Awful Doctors

[JKimRN]

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.

[dudette10, MSN, RN]

I'm sorry the doctor yelled at you but at the same time, she wasn't wrong.

*** It is embarrasing to me as an RN that a fellow nurse would feel this way. Of course the doctor was wrong. It is not her place to YELL or SHOUT at nurses. While she may well have had a legitimate concern about the care (or lack of) provided by the nurse to YELL or SHOUT at nurses is not only unprofessional but degrading and is a hostile act of bullying. That physician is lucky she didn't get slapped upside the head since bullying often begets bullying.

This might have already been said, but I believe the poster you quoted was saying that the message was correct, but the delivery was wrong. In other words, I believe you agree with the poster you quoted. :)

[dudette10, MSN, RN]

The nurse realized she did wrong. She wasnt complaining about her mistake nor was she posting on AN to have it rubbed in even further.

She was posting about how nasty the doc was. Which under almost any circumstance is uncalled for.

I "liked" the posts that I felt were very constructively worded criticism. Nothing was "rubbed in" in those posts except for the fact that prioritization of a critical lab value is what she needs to address/correct as a new nurse and to seek out resources for such. All of those posts stated that the doctor should not have reacted in that way, but the concern was legitimate. That is simply necessary for a new nurse to learn.

I do hope the OP comes back here and takes the constructive criticism the way it was intended--to help her learn. Based on her post, I think she is open to learning and committed to it, but is just overwhelmed at this time in her job.

[tewdles, RN]

I will apologize that I have not read all of the responses, so this may be a repeat.

It would be helpful if your supportive co-workers had the courage to speak up when this physician bullies one of you. The MD or DO behind the name do not give people license to treat people badly, even abusively, and it should be challenged. Her ego will be hurt but she will get over it. She is walking onto a NURSING unit, where NURSING care is provided...we have more power as a team than we generally take advantage of in these interpersonal situations.

Good luck.

[LadyFree28, BSN, LPN, RN]

I "liked" the posts that I felt were very constructively worded criticism. Nothing was "rubbed in" in those posts except for the fact that prioritization of a critical lab value is what she needs to address/correct as a new nurse and to seek out resources for such. All of those posts stated that the doctor should not have reacted in that way, but the concern was legitimate. That is simply necessary for a new nurse to learn.

I do hope the OP comes back here and takes the constructive criticism the way it was intended--to help her learn. Based on her post, I think she is open to learning and committed to it, but is just overwhelmed at this time in her job.

^This.

We live and we do learn...Esme gave wonderful sage advice.

I also suggest "Critical Thinking and Nursing Judgement" as a great resource to prioritize, learn communication skills, etc.

As a new grad again, this book is my bible. I also believe as a nurse, you can never stop learning and reviewing. Don't forget to utilize HELP, either. Utilize your charge nurse, buddy up with an experienced nurse on your shift. It helps to have a resource, and keep seeking help, especially with a patient who may have an acute event.

OP, hope you are bouncing back from your experience. Nursing is a challenging profession that you have decided to invest in. I wish you success!

[PMFB-RN, RN]

Some of you are missing the point. It does NOT matter what mistake the nurse made / makes. The PHYSICIAN is not the person to "chew her out". It's quite possible a chewing out is called for as a learning tool. However the physician is not in any position to supervise a nurse. The only exception I can think of is when a nurse works directly for a physician, like in their office for example.

Think of it this way. We nurses are not in any position to chew out maintence workers in our hospitals. They have their own chain of command and we are not their supervisors. Nor does nursing school put us in a position to be an expert in the field of faciliety maintence. If you have a problem with the preformance of a maintence workers you need to contact their supervisor and allow them to deal with it.

[kanzi monkey]

Some of you are missing the point. It does NOT matter what mistake the nurse made / makes. The PHYSICIAN is not the person to "chew her out". It's quite possible a chewing out is called for as a learning tool. However the physician is not in any position to supervise a nurse. The only exception I can think of is when a nurse works directly for a physician, like in their office for example.

Think of it this way. We nurses are not in any position to chew out maintence workers in our hospitals. They have their own chain of command and we are not their supervisors. Nor does nursing school put us in a position to be an expert in the field of faciliety maintence. If you have a problem with the preformance of a maintence workers you need to contact their supervisor and allow them to deal with it.

