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.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
I'm wondering if you caught our point: that you cannot do much about the doctor's part in the interaction, but you can control your part.
Specializes in Pharmaceutical Research, Operating Room.
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
Thanks
Nail, meet head.
I'm only 32 years old, but I see that coddled, "special snowflake" attitude in SO many people just a few years younger than me (and in some older people too!). How in God's name can you expect to deal with all the crap the real world throws at you if you get so upset, for days, because somebody wasn't nice to you?????
I don't know, maybe I don't understand it because 1) I wasn't raised that way, and 2) I'm a strong-willed, independent, successful woman who got where I am based on the work I did myself, and I never expected everybody to be extra nice while they spoon-fed me everything.
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.
As you have stated policy/procedure for checking vital signs, do you not have standing orders? It's a telemetry unit, they are likely listed in plain sight (which translates to often missed).
I get that you are new to the profession. But you've stated that you've worked nights for some time. Surely you are aware that most physicians are not barrels of sunshine for midnight telephone calls, right?
The hospitalist was flippant and dismissive, yes, that sucks. Did anyone go further up the chain? What about your CN, House Supervisor, Attending Physician? Suggestions from two of the three, and/or a one time order from the remaining would have addressed the issue.
There was some excellent advice given in this thread regarding presentation I'd read earlier. I'd suggest putting that to use to avoid that type of response in the future. A nurse who sounds unsure of him/herself when calling for orders generally will get the worst possible response.
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.
Jennifer,
I absolutely agree with you. I see this far too often, where some doctors think they have the right to be jerks to us, because they can. They aren't God; they have more schooling than us, and they make the orders for their patients, which we then carry out. Period. When I have to call a doc at night, I'm always glad when the "good" doctor is on-call I don't have to deal with the rude one. That should not even be an issue. We (doctors and nurses) are both there to take care of the patients not to have a pecking order. I had a doctor get bent out of shape because a patient said that I told him that an ototoxic drug he had been on "does" cause hearing loss. This pt had lost hearing, in one of his ears. She didn't bother to come to me and ask what I really said, which was that it "can" cause hearing loss. That information came straight from the drug book, and as nurses a large part of patient care is patient teaching.
In your case, the nurse did exactly as he should have, in my opinion. And, documenting it was great. If that pt were to have had a stroke or other issue, the nurse is covered; it was the doctor, who didn't want to further investigate.
On a side note, I always wonder, with those rude doctors, why they think they have that right. Did they not know going into medical school that they would have to take call?...and aren't they making a substantial amount of money doing what they're doing? It all comes down to immaturity.
As you have stated policy/procedure for checking vital signs, do you not have standing orders? It's a telemetry unit, they are likely listed in plain sight (which translates to often missed).
I get that you are new to the profession. But you've stated that you've worked nights for some time. Surely you are aware that most physicians are not barrels of sunshine for midnight telephone calls, right?
The hospitalist was flippant and dismissive, yes, that sucks. Did anyone go further up the chain? What about your CN, House Supervisor, Attending Physician? Suggestions from two of the three, and/or a one time order from the remaining would have addressed the issue.
There was some excellent advice given in this thread regarding presentation I'd read earlier. I'd suggest putting that to use to avoid that type of response in the future. A nurse who sounds unsure of him/herself when calling for orders generally will get the worst possible response.
Not so fast. I've never worked at a hospital that had standing orders for BP. The best I've seen is parameters included with a PRN med order.
Not so fast. I've never worked at a hospital that had standing orders for BP. The best I've seen is parameters included with a PRN med order.
Standing orders sure would be nice, though!
That's a fair assertion. The hospital I was trained to work tele on did have parameters with corresponding PRN orders to initiate. I also recall seeing similar setups when working agency in other hospital systems here. Someone mentioned earlier in the thread that most parameters start around the 180 systolic mark. That's also consistent to what I've seen just about anywhere I've worked where tele monitoring could be found. Systolic 170, or, 160> was something I'd seen commonly as well however. Just differences in the two in drug of choice and route of administration.
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.
Jennifer in Cali, the portion of your post I've quoted above is very important. It shows you have enough experience under your belt to perceive the disconnect between documentation of core measures and other regulatory requirements .... and actual real-life clinical priorities.
In other words ... the docs are just as frustrated as you are. And this where your opportunity for better relationships lies -- turn the conversation around to include recognition of the fact that we're all stuck in the world of burdensome and occasionally outright stupid documentation, in order to sufficiently demonstrate compliance with standards of care.
How do you think you can work into your conversations an underlying tone of "we're all in this together"? Do you think it would make a difference in your interactions with physicians?
We understand, we just have some other thoughts. These are highly problematic issues you are raising - the doctor's wrong and unacceptable response and behavior, and your feeling that you are being put down by your colleagues here. Stuff like the foregoing destroys a nurse's spirit and that should not be happening. I'm sorry, please hold on, don't throw in the towel yet.
An answer that has helped me more than once is along the lines of, "I'm just trying to keep you and me out of Court, Doc". Or, "Yeah, I know it's a bad time, but I followed your orders and here we are, so what do you want me to do about the BP?"
Chin up, friend, you can make it. Don't allow anyone anywhere to discourage you.
What a wonderful post! I can tell that you are a person, with whom others would like to work. :0) I have noticed that in this day and age...unfortunately...people in general are much more short and rude. Nurses to nurses, CNAs to nurses and vice versa. It is disconcerting to say the least. Kudos to you for having the attitude that you do!
Aw. Girl. Don't worry about it. Document the whole thing. Reported SBP of 170, physician respond "What are you doing taking BP at 0200 am? No orders received. Bwahahaha. Let him eat the whole thing. What a stupid guy. If they do not want to be waken up, order prn meds for all kinds of reason/situation. Sorry you feel bad but I just shrug off docs with bad attitude. I'm doing my job. Do not shoot the messenger.
I chart the conversation...... And the fact he hung up..... CYA. I had a situation like that.... I could not get the ER doc ( peds ER) the charge nurse or the house manager that night to listen. I documented each interaction as well as VS the kid finally de compensated about 0600 and was rushed to PICU. The next day I was called into the managers office to get yelled at. She started with "we hired you because your resume and refs stated you were a good peds nurse" " you sat on that kid all night" I asked her to pull up the chart.... There it was 10 hours of charting every 10 - 20 min with VS and my attempts to get IV fluids started. I said to her..... You might want to check on this....... I later transferred to peds OR. Worst peds ER I ever worked at. If you don't chart.... It didn't happen...
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Ruby Vee, BSN
17 Articles; 14,051 Posts
I'm wondering if you caught our point: that you cannot do much about the doctor's part in the interaction, but you can control your part.