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Not the Doctor’s Assistant


You probably have the same perception.

That nurses are just but assistants to the doctors.

The Yayas.

The Chimays.

The Utusans.

The Aliping Sagigilid.

(insert other derogatory descriptions you would call a nurse here.)

Pardon the exaggeration on the first few lines but allow me to expound on that claim in a while.

I was reviewing my brother weeks ago about their lesson on “Community Helpers”. It was a thin pamphlet on the different jobs that people do in the community. You probably know the drill on these types of lessons. The students identify the job based on the description indicated, vice versa. Things were going quite well until we got to the item about the nurse. I knew back then that what I saw would readily feed my next blog entry. I just had to take a picture of that specific number.

Here’s it is:
some text

No wonder why society looks down on nurses! It’s probably because even in the primary level of education, they had been accustomed with the idea that nurses are assistants to the doctors, that they are inferior to them. That they are sunod-sunuran to whatever the doctor orders.

This notion may be traced to the early history of the nursing profession when nursing was viewed as a vocation with their actions being limited to what the doctors instruct them to do so. This was the scenario until Nursing finally became a profession and later on developed its own organized body of knowledge and scope.

From my three and a half years of taking up Nursing at the UST, I was in no way acquainted to this ridiculous idea of being an “assistant” to the doctor. We were taught that we are an independent profession that focus on the more humanized aspect of health care. Yes, we may collaborate with doctors on the medical management of the patient but nurses clearly do more than work on the disease’s pathophysiology!

What I’m trying to say is that although assisting the doctor may be part of the responsibilities of a nurse, it does not constitute their entire scope as professionals. In R.A. 9173 or the Philippine Nursing Act of 2002 it is stated that the functions of a professional nurse are as follows:

(a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established;

(b) establish linkages with community resources and coordination with the health team;

(c) Provide health education to individuals, families and communities;

(d) Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and

(e) Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice;

As far as I’ve read and studied in my Professional Adjustment subject, there was no single line that mentioned about nurses in the same light as the textbooks would put it.

Sometimes it pains me to see some staff nurses panicking when a doctor arrives. One of our clinical instructors, who our group dearly call Mama V, would tell us that “Hindi kayo utusan ng mga clerks (4th year medical students).” And I loved her for that. If the nurses themselves won’t stand up for their profession, who would?

As stated in the Philippine Code of Good Governance,

” No one group of professionals is superior to or above others. All professions perform an equally important, yet distinct service to society.”

READ: NO NURSE SHOULD BE AN ASSISTANT TO ANYONE.

Let this be a call to the Philippine Nurses Association to look into the erroneous descriptions of nurses on text books and other educational paraphernalia. I believe that this issue, albeit small, directly affects the society’s perception on the profession and thus must be addressed immediately.

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  • alvinism

    Nice blog. this helps uplift the morale and persona of being a nurse and the profession as well. But anyhow, we can’t escape to that stigma because, in reality, nurses really assists or collaborates with the doctors – i mean most of our actions (in hospital/clinic settings only) usually depends to doctors orders. lets face it, nurses carry out doctors orders, or else we will be sued for abandonment of work or if do chemo treatment to the patient without the knowledge of doctors, we’ll be facing malpractice.. The important thing with the profession, never rely solely to the doctor’s orders. one may disobey him as long as the nurses know the right thing.. and always do the independent nursing functions, it’s not always giving medications or carrying out doctor’s orders.

    • http://www.minimalistsense.com RJ Naguit

      Of course, the nurses can always question the order of the doctor if one thinks otherwise as long as there’s evidence to back it up. Evidence-based practice ika nga. Probably a better term is to “question” rather than disobey. :)

  • YM

    It is not an erroneous description of nurses, it may not be a complete definition of your job description (you did, after all, used a kids’ book as reference) but certainly not erroneous. All of us do need to finish a college degree first to get a good grasp and full knowledge of our chosen field. You can’t really expect a child to know every scope of nursing, medicine, engineering, etc.. Perfect example is the item below nursing in the textbook you used, you can’t really say that the teachers’ ONLY responsibility is to teach kids new things. Teachers play as second parents, disciplinarians, role models, inspirations, friends, etc. So relax and don’t get yourself upset over this :)

    • :)

      haha! I think so, too! :)

    • http://www.minimalistsense.com RJ Naguit

      You have a point there. :)

  • mrs.chide

    ..i think you are making so much fuss about what the book stated. It says the Nurse assists the doctor,there is nothing wrong with that. You being somewhat offended by that is saying you being so unfair to other professions like i.e “Assistants”. You do not want to be a subordinate to a doctor but obviously thinks being called an assistant is an insult. You as a nurse should keep in mind that giving assistance to people that needs it is not something you should feel bad about. It is an Honorable thing to do. Sometimes pride gets in the way.

