Part III: I’m Sorry but I Did Not Get Qualified So That I Can Make Coffee for You

Dental Revelations Blog-

It is (finally!) time for the final part of the series of posts. This time it is of course the nurse’s role in the dental practice which probably is the most difficult one. Here’s why.

Experience Brings Wisdom

The dentist may know dentistry but he does not necessarily have any people skills. Or respect for others. Or ability to feel empathy. This kind of dentist is not fun to work with. Not even close to pleasant.

The nurse needs to put up with the dentist’s whimsy ways and misuse of power. Some nurses might tolerate this for a long time but some do find another job quite quickly. Especially those who are experienced ones.

But having said that, sometimes experienced nurses are allocated purposely to assist difficult dentists. To kind of bring them in the line. And oh boy if the dentist resists the change. He will have miserable time as the nurse tells him off about everything. The dentist’s whining is quickly silenced by the quick-witted nurse who do not tolerate any nonsense.

So the wisest dentists will comply very quickly as it is crucial for the congenial atmosphere of the work place. Plus the wisest dentists understand that the experienced nurses are worth their weight in gold no matter how they seem to disrespect the outdated hierarchical structure of dental practice.

Experience Brings Knowledge

In the Part I of this series of posts I wrote that sometimes the hygienists can have better knowledge on how to treat the gum disease. It is the same with the nurses – especially the nurses with 20+ years of experience. They have stared at people’s mouths for such a long time that they know a cavity when they see one. They can tell if the soft tissues look suspicious or if the filling has sharp edges that would bother the patient’s tongue.

If the dentist is lucky to have this kind of nurse assisting him he should be grateful to have extra pair of eyes looking out for problems in the patient’s mouth. But too many let their ego come in the way of team work (please read Part II for more on this subject). They ignore the fact that the nurse is looking at the mouth from another angle and can see things that are on dentist’s blind side.

Nurse Aka the Barista

One thing I have never understood is that why is it the nurse’s duty to make a cup of coffee/tea for the dentist? Please tell me one good reason why the person behind the title nurse should be considered as a servant? If anything, it should be the dentist making the coffee for the nurses as once they are finished with the patient they can enjoy their lunch in peace whilst the nurse disinfects the surgery’s surfaces and deals with the sterilisation of the instruments.

Another thing I have never understood – which I have already written about on my second post – is the fact that the patients bring gifts to the dentists but not to the nurse. Wine, chocolate, sweets, books you name it. I guess they don’t realise that dentist would not be able to do any treatment without the nurse (well without compromising good quality of treatment).

About Qualification Requirements

You may not need any qualifications to start as a trainee dental nurse.

This is a quote from National Careers Service’s website. It amazes me that in the UK you are still able to begin working as a dental nurse trainee without any qualifications and train yourself on the job. When I began working in the UK over a decade ago the dental nurse did not need to be qualified. Anyone could work as a dental nurse. Any random gal from the street. Seriously.

Somebody who has no clue about cross infection control or how to use all the equipment and materials safely would seriously compromise the patient’s, the dentist’s and the nurse’s own health.

In my current country that I work in the trainee nurses need to have certain modules accomplished before they can work as a trainee nurse. In my opinion this is far better system.

Hard Work Does Not Pay Off

The amount of work the nurses do does not show in the salary. They are very poorly paid and are expected to work on their lunch breaks if the dentist runs late and they are even expected to open the surgery in the morning on their own time.

I will tell you about one of my workplaces I used to work at. In this rather big company the nurses working hours were from 9am to 5pm. This was the time they got paid for. The problem with these working hours were that the patient came in at 9am and the surgery needed to be opened prior to that. All the nurses and the dental hygienists know that if you open your surgery properly it will take at least 30 minutes. Who would want to work 30 minutes for free? No-one apart from the charity volunteers but dentistry is no charity.

This meant that the nurses came in around 8.45am to open the surgery and they cut corners where ever they could. The same happened in the afternoon when the last patient had left. Closing the surgery also should take around 30 minutes but it was often done in less than 15 minutes. Needless to say that something important is left undone.

Pay Enough to the One You Want to Keep

Now on this final chapter I will give an advice to all the dentists who have nurses as employees. It is an advice that will make your practice a success story.

If you think your nurse is doing magnificent job

  • pay her enough money for that. Even more than what would be current going rate of the nurse
  • be flexible and take her personal life into consideration. Show that you care if she struggles with the demands of bringing family life and work life together
  • give her gifts every once in a while. Perfume, chocolate, her favourite music… anything
  • make sure you apologise if you run late before the lunch break. Let her go for an extra break later to compensate the lost time
  • buy her a lunch every now and then – after all you make gazillion times more money
  • make sure you both work in an ergonomic position
  • respect her

These are the only ways to stop your nurse looking for another job. You see every nurse know eventually that there are dentist’s who do value them more. Believe me, I know many nurses who have been rewarded generously by their employer – they have been paid more than an average nurse, they have been taken on board to a course trip overseas (even to Mauritius!), they get extra time off…

You see the dental practice who’s supportive staff keeps on changing all the time is not giving a very good impression to the patients. And that alone can be a reason for them to change dentist.


You might also like these posts:
Part I: Is It a Skyskraper? No, It’s Your Ego
Part II: Just Another Day at the Office

Where it all started

Dental Revelations Blog-2382
Do you know your dentist behind the mask?

