Hello,

I had a pretty rough night last night and I would like your ideas about what I plan to do.

First, I work at a acute inpatient psychiatric hospital and last night I put a pt into seclusion for risk to others. He is a 62 yr old male w/ very severe schizophrenia who has been on my unit for over 3 years. His baseline when on appropriate meds is a threating or delusional statement almost continually. He is rarely assaultive in the past 6 months but has a significant history of being so. Lat night he asked for and received 2mg of Ativan which normally works well for him. After that he began escalating accusing staff of giving him something else and would not respond to redirection. After about an hour of him yelling and cussing at us at the nurses station and several attempts to get him something else to calm him down, including his refusing 50mg of Visteral, candy, pop, and anything else we could think of. He threw a tray table, pushed over a table, attempted to break the tv, and took a swing at me. I told him he needed to go the seclusion room and he stormed away to his room. Although I would've let him stay in his room, his roommate is a dementia pt who is fairly frail and requires assistance to stand and walk. I followed him into his room after calling for staff from other units to help me take him into seclusion. He had a cord to use as a garrote and we proceed to take him down w/ 5 staff and take him into the seclusion room.

After that I paged the doc on call(who is there all night, and doesn't know this pt) and told her that she needed to come own to evaluate the seclusion. Per policy RN's can do a seclusion for up to 1 hour until the doc has to see the pt. In any event the doctor has to see the pt in any event. She said ok and hung up. After 45min I paged again w/ no response in 5 min, I paged again w/ no response, after 3 more min(2 mins left on seclusion timer) I paged again and asked for a stat response. She calls back asks how he's doing and by this time he had been calm for 10mins, after about 50mins of threats and banging on the door. She orders us to release him, against my better judgment and the other RN on duty.

I tell him he is to go to his room and I will get him some snacks. He is in his room and I station someone outside his door to intervene if they feel he is escalating again. After two more hours thankfully he goes to bed after coming out to the nurses station several more times and cussing us out and banging on the glass. After about 30mins after that the doctor finally decides to stop by and fill out the required paperwork. I'm busy with another pt who is escalating but I can talk down most of the time. As I finish w/ him I thank the doc for coming down, in I think and hope is a friendly tone of voice, she says "****you" and walks off. I call the house supervisor on of the unit managers not the nurse manager of my shift(night off), and tell her what happened. She says ok and blows it off.

SO, anyway I don't care to much about the patient stuff, that's my unit and I'm glad I let the pt out of seclusion but frankly the doctor not only violated policy but created a dangerous situation on my unit, not only to staff but to the other pt's as well. On top of that the way she treated me when all's I wanted was her to come talk to the pt and fill out the damn paperwork. I have heard from other nurses that this is typical behavior for this doctor and nothing has happened about this.

Anyhow, I filled out an incensed report w/ my manager and talking to her about this situation when I get the chance. Thankfully today is Sunday so I have the chance to change my mind about the other course of actions I was thinking about and to pick her brain as she is great and really supportive to me.

Since this really is bottom line a breach of her duty to her pts, per hospital policy, I was thinking about making a report to the state licensor's board about that. Don't know if it will do any good but I think that would be appropriate in this case.

Second, I was thinking about filling a harassment complain against her. The hospital I work in is a state facility and has very strict rules about harassment from co-workers, particularly about those in a higher chain in the chain of command.

Lastly I was thinking about making a grievance with my union. Although I think it best to wait until I give my bosses a chance to tell me what they are going to do about it I don't think that due what I've heard about this doc that anyone in management is going to do anything about this. But I feel that if my complaints are not addressed this is the only way that anything will happen about this.

Please let me know what you think, should I just blow this off as a bad day, or should I try a different approach? Honestly right now I'm not that ****** about it but I feel I should do something. I feel that I could let this drop without doing anything but I really feel that something needs to happen with this doctor.

Anyhow thank you so much for reading all this. Hopefully I was coherent enough for you to make some since of all this.

DaMaleNurse

After reading this I get the impression that a lot of old patients are.. older versions of pre-schoolers.

I think I would just start with an incident report, unless this is a pattern of behavior from this particular doc.

Hello,

I had a pretty rough night last night and I would like your ideas about what I plan to do.

First, I work at a acute inpatient psychiatric hospital and last night I put a pt into seclusion for risk to others. . .

After that I paged the doc on call(who is there all night, and doesn't know this pt) and told her that she needed to come own to evaluate the seclusion. Per policy RN's can do a seclusion for up to 1 hour until the doc has to see the pt. In any event the doctor has to see the pt in any event. She said ok and hung up. After 45min I paged again w/ no response in 5 min, I paged again w/ no response, after 3 more min(2 mins left on seclusion timer) I paged again and asked for a stat response. She calls back asks how he's doing and by this time he had been calm for 10mins, after about 50mins of threats and banging on the door. She orders us to release him, against my better judgment and the other RN on duty.

. . . . After about 30mins after that the doctor finally decides to stop by and fill out the required paperwork. I'm busy with another pt who is escalating but I can talk down most of the time. As I finish w/ him I thank the doc for coming down, in I think and hope is a friendly tone of voice, she says "@@#$ you" and walks off. I call the house supervisor on of the unit managers not the nurse manager of my shift(night off), and tell her what happened. She says ok and blows it off.

SO, anyway I don't care to much about the patient stuff, that's my unit and I'm glad I let the pt out of seclusion but frankly the doctor not only violated policy but created a dangerous situation on my unit, not only to staff but to the other pt's as well. On top of that the way she treated me when all's I wanted was her to come talk to the pt and fill out the damn paperwork. I have heard from other nurses that this is typical behavior for this doctor and nothing has happened about this.

