Tips for a newbie on dealing with mean doctors? - page 2

I am graduating in May and already have a position in a PCU with a large teaching hospital in my area. I am hired for night shift and am anticipating some uncomfortable situations with angry tired... Read More

  1. by   INtoFL_RN
    the advice you've been given so far is all great. i can add a couple things...

    -since you're at a teaching hospital, make sure you follow the "chain of command" when calling docs.

    -at the beginning of your shift, glance over your patients prn meds to see who doesn't have things like pain meds/sleeping pills/laxatives ordered. get these calls out of the way early in the evening to avoid a hassle later.

    -rely on your fellow nurses for advice before calling a doc! i found out that you can save a lot of calls to a doc just by asking your charge nurse or an experienced nurse for advice.

    -utilize things like sbar communication when calling a doc in the middle of the night. sometimes they aren't quite with it, and having a clear, succinct report of the situation is really helpful. a lot of times, docs can get grumpy just because they are frustrated with us not having all the info that they need to make a decision. don't assume that they always remember what patient you're referring to just by name alone. here's an example of sbar (copied and pasted from a website):

    dr. jones, this is deb mcdonald rn, i am calling from abc hospital about your patient jane smith.
    situation: here's the situation: mrs. smith is having increasing dyspnea and is complaining of chest pain.
    background: the supporting background information is that she had a total knee replacement two days ago. about two hours ago she began complaining of chest pain. her pulse is 120 and her blood pressure is 128/54. she is restless and short of breath.
    assessment: my assessment of the situation is that she may be having a cardiac event or a pulmonary embolism.
    recommendation: i recommend that you see her immediately and that we start her on 02 stat.
  2. by   hogan4736
    Quote from intofl_rn
    ...-utilize things like sbar communication when calling a doc in the middle of the night. sometimes they aren't quite with it, and having a clear, succinct report of the situation is really helpful. a lot of times, docs can get grumpy just because they are frustrated with us not having all the info that they need to make a decision. don't assume that they always remember what patient you're referring to just by name alone. here's an example of sbar (copied and pasted from a website):

    dr. jones, this is deb mcdonald rn, i am calling from abc hospital about your patient jane smith.
    situation: here's the situation: mrs. smith is having increasing dyspnea and is complaining of chest pain.
    background: the supporting background information is that she had a total knee replacement two days ago. about two hours ago she began complaining of chest pain. her pulse is 120 and her blood pressure is 128/54. she is restless and short of breath.
    assessment: my assessment of the situation is that she may be having a cardiac event or a pulmonary embolism.
    recommendation: i recommend that you see her immediately and that we start her on 02 stat.
    nice...the only things i would add, is already have the ekg done (chest pain protocol), place the pt on a tele monitor, and already have the pt on oxygen (both are nursing judgement - docs appreciate this) before you call
    Last edit by hogan4736 on Apr 5, '07
  3. by   jojotoo
    I have to call MDs at home EVERY night. Most are very reasonable. If they are not, I treat them as any other abusive caller and put them on therapeutic hold (a time out for adults).
  4. by   Indy
    I would also like to suggest that you know where your facility /unit keeps the standing orders. Look to see if any of the docs handling your patient have standing orders to cover the problem. Also look on you MAR's to make sure you don't already have a PRN med for whatever it is.

    If it's low urine output AND the patient has not got a foley cath, we usually drag the bladder scanner down to the room and do a quick bladder scan. I have noticed that on most patients when you shove a vibrating stick on top of their pubic area that it tends to make them want to get up and pee. Plus now you have a ballpark idea how much was in the bladder so you can compare it to what came out, if it's close, then you don't need a foley... and if there wasn't much pee in the bladder in the first place then you now have a really good reason to call, as I'm sure the doc wants to know if his patient's in acute renal failure.
  5. by   Xbox Live Addict
    Quote from thomask
    I am graduating in May and already have a position in a PCU with a large teaching hospital in my area. I am hired for night shift and am anticipating some uncomfortable situations with angry tired doctors. I tend to avoid confrontation, and am afraid I will be so shocked I won't be able to say anything to them. I was hoping some experienced nurses could share some tips or one liners to diffuse a tense situation and get what you want from a doctors without engaging in a screaming match. Any other tips on dealing with doctors in general is appreciated. Out of all the new things I am going to learn and all the scary things that can happen, dealing with doctors is what I am most terrified of! THANKS!!!!!
    You don't have to put up with any garbage from a dumb-*** physician with a God complex. If (s)he is unduly rude to you, tell him so in a respectful (remember, respectful and obsequious are NOT synonymous) but firm manner, call your house supervisor, and chart if he is being uncooperative - make sure your charting reflects that you followed proper standards of care. Most doctors are understanding anyway, and will be more pissed if you DON'T call them about serious conditions. They knew what they signed up for.

