Anyone having a hard time getting over the verbal abuse?

JKL33 · Feb 17, 2018

I thought everything was cool and it was over. Then, a NP from the Liver doc's team comes up to me in the hall later that day and gives me a PRINTED page from a book with the definitions and signs and symptoms of each stage of encephalopathy, and how the patient doesn't have encephalopathy. And do you know what makes me mad? My reaction. I take her piece of paper and say ok and walk away. Then I go and cry in the break room. I didn't tell her "hey why don't you give this to the IM doc who used that word?" or "Unbelievable you have time to go to your library of books and print out this article for me!". Why did I not do those things? Because we were in the middle of the hallway, I was busy (99% of the time we were understaffed, and call lights are always beeping). I did what was quickest. Later in the day I went to my clinician to tell her about it and she started an email to the department right away and said that it was NOT ok. I never found out if anything happened.
Another example is when we had a cardiologist from a private group come see our patient who was unresponsive, i think on a vent (can't remember) and on telemetry. His note was so lousy. There was barely any patient information on it. So she ended up having some weird rhythms, and while he probably knew about it, I couldn't be sure. I have to cover my butt. So, I called him twice that day for two different rhythms. He ended up being really rude to me and telling me to calm down and I don't need to be calling him. Of course, he is telling me this while I'm in a patient room and I just say Ok, sure, Ok, because I don't want my other patient (A&OX4) to hear me in an argument on the phone. I wanted to say "your note has barely any information in it and we have no idea what you know about this patient". But I took it, and I still remember it.
Has anyone gone through these things? Did you ever freeze, out of shock, or business, or inappropriate place/time for convo and not have said what you wanted? How do you get over it?
I know one reason why I'm not over these things, even tho they happened over a year and a half ago, is because I'm not working now. I am staying at home with my infant and I often think about going back to work. I always question myself, "will I be strong enough, quick enough, and skilled enough that I can respond in a way that will defend myself and stay professional?" I have these questions because I haven't had the opportunity to test myself yet. So, in the meantime, here I am. Any words of advice or personal experience would be greatly appreciated. Thank you

These types of incidents happen because other people don't feel good about themselves; think about that. They are all people who feel just a little bit better when they try to make someone else look "lesser."

Don't play that game. Don't take it personally, because it isn't personal.

IRL I tend to choose between completely letting these roll off and gently correcting the situation when I feel it's warranted (for whatever reason). But whatever the choice, do it without getting angry or resorting to retorts. Something being a retort vs a correction (IMO) is determined by the spirit with which you say it, your body language, general self control and how "hurt" you let yourself become.

I would've clarified with the Cardiology God which situations warranted a call if I was unsure. Staying calm takes the wind out of the sails of people like him.

I would've told Dr. IM that I would be happy to get him Dr. On-Call Liver's phone # (or transfer to call center to be put in touch with Dr. Liver).

If I didn't do that ^ to begin with, when Ms. NP approached with her Useful Information? Hmmm. When I was a new grad I probably would've said, "Do I look like Dr. IM?" and thrown it in the nearest trash can before she could walk away, or even on the floor if there was no trash can near-by. These days....hmmm - throw it in the nearest trash can before she can walk away. So, see, I've evolved in how I would handle that. Smart alec comments and throwing something on the floor are not cool. :saint: [Ok, in reality I would simply refer her to Dr. IM without stopping to chat or looking at her paper.]

You'll be fine if you just determine not to give these miscreants the power to hurt you.

TriciaJ, RN · Feb 17, 2018

I want to add, if one doc wants clarification from another doc about the treatment plan, they should really talk to each other. The nurse is not a go between.

THIS. That was the crux of the matter. One doctor used you as his personal secretary and then an NP didn't like the answer you gave the other doctor. Now you are verklempt and they need to learn to talk among themselves.

LadysSolo · Feb 17, 2018

I agree with the above posters that the encounters do not rise to the level of abuse, probably pretty rude, but just try to chalk it up to they are having a bad day and you just happened to be there. With the NP, I also am an NP and I love to teach and share knowledge, so perhaps she does too and just didn't handle it well. I usually try to preface such encounters with "for your future knowledge," or "just a teachable moment," realizing these phrases can come across as rude, but the people who know me and hear my tone of voice know I am really trying to be helpful. So don't be too hard on yourself, and know that some cardiologists think they are "god" and you aren't going to change them, and others don't always realize how they are coming across to you.

