A resident swore at me!

Nurses General Nursing

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I am a new grad of 6 months on a Surgical/Ortho/Trauma floor. When I first started here, I was miserable. I'm very shy and it's hard for me to talk to new people. But in the past 2 months things have gotten so much better - I feel more comfortable, I know most of the interns and attendings, and I'm actually happy. Being a new nurse, I sometimes question what I need to page the intern about, and what I don't. Sometimes I call over things that seem important to me, but apparently aren't to the team. Up until this point the interns have been really nice and humored me, explaining gently when I ask that it was probably something that could have waited. But on Thursday all of that was ruined and now I am angry and upset and I'm not sure what I should do. So I'm just going to rant in a long post here, and hopefully feel better after getting this all out.

This past week I was working 7a-7:30p. Near the end of my day on Wednesday, one of my patients was complaining of increasing pain. She had just been started on percocets that morning, and they really weren't helping her. Her daughter was there and for obvious reasons, quite concerned. I told her I'd call the intern on call to see if he could change her pain meds to something else. I started paging him at 6pm and still had received no call back by 7pm. By this time, the daughter was furious, stating this was unacceptable and she wanted something done NOW. So I looked for the person who made the last order, who happened to be the chief resident for that team, and I paged him. Several times. After another half hour, he called back and I explained my patient's pain issue. He said to give her IV Dilaudid and he'd have the intern change her pain meds to po dilaudid. I did so, the patient and daughter were happy, and I went home.

Thursday morning I came in and was told by the night nurse that the same patient was doing wonderfully on the po dilaudid. She also told me that another daughter had called that night complaining that nobody gave her mother pain meds on Wednesday (which the night nurse assured her that I did). I went in to see my patient at 8:00 am- and she told me her pain was excrutiating and would not be able to do anything if the pain stayed that way. She wasn't due for more dilaudid for another hour and rather than have the same thing happen again (and have the daughter yell again) I decided to page the on call intern right away. It was the same intern on as Wednesday, and once again he did not call me back. After another hour of paging and no response, I spoke to my resource nurse to ask her advice. I wasn't sure if I should page the chief resident again, or if there was someone else on the team I should page instead. We looked at my patient's orders, and once again the chief had written the last order, so she suggested I call him. So I paged him several times with no call back. After 20 minutes, I happened to see the chief resident walking onto the floor, so I hurried over to him. Our conversation went something like this, all the while me trying to keep up with him as he continued walking away:

Me:"Oh I just paged you. I'm sorry, but Mrs. so and so is having more pain issues just like she did yesterday-

MD: "This is the first I've heard of this."

Me: "well I've been paging the intern for an hour-"

MD: "He's in the OR."

Me: "Well, he never called me back to tell me that. Anyway, Mrs. so and so-"

MD: "There's a third year resident you should have called."

Me: "Well, I didn't know that."

MD: "Next time call the third year." and he stormed off muttering.

At this point I just stood there with my mouth open. Luckily, my nurse manager was walking right around the corner and she grabbed me and pulled me into her office right away as I began to cry hysterically. Apparently, the MD had been swearing at me as he walked away. Whether it was "f you", or "f off" I don't know, but my nurse manager heard him and he didn't abbreviate. She told me she immediately turned to this resident and told him that they needed to talk. He told her he was busy and kept walking. I explained to her the whole issue and what had happened. She assured me that I did nothing wrong and that there was no excuse for his behavior. I'm supposed to be the patient advocate, yadda yadda yadda. While I felt better when she spoke with me, the rest of the day I obviously felt like crap. I kept questioning everything I did. It's hard to stand up for yourself when you're new and you're not convinced that what you did was right. And being shy doesn't help. Anyways, my manager said she'd definitely speak to this resident and his attending. I've been off since that day, and I'm so nervous to go back in on Wednesday. I'm so scared that I'm going to have another patient on that team. And what if my nurse manager doesn't do anything - should I do something? Part of me wants to stand up for myself. He really made me feel like I was worth nothing, a lowly nurse. But part of me just wants to pretend it didn't happen and not cause any tension. I'm just so angry, I wish I could have yelled right back at this guy.