    That said, you can minimize ugly nurse/physician interactions by:

    1. "Dr So-And-So, this is Thomask at the PCU at XYZ University Hospital."
    2. Have that nursing assessment, with pertinent details, ready. Keep it short and sweet. Remember, you probably wouldn't be feeling so hot if you were woken from a sound sleep (or disturbed from other night activities, hehehe...)
    3. Have your current orders on hand; be sure to let the doc know what measures have already been tried, and what their effect was, positive or negative.
    4. Once you get more experienced and have seen most common situations, it helps to have an idea of what you expect the physician to do to help you.
    4. Repeat the order back to the Physician to make sure you get the right order. Again, most docs understand this is a standard practice designed to protect patient safety. Don't be shy.
    5. Document the Physician's response, even if he tells you to go F*$#! yourself (be sure and notify your house supervisor after you get off the phone.) CYA - if worst comes to worst, your charting needs to accurately demonstrate that you followed proper policy and procedure, and more importantly, reasonable and proper standards of care.
    6. Don't abandon that patient - Keep trying until you get the necessary help. This may again necessitate involving your House Supervisor.
    7. Remember, you get respect by giving it (usually) - respect is NOT butt-kissing though.
  6. by   grammyr
    It also seems like that if there is a jack@#@ in the bunch, he or she can sniff out a new nervous nurse. Don't ever let one see you cry because he
    fussed or yelled at you.
  7. by   thomask
    In teaching hospital are there constantly new doctors around?
  8. by   ElvishDNP
    Quote from thomask
    In teaching hospital are there constantly new doctors around?
    Where I am they rotate every 1-2 months for a year their first year, then it's something different their 2nd year, then they're gone. So they're there for a while but don't usually stay after residency. We've had a few that did and we were glad, because they're really great docs.
  9. by   goats'r'us
    don't be scared. their poo smells no better than yours.

    if you truly have something worth reporting in the middle of the night, then you're doing them a favour by calling them.

    i usually start with 'hi doctor, sorry to call in the middle of the night, but..'
    at least, that's what i used to say.
    now i work at a hospital with residents whose job it is to answer middle-of-the-night calls, and if the problem is beyond them, THEY call the narky doctors.

    in short, be nice, and allow them a little grumbling room - you HAVE just interrupted their sweet dreams, - but don't allow their grumbling to become personal - it's not your fault their patient's had something happen.. (at least, i hope not!)

    you'll be fine.
  10. by   Sisukas
    if i can add a suggestion....
    please make sure you carry out the order after you receive it. i had a doctor come on the floor yelling because a night shift nurse called him at 2 am for an anti-diarrhea med after the patient had a bunch of loose stools in a row. then she never gave the med. the patient was in dialysis all morning for me. he remembered who the nurse was and wanted me to call her and wake her up so he could ask why the h*** she didn't give the med after she woke him up for it. and you know what? i almost did.
    anyway, he remembered who she was, and for a long time after that, he did not treat her quite as nicely as other nurses when she called him at night. it took a long time for him to trust her again.
  11. by   thomask
    I am so glad I found This site!!! Everyone is so helpful to the new people. how did nurses ever get the rep for eating their young?
  12. by   mccmaeve
    The idea of the screaming MD used to scare me too.
    I agree with the reply from hogan4736, above, who wrote: "I disagree w/ starting your call off w/ an apology...It makes us sound sheepish and puts us at a disadvantage...It's their job to be on call 24/7...Not MY problem you decided to go to med school......BE PREPARED...I'll take notes before the call...I'll lay out the labs in front of me...Read the H&P before calling...If the pt is dizzy, I'll have orthos already done...Think ahead...We work for the pt, not them..."
    This is, I think, SO WELL SAID!!!!
    The writer, hogan4736 has a great plan, and when I call an MD, I try to follow it myself.
    As a newer RN, I got over my fear of screaming MD's after the second time one of them screamed at me....
    I realized that their "screaming" indicates a lack of self-control. The fact is, the screaming MD "pales" in comparison to all of the serious things that can quickly go wrong for a very ill patient.
    If an MD or anyone else screams at you, their unprofesional behavior says more (negatively) about them than it does you.
    Over time, the docs who want to work WITH you to help the patient will far outnumber the screamers.
    From a practical standpoint, and after I do the prep-work that hogan4736 describes, I make the call to the screaming MD.
    I find it helps me to remember that the # of hours in my shift is limited, and then I get to go home....but this patient is possibly dealing with a life changing event. It may be a long time till they go home.... So, do I focus on the screaming MD, or do I focus on the patient? Naturally, we all know, we focus on our patient.
    Another thought---Getting through Med School may entitle him or her to a Platinum Amex Card, but it does NOT entitle them to treat you badly!! Hold your ground, stay focused on the patient, be prepared with facts, and you will find that these screaming events are not so significant...You will see your own value! The MD really needs the info you have...
    You will also find that you are not alone, there ARE other RN's on your shift for you to consult as a resource, and a Nursing Supervisor always in any hospital.
    Again, documentation IS your friend, and as long as you say focused on the patient--the screaming will subside. Sure, it IS uncomfortable, but it is also TEMPORARY :-)
    And, it makes for a great story, much later, after you have taken good care of your patient, and the screamer is history...
    mccmaeve
  13. by   thomask
    [quote=goats'r'us;2144578]don't be scared. their poo smells no better than yours.

    My poo happens to smell like roses...

close