Doctor Hassles

Nurses Relations

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Let me start off by saying I avoid this "nurse practitioner" like the bubonic plague. This "individual" constantly insults all nurses, myself included. This nurse practitioner is rude, unprofessional, and let's be honest, not very good at her job. Any who, enough ranting and raving, let me get to the point here.

I have a patient that is elderly and has a terrible, incessant, wet, nonproductive cough; upon listening to lung sounds, I note crackles in lower bilateral lung fields and immediately suspect pneumonia. The patient does not have a fever and his oxygen saturation is 98% on RA. I fill out an SBAR and proceed to place a call to the MD.

About 45 minutes later this "nurse practitioner" calls back and responds to my findings as "Well there isn't much I can do about this. I guess you can give him duoneb treatments QID and get a cxr, even though they never show anything." I do as the "nurse practitioner" asks and call our local mobile x-ray service to get the ball rolling.

Upon receiving results, I note it says, probable for pneumonia or atelectasis of LL lung. I then place an follow-up call to the "nurse practitioner" and read the results... here is the unbelievable response: "Do you see why I hate chest x-rays?! They NEVER show anything... just as useless as every nurse I've worked with. I guess you should get a CBC and CMP to see if the WBC's are elevated. DO NOT call me if they are slightly above normal. He is have dead anyway, there is nothing we can do." At this point in time I am completely speechless and dumbfounded by the response of someone who is supposed to be an advocate for those who cannot speak for themselves (The patient is AAO to self).

The results of the CBC/CMP came back and the values are all out of sorts, so I decide to fax the results because it was during normal business hours. There was no response. I place a call to the office, and still no response. Later that evening, the beloved (note my sarcasm here) "nurse practitioner" comes into the facility and is reviewing all nurses notes and recent labs.

While in the building, I note, with the help of our amazing CNA, that the patient may have a UTI. I proceed to dipstick the urine and note it is positive for leukocytes, nitrates, blood, and excessive amounts of bilirubin and the specific gravity of off. I walk up to the "nurse practitioner" and tell her my findings hoping "this person" would order a UA+C&S but, instead the response was: "Are you SERIOUS? Push oral fluids!!!" Rolls eyes and turns the back towards me.

I had to walk away... I can not believe how ridiculous this person is! I do not know how to handle the situation other than calling the medical director to get this patient taken care of. How do you guys handle or tolerate this type of person? I am at the end of my patience rope with this person. Please advise and be kind. Thanks!!!

Boston it according to the OP it seems like the NP does not communicate well with the staff to begin with. I agree that trusts must be built, however I think it could be possible that the NP needs an attitude adjustment.

So far as the treatment plan: I can totally see why the NP ordered what she did. With the elderly we have to be careful with over prescribing.

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I can understand the consertivive treatment the NP prefers for this patient. However, as someone else stated, it is the manner in which the NP is speaking that appears to be the problem. Instead of being so flippant, she could briefly educate the nurse (OP) on her rationale for her treatment of choice. It sounds like it could have been a great educational opportunity. We as nurses have to know why we are treating a patient the way we are right? I can imagine a family member crabbing at the nurse "why aren't you doing anything." In this case the nurse can only think to herself "um, because the NP said so." While instead she could learn the NPs rationale and then explain it to the family. I also take issue with the NP saying "he's half dead anyway." How crass. We may *think* these things, but holy cow, we don't SAY them!

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The physician who she works under is just as bad as she is.

I see that a lot. Either the MD advocates for their hire because they get along in the first place or the NP learned the style from the attending. Either way, rock and hard place.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
It seems like you have deeper seeded roots than this one interaction, and it is clearly effecting your working relationship. All else aside, I would suggest sitting down and having a direct talk with him/her: it may be bet for both you and the patient.

A few questions, why the quotes around nurse practitioner? Is he/she a NP or not?

I have worked with "so called" professionals who proclaim they actually went to school for medicine do I get the "nurse practitioner" quotes as emphasizing that the OP believes they are a "so called" professional.

I too have worked with "professionals" that claim they "know" what they are doing along with that disparaging tone that is used to supposedly indicate strained tolerance and impatience....for they are far too busy and educated to be bothered by a lowly nurse.

OP.....I would try to engage them....see what makes them tick. I would have this conversation in front of my manager to prevent a "he said she said" situation with you being on the loosing end of that conversation for I know this type to usually be vengeful and insecure.

When all else fails.....I would do what you did...go around them.

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I had a provider like this who refused to speak to the floor nurses, and he was the medical director. Didn't matter if it was after business hours and we had a problem, if the floor nurses called him, our answer would be, 99% of the time,

"Don't call me for this (his favorite expletive), I don't have time. Send them out if you're so freaked out about it."

We ended up sending out an inordinate amount of patients to the ER, most of whom could have been easily treated in house. Of course this started messing with the facility's reimbursements. When the money started talking, our usually do-nothing supervisors decided to step in. The DNS and managers had a meeting with the medical director, and suddenly he was happy to treat issues in house, after hours, with no problem.