  • http://narsako.wordpress.com/ Nars A. Ko

    excellently made. Good job!

  • Dr. Paul Dexter Santos

    hmm..this is the kind of nurses that makes the relationship between a physician and nurses worse than it is..whats wrong with seeing that page on a textbook..majority of a nurse’s job is to assist in the management of a patient and to carry out the doctor’s orders..so i would just like to ask what do you think are the nurses doing whenever they FOLLOW whats written and ORDERED to them at the doctor’s orders?and one thing what does clerks (junior interns) are for you?what is wrong with following some orders from them when they are to become doctors..it is your job to follow their orders..and what would you do without the doctor’s orders?dont feel bad about hearing some statement where there is truth to it..and one last thing nurses wont learn how to take care of a patient without a doctor’s orders..

    • http://www.minimalistsense.com RJ Naguit

      What I’m trying to point out in my article/blog entry is that nurses are not ONLY assistants of the doctors. Yes, nothing wrong with following the doctor’s orders since it is PART of our responsibility. Following legitimate orders from clerks is really okay, but not to the point that even their responsibilities are delegated to the student nurses. I probably have stated that vaguely.

      • cmaty

        so whats wrong when clerks pass some of their responsibilities to student nurses? is it not skill more to SN’s when they get more responsibilities? is it practical for example to get the VS twice just because the clerk cant ask the SN to do it for him?

        • http://www.minimalistsense.com RJ

          Nothing really wrong about it. But when the clerks start to abuse it by doing it all the time, dun na hindi nagiging tama yun.

          I think it’s very impractical to take it twice. probably the best way to go is salitan na lang pagkuha ng VS since it’s a shared responsibility by the clerk and the SN. That way the learned skill is also shared. :)

          • cmaty

            un nmn pla eh, i dnt know how clerks can abuse SN’s, are they asked to make histories for the clerks? are they directly asked to drain the UO or NGT?

            Salitan nga ng VS may maririnig k naman na comments…

            And we may not be ordered by SN’s but are you aware of SN’s stealing clerks’s histories and copying them for reason i dnt knw why, i mean im not familiar with thier requirements but come on, alot of my collegues repeated thier histories because it “wasnt” inserted? is this not a form of indirect abuse?

            I rest my case here, but i think its also unfair to say clerks delegate thier reponsibilities when i dnt think they even have too much interaction to begin with to delegate responsibilities

  • j

    it is a good article but i think it depends on how the professionals treat it and know the meaning of a health care team,we had different roles to attend in our patient, i am also a nurse who passed the boards last 2006, during my early years as a student we were trained and was instilled to our minds by our mentors that we were at the same level of the clerks, some of us will agree on it based on the skills we learned during our training years, the clerks will just learn it during their 4th year level when their 36 hours of duty comes. Kaya nga proud tayo na we are the first line care of patients db :) I work as an icu nurse for 1 year, i did not t have any bad encounters with the clercks or interns, they treat me well i treat them well,its just give and take relationship we were on the same team d ko sinunod ang payo ng mga mentors ko na we are much better than them para sa akin parehas lng cguro at that time we are much better on the skills pero sila theorethical magaling. I say this because i experienced it both. iIdecided to took up medicine last 2007 im on my 5th year level as a medical intern. Last year it bothers me kasi im a clerk, why do the other nurses still treat the clercks that way they try to pick some clerkcs they know that can be bullied well im not one of them because i instill in them before my clerckship starts that before i enter this medicine course im am also like u you guys a nurse, there is also a time when it suddenly ring my ears when one of the nurse expressed “Dapat hindi ako nag lolog ! dapat mga clerks/ji, hindi ako nag aral ng apat na taon para gawin to dapat sakanila! Would you beleived that? how about those people who took up medicine course it? before they will have their degree of medicine, they will have to take 8 years! another instance, as a medical intern we were titled to be a doctor already, but some of our beloved health care team calls them/us Intern intern intern! pa to follow! sana man lang gnwa nila sir/mam, thats a much more professional way kung ayaw nyo tawagin na doctor! some us think that before you become a doctor you should pass the boards, that’s wrong… bakit un mga nag doctorate ng education, or ng philosophy? ano twag pagka graduate? dba doctor?! e bakit ganun pag mga mga medical interns nkuha na nila title para maging doctor db. cguro d pa pwededng tawagin as licensed physician db. there are incidence that those clercks or interns will also fight back intindihin nlng din. Kung tayo ngnag mga nurse sa straight na 16 hours duty natutuliro na, un mga clercks and interns kaya na 36 hours cguro tulirong tuliro na at bobombahin pa ng mga residente at consultants. Well im just trying to put up two side of it, meron mga clercks and interns na mayabang din dahil sa status nila. kaya minsan d nadedefine anf meaning ng health care team kasi the two most important professions in the hospital or the two noblest and greatest in need un pa ang nag aaway. sana let us put our prides aside and magintindihan nlng tau, wala naman di nakukuha sa matinong usapan eh. on the both parties let us put our prides down so that we can perform a much more holistic care for our patient.

