Yelled at nursing station by doctor

[longjourneydream]

hello,

i am a new grad working day shift from the er for 6 months;and by my choice decided i needed more priority setting, and basic skills for at least 6 months on a medical telemetry before i decided to go back to a specialty.

i have been off orientation for a week and a half now.

my last assigment was not bad 1st part of the day.

long story if you have time (if you want to skip down to blue that is the important part)

here goes the bla,bla,bla

i gave my ffp before my lady had to go down to specials to have a shunt put in for dialysis. took the report on gi bleed from er, and another report of a icu transfer from pacu of an infected peritioneal dialysis shunt.

prior to that i discharged two other patients,and was anticipating discharging another.

i took lunch. afterward,the fun began...

no help from the cna except vitals and accuchecks.

admitted my lady with hx of dementia, she was a gi bleed and she need 3 units of blood and had a protonix gtt and was a hard iv start.

10 minutes afterward got my lady from pacu that needed vitals q 15 for 1 hour, 15 minutes later got my lady back form specials also needed vitals q 15 for 1 hour, and also needing and order for phenergan due to n&v.

concent for blood not done ,had that done and initated blood for gi bleed.

nurses aide took my dinamap because she needed to do routine vitals, but did not come back to help with other vitals,left me to fend for myself.

gi bleed having stroke symptoms expressed by husband, along with vomiting blood. cleaned her up, got help with starting another iv while i got phenergan for post-op across the hall.

my other post-op next bed near gi bleed needed help calling husband that was still in surgical waiting and nobody ahd told him his wife was alright and in her regular room.

my help started me two new iv's and i was set to go. in the mean time my man that was suppose to go home was waiting for dischage was angry and wanted me to call his doctor. doctor called back gave orders for discharge with me to call all meds to pharmacy prior to discharge and arrange for a ride.

running around taking vitals for my post-ops making sure my transfusion is going well, keeping track of my other post-ops getting my 1700 meds done etc...

here is what you want to read:

after giving my 2nd unit of prbc's my lady vomited blood all over the place, was flaying around and trying rip out her iv's. the husband had called in a private aide to stay with his wife knowing she could not be left alone,afterward he left and she became worse the private aide tried to keep the patient from hurting herself and ripping out her iv's. i called for a order for 0.5 mg-1.0 iv adivan and restrain if needed. i gave my 0.5 order adivan

in the mean time a wonderful co-worker decided to give me a hand and dischage my other man who was angry and wanted to be discharged now!

i told the private aide that we will get the patient cleaned up after she settles down, because everytime we went to touch this patient she would get wild.

i hung my abx on room next door, then it was time for report.

my lady was sleeping, i figured to give report then help clean lady up afterward with the oncoming shift.

i gave report,and i offered to help clean lady up with oncoming rn, she told me i had so much charting to do,to just do that.

after i sat down to chart the door flew open, nurse said the doctor is furious and i need you to clean her up now.

as i went down the hall the doctor walking down the hall, he said to me, who is in charge? i told the doctor that i had been taking care of the patient. i went over to the doctor in a calm voice and tried to get him to calm down, i stated,"i was trying to keep her safe, she was tying to get out of the bed and i was trying to settle her down. he stated, "i do not care what the reason is, would you have your mother laying in blood like that? has anyone been in there to see this patient? i told the doctor the priority is to keep the patient safe then when she calms down,to then clean her up, and she was never left alone for one minute. i said to the doctor, "i do not blame you for feeling the way you do about your patient. he said i do not care, i just want this reported to anministration, enough said...

due to this being the change of shift doctors, nurses etc were at the station witnessing this event.

all the nurses could not belive how this doctor who has such a good manner could lose his temper like that?

i documented the incident and i documented in my nurses notes, i went to my director at 0600 and explained the incident, wrote my event report, and now i'm hoping this doctor will not give me touble later.

all in the life of a nurse... and i'm just starting!!!!

[EmmaG, RN]

He shouldn't have shouted and berated you in front of the others.

However.

There was no excuse (short of a code) to leave her like that. Just a clean gown and covers and wipe her face off with a damp washcloth; even if it not a complete bath, it's far better than leaving her in that mess.

I know that isn't what you want to hear, but that's my opinion.

[jjjoy, LPN]

What's difficult as a newbie is when told "you should have done X" it sounds like "your judgement call on this was all wrong" which gets interpretted as "your judgement stinks" which leads the newbie to wondering if they have what it takes to be a nurse at all.

I think in cases like this, it helps to let the newbie where they went right as well. That while there might have been a better way to deal with the particular situation (cleaning the woman up at least a little) that what her judgement overall wasn't totally off (patient safety taking priority over how the patient looks).

Given her lack of experience, she's imaging the absolute worst case scenario that might happen if she approached the women to straighten things up more - like the patient might get even more upset and cause harm to herself. Experiences just like this will help her learn how to prioritize in the future & what to realistically be concerned about.

I don't know that it should be expected that she should have done any differently given her experience to this point. More important is how her practice develops over time & that the patient wasn't endangered or harmed by this incident.

[Simplepleasures]

Live and learn, its a lifetime of learning in nursing, everybody makes mistakes, but it is nothing less than cruel to humiliate someone in front of their peers.

[EmmaG, RN]

What's difficult as a newbie is when told "you should have done X" it sounds like "your judgement call on this was all wrong" which gets interpretted as "your judgement stinks" which leads the newbie to wondering if they have what it takes to be a nurse at all.

