Awful Doctors

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As a newly graduated nurse, I am still in the midst of trying to grow in self confidence and improve my critical thinking skills. I have only been working as a nurse for four months now and there is this horrible doctor that works on my floor. This is not the first time this same particular doctor has chewed me out but this time, this was by far the worst.

Early in my shift, I received a critical potassium level of 2.8 and reported it to this doctor. She ordered me to start an IV 60meQ of potassium and to draw a potassium level stat after the IV was completed. To start off complications, the patient's IV site was infiltrated and I wasn't able to take the time to start a new IV until three hours later. She complained that the site was burning too much so I started it off at 50ml/hr instead of the prescribed 88ml/hr.

Later in the day, this doctor comes up to the floor and demands why the potassium level hadn't been drawn yet. I explained to her the situation and it was just horrible. This doctor raises her voice at me in front of the whole nursing station and says, "Then you should have called me and I could have easily written an order for KCl po! That her potassium was this low and that it's taking this long to get her potassium is ridiculous. This is just unacceptable!!" Silence fell from the whole audience and I just nodded my head and walked away. It took all the strength I had to not burst into tears.

Quite a few of my coworkers came up to me to hug me afterwards and it's well known that this doctor has a tendency to be this rude. I understand my mistake and it was a learning experience. If she had a problem that needed to be addressed, she could have easily taken me aside and I would never make the same mistake twice.

My day just went downhill from there. I had a new admit and a million new orders for my other patients. As soon as I clocked out for the night, I burst into tears. I dread going back into work tomorrow.

Eek, nothing worse than making a mistake and then having some almighty nursing students who have taken 1 semester of patho and fundamentals come forward and tell you how wrong you are. The patient is fine, the nurse learned from her mistake, it's OKAY! One day you will make a mistake and you will feel awful about it and I can only hope that the people you ask for advice won't be as condescending.

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Eek nothing worse than making a mistake and then having some almighty nursing students who have taken 1 semester of patho and fundamentals come forward and tell you how wrong you are. The patient is fine, the nurse learned from her mistake, it's OKAY! One day you will make a mistake and you will feel awful about it and I can only hope that the people you ask for advice won't be as condescending.[/quote']

Exactly. Because they won't EVER make a mistake and the seasoned ones never have.

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Exactly. Because they won't EVER make a mistake and the seasoned ones never have.

:yes: I remember being a student and getting an A on my test and thinking that I was unstoppable and knew everything. Started working in a hospital and I had an entire humble pie slammed in my face. In fact, I eat a slice almost every day!

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Based on the OP's description of the interaction with the MD, it sounds like the MD may have been a little panicked. I have been the ordering clinician for a patient with a baseline low K (baseline because she had bowel surgery and wasn't able to take anything PO), and after a prolonged day of IV repletion where lines blew, infusion stalled for pain, the patient refusing new lines, etc--even after a full day of receiving 60 meq the potassium was down to 2.1 the following morning (and she had a lot of ectopy). I work in the evening, and I personally felt that both my morning counterpart who writes orders and the nurse did not act quickly enough, and that she absolutely needed a central line which we couldn't get after 5 pm on the floor.

I felt helpless and afraid more than anger. I felt like these were things that could have been anticipated, and both the nurse and my colleague dropped the ball by not being more aggressive about ensuring this was dealt with. Sometimes we have to say "jeez, this system for doing such and such for this patient is just not working today. Will have to figure out how to get this done another way, but I have too much to do to make it work now". And then other times, we have to be "all over it". Such as with a dangerously low potassium. As Tim Gunn says- "make it work".

In my situation I brought it to my colleague's attention by saying just what I said above- "you should have been all over that". And then we moved on (my colleague is excellent and totally got it) and I kept up the effort to get her repleted without good access overnight. She got a central line the next day and didn't need transfer to unit, but that's what we watched for.

Advice for the newbie nurse--don't be afraid to page the on call. All you are doing is communicating about something YOU think or know is important. It sounds like the "awful" MD was probably feeling worried about the patient--if there is poor PO intake, the K is likely lower now. I agree that she shouldn't raise her voice--however she was able to communicate her frustration to you--that is, had she known the infusion wasn't running, she would have given it PO. Lesson learned.

She was also probably upset with herself for not having been "all over it". She has perhaps now also learned that IV kcl is not the best route if there is an enteric option.

In the future--always think of repleting potassium orally. I see doc's order it IV all the time, an it often doesn't make sense. Especially if the level is

Good luck!

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I reread the op what did the physician say that was so wrong? Only that she yelled? This is a daily occurance where I work. Coworkers will most likely critique you for "allowing this to happen" meaning letting the 3 hrs go by......