    • http://www.minimalistsense.com RJ Naguit

      That’s a nice narration of your experience. At least you got two experience two sides of it diba? Of course there will be therapeutic and non therapeutic nurses. Same with doctors that’s why I try not to generalize and keep an open mind. :)

  • nes

    when we were in college one of my instructress always instill in us that we are not the so-called “alalay ng doktor”, in the Nightingale pledge it was mentioned “to aid the physician…”, yes we work independently, interdependently and dependently. i think here in the Phils it’s a notion that nurses are just followers of physicians.But we have our own mind, pero dapat hindi din nag-mamarunong, we can always ask, or question them or refuse to do such action for instance. i remember when i was a student there was this surgeon who is scaring the hell out of me to give this particular medicine to the patient, i refused, i told him, my C.I must know it first before i give it. i was just protecting myself and so is my CI.wala cyang nagawa but then he definitely got the idea.

    • alvinism

      tama lng yun. no nursing students may admimister meds in any route without the CI’s presence or knowledge. u got the best trait of a good nurse: ur common sense! :D

      • h

        too bad the author of the article doesn’t…

        • http://www.minimalistsense.com RJ Naguit

          Paano mo nasabing wala akong common sense?

    • http://www.minimalistsense.com RJ Naguit

      I completely agree. :) I am not certain when the nightingale’s pledge was made but it’s also worth considering that it probably was done a long time ago when nursing practice was still archaic and still completely dependence on the doctor. I still agree that although it may constitute part of our duties, it does not constitute the whole thing. :)

  • wtf

    let me make one thing clear. i have nothing against nurses. i think your job to be a noble and honorable one. but this article… tsk tsk. this is EXACTLY the reason why doctors and nurses don’t get along. not because of nurses per se, but because of nurses like this. first, so what if the CHILDREN’S WORKBOOK said you assist doctors? is it because it described the fireman as “a well-built courageous man or woman with outstanding constitution, incredible fortitude, and saint-like disregard of their own well-being that serves as the front line of a nation’s battle against raging infernos, accidental and deliberate alike”??? yeah, i totally get where you’re coming from. that description is too much! not all firemen are well-built after all, right? why would they expect a CHILDREN’S BOOK to spout such shallow and misguided nonsense?! second, yes, you do have your own minds. yes, you can decide for your own. but inside the hospital, these precious decisions of yours are all ultimately dependent on the physician’s orders. you can’t just use semantics in getting around that fact. you also mentioned nurses not being under clerks. this is true. but that doesn’t give you an excuse to treat them like crap. they are students, yes, but post graduates. they will, after all, very nearly have one whole degree more than you. so treat them as such. this especially goes for those higher than them. those who already do have AT LEAST one degree more. interns are not waiters. residents are resident DOCTORS. when you treat them with blatant disregard for their situations, please remember these things: (1) their work hours are at least FOUR TIMES LONGER than yours, wherein they do actual TIRING WORK. (2)they still have reports, lectures, exams and activities – for which they have to study and prepare for – where they are required to be at their sharpest and remember everything they’ve heard and seen for the past 3-8 years, even after working four of your shifts straight. (3)they are often asked to be in 2 places at once. so if they seem agitated or in a hurry and not bow and kiss your feet, please cut them some slack. they have other feet to kiss. which brings me to my last point. you said nurses should not be assistants to anyone. okay, so nevermind that you just used the word “ASSISTANT” as an INSULT. so for all the assistants out there…. anyway, what the children’s book says is correct. there is no denying that fact. nurses do assist physicians in treating patients. and since you seem to have an unhealthy obsession with semantics… nurses do assist/aid/support/help/cooperate with/collaborate with/reinforce the methods of physicians in treating patients. i apologize for running out of terms off the top of my head.no, you don’t manage the patients. you support the doctors’ treatment plan. you carry out their orders. very often you serve as the bridge between patient and physician. these are VERY IMPORTANT ROLES. and i don’t, for the life of me, know why you just have to get your panties in a wicked bunch over these facts… you even brought up the nursing act when your entire argument is moot. you DO assist the doctor in healing our sickness. now, when another children’s book calls you something else – something not true – feel free to rant about THAT and stop trying to sound like you know what you’re talking about.

