Hi Allnurses! New grad RN here, and I've been on my own, out of orientation for a few months now.
I work on a busy med-surg floor that does it all, and wow, what a roller-coaster ride this has been. So I just have to share a recent experience with an MD that left me baffled. It actually happened to a fellow nurse, but I think it sums up perfectly the difficult position we nurses are often placed in, when dealing with tired grumpy doctors, and trying to take care of our pts with due diligence.
So another nurse took his pt's BP at around 0200. The pt was on tele, so it's commonplace on our floor to take BP's on such pts around that time, esp. if the nurse has a concern. So the nurse got a bp of 170+ systolic, on a pt who's baselines is about 125 - 135 sbp. He called the night-time hospitalist to let him know, as per hospital policy, and the doctor's response? "What are you doing taking a BP at two in the morning!?!" The nurse began stammering out a response, when the doctor hung up on him.
Wow... so what do you say to that???? The nurse handled it well, I guess as well as can be handled. I asked him what he was going to do, and he said he would chart the conversation, and let the charge nurse know. What else could he do?
I feel that we nurses are often put in impossible situations when dealing with doctors who are tired, overworked, and just don't have time or want to deal with our patients. But the worst part is that this type of behavior by doctors seems to be tolerated. But God forbid if the nurse didn't follow up on that elevated BP, or even fail to take an 0200 bp in the first place. And lets not forget the most important part, the pt's health and well-being, who is at the center of all of this.
Lots of food for thought here. I feel that a few of you understood where I was coming from, and gave the support I was looking for, so thank you for that. To the others, it seems I did not make my intent for this post clear, so I will attempt to clarify, and try to keep this conversation going in a constructive direction.
Firstly, I'm a new nurse. This job is harder than I ever realized it would be. I mean, I knew it would be hard, nursing school was hard, precepting my final semester was hard, and orientation was hard. Working nights when I'm a morning person is hard, being on my feet for 12+ hrs with a single 1/2 hr break is hard, and going for periods of days without seeing my family because I'm in work/eat/sleep mode is hard. But being on my own, responsible for my patients, in a health care setting filled with litigation, complex policy, complex technology, doctors, specialists, charge nurses, entitlement, very ill patients, their family, and then somewhere in all of this, is me feeling like I'm being pulled in a million directions all at once, has been harder than I ever imagined it would be.
The original post was me, trying to wrap my head around why an MD would question a nurse, not for calling about a 170+ SBP, but for taking the BP in the first place! He questioned this nurse's clinical judgement, and that is hard for me digest.
Before I continue with my thoughts on this, I would like to clarify that we do not "wake up" our night-time hospitalists. They are very busy, usually working in the ER, fielding calls from nurses throughout the hospital, and attending to rapid responses as they emerge. I'm not sure why, but there are quite a few assumptions being made about the situation I presented, when I gave very little info to begin with. This was not my pt, and the nurse taking care of him is a confident nurse, with a lot of experience, who knows how to talk to docs. He "stammered a response," because the doc kept cutting him off. I didn't give a lot of details because this was not supposed to be about "should we take a BP at 0200, and why," or "what should a nurse do if she gets a high BP reading at 0200," this was about a nurse being questioned as to why he took the BP in the first place. This post is about a new nurse (me), trying to understand and cope with being caught between hospital policy, charge nurses, doctors, and what's best for the pt, when these forces often seem to work against each other. It's about how to cope when your clinical judgement, on something as simple as taking a 0200 BP, is being questioned, esp. considering the pt had a significant change from baseline.
And yes, I know docs can be very rude to nurses, even uncivil, and hostile. But this post is about so much more than a doc simply "being rude." In my short time as a nurse, I've dealt with rude docs plenty of times, and never felt inspired to write about it. I have quickly come to accept this as part of the gig, and I agree, things get easier when one learns the art of communicating effectively with the docs.