Ordering clinicians are not always familiar with the nursing chain of command. They may not know who to take their grievance to, when that person is around, or what their role is. In a situation where something occurs and harm may come to a patient, the immediate line of communication is ordering clinician-->

I have seen and experienced similar situations (in both roles), and I have been in situations where a nurse became emotional about an error that I found very concerning (and also been that nurse "feeling" scolded). The first thing being addressed in a "miss" or "near miss" situation is the patient. If emotions are unresolved after safety is established, that issue can be addressed independently, when patient care is secure.

Yes, verbal/physical/emotional abuse from one clinician to another happens, and it needs to be dealt with. But it's expected that emotions run high when patient safety is at stake. Sharp or "unfriendly" communication is not necessarily inappropriate when something need to be done quickly, and "chewing out" is subjective.

If my mom's K was

[tewdles, RN]

The fact that a physician may or may not know the correct chain of command does not give them license to verbally abuse a nurse.

[LadyFree28, BSN, LPN, RN]

I think most respondents have to put into perspective that the MD MAY have handled the situation inappropriately-emphasis on the MAY be cause we were not there-however, it does not overemphasize the point that this was a CRITICAL lab value.

Still the OP has to take that lesson learned...pt could've coded, and she would be either answering the BON and/or looking for work. From her post, she has stated this.

If there is a separate issue related to the MD's behavior, then that also needs to be looked into, discussed with the NM, etc.

As for other co-worker's stating the MD does the same thing to other nurses, how long they have been on the unit? Are there an overwhelming number of new grads who have done similar failure to rescue events??? Since we don't have that information EITHER, the fact remains to focus on the OP utilizing her resources more so than the MD's actions...the delay of intervention for the critical lab value is more startling than the MD's response, that the OP posted, in my opinion.

[metal_m0nk, BSN, RN]

Nursing is not an easy job. There are a lot of knocks to take when you're first starting out. The trick is to learn to take your knocks, reflect, and move on. This too shall pass.

[metal_m0nk, BSN, RN]

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.

I think at least part of the reason why what is widely considered as abuse is changing is because with the passage of time we are beginning to more fully understand the real physiological and psychological impact of our interactions with others.

[PMFB-RN, RN]

Still the OP has to take that lesson learned...pt could've coded, and she would be either answering the BON and/or looking for work. If there is a separate issue related to the MD's behavior

*** The BON _IS_ an appropiate body to look into a nurses actions. A physician is NOT.

As for other co-worker's stating the MD does the same thing to other nurses, how long they have been on the unit?

*** Obviously I have no idea about this particular physician. My experience tells me it's highly likely. We all know certain physicians who seem to enjoy bullying nurses and who seem to think that since they are a physician they are in a position to tell nurses off.

[LadyFree28, BSN, LPN, RN]

*** Obviously I have no idea about this particular physician. My experience tells me it's highly likely. We all know certain physicians who seem to enjoy bullying nurses and who seem to think that since they are a physician they are in a position to tell nurses off.

^Ahhh, the "experience" factor...how could I forget that? ....

Again since WE WERE NOT THERE, I refuse to partake in what the physician did...the more important PRIORITY is addressing the OP's failure to rescue; the MD can be sorted out later. A lot of posters decided to do so...that doesn't make any who chose to PRIORITIZE as nurses do in terms of responding to the issues. No one is disputing how some physicians treat nurses. Again, for me, the PRIORITY is making sure she is able to prevent this occurrence from happening again, and asking for help, especially when a potential critical event is faced.

The doctor followed up and the expectation was that the critical value was dealt with TIMELY, and in turn, the doctor still responded on the importance if that. AGAIN, not there for the TONE, but doesn't diminish that the doctor was correct.

We are collaborators with doctors...we must be able to communicate clearly and TIMELY in order to make sure we minimize additional complications, or we are all going to be up a certain creek that starts with an s and ends with a "t"...making this post about "us v. them" doesn't erase the OP's potential disaster. If anything can be made of it, the FIRST thing is honing those skills and utilizing their resources, and ADVOCATING for the pt by being assertive while talking to the doctor, regardless how the doctors feel about nurses...making sure we, as nurses are doing our part, using that doubt, fear etc. by getting help, etc...the suggestions made by other posters.