how to deal with this intensivist

Specialties MICU

Published

Hey Everyone,

We all had a horrible week. Acuity is extremely high, we dont have enough nurses. Everyone is burned out and overworked.

On my last day of many consecutive days in a row I missed that my patient should have been on a type of respiratory modality overnight. It was a new order given at change of shift, but I had the patient the night before and she was already on it the night before, so I didnt really think about notifying RT. I didnt catch this until the following morning. I immediately told the charge nurse and head nurse and called the doctor.

I said it was all my fault. I know I read the order. I just was so exhausted that I missed the fact that RT never started the treatment. The patient was respiratory-sound so I didnt have any respiratory distress or desatting to jog my memory.

This is my first really big mistake and I feel horrible, but Im also putting it in perspective, that I need to move on and learn from this. I think there were two major factors to my mistake:

1) being exhausted and overworked

2) getting orders at the beginning of my shift when I will review them quickly because I am stressed and busy

So anyways, I call the doctor and he doesnt yell. He just continues to hang up one me. Even when I had to call him later about another patient who was in 10/10 pain, he continued to hang up on me. I was almost brought to tears when this guy kept hanging up on me while my patient who had major abdominal surgery is suffering because a doctor is mad at me about a totally different patient. I charted all of this and told the charge nurse. Luckily this all happened before change of shift, so the oncoming nurse was able to deal with the client's pain and get orders where I could not.

I feel like Im in a bind having this Dr. be so mad at me. He is our intensivist and guides the overall care for most of our patients. I call him at least once a shift and he charts on our unit. I dont know how to deal with him now.

What if when I come in to work again he continues to ignore me? How will I ever get any orders for my patients? What if he comes on the unit and acts like nothing happened? Or even worse, what if he sees me on the unit and chastises me further?

Thanks for the advice.

Specializes in ICU, Research, Corrections.

So, have you had to see this doc again and how did he act. Curious minds need

to know! I am actually ****** off at this doctor and I don't even know him!

Specializes in CVICU.

What a prick. I would report him to your facility's medical director. Leaving a patient in pain because of a personal tiff is uncalled for and DANGEROUS. Nobody should have to suffer because of someone's ego and personality problems.

Specializes in CVICU.
Sometimes in the ICU, you unfortunately have to do things that make you uncomfortable.

Don't apologize to the intensivist. Grow a pair and ask him "Hey, why did you hang up on me repeatedly last night? That was unprofessional and it won't be tolerated"

Absolutely. Go up the chain of command, go to the medical director. Call the ethics committee. You'll stir the pot, but if it's the right thing to do, they are the ones who will look bad in the end.

I once called ethics because everyone from the resident, chief resident, and attending refused to address a patient's and family's wish of DNR status. The patient was over a couple of weeks post-op, with a poor prognosis. Guess what? Ethics agreed with me and the patient was made a DNR the following day. I don't think the physicians even understood the difference between DNR and comfort cares.

The chief resident was a total B to me for quite a few weeks after that. All I did was make it a point to smile and say "hi" to her every day. Sometimes stepping out of your comfort zone is the best thing to do.

One of my favorite nurses was being berated by a pompous physician one day. She told him not to talk to her like that on the phone. He went on berating her, so she pulled out the trash can and plopped the phone in it. After that, the physician came up to the unit and yelled at her. She wouldn't have it and walked away. The next day, he finally apologized to her. After that, he was much more pleasant.

Specializes in floor to ICU.

CNL2B: DO NOT TAKE FULL RESPONSIBILITY FOR SYSTEM ERRORS.

So true. *Sigh* Seems everything ultimately falls on the nurses shoulders.

Consent not signed? Nurses fault

Room is dirty? Nurses fault

Patient's family is unhappy? Nurses fault

Hurt your back turning a patient? Nurses fault

Patient didn't get meal tray despite being ordered? Nurses fault

Labs were ordered in the computer, drawn and sent but no result yet? Nurses fault

Pharmacy mislabeled the med and it was given? Nurses fault

Home med sheet not filled out yet? ( because no one knows what mama takes and I have no idea what the "little blue" pill is) Nurses fault

Patient satisfaction scores down? Nurses fault

Crappy channel selection on the tv? Nurses fault

Patients unable to be taken care of properly due to staffing issues? Nurses fault

Patient got a bedsore (even though they weigh 600# and the bigboy bed doesn't have a "rotation or turn" feature and it takes three people to hold up the tremendous panniculus just to apply powder to her abdomen skin fold)? Nurses fault

I could go on and on....

is there any history with this md. proper or not, if he has a thing against you, find out what it is. some nurses feel they have something to prove and will pester docs for the "betterment" of the patient (guilty as charged). if you have (unknowingly) something that rubs this guy the wrong way, try to reconcile it and change your approach. Meanwhiles, your patient is suffering and he's not acting professional at all, but you have to learn to pick your battles with surgeons and other docs. Running to authority figures and so for every infringement, whether right or wrong, will not win you points with those who can make your life miserable.