What was difficult for me to wrap my head around, in this situation, was the doctor's response of "What are you doing checking a BP at two in the morning!" In my hospital, on my unit, that is what we do, esp. if the pt is on tele, and/or the nurse has a concern. I'm assuming this experienced nurse did a BP recheck, assessed for and treated pain, gave PRN BP meds if they were on board, and everything else that was mentioned here that a prudent nurse should do. I'm assuming all of this, because these are standard followups to an elevated BP, and this was an experienced nurse, who knows well the expectations and how to effectively talk to the docs.
I really don't have much more to say about this... I think the doc crossed all kinds of lines. If the nurse didn't follow up on that BP, and there was a bad outcome for the pt, the nurse would have been on the hot seat (and let's not forget the pt, who is at the center of all of this.) Not sure if I will ever be able to wrap my head around how incivility perperated by MD's on nurses is not only accepted, but often (as it seems from many responses to my original post), the nurse is blamed, because it MUST be his/her fault, surely they did something to evoke such a response from a doctor. Which is really, nurse-to-nurse incivility. I'm realizing this profession of caring is many times, anything but.
So, you're facing the stresses we all face everyday as a nurse, you'll get the hang of it. It gets better, kind of. You learn how to cope and how to become a strong, competent nurse. The reactions to this post may not be what you expected, but that's life. Maybe you just posted this to vent or release some frustration but people are always sitting behind screens waiting for a chance to let their anger out on strangers, you have to stop taking it personal.
The doctor was rude and the nurse was not wrong for calling, any good nurse would report such a change of condition. Dealing with rude people is something you just have to get used to, don't feel like you have to constantly defend yourself. Your a grown adult in a very respectable, professional career- so portray yourself as that.
Thank you RN to ACGNP, so all I need to do is stop taking things personal, realize that I have to deal with rude people, and stop defending myself so much, and act professional. Very helpful advice, thank you.
I really don't have much more to say about this... I think the doc crossed all kinds of lines. If the nurse didn't follow up on that BP, and there was a bad outcome for the pt, the nurse would have been on the hot seat (and let's not forget the pt, who is at the center of all of this.)
OP:
I definitely am not disagreeing with you that the doctors response was inappropriate. Or that the nurse is put in a difficult position by being obligated to call if they are concerned about a patient change when calling results in a response like that doctor gave.
I am genuinely wondering though, (please take this in the spirit that it is meant- open dialogue)...
What do you think would improve the situation? Not just the instance that you described, but in the larger picture of healthcare...how can this be improved and how can it help patients?
First and foremost (from my limited persective), I would like to feel that me and the docs are on the same page. It is obvious the hospital has objectives, core measures, and standards that need to be met to receive medicare monies and accreditation. I would love it if I felt that nurses were on the same page as the doctors, working toward the same goal. But what I get all the time instead, is make sure the doctor is ordering this, or ordering that... so we meet core measures. But when you contact the doctors (for example: you need an order for SCD's), they are put off, irritated, bothered, etc., and you have the doctor on one side making you feel stupid for contacting him about such-and-such, and on the other side, you have your charge saying, it is your responsibility to make sure the doctor orders such-and-such.
I am constantly being put between what the hospital needs the docs to do, and what the docs are doing. I mean, tell me what you need me to do all day long, all the charting, the reporting etc., but somewhere along the lines, it seems nurses have also become responsible for making sure MD's are putting in orders that the hospital needs for them to meet core measures.
And when you contact the MD, and they chastise you for doing what you are supposed to do... And when you have the charge on the other side saying "have you contacted the doctor about this? They don't want to do anything? Well they need to, you need to call them again." It's an impossible situation.
And honestly, this site, Allnurses, has made me feel more alone than ever. I'm pretty sure after this discussion is done, I'll never come back here. It has done nothing for me, except make me feel more isolated, more frustrated, and more alone.
