Should I do anything about being yelled at?

  1. Just wondered what everyone thought about this. The other night I worked I had an elderly patient whose main issue was blood loss and heart related issues. Her daughter accompanied her and when I was admitting her to the floor and going over what we were going to do (the dr. ordered catheter, etc) (daughter is POA), the daughter said "she just needs the units of blood, I don't want you to place catheter!". So I said "OK let me check with the dr. and see if he has any objection to that." (This was a hospitalist admit, and it was nighttime so the night shift hospitalist was the contact). I called him and he asked a few questions and said "no problem d/c the catheter order". At no time during the report from the ER was there mention of acute kidney issues so I thought everything that I was doing was ok.

    Then in the morning, the day shift hospitalist that wrote the order came in and started yelling at me at the nurses station during nurse report. It was very embarrassing. In short, she said "What sort of intelligence did you use to decide to not place a catheter on this pt?" I told her the story above and then she started yelling more saying "I can't believe that you would not do this order, you can't just rely on the night shift dr., they don't know what's going on with the patient. It was up to you to educate the pt about why it was necessary." I was so stunned I didn't even think to say until the dictation came up at 2 am and labs came up I didn't even know that this lady had kidney issues. But I did say, "the daughter was very upset about what occurred in the ER, so I didn't want to push the issue."

    The dr. then said "what do you think? Do you think this is Burger King, we don't just give the patients things their way, we have to be smart and explain to them why it's needed because they have no clue".

    Anyway, I get that I should have pushed the catheter issue more. But, after the yelling and after she left some of the other nurses were like "Gosh I'm sorry that happened to you, etc., I would have done the same thing." What I am wondering is if I should personally talk to this dr. about how I wish she had talked to me away from eyeryone else or if I should complain to my manager. what do you all think?
  2. 26 Comments

  3. by   JBudd
    Take it to your manager, let her confront the doc or his supervisor.
    Yelling is not conducive to teamwork, and patients DO have the right to refuse things.

    You didn't say what the kidney issues are: a catheter isn't going to "fix" them, only let you watch I/O, and prevent retention.
  4. by   llg
    I agree. Talk to your manager. But I would also write up the incident and get statements from the witnesses. (Have them sign the summary of events.)

    If the doctor is usually a nice person and this was an unusual outburst, I would simply give a copy of the documentation to my manager for his/her files (and keep one for myself) -- but not make a huge issue out of it. I would let the manager address it. If it is a pattern of bad behavior -- or becomes a pattern of bad behavior, then having that documentation available will be helpful to deal with that pattern. If it is or becomes a pattern of behavior, then I would definitely file whatever official complaint is possible at your hospital. The Joint Commission requires that facilities not tolerate such behavior and I would ask that your facility deal with this.
  5. by   Seas
    I would write her up.
    A doctor recently got a little mean with me on the phone. It wasn't half as big as this issue, but still not nice. When I told this to my charge nurse, she encouraged me to write this up. A few days later, the house manager told me he got my complaint, and also told that doctors are employees at the hospital just like us and it is my right to write it up if needed to. And nobody is entitled to be rude like this no mater what their title is.
  6. by   MN-Nurse
    I would want a little more information than just the family saying, "I don't want a catheter."

    I had a similar situation the other day. A patient came in with a SBO and had orders for an NG tube and a foley. 80 years old, had a history of BPH, but was AOx3, good renal labs, up independent and often, voiding OK amounts, compliant with urinal use, clear, yellow.

    I got the NG tube in near the end of my shift and told him the foley was ordered but I would let him rest a little before I shoved something in the opposite end. He didn't want the catheter and I couldn't see any reason he really needed one.

    When the next nurse came on, I gave her the situation. She was thrilled I had placed the NG tube and said she'd be happy to take care of the foley. I mentioned I didn't see why he needed a foley but didn't press the issue at all.

    Not surprisingly the foley insertion was painful, the pain never went away and they d/c'd it before my next shift with the patient. I told him as long as he kept voiding ok and his bladder scans were fine, I wouldn't come after him with any more tubes.

    He loved and appreciated my care and his SBO resolved a few days later with conservative management. However, I really owed him an apology for not calling the admitting MD myself and getting that foley order d/c'd instead of passing that decision to the next RN.

    If an MD would have yelled at me for that, I would have taken it on the chin with no regrets whatsoever.

    As it was, I screwed up by not advocating for my patient. That's worth getting yelled at by some goofball MD.

    Col. Hans Landa: "You'll be shot for this!"

    Lt. Aldo Raine: "Nah, I don't think so. - More like chewed out. I've been chewed out before."
  7. by   Altra
    I'm sorry this happened to you.

    I have to say, however, that I would have made it my business to know what the rationale was for the catheter and attempted to redirect the patient's daughter by educating her on that rationale. Yes, she has the right to refuse but she needs to be made aware of what she is refusing: the ability for I/O to be strictly monitored, etc.