    • cmaty

      well said, better than what i was about to write, ill just add something, if a nurse believes they can manage patients better than doctors then be a DOCTOR, at the end of the day even if for some reason the doctor is right or wrong its his call to make because the responsibility is on his shoulder, and may i correct something, i have always believed that clerks/JI are not under the nurses,they are a separate leg of hierarchy, nurses on nursing while clerks are on DOCTORATE leg, interns are those who have successfully fullfilled at least 4-5 years of doctorate/post grad studies, such that a nurse has an RN they have and MD, and by this title they are already granted, by law, the title to be called DOCTORS at par with Ph.D ( Doctors of Philisophy) who are also called DOCTORS. most of the time interns are just… interns but on a personal note i dnt care what they’re called so long as nurses give the respect due of a HUMAN… nurses takes care of how many patient per floor? interns takes care of how many patients per building? or the whole hospital? still think you “better” than doctors? then i dare you to be one, i thank you (bow)

      • http://www.minimalistsense.com RJ Naguit

        I didn’t say that we we’re supposed to be “better” than doctors.

    • http://www.minimalistsense.com RJ Naguit

      First of all, I haven’t written anything about clerks being under nurses thus being worthy to be treated like crap, their workload, their duty hours. Please stick with the topic.

      Being an “assistant” and another profession being labelled as only an “assistant” is a different thing. The difference may be subtle but is really worth noting as it affects the image of the profession. I did not, in any way, wanted to offend those with assistant positions.

      • cmaty

        to put it in a nut shell i think this blog shows how insecure nurse can be to doctors

        you dnt want to be called assistants, fine, you just dnt assist it not the entirety of you profession, fine. if you’re made to monitor VS or give the meds is that not a from of assistance? let me ask, if your not to assist doctors then what are you to do that does not overlap a doctors responsibility?

        what i see here is lack of pride in the nursing profession, lack of self respect, forgive me but thats how i see it, i dnt see whats wrong with being “assistants”. take this for example, lets say nurses dnt assist doctors and they just get “doctor’s assistant” to give meds to monitor VS to be scolded on to be the yayas’ as you coined it, then what are nurses to do? the other responsibilities enumerated in the nursing act of 2002?
        i dnt get y you get scared whenn the doctor makes round if havent done something wrong.
        I think the book your quoting is just lost for words in describing your profession, your right your not assistants, but if its the closest adjective they believe is easier to use for children to understand then i see no problem. no ones calling you yaya’s and i believe doctors never even thought of you as such, you may just feel that way and started coining the term on yourselves. assistance may not be the entirety but it is still part of it. if a day comes i become a yaya i would be proud to be one and when someone looks down on me i will not take offense because i do the best of what a yaya does, by then this article would never have been written

  • Dr. Paul Dexter Santos

    and one last thing..this is a stupid blog that shows what kind of a nurse are you.

    • http://www.minimalistsense.com RJ Naguit

      Paano mo nasabi na stupid ang blog post ko?

  • pinoyRN

    Oooh, I just stumbled in on this article and wish to put my two cents in. One, as a Nurse, I so see what the writer meant about why she feels the term ‘assistant’ seems insulting. I’ve worked as a Nurse sa Pinas and honestly, comparing how the residents and doctors treated Nurses there as opposed to where I am today, is quite different. Assistant meant more as alalay or utusan or ‘sino-ka- para-kwestyonin-ang-order-ko-ha?-nagtapos-ka-ba-ng-10-million-years ng-med-school-basta-gawin-mo-yan-period!’ I don’t know how it is now but that was how it was on the ward I worked at. Granted not everyone one of them was that way, but majority of the docs I worked with had rather archaic ideas. Heaven forbid kontrahin mo sila or depensahan mo yung action mo pag hinde ka nila ni-reklamo sa supervisor (or in my case Madre). Can you blame the writer then for looking askance at the term ‘assistant’ when their experience maybe was of the ‘a nurse should be seen, not heard’ type?