Lots of food for thought here. I feel that a few of you understood where I was coming from, and gave the support I was looking for, so thank you for that. To the others, it seems I did not make my intent for this post clear, so I will attempt to clarify, and try to keep this conversation going in a constructive direction.
Firstly, I'm a new nurse. This job is harder than I ever realized it would be. I mean, I knew it would be hard, nursing school was hard, precepting my final semester was hard, and orientation was hard. Working nights when I'm a morning person is hard, being on my feet for 12+ hrs with a single 1/2 hr break is hard, and going for periods of days without seeing my family because I'm in work/eat/sleep mode is hard. But being on my own, responsible for my patients, in a health care setting filled with litigation, complex policy, complex technology, doctors, specialists, charge nurses, entitlement, very ill patients, their family, and then somewhere in all of this, is me feeling like I'm being pulled in a million directions all at once, has been harder than I ever imagined it would be.
The original post was me, trying to wrap my head around why an MD would question a nurse, not for calling about a 170+ SBP, but for taking the BP in the first place! He questioned this nurse's clinical judgement, and that is hard for me digest.
Before I continue with my thoughts on this, I would like to clarify that we do not "wake up" our night-time hospitalists. They are very busy, usually working in the ER, fielding calls from nurses throughout the hospital, and attending to rapid responses as they emerge. I'm not sure why, but there are quite a few assumptions being made about the situation I presented, when I gave very little info to begin with. This was not my pt, and the nurse taking care of him is a confident nurse, with a lot of experience, who knows how to talk to docs. He "stammered a response," because the doc kept cutting him off. I didn't give a lot of details because this was not supposed to be about "should we take a BP at 0200, and why," or "what should a nurse do if she gets a high BP reading at 0200," this was about a nurse being questioned as to why he took the BP in the first place. This post is about a new nurse (me), trying to understand and cope with being caught between hospital policy, charge nurses, doctors, and what's best for the pt, when these forces often seem to work against each other. It's about how to cope when your clinical judgement, on something as simple as taking a 0200 BP, is being questioned, esp. considering the pt had a significant change from baseline.
And yes, I know docs can be very rude to nurses, even uncivil, and hostile. But this post is about so much more than a doc simply "being rude." In my short time as a nurse, I've dealt with rude docs plenty of times, and never felt inspired to write about it. I have quickly come to accept this as part of the gig, and I agree, things get easier when one learns the art of communicating effectively with the docs.
What was difficult for me to wrap my head around, in this situation, was the doctor's response of "What are you doing checking a BP at two in the morning!" In my hospital, on my unit, that is what we do, esp. if the pt is on tele, and/or the nurse has a concern. I'm assuming this experienced nurse did a BP recheck, assessed for and treated pain, gave PRN BP meds if they were on board, and everything else that was mentioned here that a prudent nurse should do. I'm assuming all of this, because these are standard followups to an elevated BP, and this was an experienced nurse, who knows well the expectations and how to effectively talk to the docs.
I really don't have much more to say about this... I think the doc crossed all kinds of lines. If the nurse didn't follow up on that BP, and there was a bad outcome for the pt, the nurse would have been on the hot seat (and let's not forget the pt, who is at the center of all of this.) Not sure if I will ever be able to wrap my head around how incivility perperated by MD's on nurses is not only accepted, but often (as it seems from many responses to my original post), the nurse is blamed, because it MUST be his/her fault, surely they did something to evoke such a response from a doctor. Which is really, nurse-to-nurse incivility. I'm realizing this profession of caring is many times, anything but.
"He questioned this nurse's clinical judgement". Yes, and good nurse's question the doctor's. It's checks and balances for the best patient outcome.
Sleeping or busy, the hospitalist did NOT want to hear about a somewhat elevated BP . No nurse has to accept "incivility" or blame. We don't accept it.. we call it out. " I am informing you of the blood pressure per standing orders, do you want any other actions at this time" will suffice. Then let it roll off your back.
We are not blaming you for your response.. we are trying to show you how to handle such issues in the future.