Any advice??

~Jaime

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I agree with Tweety. An incident report is not a write-up, but a good paper trail if someone is a problem.

Specializes in Medical.

Hey, pumpkin - given the on-going issue with pain relief for this patient, and your having copped it for a couple of shifts, it's not surprising you were a bit in edge to start with, wedding aside (congratulations, BTW! :balloons: )

Having been many times in the situation where I have a patient in pain (and, half the time, agitated and angry relatives who don't understand that I can't just help myself to the DD cupboard and initiate a narcotic) on the one hand, and an unresponding resident on the other hand, I can appreciate the stress.

I can't really add anything to the excellent advice you've already been given - document, go further up the medical chain when you're not getting the response you need, and go further up the nursing chain when you're out of your depth.

I don't agree that abuse from (male) doctor is something that (female) nurses just have to accept. I do appreciate, though, that that's a hard stance to take when you're inexperienced and distressed. This kind of rudeness and disrespect is not acceptable, under any circumstances whatsoever. :angryfire

That said, although I've now got more experience than a reg and resident combined, there is something in the power relationship that can still make it hard for me to always be directly confrontational when I disagree with a doctor. I'm very good at playing the nurse-doctor game, but too many times in the past I've allowed a doctor's opinion to go unchallenged, and I always kick myself afterward.

Tangentally related to the original post, I have a question for the group.

What do you mean "write them up". We can do an incident report where I work Incident reports aren't the same as "writing someone up".

Where I work up we only have incident reports; when I've read about people being written up, writing someone else up, or being concerned about being written up, I've translated that as filling out an incident report, but I've clearly been mistaken. So what is "writing someone up", how is it different from an incident report, and why is it so dreaded?

[quote name=hipab4hands

____________________________

Usually after the 3rd or 4th phone call in the middle of the night, she would just tell us "do whatever you want/need to do."[/quote]

interesting.

so when a resident says that, what are the implications of such doctor's orders?

i mean, how do you note/chart such a vague doctor's order?

leslie

It's easy. If I needed something specific, I would confirm with her- "Then you are giving me a verbal order to do/give _____________. " That's what I would chart.

If I needed more of a consult, where she had to make the decision, I would make her be specific about what she wanted done- "I want you to do ____________." I would reconfirm the order before hanging up and then chart the order.

It's easy. If I needed something specific, I would confirm with her- "Then you are giving me a verbal order to do/give _____________. " That's what I would chart.

If I needed more of a consult, where she had to make the decision, I would make her be specific about what she wanted done- "I want you to do ____________." I would reconfirm the order before hanging up and then chart the order.

thanks hipa. that does explain everything.

leslie xo

It's easy. If I needed something specific, I would confirm with her- "Then you are giving me a verbal order to do/give _____________. " That's what I would chart.

If I needed more of a consult, where she had to make the decision, I would make her be specific about what she wanted done- "I want you to do ____________." I would reconfirm the order before hanging up and then chart the order.

thanks hipa. that does explain everything.

leslie

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so sorry this happened to you pumpkin. had a crna call me after sending a pt. down for surgery. i saline locked his cardizem drip per dr order, since it was being used to control heart rate, not convert him to sinus rhythm from his chronic afib. his rate was in 80's, and also on digoxin. she demanded to know what made me think i had the authority to dc a cardizem drip, threatened my license, wanted to know my full name so as to report me to bon, etc. each time i tried to give her answers she yelled, do not get smart with me! she had the chart in her possession along with his mar, and if she did not understand the implication of dig with cardizem under general anesthesia once the pt. was stable with heart rate, i could not find the words to explain it to her. she was sure i had thrown the pt into afib by dc'ing the drip. cared less about the physician's orders. i handed the phone over to my charge nurse, wrote her up, and to this day wonder who pi**ed in her fruit loops! :rolleyes:

Where I work up we only have incident reports; when I've read about people being written up, writing someone else up, or being concerned about being written up, I've translated that as filling out an incident report, but I've clearly been mistaken. So what is "writing someone up", how is it different from an incident report, and why is it so dreaded?

