Today I had a mini meltdown at work. I had a patient who was quiet ill and the earlier in the day, the family had requested a specialist consult. The nurse previous to me had checked with the hospitalist, who denied the family's request. The family had left at that time, and I'm not sure if this doctor's decision was communicated with them or not. However, when I came on shift, they returned and filled the room. When I entered, they started asking questions and I answered as best I could. Then they asked when the specialist was coming. When I explained to them it wasn't ordered, they became irate & demanded to get one involved.
I admit I was a bit intimidated by their attitude and numbers, so I caved. The hospitalist had left for the day but was still on call. When I paged him to ask him about the specialist as well as a few other questions the family had, he returned by call and ripped me apart for asking him about the specialist yet again when we he had already said no.
He hung up on me and I felt the tears coming. I excused myself to the restroom, took a few deep breaths, and did my best to return to work and talk with the family.
The hospitalist called back to apologize for his reaction an to address some of the other questions, and that almost restarted the flow of tears again.
I think I've been working too much OT lately. Does anyone else cry when frustrated or being berated? I want to be able to handle these situations with grace and not dissolve into a blubbering mess.
I've cried out of frustration or embarrassment, being over tired is usually involved as well.
I bet he's over tired as well, he realized his unreasonableness and was good to try to repair.
It would have been better if the exiting nurse had told you that he denied a major family request so you could have brought your charge into instead of being ambushed, probably would have prevented the whole thing.
I know I am wayyyy more likely to start crying about something that wouldn't normally make me cry when I'm tired. So from my point of view...yes...probably too much OT.
Does your facility have patient advocates? Perhaps this could have been a situation you could have punted to the patient advocate, rather than getting in the middle of a disagreement between a family and a physician you knew already weren't on the same page in the middle of a shift when you have other patient care issues to attend to.
I'm a crier I always have been. Try as I might I have never been able to control it. I cry if I get mad, I cry if I get frustrated, if I get yelled at. I also cry if I have a patient die. Can't help it. I have learned to just excuse my self for a few min if possible and go to the bathroom and cry after I give in and do then I'm ok.
1) I completely agree with above posters about your exhaustion making you more susceptible to this sort of reaction. Stop working so much overtime for six weeks and see if you feel better.
2) Am I missing something? Since when can a family be refused like this? I would go up the nursing management chain to get support for them in making the choice that is their right. They can call the specialist themselves if they want to. It may well be that if the specialist doesn't have privileges at that hospital, s/he can't consult. It may be that the patient's insurance will want a preauth from a PCP to pay for it, but if the PCP won't give it, the family is within their rights to get the consult on their own dime. Does the hospitalist work for the hospital or the PCP practice? Why does s/he think s/he can get away with this? Don't let anybody threaten you with "alienation of Dr-patient relationship suit." Your first duty is to the patient/family, not to the physician.
So many people conflate the idea of "My insurance won't pay for it" with "I can't have it." This is not true. You can have anything you want to pay for, given the constraints of hospital privileges. Even without privileges (to admit, prescribe a plan of care, operate, chart ...) the family can have anybody they want come to see the patient-- traditional medical specialist, voodoo practitioner, doula, witch doctor ... and examine him if the patient consents or the family member with DPA/POA/HCP does.
Hugs!! I'm prone to crying when angry/frustrated, although I generally hold it together at work okay--now. I used to work in this LTACH and at least teared up every shift, if not cried in the BR. I just felt spread so thin in that place that I wasn't providing good nursing care, and I always want to provide good care. Now I work somewhere where there is more help available, good working relationships with the docs, and supportive management.
However, it is way worse when I'm exhausted. So yes--stop the OT for a while!! Use the time for some serious self care. In the case of my LTACH job, I also think hormones played a role. I started there when my 4th baby was 3 months old, and the tears almost magically stopped when I weaned her at 15 months. I conceived my youngest son a couple months before I left, and then struggled again.
For future conflicts, the other posters had some good suggestions--involve your charge RN, communicate with the case manager if the pt has one, connect them with the pt advocate, etc.
I've personally never heard of a dr-pt alienation suit...interesting. I'd think that as long as you only state facts, that shouldn't be an issue: the on-call hospitalist's refusal to order the consult is a fact. "I'm so sorry that he is being such a rectum!! None of us RNs like him because he has a God complex and neeeevvvvver listens to pts, families, or us..." is unprofessional and will likely erode trust.