    Where, I’m working at today, I don’t consider the term ‘assistant’ to the doc a derogatory term as it means more of me ‘assisting-each-other-as-part-of-the-medical-team’ to care for a patient. Being the one who works more closely with a patient, doctors, residents, interns, etc, value my opinion as a Nurse. I can make suggestions, question orders (especially of newbie residents), carry out independent nursing functions. In fact, doctors rely on my judgment and skill as a Nurse in making their patient’s better. Ibang-iba from back home. The term ‘assistant’ = ‘collaborator/team-mate’. So yeah, I do understand where the writer is coming from and I don’t think its right for us to criticize their common sense or what kind of nurse they are, lalo na po yung mga doktor or intern na nag-comment. Let’s keep it constructive guys.

    Two, those comments about “I dare you to be one (a doctor)”, don’t you think that’s out of place? Minsan, its not a matter of whether we are afraid of being a doctor, or don’t have the smarts for it but more of we ‘don’t have the money for it’. I know we didn’t have when I was growing up. I once told a Resident friend back home when I was so irritated with her cocky colleague that the only difference between him and me was that my parents didn’t have the money to put me through med school, that was it. Not brains, not skills, not passion, just plain old money (or lack thereof). :D Now everyone, please let’s all try to get along and work together. After all, its the patients who are important, not us.

    • cmaty

      one, as i’ve said this is all a matter of perspective. since you mentioned that assiting is being part of the medical team i thank you, not many people thinks that way. your right, theres no problem with questioning orders but you see most of the time some nurses do not simply question, they persist in their opinions. tama ka naman eh, doctors do value your opinions but when it crosses the line awat na, if a doctor dismisses the opinion then dnt push it. ang dami kasi ng tendencies na pinipilit pa ang disproven na. Medical team. we have our roles and responsibilities lets stick to it. you have suggestions, say it, if accepted fine, if not then hndi dnt feel bad because yes nagtapos-kami-ng-10-million-years ng-med-school as basis not to accept whatever suggestion were made. Doctors are theories nurses are the practical/hands-on approach. They both learn by experince as well but doctors do still have 10 million years added exclusive theoretical background. feeling ko kasi minsan sa dami ng experience ng nurses is when they start to have more questions, which is ok but still diba experience is different from theories. decisions based on gut feeling is a little dangerous than gut feeling with some learned facts however newbie a doctor is. at the end of the day its not simply because its the doctors call but rather the doctors neck thats in line. its their responsibility, captain of the ship principle. when nurses makes mistakes its not simply “ngkamali” yung nurse directly but responsible parin ang doctor, kargo parin nya, reflected parin sa kanya. in as much as i want this to be constructive i cant. because wla akong nkikita sa article but how bullies doctors are and how poorly nurses are treated. and i knw those supervisors your talking about, judging from this article we are thinking of the same place. i try to understand where your coming from, baka naman i just have biased opinions. i do have classmates who were nurse turned to doctors and i ask them these arguments time and time again to understand you perspective, but i guess you’ve read all the comments here, one made by an RN,MD., and even he has concerns, have you read them? better yet have you tried to understand them? which brings me to my next pooint

      two, i made the “dare” statement and by all means this has nothing to do with money, its true medicine is expensive, but i have classmates whose parents were poorer than farmers, and thier doctors. i find that saying lack of finances should not hinder anyone’s dream. money is hard to find, not impossible. i knw a med student who has been in med school for 6 years due to finances. she works every other year to sustain every other year of schooling. now shes a doctor. money never stopped her. no one is too old for being a doctor, too old for learning. they say it takes one to know one, and that one protects his kin. so i “dare” you to be doctors to see from where were seeing. view things from the “top”, as this blog implies, not to throw rocks but to feel what we perceive. again this is simple perspective. imagine yourself owning a house and hiring a proffesional interior designer and you quarrel over the best paint color for your room and he insists on it rather than what you would prefer, would you not at some point have this feeling that “this is MY room, my CALL”? How can a team work perfectly is when the head makes decisions and members go for mutiny when their feelings are disregarded? similar to the story of when the body parts held mutiny on the brain which did nothing physically and just kept giving orders and that they were tired of just following it, remember how it ended?

      Pride, role, place, perspective, acceptance. like the body we have our own roles, some are higher some are at the bottom but all equally important. as soon as this is realized, the sooner things will be better.

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