"Writing someone/something up" is just putting in writing on whatever form is appropriate at your institution for that particular event. If an MD patted you on the fanny, you can go tell your manager and they can write it up. However, that's secondhand. Just write it up on the appropriate form and give it to your manager for followup. This should not be that difficult. If you just tell me about the incident, I can't do anything about it. Just write it up and I'll be able to follow through. We have an "Event Form" for say a patient falling out of bed, a staff injury form if staff hurts their back, and a napkin or blank progress note if you want to write up someone for smoking dope in the bathroom.

Specializes in Medical.
"Writing someone/something up" is just putting in writing on whatever form is appropriate at your institution for that particular event. If an MD patted you on the fanny, you can go tell your manager and they can write it up. However, that's secondhand. Just write it up on the appropriate form and give it to your manager for followup. This should not be that difficult. If you just tell me about the incident, I can't do anything about it. Just write it up and I'll be able to follow through. We have an "Event Form" for say a patient falling out of bed, a staff injury form if staff hurts their back, and a napkin or blank progress note if you want to write up someone for smoking dope in the bathroom.

Thanks. We have two kinds of incident report, staff and non-staff (which incoldes patients), so all those things you mention would be incident reports. BTW, 'fanny' means something different in Aus than in the US - any doctor patting mine will end up with more than an incident report!

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
"Writing someone/something up" is just putting in writing on whatever form is appropriate at your institution for that particular event. If an MD patted you on the fanny, you can go tell your manager and they can write it up. However, that's secondhand. Just write it up on the appropriate form and give it to your manager for followup. This should not be that difficult. If you just tell me about the incident, I can't do anything about it. Just write it up and I'll be able to follow through. We have an "Event Form" for say a patient falling out of bed, a staff injury form if staff hurts their back, and a napkin or blank progress note if you want to write up someone for smoking dope in the bathroom.

In our institution those are called "incident reports". They go to risk management and then to whomever after that. And yes anyone can write up these kinds of reports.

I guess after my years of being a charge nurse and house supervisor when I think of "writing someone up" I'm actually thinking of disciplinary action forms where you counsel the individual face to face, they sign it or not, and it goes into their personnel file. Only supervisors and managers can do that to employees they directly supervise. We have no power to write doctors up in this fashion and in return they have no power to do it to us. I like it that way.

Sorry for my confusion of what you were saying. Thanks for the explanation. :)

Any advice??

I only give a physician 3 pages (it doesn't matter if he is an attending or an intern) and if they do return them go up the ladder. Have been known to page the Chief of that department if cannot get in touch with anyone else. You would be surprised how quickly you get return calls after that. I have a little bit of an advantage though, I am male, 6'1", large and a former Marine self defense instructor, freestyle wrestler and 2 years as a pro-football player. Tends to make the reseidents as well as the attending hesitant to irritate me. That and the fact that only call when it is something that cannot wait until rounds. I get counseled on the average of once a month for my interactions with the medical staff, but I am also the one that they come to for problems with non-healing wounds and hyperbaric questions.

Specializes in ICU,CCU,Med-Surg,Post Partum,Tele, ER.

Don't feel bad. I have been there also. I am an RN on a medical surgical floor. The good thing about where I work is that it is a small hospital (266 beds) and I get to know the physicians very well. Whenever they get "testy" with me, I politely tell them that all I am doing is calling on behalf of my patient and if they chose not to do anything about the situation, I will politely let the pt know that it is out of my hands. When I get finish saying that, you can best believe that I get what I want.

Sheryl :)

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