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Specializes in Med-Surg.
Eek, nothing worse than making a mistake and then having some almighty nursing students who have taken 1 semester of patho and fundamentals come forward and tell you how wrong you are. The patient is fine, the nurse learned from her mistake, it's OKAY! One day you will make a mistake and you will feel awful about it and I can only hope that the people you ask for advice won't be as condescending.

While I agree with you that when a nurse comes on here to ask for advice, we should give it in a non-judgmental manner, I just went and re-read the OP...and there was nothing in there I noticed that was seeking advice. It seems like what was being sought was a sympathetic hug and pat on the back, that the mean old doctor over-reacted. Had she come on here, explained what happened, and asked: "How do you deal with doctors who yell at you?", "How do you stand up for yourself with bully co-workers?", or "Can you give me tricks for better time-management so this kind of thing doesn't happen again?", the whole thread would be different.

And I'll also agree with other posters, PO K+ seems to work much better than IV either way. You live and learn though.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I reread the op what did the physician say that was so wrong? Only that she yelled? This is a daily occurance where I work. Coworkers will most likely critique you for "allowing this to happen" meaning letting the 3 hrs go by......

*** How embarrasing to me that so many nurses are so ready and willing to be bullied and abused. As said in the OP this particular physicians has a history of "chewing out" nurses, or at least the OP, then shouts at her in a degrading manner in front of her co-workers. That is unacceptable in any place I have worked in the last 10 years. Any physician who attempoted such bullying behavior in front of me would get put in her / his place pretty quick.

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*** How embarrasing to me that so many nurses are so ready and willing to be bullied and abused. As said in the OP this particular physicians has a history of "chewing out" nurses, or at least the OP, then shouts at her in a degrading manner in front of her co-workers. That is unacceptable in any place I have worked in the last 10 years. Any physician who attempoted such bullying behavior in front of me would get put in her / his place pretty quick.
In situations like the op's I would feel like I as the nurse failed and defending myself would make the situation worse or be seen as making excuses. Now , when drs are rude to me about things I have nothing to do with(even pts that are not even mine) I have no problem telling them off in a snarky sarcastic manner. Most have been shocked into silence. An attending surgeon asked ke to go get supplies for some procedure (not my pt and he did not ask for specifics or even say please) but I went anyway as he was already barking orders and I was such a passive person before.. I came back with what I thought would suffice and he yelling "how am i supposed to do the "procedure" with this!" while all the residents stared. ai replied in a sacastic rude tone, " how am i supposed to magically know what you want?" and walked away. I guess that isn't telling someone off but the look of shock on his face and the suprise/fear in the residents eyes still makes me lol

I guess one can get so used to this s/he doesn't even care anymore.

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Specializes in Med Surg.

This whole situation also shows a flaw within the system. My facility has protocol orders for electrolytes. We can give potassium PO or IV. By simply having that order set, this all could have been avoided. No time to resite am IV in the middle of a crazy shift as an overwhelmed new grad? Take 5 minutes to give a couple of pills and move on. Everybody wins.

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Specializes in Emergency, Telemetry, Transplant.
This whole situation also shows a flaw within the system. My facility has protocol orders for electrolytes. We can give potassium PO or IV. By simply having that order set, this all could have been avoided. No time to resite am IV in the middle of a crazy shift as an overwhelmed new grad? Take 5 minutes to give a couple of pills and move on. Everybody wins.

On the tele unit on which I used to work, we had a potassium protocol that was similar. However, it was still up to the doctor to choose to go with a protocol and how the potassium would be replaced (PO or IV). Some doctors (especially CT surgery and some cardiologists) preferred to handle each K on an case by case basis and not go with the protocol. The doctor in the OP might have gone with IV when PO was appropriate just to be difficult about it.

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Words like "abuse"and "bullying" used to really mean something different. These were powerful words reserved for intolerable situations. Even a mildly raised voice is now considered "abuse"?

I must be getting older.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Words like "abuse"and "bullying" used to really mean something different. These were powerful words reserved for intolerable situations. Even a mildly raised voice is now considered "abuse"?

*** Seems a strange thing to say when what is being discussed is not a mildly raised voice. If you think so please read the OP where the nurse describes a physician's track record abusing her power and bullying a nurse by "chewing her out" in front of her coworkers and not the first time.

Nothing at all wrong with being chewed out IF it's by the appropiate person. A physician is NOT in a position to disipline nurses or chew them out, despite what many of them seem to think. It is my pleasure to disabuse them of their misconception.

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