Mavrick, BSN, RN · Feb 17, 2018

Of course, he is telling me this while I'm in a patient room and I just say Ok, sure, Ok, because I don't want my other patient (A&OX4) to hear me in an argument on the phone.

You are in an alert patient's room talking on the phone with a Dr. about another patient????

Your poor judgement has many facets.

As other have suggested, your definition of abuse is suspect. Crying over a piece of paper with definitions? If you want to make the NP's attempt to educate an act of abuse then you are making much ado about nothing.

Stay home. You're not ready for nursing IRL.

brandy1017, ASN, RN · Feb 17, 2018

I want to add, if one doc wants clarification from another doc about the treatment plan, they should really talk to each other. The nurse is not a go between.

Agreed, but many times they expect the nurse to call and do the work for them. Worked with a traveler who I was really impressed with the Dr was trying to give her orders to put in the computer and she wasn't having it. She told him got to go, busy with another pt, you can put the orders in. He called back and she reiterated her stance and hung up on him. Loved it! Unfortunately, I am not that brazen and find myself stuck putting Dr's orders in. Had a run in with one Dr when I mentioned he was able to put the orders in himself after complaining I was talking too fast he blew up at me and claimed he was unable, finally at the end he apologized.

Wuzzie · Feb 17, 2018

Unfortunately, I am not that brazen and find myself stuck putting Dr's orders in. When I mentioned he was able to put the orders in after complaining I was talking too fast he blew up at me and claimed he was unable, finally at the end he apologized.

He might be interested to know that the the Joint Commission seriously frowns on this practice and he can get dinged for it.

brandy1017, ASN, RN · Feb 17, 2018

You are in an alert patient's room talking on the phone with a Dr. about another patient????
Your poor judgement has many facets.
As other have suggested, your definition of abuse is suspect. Crying over a piece of paper with definitions? If you want to make the NP's attempt to educate an act of abuse then you are making much ado about nothing.
Stay home. You're not ready for nursing IRL.

She probably answered the ringing phone in her pocket. What was she supposed to do hit the decline button? Tempting I know lol. Next time just remember to leave the room, not a big deal. Now the OP knows she was overreacting and should be able to handle these situations and recognize the NP handout was simply a teaching moment. Cut her some slack, you live and learn. It takes time, practice, experience, teamwork and a good mentor to grow as a nurse. We don't come out of the gate prepared for real-life nursing!

brandy1017, ASN, RN · Feb 17, 2018

Wow Ruby, you've really been threw the mill!

To the OP you sound like you were a new nurse working in ICU and learning on the go. I admire RN's that work ICU, especially new grads, very brave; I wouldn't do it for a million bucks! Some Dr's can be rude, although in my experience the majority are not. Surgeons have a reputation for rudeness and arrogance though.

I remember as a new grad I probably drove the doctors crazy calling over every little thing. Luckily almost all were gracious and kind and even thanked me for calling. With experience, I learned what was really an emergency and what could wait for the next day. I almost never call doctors anymore. Of course in ICU people are critically ill, maybe next time try out a less intense unit like a tele step down or med-surg.

Try to remember the doctors are overworked, exhausted, many burnt out and give them the benefit of the doubt. It's why I usually don't fight when they want me to put the orders in. The computer crap has really added to their workload too and they have to document incessantly and check the boxes just like we do! I'm glad I'm not a doctor and that I can go home at the end of the day and leave it behind me, whereas they are on the clock 24/7!

JKL33 · Feb 18, 2018

Try to remember the doctors are overworked, exhausted, many burnt out and give them the benefit of the doubt. It's why I usually don't fight when they want me to put the orders in. The computer crap has really added to their workload too and they have to document incessantly and check the boxes just like we do! I'm glad I'm not a doctor and that I can go home at the end of the day and leave it behind me, whereas they are on the clock 24/7!

