Dealing w/rude feedback

NurseNature · Sep 24, 2008

You sound just like me! Exactly. I end up second guessing myself just like you did and then I get upset for not speaking up for myself and then I go back and forth and back and forth. I am just out of orientation and this has actually been one of the biggest issues for me. I guess I just expected that everyone would be professional and looking out for the patient's best interest at all times and that everyone could just be civil with one another and share knowledge freely and politely when the opportunity arises.

No Doctor, I realize I am not an M.D., and no, I do not want to be one, and no I am not trying to second guess you, necessarily. Many times I just do not know why you are doing what you are doing and it would be helpful for me to know.

I have been just finding a random Dr. in the hall or calling a resident to ask a question, or even pharmacy, in order to seek the knowledge I am trying to obtain if no other nurses know and the Dr. is a butthead. Then at least I am a little bit armed when I call him or speak with him.

TopazLover, BSN, RN · Sep 24, 2008

Some days you just don't have time to read every report critically. Chalk it up to experience and do your best. He is not paying your salary so feel free to ask the people within the system anytime you want. They are being paid to help you out.

Pharmacy can usually help and will when asked. Sometimes we don't use their brains enough.

If you have a minute to think, ask another nurse. Someone may have an established rapport with him and can ask more easily than you. Not the best answer but sometimes it gives you a little space to regain confidence when working with a B-tt head. Sometimes it is even harder when they can be nice. You never know what you will run into. Remember random reinforcement?

nerdtonurse?, BSN, RN · Sep 24, 2008

I can commiserate. I had a pt, going bad in a big way, pco2 was 90, respiratory acidosis, and just shocky as hell. Doc wants me to give him 2 units of blood, on top of 900 ml of antibiotics in NS that he'd been getting. His lungs start sounding wet (and it wasn't just me, the RT and my charge both agreed on that one). Hgb was 9.1. So, I call the doc.

Basically, the conversation went like this.

Me: "Doc, I'm calling about Pt. X in Room Y. I found him unresponsive, foaming at the mouth, o2 sat could not be obtained. We put him on a 100% rebreather, first readable sat was 78. We've got him back up to around 90, backed him down to a venti mask at 50% so he can blow off the co2, and I'd like to put him on a bipap. Pt is also combative, and I'd like an order for wrist restraints to keep him from taking the mask off, since we're having to stand by the bed and hold the mask on his face. His lungs are sounding wet, and I'm concerned about fluid overload since he's taken in 950 cc's and only put out 200 since he came to the ER and his lung sounds are more diminished that at admission to the floor. His BP is 96/52, Hgb is 9.1, he's still using accessory muscles to breathe, do we want to wait until the respiratory issue calms down a bit before we start the blood?"

Doc: "Hang the blood."

Me: "How about the bipap and the restraints? You've also got an order for Lasix 80 after the first unit, and his bp is low. It'll come up some with the blood, but--"

Doc: Hangs up phone.

So much for Airway, Breathing, Circulation, we'll just hop straight to circulation and hope A and B sort themselves out....

Well, after cussing in 3 separate languages for a minute, I put the pt on the bipap, fought with the lab because they only got orders for type/cross match, not the order to get 2 units of PRBCs ready, hung the blood, put on the restraints, and then listened to my pt yell and cuss at me everytime I went in the room, demanding narcotics (can you say, "finish off the respiratory drive?") Pt then threatened to follow me home and shoot me. Oh, the joys of nursing. I told him, "Mr. X, you trash talk all you want, because you know what? You're talking and you're breathing, and you weren't doing that 2 hours ago."

And the doc comes in and yells at me at the nurses' station for "questioning his orders."

I told him, "Doctor W, the one discussion I never want to have with you is that a patient died because I didn't tell you something. It's my job to make sure you know everything I know when you make a decision."

"You questioned my orders!"

"Doctor, it was 3 in the morning, and you were obviously asleep when I called. I wanted to make sure you understood my concerns before you made a decision. I'm protecting my patient, myself and YOU."

He got mad and huffed off.

But the guy was still breathing and cussing when I left, so I guess that's something....

jjjoy, LPN · Sep 25, 2008

My sympathies go out to you! And my kudos to you also for keeping your patient's safety primary despite both the MD and patient fighting your efforts.

The thought of having to put up with that on a regular basis makes me feel sick to my stomach. Unless I KNOW, KNOW, KNOW what I'm doing and have a good deal of experience and confidence in the matter, I just want to put my tail between legs and run away... after stifling the urge to slap someone!