Anyhow, I filled out an incensed report w/ my manager and talking to her about this situation when I get the chance. Thankfully today is Sunday so I have the chance to change my mind about the other course of actions I was thinking about and to pick her brain as she is great and really supportive to me.

Since this really is bottom line a breach of her duty to her pts, per hospital policy, I was thinking about making a report to the state licensor's board about that. Don't know if it will do any good but I think that would be appropriate in this case.

Second, I was thinking about filling a harassment complain against her. The hospital I work in is a state facility and has very strict rules about harassment from co-workers, particularly about those in a higher chain in the chain of command.

Lastly I was thinking about making a grievance with my union. Although I think it best to wait until I give my bosses a chance to tell me what they are going to do about it I don't think that due what I've heard about this doc that anyone in management is going to do anything about this. But I feel that if my complaints are not addressed this is the only way that anything will happen about this.

Please let me know what you think, should I just blow this off as a bad day, or should I try a different approach? Honestly right now I'm not that ****** about it but I feel I should do something. I feel that I could let this drop without doing anything but I really feel that something needs to happen with this doctor.

Anyhow thank you so much for reading all this. Hopefully I was coherent enough for you to make some since of all this.

DaMaleNurse

Dear DMN,

First of all, THANK YOU for working with the patients (acute psych) that many of us find difficult or impossible to work with. Secondly, thank you for providing patient care that keeps all your patients safe.

Regarding your immature physician situation, here is my advice. YES, filing the incident report for such a situation should always be done. As you stated, there are 2 issues here: the physician's failure to follow medical staff rules for seclusion that relate to patient and staff safety plus the inappropriate behavior on her part creating a hostile work environment.

As to filing a complaint with the medical board, yes you can do it, but as an non-management employee, it's not really your responsibility or place to do so. The better route is to get your manager to follow up with the risk manager to make sure the issue goes to medical staff board for action. If the physician's behavior has been an ongoing problem with the staff, make sure that info gets to the risk manager as well.

And since you are blessed (yes, blessed) to have both governmental employment and union protection, you can pursue the harassment issue through the state HR and the union venues. But I would wait to see what your manager and risk management can do first. Certainly you can mention to your manager that you are so upset about the hostile workplace issue you may pursue it further through HR and the union if the hospital administration lets it drop.

Maybe the larger question is why is this physician working in acute psych as it certainly does not appear to be a good match for her. Perhaps being dressed down by the medical staff board will motivate her to find a different practice situation.

I hope this is helpful.

HollyVK, RN, BSN, JD

I agree that you should speak with your manager/supervisor as soon as possible, as the MDs immaturity & unprofessionalism are unacceptable. That conversation with your manager, and his/her response, will dictate how you need to proceed next, whether it's an incident report, report of harassment, or grievance with the union.

Absolutely do not let this go. The MD put the patient and staff at risk. Hoping your next day at work is better.

If you feel that strongly about the physician's inappropriate behavior I would report her to the medical board. She has a responsibility to the public and in this case the "public" (other psych pt's) cannot speak for themselves (because they were probably unaware they were at risk). If your hospital is like most, NOTHING will be done about this inappropriate behavior. Let me ask you this: if YOU were the one who responded in this manner would anything happen to you? Enough said...

even in spite of her reputation, this is the first time she has responded this way to you?

if so, i'd start out w/an incident report...

but if able, would cc a copy to her and to your union rep.

i realize incident reports are for internal purposes only but at least you could cc the doctor.

make sure you noted all the times you paged her...

actually note all relevant info.

if this happens again, i wouldn't hesitate to bring it up the chain.

best of everything.

leslie

If you feel that strongly about the physician's inappropriate behavior I would report her to the medical board. She has a responsibility to the public and in this case the "public" (other psych pt's) cannot speak for themselves (because they were probably unaware they were at risk). If your hospital is like most, NOTHING will be done about this inappropriate behavior. Let me ask you this: if YOU were the one who responded in this manner would anything happen to you? Enough said...

I was told by the State Board of Medicine along time ago, that they wished that more nurses would "start a paper trail on diffucult physicians". If this is ignored for years, as it usually is, when the, "you know what hits the fan", the Board has no paper trail or "history" to really discipline the physician the way they need to be disciplined. You are not doing anyone a favor of ignoring this and allowing this physician continue with the unprofessional behavior. I know that if this were to happen to me, and the physician was one who has been abusive for years, and the problem has never been properly adressed, I would be really pi$$ed!!. Not only that, you are placing patients at risk if this physician continues to refuse to see patients that need to be seen by a physician for a pressing matter. You would be held accountable if the patient had a bad outcome because the physician would not come in to see the patient.

I testifed at a deposition two years ago in a matter just like that. The nurse did not win.

I say write a letter to the hospital administration, Risk Manager, and also the Board of Medicine. And don't forget, keep copies of everything for yourself. It might also mean, sending the letter Registered Mail with a return receipt. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Just my 0.02$ worth...I would follow hollyvk's advice first and then if you feel like you have not had aedquate follow up with your management I would follow up with lindarn's advice.

I had a situation similar to this and a gradual professional escalation of 'pressure' works best and does not make it seem like a vendetta or insubordination on your part, but does show that you are standing up for established procedures and policies, (and for yourself).

I would most DEFINITELY write incident reports AND letters...that doctor not only DID NOT follow the policy, she put you, the rest of the staff, AND the other patients in danger by not doing so.