remember those days, and their memories were not fond. The point of all the sitting and not sitting, giving up of chairs, and attending the physician like a pug dog follows a child was not “professional courtesy,” but a reminder of the power relationship between physician and nurse, and the place of nurses and nursing in the hospital hierarchy.

Kieffer misses this point. She ignores the obvious symbolism, that who gets to sit and who doesn’t speaks directly to hierarchy and deference to superior authority. Nurses who robotically and without thought give up their chairs are implicitly saying, “Here, doctor, take my seat, because what I am doing can hardly compare to the importance of your mighty role in the provision of health care.”

Let’s put this in practical terms: if I am sitting in the nurses station, I am charting or otherwise doing something requiring the convenience of seating. I am not going to offer up my chair to a physician qua physician for her or his convenience. The reason for this is simple: I have work to do. Which in the scheme of things, is as about as important for overall patient care as any physician’s. If you believe what you do is somehow of less importance or insignificant compared to a physician’s, by all means give up your seat. (Neck rubs for said physician are optional.) If you believe your time and convenience is at least as important of the physician’s, kindly yet firmly direct them to the consultants’ room — or any other alternate seating.

I will grant Kieffer this: she is right on the larger issue of professionalism. If nurses are sitting around texting or Tweeting or drinking coffee while looking over catalogues, by all means move if a seat is required. But that’s just common sense and courtesy, and not restricted for physicians alone.

One last point: does anyone know why, exactly, we are talking about nurses giving up their chairs for physicians, in this the year of God’s grace, 2012? Does anyone actually think Kieffer is correct?

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  1. #1 by pat on Tuesday 10 April 2012 - 1133

    3 months ago while sitting at the Nurses station with 9 charts stacked in front of me a MD stood behind me and cleared his throat 3 times , when I finally acknowledged his attempts to get my attention he stated ” I would like to sit down” my reply “ok as soon as I am done its all yours” . He then asked “and when will that be” It took all I had not to say when hell freezes over but smiled and stated when I have finished writing notes for 6 pts and documented 30 meds .

    2012 in New York RN’s who are working at the NURSES station do not give up seats for MD’s. Would it be acceptable for me while working a overnight to go catch a nap in one of the MD on call rooms?

  2. #2 by Anonymous on Tuesday 10 April 2012 - 1244

    Sorry, but I don’t see giving up a chair that you are already occupying to be less than professional. Now, running at full tilt across the nurse’s station, hip checking a doc out of the way, and then sitting down, THAT I could see as unprofessional.

  3. #3 by David on Tuesday 10 April 2012 - 1420

    Definitely agree all nurses should give up their seats for doctors. One reason is that their feet might be sore. As an extra courtesy foot massages should be offered and, while you’re down there, shoe shines (if required). Also, nurses of color should always give up their seats to white nurses.

  4. #4 by torontoemerg on Tuesday 10 April 2012 - 1509

    I’m sensing some snark here.

    Oh well, bring it on :)

  5. #5 by @marcoboochi on Tuesday 10 April 2012 - 1613

    I do not think that Kieffer’s theory is entirely correct. To use an anecdotal reference, Professors generally do not derive solutions with real world applicability in their most basic forms. Moreover, quid pro quo only works when all parties are in agreeance. I do think that you are right in your thinking. If I am sitting down and working then no you will not get my chair. However, if I’m not doing anything productive then I wouldn’t think twice about giving it up. As you said this is (well SHOULD) be common sense but from my ER experience common sense isn’t common after all.

    • #6 by torontoemerg on Tuesday 10 April 2012 - 1829

      I had forgotten about the quid pro quo element… elementary games theory….

  6. #7 by gregmercer601 on Tuesday 10 April 2012 - 1747

    As a Psych Nurse I know likely rationalization when I see it. Kieffer seems to be spinning an elaborate explanation around a simple but uncomfortable situation. On the one hand, Physicians have no reasonable reason to expect a chair from anyone. On the other hand, for many Physicians and Nurses, there is a nontrivial probability that the decision to keep or cede the chair or anything else a Physician wants will have significant professional consequences: neither fair nor right, but certainly real given the power differential and egos involved, and Nurses’ typically poor willingness or ability to stand up for each other. We can spin a nice story about how giving in makes you the bigger person, but the real story here is that ugly one of power and the real potential for abuse. The decision is not about setting a civil example: it’s clearly about whether standing up for oneself and one’s dignity and rights is worth the risk. Otherwise no one would waste their time on what on the surface (if we ignore that underlying tension) a trivial issue, would we?
    Personally, I have no set answer: sometimes I cede my seat out of courtesy to someone I respect and like, or when I don’t really need that seat in any case. Sometimes I don’t, when respect is lacking or not reciprocated. A Physician who calls my bluff in such a case invites whatever embarrassment they’ll experience when their demand gets them nothing, and it rarely happens any more. I work in a teaching hospital, and I consider part of my duty to Nurses everywhere to teach Physicians in training that respect for Nurses is not optional and the alternatives unpleasant enough to avoid. I wouldn’t work anywhere where other considerations came into play, and fortunately I haven’t had to. Second class existence is not worth any pay scale I am likely to receive anywhere, although I fully respect that other’s options, needs, and priorities mat dictate otherwise.

    • #8 by torontoemerg on Tuesday 10 April 2012 - 1828

      “We can spin a nice story about how giving in makes you the bigger person, but the real story here is that ugly one of power and the real potential for abuse. The decision is not about setting a civil example: it’s clearly about whether standing up for oneself and one’s dignity and rights is worth the risk.”

      I think that hits it on the head, Greg.

      The funny thing is that I half-intended the post to be snarky… but even as I wrote it I realized there are bigger issues.

  7. #9 by Jennifer Olin, RN on Tuesday 17 April 2012 - 2254

    I may give up my chair, but stay off my computer. I work in the OR, most rooms have two, don’t get on mine. Besides the fact that I am in the middle of charting, collecting dropped instruments, and counting to make sure you didn’t leave anything in the patient, I’m not done. Just because the monitor isn’t on doesn’t mean it doesn’t work. And, please, don’t ask if I’m finished. You know I’m not. Physicians at most hospitals are provided work space; it may be petty, but this is mine. And, since the doctor wants a quick turnover, stopping me from getting my work done only delays yours. It is a sign of disrespect and I’m lucky most of the Docs I work with don’t do it. However, the residents and fellows are another story. Attendings, please train, I shouldn’t have to.

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