Manager interrupting

[lifeisgood516]

I am curious to see what other nurses think about a situation that occurred last week.

I was reviewing the preop checklist at the desk with the GI lab nurse. My manager called my name, so I responded "one second, I'm signing off on this patient." Her immediate response was, "No, a physician needs to speak with you." The physician comes to my other side and starts talking about a patient and discharge planning as I was trying to write down the patient's vitals and sign the checklist. After I did that, I looked at her puzzled, and asked which patient she was referring to. She said the patient's name... same last name, but different patient. So I sent her off in the direction of the correct nurse.

I am a MSN-prepared nursing professor, and this is my casual job at the hospital. I am appalled at the manager's behavior. I find it unacceptable to interrupt another collaboration between healthcare providers for non-emergent issues, especially when it involves sending a patient for a procedure. The mindset that a physician's words are more important is not sitting right with me.

What are your thoughts?

[macawake, MSN]

unfortunately, you know it's the culture of nursing.

Oh, I know.. But even if it's only on a small and local scale, I do what I can to change it. Only we can change how we're treated, it won't happen by itself. No one else will stand up for us if we're not willing to do it ourselves. Coming from a law enforcement background where we wouldn't put up with half the crap that nurses habitually accept. It was quite the culture shock when I started my new career.

I understand the need for flexibility and cooperation in the workplace and sometimes we have to adjust and compromise to achieve the best results but what I won't accept is the subservient martyrdom I've observed in some of my coworkers. The downtrodden yet strangely proud attitude of "this is how it's always been".

The situation that OP described was one where she tried to prioritize (and correctly so in my opinion), but that attempt was undermined by the nurse manager. We should aim to support, not sabotage each other. In the situation described the physician could have waited a couple of minutes in order to facilitate an uninterrupted hand-off.

[klone, MSN, RN]

If you don't let someone know the very first time something happens it would continue to happen. The approach is what matters.

I treat once as an outlier. Everyone can have a bad day or a moment of thoughtlessness. If it happens a second time, then I would address it.

[Julius Seizure]

The bottom line is.. All nurses would like to complete a task, before moving on to another. That is not the way nursing flows. OP wanted to "finish signing off on a patient". That task could have easily waited, while she addressed the physician's questions.

I work from home in a challenging position. I analyze incoming cases and answer a call line. I PRIORITIZE. If a physician needs my attention to an issue, I put my documentation on hold and assist the physician. I would never expect a doctor to wait while I am finishing a task that can wait.

CAN the task easily have waited? Maybe. You know what else could easily have waited? The physician. I didn't see anything in the OP's account of the situation that made it sound like the physician had a particularly urgent situation that he/she needed help with - not any more important or urgent than what the OP was already doing.

As you said, prioritization is important. But, in terms of prioritizing, what is the rationale for stopping what is already being done to handle this other non-urgent matter? If there is no reason for the second task to warrant that, then it is truly more efficient and safer to finish the task that was started before moving on. Being a physician is not a good enough reason in and of itself to override any other item.

In fact, the OP wasn't just documenting, the OP was interacting with another health care worker whose time is also valuable. To accommodate the physician immediately meant putting that other person on hold - why would that not matter?

Simply being a physician does not automatically make that person's issue the most urgent or important one. We need to respect the time of ALL of our colleagues....including other nurses.

[ILUVERNSG, MSN, RN]

My opinion: the manager was abrupt, rude, disrespectful. She could said things differently. Some people are just like that. Pick your battles.

[Nurse Beth, MSN]

Oh, I know.. But even if it's only on a small and local scale, I do what I can to change it. Only we can change how we're treated, it won't happen by itself. No one else will stand up for us if we're not willing to do it ourselves. Coming from a law enforcement background where we wouldn't put up with half the crap that nurses habitually accept. It was quite the culture shock when I started my new career.

I understand the need for flexibility and cooperation in the workplace and sometimes we have to adjust and compromise to achieve the best results but what I won't accept is the subservient martyrdom I've observed in some of my coworkers. The downtrodden yet strangely proud attitude of "this is how it's always been".

The situation that OP described was one where she tried to prioritize (and correctly so in my opinion), but that attempt was undermined by the nurse manager. We should aim to support, not sabotage each other. In the situation described the physician could have waited a couple of minutes in order to facilitate an uninterrupted hand-off.

Wish I could double like this

[MunoRN, RN]

Patient hand-offs are well known as an opportunity to prevent or contribute to harm to a patient, they should not be interrupted for a non-emergent issue. I wouldn't have any problem reminding my manager that I'm handing over a patient and that the MD will be the very next thing on my list, if my manager has any problem with that, then I'd be happy to go over my job description with them, as well as hers, and remind her of my employers standards on communication and preventing patient harm as well as current best practices which would include a reading list of John Nance's Why Hospitals Should Fly, Atul Gwande's The Checklist Manifesto, AHRQ, NIH white papers, etc.