Brandy ~

It's nice that you recognize their stress, truly; as far as acute care I too believe their stress level and workload is as ridiculous as ours in its own way. And yeah, CPOE has been imposed in an unnecessarily-frustrating manner IMO. However - - for your own sake and for everyone involved, really, I encourage you to find the pleasantly-confident sweet spot where you can kindly decline to enter routine orders. You have to. Don't think of it as "brazen" to decline to do something that, while kind in appearance, is not the best and most safe way to do things. Pleasantly declining is not rude or brazen, but rather the right thing to do in most non-emergency situations. Does your place have any expectations regarding verbal orders and POE?

Kooky Korky, BSN, RN · Feb 18, 2018

Call me a pansy, thin-skinned, not cut out for nursing, but hey I'm here, I'm me, and I'm staying as a nurse so just please help!
I worked on a med-surg floor in a top hospital in Florida, Magnet hospital with residency training and all that.
So, like every nurse, I made mistakes, a lot of them my first six months, but astonishingly I received the harshest criticism from actions I made that actually were not mistakes.
For example... An IM doc called me to ask me to call Liver doctor to ask what is plan for patients worsening encephalopathy. I called Liver doc as that was who had last written note, not PA or NP. Anyway, she gives me the scoop and I call the IM Doc back. I thought everything was cool and it was over. Then, a NP from the Liver doc's team comes up to me in the hall later that day and gives me a PRINTED page from a book with the definitions and signs and symptoms of each stage of encephalopathy, and how the patient doesn't have encephalopathy. And do you know what makes me mad? My reaction. I take her piece of paper and say ok and walk away. Then I go and cry in the break room. I didn't tell her "hey why don't you give this to the IM doc who used that word?" or "Unbelievable you have time to go to your library of books and print out this article for me!". Why did I not do those things? Because we were in the middle of the hallway, I was busy (99% of the time we were understaffed, and call lights are always beeping). I did what was quickest. Later in the day I went to my clinician to tell her about it and she started an email to the department right away and said that it was NOT ok. I never found out if anything happened.
Another example is when we had a cardiologist from a private group come see our patient who was unresponsive, i think on a vent (can't remember) and on telemetry. His note was so lousy. There was barely any patient information on it. So she ended up having some weird rhythms, and while he probably knew about it, I couldn't be sure. I have to cover my butt. So, I called him twice that day for two different rhythms. He ended up being really rude to me and telling me to calm down and I don't need to be calling him. Of course, he is telling me this while I'm in a patient room and I just say Ok, sure, Ok, because I don't want my other patient (A&OX4) to hear me in an argument on the phone. I wanted to say "your note has barely any information in it and we have no idea what you know about this patient". But I took it, and I still remember it.
Has anyone gone through these things? Did you ever freeze, out of shock, or business, or inappropriate place/time for convo and not have said what you wanted? How do you get over it?
I know one reason why I'm not over these things, even tho they happened over a year and a half ago, is because I'm not working now. I am staying at home with my infant and I often think about going back to work. I always question myself, "will I be strong enough, quick enough, and skilled enough that I can respond in a way that will defend myself and stay professional?" I have these questions because I haven't had the opportunity to test myself yet. So, in the meantime, here I am. Any words of advice or personal experience would be greatly appreciated. Thank you

You should have told the first doctor to call the second doctor himself, that you would not have time or that you have learned the hard way that something always gets lost in translation. You are not the first doc's secretary are you?

Ask the NP to send the same info to the first doctor, or you send it to him yourself.

go back to work soon so you won't lose your nerve altogether.

Kooky Korky, BSN, RN · Feb 18, 2018

I agree with Ruby. I am not seeing verbal abuse here.
The NP might have been a little abrupt, but not enough to cause you to have to run away and cry.
And with the MD if you don't know what to be looking for, ask.
Docs are busy people and don't want to be called repeatedly about minor things.

By the same token, the

cardiologist could have clarified and taught, too.

Crush · Feb 18, 2018

I would not call you a "pansy" or any other name. We all make mistakes or overthink some things, etc from time to time. Heck, we are all human. You have some good constructive criticism here so I won't rehash that. Be gentle with yourself. Get back to work and find ways to leave work at work. Find ways to stop ruminating over a bad shift ( sometimes easier said than done ).

Yes, I have frozen or not answered back at times in my career when I know I should have. Use those as learning opportunities. Use the constructive feedback here as a learning opportunity to grow from. Wishing you the best.