Jennifer in Cali, I'm sorry that you feel worse after coming here. If you only want a specific kind of response, it is helpful to note it in your original post. I hope you understand that this is a public forum and anyone can post whatever they want within the terms of TOS. What a lot of posters do is learn from the helpful responses and disregard the rest. You can use the report button to report anyone who you feel has violated The terms of service.
It is bad for doctors to be rude, just like it is bad for nurses to be rude. No one's denying that. Most of us are just used to it and don't care anymore. Another thing to remember that people's perceptions of rude are different. What I think is perfectly civil, although blunt, sets a lot of posters off, while I think some of the things people say on here are outright mean-spirited and nasty. Try to see things from outside your own perspective and you will find yourself getting offended less and less.
well, first, good thing the doctor didn't say that to you, but a fellow nurse, because if it was such an emotionally catastrophic event and you were not even involved, I can only imagine the emotional trauma it would have inflicted on you had you been the nurse.
I mean, this is life, you have to have more control on your emotions than getting all upset for several days because somebody hung up on another person in your vicinity. Like, did you just discover the planet does not revolve around yourself? Also, people are mean sometimes, O M G can you believe that??? People not playing nice??
Also, If somebody could have paged me in the middle of the night for a bp of 170 or so, I would have done nothing, as I have done nothing about similar calls for two years working as a hospitalist. How many negative outcomes???? one minus one= zero. I do always have something ordered for 180+ though in almost all situations via PRN protocol though, but if somebody called me about an asymptomatic patient at 2 am, my response would be the same minus hanging up on whoever. I try not to be rude.
So to sum it up
-you posted about another nurse getting hung up on
- it is bothering you days later
- You must have been pampered in your life until this point
Specializes in Cardiology, Cardiothoracic Surgical.
I work cardiothoracic/cardiac stepdown at 2 different places, and the smart docs have thought out these scenarios in their PRN orders. The not-so-smart ones figure it out pretty quickly.
Nothing drives me up the wall faster than docs who leave me no parameters to address little issues(post-surgical patient with absolutely no pain coverage. Good one, Doc!)
Usually we give labetalol or hydralazine for a high BP (we start caring over about 180 SBP) confirmed out of range with multiple pressures, including a manual, and also after we've addressed concurrent causes (vomiting, pain, discomfort, anxiety, etc.)
I think the jist of it is this: If your routine protocol says VS every 4 hours, you have BP parameters to follow and this BP is out of them, then yes a call to the doc is justified. If he gets irritated remind him that this is the floor protocol and you are following that. Then just chart you called, why and if you did or did not receive orders. If you don't like the answer you go up the chain of command. Pretty cut and dry.
Specializes in Cardiac (adult), CC, Peds, MH/Substance.
I mostly agree, but I think docs respond better to "because that is what's ordered. Do you want to change the order?" It makes them realize in their unprofessional, grumpy state, that it's their decision and liability
I think the jist of it is this: If your routine protocol says VS every 4 hours, you have BP parameters to follow and this BP is out of them, then yes a call to the doc is justified. If he gets irritated remind him that this is the floor protocol and you are following that. Then just chart you called, why and if you did or did not receive orders. If you don't like the answer you go up the chain of command. Pretty cut and dry.
RNtoACGNP
48 Posts
So, you're facing the stresses we all face everyday as a nurse, you'll get the hang of it. It gets better, kind of. You learn how to cope and how to become a strong, competent nurse. The reactions to this post may not be what you expected, but that's life. Maybe you just posted this to vent or release some frustration but people are always sitting behind screens waiting for a chance to let their anger out on strangers, you have to stop taking it personal.
The doctor was rude and the nurse was not wrong for calling, any good nurse would report such a change of condition. Dealing with rude people is something you just have to get used to, don't feel like you have to constantly defend yourself. Your a grown adult in a very respectable, professional career- so portray yourself as that.