Talking with the doc in private, informaly may go a long way. Just let him/her know that you are doing your BEST to give the best patient care you can and that the patient is your priority. Be very careful not to insinuate that you even think for the slightest second that HE/SHE is not doing the same from his/her end. Next, apologize for your mistakes, and for "rubbing" him/her the wrong way, and ask him (or her... sorry, I forget) if there's a better way to get a hold of him. Let him know that you were bothered by the hang ups in a polite way.

Specializes in Trauma ICU.

I agree with the writer who said "don't apologize". The mistake you made was minor in the fact that it didn't cause the patient harm and I agree that RT's should check orders every 2 hours on their patients and every hospital I have ever worked in at least in the ICU..that was the practice. But I have let a doctor or 2 know in my day that they will not talk to me like that...that is a bad habit of intensivist with their G** like complex to just treat you like crap...well I demand my respect or we don't have to talk...I remember one doctor was so rude to nurses that every time I had to page her I had the charge nurse handle it and my explanation was...this doctor will make me lose my job if she continues to be so rude over the phone..I even told my manager how I refused to deal with her over the phone..in person was a different story. Being a new grad is tough and learning how to deal with the physicians is another realm in itself. Don't apologize and if the physician does't bring it up then let it go...if he continues to hang up on you or treat you like crap in person ...report it...you should not have to be uncomfortable in your working environment...jus my :twocents:

Specializes in critical care, PACU.

thanks everyone for the support and advice

well I lucked out and he was gone for a week and I finally talked to him recently for a patient and he was back to his usual self.

I havent seen him but he was fine. Im just going to forgive and forget. If he pulls something again Ill say something but I really do like and respect the guy and that's why it was so hard to be disappointed by him.

I didnt get an apology but I also didnt get yelled at or hung up on again so Im happy with it.

It was funny. When I called I was talking super fast because I was afraid he would hang up and he was all "slow down and relax I cant understand you." and I wanted to say "well Im scared you'll hang up on me" but I didnt want to push my luck ;)

thanks guys, Ill keep you posted :)

Specializes in critical care, PACU.
CNL2B: DO NOT TAKE FULL RESPONSIBILITY FOR SYSTEM ERRORS.

So true. *Sigh* Seems everything ultimately falls on the nurses shoulders.

Consent not signed? Nurses fault

Room is dirty? Nurses fault

Patient's family is unhappy? Nurses fault

Hurt your back turning a patient? Nurses fault

Patient didn't get meal tray despite being ordered? Nurses fault

Labs were ordered in the computer, drawn and sent but no result yet? Nurses fault

Pharmacy mislabeled the med and it was given? Nurses fault

Home med sheet not filled out yet? ( because no one knows what mama takes and I have no idea what the "little blue" pill is) Nurses fault

Patient satisfaction scores down? Nurses fault

Crappy channel selection on the tv? Nurses fault

Patients unable to be taken care of properly due to staffing issues? Nurses fault

Patient got a bedsore (even though they weigh 600# and the bigboy bed doesn't have a "rotation or turn" feature and it takes three people to hold up the tremendous panniculus just to apply powder to her abdomen skin fold)? Nurses fault

I could go on and on....

haha this is so true! I am covering myself whenever others mess up from now on. It's not about blaming others but making sure you dont get blamed for their shortcomings

I would not leave things as they are.

Personally, I would just say to him I don't appreciate you hanging up on me.

You put my patient's at risk. Depending on his answer, things could be

straightened out, or you are going to have to go to management for guidance.

I'm slightly less polite than this... if he continued to hang up on me after the first time, I would simply continue to call him back, and when he finally answers or stays on the phone long enough, I would say sweetly and kindly "Sir, I very much need your attention for (patient name)" and continue with what I needed. You can't change another person's behavior, only how you choose to react to it. Often, people assume that when we get angry, we are being defensive (a sure sign of guilt). So be persistant and professional, but don't allow this person or their high school habits to interfere with your ability to provide care. Good luck!

well I took responsibility because as a new grad I was having trouble with criticism and I learned over time that what they expect from you is to basically throw yourself under the bus and offer no excuses, because no excuse is good enough to validate making a mistake. so that is what I did. I do think respiratory was partly at fault but as the nurse, being the overall manager of care I should have noticed it wasnt done..

Being a new grad DOES NOT MEAN YOU TAKE ALL BLAME! I can't stress that enough! I recently got thrown under the bus by a seasoned nurse that I thought I could trust, and when the write up came, I refused to sign it because it was a complete lie! No one should ever ask you to assume all the blame because you are a new grad. We might be green in some areas, but that doesn't mean that we are stupid. Its high time some of these 'seasoned nurses' understand that. Not all experienced or seasoned nurses are hateful, but when you run into one that is, don't back down! Stand your ground firmly and with professionalism, but don't allow yourself to be their scapegoat.

I had a similar situation happen to me a few years ago. I wrote a letter to my manager and the medical director and CC'd him in on it. It was not a nice letter- I let him have it in the letter. Before the end of the day he called me at home to apologize for being such an ass.

Ugh,

be careful with docs like that who are so hot and cold...

that may be their way of trying to be dominant over you read: putting you in fear that one slip up or wrong move/question not sucking up will result in their silent treatment wrath.... forgive, but do not forget or walk on eggshells, this is a smart manipulation move. trust me

+ Add a Comment