There was whispering behind the reception desk when I arrived to work.
“Morning!” I said cheerfully and carried on downstairs to get changed to my uniform.

I was a dental student working as a trainee and was very happy that I was earning little extra on top of my student allowance. There wasn’t many dental practices who took in trainees on those days to work as nurses until they graduated.

I put the uniform on and went upstairs to the reception before setting up my surgery. There were two nurses and a receptionist still whispering as the reception was filling up with that morning’s first patients. I was a newbie but understood that something was going on. Something that made the nurses very annoyed. I heard a word Harry.

One word and I knew what was going on. Even though I had been working as a trainee only for a month, I knew almost all the secrets the practice had. Harry was a dentist and a partner of the practice which meant he had lots of freedom to decide how things were run. He was the one who paid our wages. Or to be precise, he made the money that paid our wages but it was the other partner of the practice, Sally who run the payroll. She had no dental education and dealt with all the finances of the practice.

Harry and Sally had been lovers on and off many years and had had this dental practice in the heart of the city for a long time. It was a very popular practice amongst celebrities who had extensive cosmetic treatment done by Harry. Veneers, crowns, implants… yes, implants as well even though he wasn’t an oral surgeon. He was a regular dentist who never attended any annual dental show case to revise. Worrying combination.

Now back to that one morning when Harry had once again done something to stir up feelings at the practice.

Harry had arrived to work drunk. Wasted. Pissed. Drunk as a skunk. And it wasn’t the first time. One would think that a dentist cannot work when drunk as they use various instruments that can cause serious damage to the patient, nurse and the dentist himself if used incorrectly. The drill for example, that is used for drilling through the enamel of your tooth – the high-pitched one – rotates up to 400 000 rpm. Imagine it in the hands of a drunkard. Scary as hell in my opinion.

Did Sally or Harry’s colleagues stop him from treating patients? No they didn’t. Neither did I but my excuse is that I was a newbie and didn’t have any say on anything really.

On this particular morning Harry was guided by his trusted nurse Tina from downstairs office which he shared with Sally to upstairs where the surgeries were. Half way up the stairs Tina realised that on her own she’s not able to prevent him from falling so she called help and another nurse came to her aid. Together they managed to steer Harry safely upstairs.

“Not that way!” I heard Tina whisper to Harry who was entering a wrong surgery. Tina pushed Harry from his shoulder to the direction of his surgery where the first patient was already in the dental chair with safety classes and a bib on. Tina sat Harry down to his chair and put a face mask on.

This is as much as I could see what was happening. The patient was treated and she left without complaints. So did the next one. No-one ever complained that the dentist was drunk. Didn’t they notice? They must have as the smell was obvious.

Why didn’t Tina say anything? She had worked with Harry for ages and had seen everything that is going on. How did she put up with this kind of behaviour and malpractice? I got an answer to this question couple of years later (already after I had left the practice) when I found out that Tina was Harry’s mistress. Love is blind, it sure is in many ways.

One day Tina was off sick and I was told to replace her as Harry’s nurse. I soon realised that the nurse was expected to do much more than what nurses normally do. And that was probably how Harry could carry on as he did. When Harry wasn’t able to do the treatment, Tina did it. Thankfully Harry realised that I wouldn’t be able to replace Tina fully. I wouldn’t use turbine (the high speed drill). So he was only hung over on the day when I was working with him. Phew!

What I saw that day, I never forget.

Patient one.

A 70 year-old man who had had two implants done to replace lower front teeth. The plan was to have an implant supported bridge done once the implants were fully integrated to the bone. He came in to complain odd feeling and appearance of the area where the implants were done.

The patient had a very low alveolar bone and the mucogingival junction was almost on top of the alveolar bone. The alveolar mucosa had probably pulled the area where the surgery was performed and opened up the incision. As a result the alveolar bone was exposed.

“Should it be like this?” the patient asked.
“Well it shouldn’t!” I thought.
Harry examined the area quickly and slurred something vague. Then he sent the patient home until the next scheduled appointment. My eyes were as wide as saucers but of course Harry didn’t see them as he was out of the surgery already before the patient was.

Patient two.

A 50 something year old lady who had started a restorative treatment for her lower teeth. The plan was to restore the bite by two rather long bridge. The bridges were going to be cemented today.

Harry fitted the bridges. He had difficulties in getting them in place and he had to use a drill to file away some of the metal of the bridge. Eventually the bridges went in and the patient was asked to bite the teeth together only to notice she wasn’t able to. Only the very back teeth were in contact leaving the mouth quite open. Harry took the high speed drill and started to file away the ceramic.

He drilled off a large area of ceramic and part of the metal structure underneath. I wanted to close my eyes as he was destroying the beautifully shaped cusps of the bridge but then the mouth of the patient would have flooded. So I carried on watching this mad man’s way of cutting corners.

Once Harry was done, he cemented the bridges into their places.

“The bite does not feel right…” the patient said.
“It will feel odd at first. It needs some getting used to.” Harry replied and left the surgery.

The patient left the practice with horrid looking bridges and bite that was not anywhere close being balanced.

I was in shock after that day. I knew this wasn’t going to be my future work place. Not a chance. And it wasn’t.

 

If you are interested to read more on the subject in another blog, visit here.