But like the venerable GrnTea said, your first duty is to the pt and family. Sometimes I've been able to smooth feathers by assuring them that I am in their corner, I know they know the pt better than we do, and I am doing my best to make what they need happen--even if I'm getting pushback right this moment.
I'm not a crier. I wouldn't have cried. I also wouldn't have called the hospitalist to ask for what he'd already refused to order.
I would have advised the family that the hospitalist would be back in the AM , and they could speak to him/her then. It's not that I don' want to advocate for the patient, it's just not entirely my job to get between the two.
If the family insisted, I would have contacted the supervisor or even risk management. I would advise them of their rights regarding specialized care for their loved one.
My question would be, why didn't somebody in that family ask those vital questions of the hospitalist, while he was on the unit?
I wonder if the OPs melt down was in part because they were pressured into doing something that went against their better judgment.
Specializes in Acute Care - Adult, Med Surg, Neuro.
Thanks for the support, everyone. I am saving up for something specific and am almost done, so the OT should end in a few weeks. The patient was admitted with a GI complaint and had been having complications (multiple abcesses), and had an extended length of stay. I think the family members had been googling things and presented a lot of scenarios/diagnoses that the hospitalist found unlikely. He stated to me that he thought he could handle the case and that a GI specialist didn't need to get involved. I remember him specifically yelling at me "Since when do we let family dictate plan of care?!" at one point.
I doubt he would have come back to speak to the family, as he was driving in his car when answering the phone. I know our hospitalists are so busy that swinging back around to see a patient for the second time is often a hardship. I think I ended up telling the family the doctor's decision and encouraged them to speak to him in the morning if they had further concerns. I guess I'm not sure of their rights in this situation. I know patients and families always have a right to a second opinion, right?
Specializes in Complex pedi to LTC/SA & now a manager.
Absolutely patients/caregivers have the right to a second opinion or specialist opinion. (In some states, insurance is mandated to pay for a second opinion for certain medical conditions such as cancer) This is part of the patient bill of rights. It sounds like the hospitalist failed to communicate with the family/patient that he declined to order a GI consult and why. (IMHO he should have it would have made everyone's life easier. )
"Doctor, the patient's son would like to discuss the plan of care." Hand the phone to the son.
This is more efficient than have to deal an angry family and an angry hospitalist- both of whom by the way, would never speak to each other the way they spoke to you.
Chew some gum if you feel the tears welling up. It somehow turns off that urge to cry .
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
It gets easier when you teach yourself to take NOTHING personally, even if it was meant that way. If the family is yelling because the doctor didn't do what they wanted, not your problem. If the doctor is yelling because the family is being a pain in the butt, not your problem. If you saw someone's toddler throwing a tantrum in a store, would you feel responsible? No, because it's not your problem. When anyone in your workplace is acting like a toddler, you don't have to make it your problem.
You can make sympathetic noises, put on your concerned nurse face and let them vent. But unless you personally killed their loved one, you are not responsible. When they settle down you can offer to call the doctor or just bring them coffee. When you call the doctor, you can sympathize that he has to deal with such needy people. Then you can ask what you should tell them right now. But you do not have to own their problems.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
If you saw someone's toddler throwing a tantrum in a store, would you feel responsible? No, because it's not your problem. When anyone in your workplace is acting like a toddler, you don't have to make it your problem.
Bingo! I'd like to elucidate your very salient point...
We are not responsible for the manner in which other people act. We cannot and do not make people behave in certain ways. We cannot make another person angry or displeased.
People choose to act out. People choose to behave badly. People choose to become angry or displeased. Essentially, people have the ultimate choice on how they react to life's occurrences.
So when I observe a physician throwing a tantrum or a family member screaming, I remain calm and refuse to engage with them because these people are choosing to react badly and I maintain my choice to refuse to deal with people who treat me badly.
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Sometimes I've been able to smooth feathers by assuring them that I am in their corner, I know they know the pt better than we do, and I am doing my best to make what they need happen--even if I'm getting pushback right this moment.
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Libby1987
3,726 Posts
I've cried out of frustration or embarrassment, being over tired is usually involved as well.
I bet he's over tired as well, he realized his unreasonableness and was good to try to repair.
It would have been better if the exiting nurse had told you that he denied a major family request so you could have brought your charge into instead of being ambushed, probably would have prevented the whole thing.