It's unfortunate that we don't view ourselves as being an integral part of patient safety and effective care, and therefore should freely alter our practice to fit the needs of others.

[Boomer MS, RN]

Patient hand-offs are well known as an opportunity to prevent or contribute to harm to a patient, they should not be interrupted for a non-emergent issue. I wouldn't have any problem reminding my manager that I'm handing over a patient and that the MD will be the very next thing on my list, if my manager has any problem with that, then I'd be happy to go over my job description with them, as well as hers, and remind her of my employers standards on communication and preventing patient harm as well as current best practices which would include a reading list of John Nance's Why Hospitals Should Fly, Atul Gwande's The Checklist Manifesto, AHRQ, NIH white papers, etc.

It's unfortunate that we don't view ourselves as being an integral part of patient safety and effective care, and therefore should freely alter our practice to fit the needs of others.

Well said. I enjoyed The Checklist Manifesto.

[ILUVERNSG, MSN, RN]

AMEN TO THAT!!!

[RNbubu]

I get interrupted all the time where I work (tele floor). Interrupted by charge nurse, manager, Mds, secretary, my pt's roommate. Sometimes there are 3 people wanting to talk to me at the same time, all while I am in the middle of doing a task. It is one of the things that frustrates me the most. It seems to to be the norm where I work. Nobody thinks it is a big deal but me. We carry these awful pagers that people use to reach us and that serve kind of like a phone. Sometimes I am with a patient and a case manager or an MD or pharmacy or even a co-worker nurse calls me - you pretty much can't choose to not answer it because it connects to you automatically - and they start talking about whatever it is, they don't even ask if you are busy or not. Sometimes I am with a patient and the charge nurse is calling me to say my New admit is here, or what time I am discharging the other patient because they need the bed. The MD calls you to ask a question about a different patient. So many interruptions. So frustrating. I usually say, I am with a patient and can't talk now. Still, that was an interruption.

[cayenne06, MSN, CNM]

The bottom line is.. All nurses would like to complete a task, before moving on to another. That is not the way nursing flows.

Actually, BTDT, completing our tasks before moving on is in the best interest of our patients. Of course we need to be able to jump from task to task and prioritize- juggling multiple pressing demands and shifting patient status, part of being a nurse.

But. Regardless of how well you feel you are able to multitask, the data is quite clear that our attention and performance suffers when we split our attention. Even if you are really smart, and even if you feel like you are doing a top notch job. The more fractured your focus, the slower your reaction time and the greater your risk for making clinical errors in judgment and technical skill.

All nurses are pulled in MANY different directions. We prioritize and act as best as we can.

If you were not in an emergent situation, you should have been able to handle both of these tasks at the same time.

Wait. Are you serious here? It is best to do one thing at a time. Depending on the whole situation, the OP should have either finished what she was doing, or went and addressed the doctor, if their need was more urgent. In this case sounds like the RN was prioritizing correctly.

Attempting to do "both at once" is needlessly putting patients at risk. Which is kind of a jerk move, to be honest.

It is not having 2 conversations at once, it is managing input/output from two different directions.

Call it multi-tasking, if you want.

I have ran 2 codes at the same time.

Ah. You are not serious. You can't be serious, because everyone on code teams is trained to lead, and hopefully work as lead on rotation to maintain their skill.

That is some deadpan there, well played. I refuse to consider the possibility that you are being serious here!

[ambr46]

I don't think it's a huge deal beyond slight irritation. I probably would have told the doc that I would be right with him and finish up. I have honestly never had a day without multiple interruptions.

[psu_213, BSN, RN]

I am not defending the behavior of the NM or the MD, but petty disruptions are something that happens. They were rude, and the disruptions stink, but you have to get on with it.

What always annoyed me were all the calls forwarded me during my med pass. We had a secretary who would forward any call at any time to the RN. For example, got a call forwarded during med pass: "Hi, this is Mrs. Smith's daughter. She always drinks regular coffee with breakfast. She got decaf coffee yesterday and then fell asleep around 10 am. Make sure she gets the right coffee with breakfast today."

My phone would ring when I was in a C diff room passing meds. I wouldn't answer. I'd stick my head out and tell the secretary "Sarah, I'm in a room. If whomever that was calls back, take a message." Less than 30 seconds later, my phone would ring again. Per Sarah: "But Mrs. Smith's daughter really needs to talk to you again." (All names changed to protect the innocent.). Then again, customer service obviously takes precedent over patient safety.

And you really want to be careful about counseling some people...they will go to HR and report a hostile because your smile wasn't sincere enough. At least it's unlikely that the NM or MD will do that.