I want to work on not being so flustered by such rudeness. I guess I have lifetime of being non-confrontational to overcome so it won't happen overnight. I also have a lifetime of perfectionism to overcome as well, so I don't get too down on myself for not getting things "just so" all the time. And the only way I'll get better it is to go through it again and again.

It does me good to hear how others with my tendencies have had to deal with such situations and how they managed them... so I don't get so frustrated with myself when I find myself in a similar situation and still not handling it as well as I'd like. To know that it's okay for it to take time and SEVERAL similar run-ins before it might start to feel less uncomfortable.

DLS_PMHNP, MSN, RN, NP · Sep 25, 2008

IF I cannot think of anything constructive to say at the time, I simply say

"thank you for that feedback", smile sweetly, and walk away.

(And curse under my breath) :)

Best,

Diane

Daytonite, BSN, RN · Sep 25, 2008

Just now, I asked an MD to document why a certain routine drug wasn't prescribed. He looked over the records and chastised me "if you had read the report CAREFULLY, you would've seen there was XYZ." "I didn't realize that would mean no ABC later." "It was a XYZ! Of course they don't get ABC!" "Alright. I can see that. For the purposes of QA, the reason for not giving ABC still needs to be specifically documented." "It IS documented. The REPORT says XYZ happened." He'd signed the paper I needed so I dropped it. While leaving, he was muttering "All you have to do READ the report!"

I have no idea what any of the above means. Why does a nurse need documentation that "a certain routine drug wasn't prescribed"? Isn't that the physician's perogative? He defends his own medical decisions in the physician's progress notes.

Sisukas · Sep 25, 2008

The job of some nurses in our hospital is to do Quality Assurance for reimbursement...sounds as is that's what the OP does.

Daytonite, BSN, RN · Sep 25, 2008

The job of some nurses in our hospital is to do Quality Assurance for reimbursement...sounds as is that's what the OP does.

OP is a student or new grad to my knowledge and posts on the student forums a lot.

jjjoy, LPN · Sep 25, 2008

FYI -

Yep, it's in the area of QA. There are certain practice standards that if not followed should be clearly documented as to why not. The rules I was given are that if they don't explicitly state why they didn't follow certain standards, the MD is supposed to spell it out "Contraindicated due to XYZ". I can see why that annoys the docs. I certainly don't want to come across as questioning their judgement. Luckily, that's not the bulk of my job, but it comes up every now and then. This particular role "prefers" RNs with experience but it's not required. Many people in a similar role don't have any nursing background. I've been out of school awhile but I'm interested in nursing education issues.

Daytonite, BSN, RN · Sep 25, 2008

nursing qa or medical qa? i did nursing committee qa, for many years. the medical staff which is a separate entity from the nursing staff also has a qa committee that does qa on itself and polices itself. it's proper name is peer review. while they may depend on other facility staff to collect their data, i'm pretty sure that questions as to why a doctor did or didn't do something are usually done confidentially with the doctor via a private conversation or phone call. sometime another physician colleague is the preferred person to do that. this is how the people running the medical staff qa committee explained that to me when we went through their peer review form. some doctors get nasty when anyone else questions their judgment. it is peer review after all. although the specifics of peer review are confidential, the statistics become part of their performance record and are reported to medicare and a couple of national databases. and those things are looked at by the medical staff. there might be good reason for crankiness.

that aside, if any doctor is being rude, report his behavior to his chief and the doctor who heads the qa committee of the medical staff.

jjjoy, LPN · Sep 25, 2008

The point here was that I was venting in regard to rude feedback. Even though I can understand that I shouldn't take it personally, I find myself feeling crushed emotionally. Defensive to others and critical and unforgiving towards myself.

The bottom line is that I have a thin skin and that's something I know I have to work on. While I can (and do!!!) reflect on how I could handle a situation better, at some point, I also have to accept that no matter how hard I try to find the best way to do something, someone somewhere won't like it for whatever reason and will respond negatively.

Sometimes, I get very discouraged by negative feedback, taking it way too deeply to heart... "Boy I guess I did THAT all wrong! I guess I deserved to be scolded! Why didn't I think of that?! Maybe I should just quit now because if I didn't get that, I might be hopeless."

So, for me, it's more productive to think "I guess he's having a bad day. I can see why he thinks I should've caught that. Oh well, I'm human. I do well most of the time. I certainly won't miss that again!"