how to deal with this intensivist - page 2

by fiveofpeep

3,798 Views | 26 Comments

Hey Everyone, We all had a horrible week. Acuity is extremely high, we dont have enough nurses. Everyone is burned out and overworked. On my last day of many consecutive days in a row I missed that my patient should have... Read More


  1. 1
    Quote from fiveofpeep
    I didnt feel right calling the surgeon because the intensivist made the narc drip nontitratable so we could start weaning off the vent and I didnt want to supersede him. the pt could at least have had some prn morphine for break thru pain or something though.
    It would have been OK to describe the vent weaning goals to the surgeon or the house medical officer. At best, they could have acknowledged the weaning goals and still given you pain orders. Or, they could have called the intensivist and told him to manage his case appropriately and call you back.

    If you are charting that your patient is in pain, you called for orders and the MD hung up on you repeatedly, then you still need to call someone else for orders, I think. It's not good for the patient to let it go, and it wouldn't hold up in court.
    It's not the same as an MD listening to what you have to say, acknowledging the situation and saying the current orders are fine as is.
    fiveofpeep likes this.
  2. 0
    oh rest assured, I most certainly would have called someone higher up the chain if I had stayed later, but this all happened right before I was handing my patient off to another nurse for the rest of the day and I knew he would take her calls and I couldnt stay later because I was already helping out with overtime and reached the max hours.

    thanks for the advice. I do agree I should have done more to get this under control if I had had more time.
  3. 0
    So, have you had to see this doc again and how did he act. Curious minds need
    to know! I am actually ****** off at this doctor and I don't even know him!
  4. 3
    What a prick. I would report him to your facility's medical director. Leaving a patient in pain because of a personal tiff is uncalled for and DANGEROUS. Nobody should have to suffer because of someone's ego and personality problems.
  5. 1
    Quote from meandragonbrett
    Sometimes in the ICU, you unfortunately have to do things that make you uncomfortable.


    Don't apologize to the intensivist. Grow a pair and ask him "Hey, why did you hang up on me repeatedly last night? That was unprofessional and it won't be tolerated"

    Absolutely. Go up the chain of command, go to the medical director. Call the ethics committee. You'll stir the pot, but if it's the right thing to do, they are the ones who will look bad in the end.

    I once called ethics because everyone from the resident, chief resident, and attending refused to address a patient's and family's wish of DNR status. The patient was over a couple of weeks post-op, with a poor prognosis. Guess what? Ethics agreed with me and the patient was made a DNR the following day. I don't think the physicians even understood the difference between DNR and comfort cares.

    The chief resident was a total B to me for quite a few weeks after that. All I did was make it a point to smile and say "hi" to her every day. Sometimes stepping out of your comfort zone is the best thing to do.

    One of my favorite nurses was being berated by a pompous physician one day. She told him not to talk to her like that on the phone. He went on berating her, so she pulled out the trash can and plopped the phone in it. After that, the physician came up to the unit and yelled at her. She wouldn't have it and walked away. The next day, he finally apologized to her. After that, he was much more pleasant.
    fiveofpeep likes this.
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    CNL2B: DO NOT TAKE FULL RESPONSIBILITY FOR SYSTEM ERRORS.

    So true. *Sigh* Seems everything ultimately falls on the nurses shoulders.

    Consent not signed? Nurses fault
    Room is dirty? Nurses fault
    Patient's family is unhappy? Nurses fault
    Hurt your back turning a patient? Nurses fault
    Patient didn't get meal tray despite being ordered? Nurses fault
    Labs were ordered in the computer, drawn and sent but no result yet? Nurses fault
    Pharmacy mislabeled the med and it was given? Nurses fault
    Home med sheet not filled out yet? ( because no one knows what mama takes and I have no idea what the "little blue" pill is) Nurses fault
    Patient satisfaction scores down? Nurses fault
    Crappy channel selection on the tv? Nurses fault
    Patients unable to be taken care of properly due to staffing issues? Nurses fault
    Patient got a bedsore (even though they weigh 600# and the bigboy bed doesn't have a "rotation or turn" feature and it takes three people to hold up the tremendous panniculus just to apply powder to her abdomen skin fold)? Nurses fault