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I had a provider like this who refused to speak to the floor nurses, and he was the medical director. Didn't matter if it was after business hours and we had a problem, if the floor nurses called him, our answer would be, 99% of the time,

"Don't call me for this (his favorite expletive), I don't have time. Send them out if you're so freaked out about it."

We ended up sending out an inordinate amount of patients to the ER, most of whom could have been easily treated in house. Of course this started messing with the facility's reimbursements. When the money started talking, our usually do-nothing supervisors decided to step in. The DNS and managers had a meeting with the medical director, and suddenly he was happy to treat issues in house, after hours, with no problem.

Love it! Money Talks.

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Specializes in Med/surg, Quality & Risk.
I had a provider like this who refused to speak to the floor nurses, and he was the medical director. Didn't matter if it was after business hours and we had a problem, if the floor nurses called him, our answer would be, 99% of the time,

"Don't call me for this (his favorite expletive), I don't have time. Send them out if you're so freaked out about it."

I like to write quotes like that directly into my nurse's notes. Our notes print out on the 1-2 page "daily progress" sheet for each patient. They very much enjoy seeing their words in print at the bottom of the page. So does the chief of staff.

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Specializes in Med/surg, Quality & Risk.
Let me start off by saying I avoid this "nurse practitioner" like the bubonic plague. This "individual" constantly insults all nurses, myself included. This nurse practitioner is rude, unprofessional, and let's be honest, not very good at her job.

Wait, I think I recognize this person. Do they spend time on allnurses.com?

All kidding aside, the comment "just as useless as every nurse I've worked with" violates behavioral standards and should be written up as such and complained about. I don't work to be abused.

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Specializes in Med-Surg.
I like to write quotes like that directly into my nurse's notes. Our notes print out on the 1-2 page "daily progress" sheet for each patient. They very much enjoy seeing their words in print at the bottom of the page. So does the chief of staff.

Yup, done that too. Didn't need to be done more than once either. When the other MDs reviewed the notes for last 24 hours and saw this, it didn't take long for it to get to the Dean of MDs for the hospital. He had to formally apologize to me for his behavior. Love seeing a grown man swallow his pride and apologize to the 'lowly nurse'! :p

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I like to write quotes like that directly into my nurse's notes. Our notes print out on the 1-2 page "daily progress" sheet for each patient. They very much enjoy seeing their words in print at the bottom of the page. So does the chief of staff.

LOL, as long as those are truly exact quotes and are not given out of context, I personally have NO problem with it. What does bother me are those quotes that are somehow misquoted or taken out of context. This can cause big problems. The bottom line is the practitioners, docs, as well as nurses should be carefully of what they say and how they say it, and then document their own quotes in case of conflict. But you don't want to get into some kind of quote wars. That's ridiculous too.

The NP's comment about nurses was idiotic, and it colored the whole interaction. On top of that, at least in context with the OP, it sounds like she or he (don't remember) didn't really give a damn. If she wanted to practice conservatively, she should have explained her rationale, b/c most nurses do really care about what's going on with their patients, and she should have taken a better attitude and tone. She doesn't sound like she has a cooperative spirit, and this in my opinion is primarily her problem to straighten out--only, for the nurses and patients, it becomes their problem as well.

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LOL, as long as those are truly exact quotes and are not given out of context, I personally have NO problem with it. What does bother me are those quotes that are somehow misquoted or taken out of context. This can cause big problems. The bottom line is the practitioners, docs, as well as nurses should be carefully of what they say and how they say it, and then document their own quotes in case of conflict. But you don't want to get into some kind of quote wars. That's ridiculous too.

The NP's comment about nurses was idiotic, and it colored the whole interaction. On top of that, at least in context with the OP, it sounds like she or he (don't remember) didn't really give a damn. If she wanted to practice conservatively, she should have explained her rationale, b/c most nurses do really care about what's going on with their patients, and she should have taken a better attitude and tone. She doesn't sound like she has a cooperative spirit, and this in my opinion is primarily her problem to straighten out--only, for the nurses and patients, it becomes their problem as well.

I love your response! This practitioner doesn't give a damn and not one nurse wants to deal with her at all!... it's actually a pretty sad situation, especially for her patients.... Luckily, she doesn't have many at our facility anymore.

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Specializes in Adult Internal Medicine.

I have hemmed and hawed about responding but I feel inclined to from the other side of this experience.

This has really become a question of a chicken vs the egg. Was the NP initially rude to a nurse or was a nurse disgruntled about the NP's plan being different from theirs? It doesn't matter: the fact if the matter here is both sides are wrong. Both sides are perpetuating a downward spiral in work relationships.

Can the OP honestly say this interaction wasn't jaded by the "other" nurses wide spread dislike of this provider? Is anything really solved by nitpicking and ultimately making this NP apologize? All would be best served, including the patient, if conflicts were resolved rather than escalated.

Did the NP make some off-color comments? Sounds like it. Which one of you can say you NEVER have?

As far as the quotes around "nurse practitioner", despite the fact you don't like her or think you know more than her (an perhaps you do), it doesn't change the fact she is board certified, in the end is it more than just petty and disrespectful?

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