I think in cases like this, it helps to let the newbie where they went right as well. That while there might have been a better way to deal with the particular situation (cleaning the woman up at least a little) that what her judgement overall wasn't totally off (patient safety taking priority over how the patient looks).

You're right, and I apologize to her. That was not my intention in my post. I was focusing on the doc's complaint.

[longjourneydream]

He shouldn't have shouted and berated you in front of the others.

However.

There was no excuse (short of a code) to leave her like that. Just a clean gown and covers and wipe her face off with a damp washcloth; even if it not a complete bath, it's far better than leaving her in that mess.

I know that isn't what you want to hear, but that's my opinion.

Her face was wiped off top linens taken off, and due to her combativness could not be touched.

She was never left alone for one minute, which keeps her safe from harm;this is the priority.

I do not blame the Dr. for being mad due to what he had discovered, but she was recieving blood and a Protonix, and i did not want to risk her to lose her IV's. Bloody vomitus will not harm this patient, it just does not look good to those that discover it, besides she was only in the blood for a little over an hour.

My only point here is the Dr. did not want an explaination to what had happened...

The only thing I would have done differently, would have been to catch the doctor before going into the room. He was at the nurses station for at least 30 minutes talking to another doctor about how this other doctor may be getting sued. You see this doctor was the specailist whom was consulted for the ptient's GI bleed. He was not the patient's PCP. If I had given him the "heads up," he may have been more understanding...

[EmmaG, RN]

Her face was wiped off top linens taken off, and due to her combativness could not be touched.

She was never left alone for one minute, which keeps her safe from harm;this is the priority.

Then I really don't understand his complaint.

Thanks for clarifying.

[justme1972]

I like reading posts like this (but sad when things like this happen to new nurses) because as a student, reading these will hopefully help give you some insight to what working in a hospital is really like.

I read the entire post and for the life of me...I can't think of what the nurse did wrong.

If the client was trying to rip out an IV and every time you touched her...she got wild...how can you safely clean up a patient like this?

The patient wasn't left alone, the nurse called to get a script for something to calm her down, and the private caregiver was given detailed instructions of what was being done and why it was being done. It seemed the nurse was simply waiting for the medication to take effect before proceding, b/c cleaning her up anyway would do nothing but harm.

I know it had to have been shocking for a physician to walk in and see a patient in that condition, but there was a reason for it, and it wasn't neglect.

The only thing that I could possibly think of (and of course, this is knowing what happened afterwards) is cleaning up the patient as soon as she calmed down and doing the charting afterwards....but then again, the incoming RN said she would do it, it wasn't like the nurse was trying to avoid the task at all...don't you have to have trust in your co-workers?

[deeDawntee, RN]

I am sooo sorry that happened to you. It sounds like one of those unfortunate events where the Doctor comes in on the middle of something and doesn't know the whole story. It is totally unacceptable the way he reacted without getting the whole story first. What a jerk. Also, the nurse who took over and told you to go chart should have stood up and taken responsibility, she really passed the buck, when she accepted the patient the way she was, she also accepted responsibility. I hope you added that in your report of the incident. I think you did a very good job with everything you had to deal with on your shift. It sounds like one of those shifts that is not for the faint hearted.

Hind sight is 20/20, as they say, and I have learned, that I will double team with the nurse coming on to finish something that really needs attention. At that point, I consider myself as her helper (in a way, I consider myself a resource for her or for Doctors who may be returning pages or rounding) she is now in charge of the patient, but I will stay until the situation is more manageable. We do that on the ICU all the time with patients who have crashed at the change of shift. Now, if the other nurse, is off getting her coffee, chatting to coworkers, and not concerned, well then, I am off and it is her problem.

This is where being thick-skinned is useful. Sometimes I have it and sometimes I don't. I know the situation still stings. Do you feel you need to take some action to let this go?

[canoehead, BSN, RN]

What you did makes sense to me. You had a good reason for waiting, and the patient was well cared for.

[Logos]

Oh this kind of thing scares me- I know myself and I frequently would want to give it right back to the doctor- are we aloud to go scream at the Dr.'s when they do something we perceive as wrong? Then what gives them the right to do it to us. Nothing obviously. I am afraid I would not be a nurse for very long if I have to put up w/ BS like that. It is not acceptable for ANYONE to yell at me, (I get enough of that from my four year old. :) ) If what you did was right or not is a moot point. That's not the issue for me, the issue for me is this man is a acting like a "dick" and we are just supposed to shut up and take it? Oh I hope not, because that would just not work for me.

I am sorry you were treated so crappy, but you did remain calm and did not let your emotions cloud your judgment so in that regard you are one up on this Dr.

[NurseRatched67]

I agree with the poster above that you need to look at this as a learning experience.

I would write down in a journal everything that transpired that day....from your overload of patients, to the lack of CNA assistance to the doctors response.

Find a co-worker who you trust or a manager in the same light. Ask for some time with them and go over one to one what happened. Examine what was happening and in what order and if anything could have been changed.

Don't be scared of feeling "blamed"...we've all been there and felt that no matter how great the care was we provided, it still wasn't good enough.

Have someone to work with to answer you questions. Some times when we are busy, we fail to realize that the floor and other staff members might just be as busy as we are.

Don't feel that asking for help in examining that day is an indication that you did anything wrong. We all that hindsight is 20/20, but it's good to purge this from your brain and see if there are some ways that you didn't think about at the time to help you in the future.

Talk it out with your manager...you'll feel better.