    I could go on and on....
    Last edit by General E. Speaking, RN on Aug 14, '10 : Reason: spelling... again!
    walkingonthestars, Tsiasn, CABGx4, and 4 others like this.
  7. 1
    is there any history with this md. proper or not, if he has a thing against you, find out what it is. some nurses feel they have something to prove and will pester docs for the "betterment" of the patient (guilty as charged). if you have (unknowingly) something that rubs this guy the wrong way, try to reconcile it and change your approach. Meanwhiles, your patient is suffering and he's not acting professional at all, but you have to learn to pick your battles with surgeons and other docs. Running to authority figures and so for every infringement, whether right or wrong, will not win you points with those who can make your life miserable.

    Talking with the doc in private, informaly may go a long way. Just let him/her know that you are doing your BEST to give the best patient care you can and that the patient is your priority. Be very careful not to insinuate that you even think for the slightest second that HE/SHE is not doing the same from his/her end. Next, apologize for your mistakes, and for "rubbing" him/her the wrong way, and ask him (or her... sorry, I forget) if there's a better way to get a hold of him. Let him know that you were bothered by the hang ups in a polite way.
    fiveofpeep likes this.
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    I agree with the writer who said "don't apologize". The mistake you made was minor in the fact that it didn't cause the patient harm and I agree that RT's should check orders every 2 hours on their patients and every hospital I have ever worked in at least in the ICU..that was the practice. But I have let a doctor or 2 know in my day that they will not talk to me like that...that is a bad habit of intensivist with their G** like complex to just treat you like crap...well I demand my respect or we don't have to talk...I remember one doctor was so rude to nurses that every time I had to page her I had the charge nurse handle it and my explanation was...this doctor will make me lose my job if she continues to be so rude over the phone..I even told my manager how I refused to deal with her over the phone..in person was a different story. Being a new grad is tough and learning how to deal with the physicians is another realm in itself. Don't apologize and if the physician does't bring it up then let it go...if he continues to hang up on you or treat you like crap in person ...report it...you should not have to be uncomfortable in your working environment...jus my
  9. 1
    thanks everyone for the support and advice

    well I lucked out and he was gone for a week and I finally talked to him recently for a patient and he was back to his usual self.

    I havent seen him but he was fine. Im just going to forgive and forget. If he pulls something again Ill say something but I really do like and respect the guy and that's why it was so hard to be disappointed by him.

    I didnt get an apology but I also didnt get yelled at or hung up on again so Im happy with it.

    It was funny. When I called I was talking super fast because I was afraid he would hang up and he was all "slow down and relax I cant understand you." and I wanted to say "well Im scared you'll hang up on me" but I didnt want to push my luck

    thanks guys, Ill keep you posted
    Hoozdo likes this.
  10. 1
    Quote from General E. Speaking, RN
    CNL2B: DO NOT TAKE FULL RESPONSIBILITY FOR SYSTEM ERRORS.

    So true. *Sigh* Seems everything ultimately falls on the nurses shoulders.

    Consent not signed? Nurses fault
    Room is dirty? Nurses fault
    Patient's family is unhappy? Nurses fault
    Hurt your back turning a patient? Nurses fault
    Patient didn't get meal tray despite being ordered? Nurses fault
    Labs were ordered in the computer, drawn and sent but no result yet? Nurses fault
    Pharmacy mislabeled the med and it was given? Nurses fault
    Home med sheet not filled out yet? ( because no one knows what mama takes and I have no idea what the "little blue" pill is) Nurses fault
    Patient satisfaction scores down? Nurses fault
    Crappy channel selection on the tv? Nurses fault
    Patients unable to be taken care of properly due to staffing issues? Nurses fault
    Patient got a bedsore (even though they weigh 600# and the bigboy bed doesn't have a "rotation or turn" feature and it takes three people to hold up the tremendous panniculus just to apply powder to her abdomen skin fold)? Nurses fault

    I could go on and on....
    haha this is so true! I am covering myself whenever others mess up from now on. It's not about blaming others but making sure you dont get blamed for their shortcomings
    grandmawrinkle likes this.


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