    As for the conversation with the daylight hospitalist ... I would have cut him/her off mid-sentence with, "the patient's daughter refused the intervention - end of story" and walked away.
  8. by   TheCommuter
    I suppose I am the voice of dissent here, but I feel that it is more effective to put an end to the yelling at the moment it is happening. Confront difficult people at the very moment they are being difficult. Be assertive.

    My favorite phrase to yellers is, "This conversation is over." After hearing this, most of them usually get the point and lower their voices if they wish to continue talking to me because I will not acknowledge a disrespectful screamer.

    Other helpful redirects:
    "Please stop yelling at me."
    "This discussion needs to happen behind closed doors."
    "Your behavior is not very professional today."
  9. by   not.done.yet
    Ditto what The Commuter said. It is a bullying tactic that usually goes away immediately when calmly met with professional boundaries.
  10. by   Perpetual Student
    I agree with TheCommuter, better to address poor behavior at the time. Health care workers are like dogs--no sense smearing their noses in it a week later. All of this writing stuff and complaining to management business seems pretty petty and weak. Honestly, I can understand why that doc was annoyed, though she clearly handled it wrong by yelling at you.

    If the reason for the admission was "blood loss and heart related issues" can't you imagine why monitoring urine output closely might be very important? I love the doc's line that this isn't Burger King.
  11. by   dudette10
    Quote from Perpetual Student
    All of this writing stuff and complaining to management business seems pretty petty and weak.
    Agreed. A good nurse I work with and who is my mentor has been on the receiving end of "running to mommy" and twisting the truth, and it just reeks of 2nd grade-level skills in interpersonal communication.

    I'm not saying the OP is twisting the truth, but the "running to mommy" part certainly applies. As for the situation the OP speaks of, you don't mention a pattern of behavior, and I'm sure you would if she did indeed exhibit a pattern. Let it go.

    If it continues, have a "Come to Jesus" talk in a private place. That's always worked for me.
  12. by   Guttercat
    I've only snapped at a doc once.

    Needed to call a covering doc that was not familiar with renal patients. I'd never interracted with her before as she was from out of town. She was kind of "dumped" on by nephrology, actually. As tactfully as I could said, "I'm sorry to bug you with this issue as I know renal is not your specialty but here's what's going on..."

    She interrupted and went balistic on the other end of the phone: "Do you have any idea who I am? I'll have you know I graduated from such and such doctor school with a Magna cum Superior Super Skill Superpower and who do you think you @^5* are!!!"

    I paused briefly, and said, "You know. I don't need this sh&t. I'm just trying to look out for my patient." Coulda heard a pin drop on the unit. Everything went silent

    Poor MD later apologized. She'd been having a hell of a day before I called. I actually liked her spunk. Sometimes people just lash out because of a whole lot going on we don't know about. Doesn't make it right, but sometimes it happens.

    As to the OP's conundrum. That doc went WAY overboard in chewing you out in that manner. I'd be torqued. In our hospital, the hospitalists report off to eachother on the patients they're covering. I would've asked this doc why the hell the night shift hospitalist covering her patient had no idea what was going on, and perhaps they should start communicating with eachother when picking up eachothers' patients.
  13. by   Art_Vandelay
    I really like a combination of The Commuter's and Altra's answer. Cutting the doctor off mid-sentence with the phrase "this conversation is over" combined with walking away maintains your professionalism but doesn't allow the behavior to continue or affect you. In retrospect, my original response was anger in return. Yes, there are better ways of dealing with poor behavior. I'm just suprised The Commuter could offer "Please" stop yelling at me. I'm not there yet.
  14. by   Creamsoda
    Funny, similar thing happened to me. I interpreted a certain order the way that I did, well a few hours later, the hospitalist calls me "did you take care of this paitent! Why did you do such and such!!!! do you think your a doctor? Do you always practise medicine without a license?" She went on and on and on. I tried to get my words in to explain why I did what I did and my interpretation of the order but she wouldnt hear it. She spoke to me worse than when I discipline my dogs. She went on to say that she was going to email so and so, and then said "you need to write yourself up right now". Which I was completely happy to. In speaking with a bunch of other people later on about her, she is apparently always a witch. One of our other docs said to just let it roll off my back. I had planned the next day to write her up for unproffesional behaviour. I decided not to, but if she EVER speaks to me like that again, im going to write her up. Probably wont do anything, but im sure if a doc gets enough complaints, eventually something may be done. I have no problem if she felt I did something wrong, speak to me proffesionally, I am more than understanding. I spoke with my manager, she told me to not even worry.

    So my advise, if this doc is prone to behaving like this, write them up about their behaviour. Its not right. If they typically are not like that, you could let it pass, or you could talk with them the next time you see em.

    But now I know with this doc, I will be way more carefull in interpreting her orders. If I have to call her a million times, I will.