developing that "thick skin"

[mycatmax]

So how do you do develop that "thick skin"? This is my 5th week on the floor... brand new rn...

Today was the first day I had a doctor try to make me feel like a bad nurse. Just a rude comment was all. But still, when he said what he did my heart sank into my stomach, I felt it.

I know FOR SURE that this will not be my first, nor my worst encounter. I'm a sensitive person. Just need some words of encouragement, please:)

[Jo Dirt]

Tell him yes sir, you are absolutely right!

I'll bet that would stump him.

[rn/writer, RN]

It can help if you "reheorifice" some possibilities ahead of time. Think of really nasty comments someone can make to you, and not just in your job setting, but anywhere. Then try to think of some responses you can pull out on the spot. This is the alternative to thinking of a snappy comeback six hours later.

I'm not necessarily talking zingers, but replies that let the other person know they are out of line.

Some suggestions--

I though you were better (smarter, more professional, etc.) than that.

Let's talk about this outside the patient's room.

I don't respond well to swearing.

I'm sure you can think of others.

Another tactic is to buy time.

Excuse me?

I beg your pardon.

What did you just say?

In addition to giving you a few precious seconds to cover your shock, these phrases also serve to put the other person on notice that they've crossed a line and may want to consider backing off.

The key to all of this is to be prepared. Think about what you want to do ahead of time. Write down some phrases (helps you commit them to memory) and practice in your car or in the shower.

Separate yourself from other people's reactions to you. Hang on to your confidence even when you've made a mistake. Be gracious when corrected, but insist on decent treatment.

I wish you the best.

[deeDawntee, RN]

I am soooo sorry that happened to you. Doctors can be some of the most immature, rude and condescending people on the planet. And OF COURSE, it would affect you, you are a kind and gentle soul just trying to do your best in a new situation. There is a delicate balance between both maintaining your kindness and gentleness, and being rightfully angry at a mean, rude and unnecessary comment. You SHOULD be angry...anger has power in it... to know that what was said was not OK and not about you will help you release it...

Personally, I just shake my head and wonder how such a miserable human being functions in the world. Mean people suck no matter who they are. I have to imagine that people like that are not getting along well with others anywhere in their lives. (they failed that part in kindergarten!) It may also be helpful to vent with other nurses who know the Doctor as well. You definitely should use the people on your team. For instance, if any of us have to call a notorious Doctor in the middle of the night, we will let each other know and say something like, OK I'm about to call Dr X, will somebody please catch my head if he tries to rip it off....or whatever...it just helps to have someone else supporting you as you call or talk to the Doc.

[BlearnRN]

I know what you mean. I have been a nurse for a little over a year, and yes I have become so upset (my eyes start tearing and my face turns red ) at certain ways I have been talked to. Anyway I have been told by several of my nurse friends that I need to develop a thick skin.... The thing that has worked for me is to concentrate on the pts I have. I am able to work through my emotions by telling myself that " I can't help my pts if I can't calm down and do my job". If someone says something nasty to me, I usually blow it off to a bad day or I will give the attitude straight back to them - not in an unprofessional way-. Example: A doc was annoyed that I called her to verify and assessment with her, so I explained that the nurse before said that the pt neuro checks were normal...but when I did them, they were far from normal... as soon as I did that the doc backed off.

---It just takes time to develop a "thick skin" or your way of dealing. But it doesn't protect everyone all the time...emotions still get through.

[crb613, BSN, RN]

I made up my mind from day one I would not put up with this kind of crap. I am doing the very best I can to give the best care I know how to give. Will I make mistakes? Sure I will, but I refuse to be treated like a child, or an idiot only to be corrected by someone that sees themself as superior. Decide how to want to be treated, & don't settle for anything less.

[rn/writer, RN]

You SHOULD be angry...anger has power in it... to know that what was said was not OK and not about you will help you release it...

This might work for some, but I'd like to offer an alternative view.

When people get angry, they tend to get flustered and actually lose some of their control. This upsets the balance of power in favor of the other person.

And really, what are you going to get angry about. That the person was rude to you? So what. People are rude all the time. And that means there's a good chance they won't give a hoot that they upset you. Or worse, they'll get off on thinking they pushed you around. They might turn up their own volume to outshout you. At any rate, ranting rarely improves things.

You could get angry that they're ignorant, but again, so what. Ignorant people flood the planet. If they're ignorant but well-meaning, getting angry with them is only going to make them defensive. Better to keep your cool and offer the information they need without blasting them. If they're ignorant and proud of it, you're probably not going to change much by taking them on.

The real trick in a situation where someone treats you badly is to stay calm but still address the situation. This catches people off guard. And it allows you to look very cool and self-controlled.

This takes practice, but it's well worth the time and effort. Rather than getting into a verbal slap fight, you can learn to sidestep the blows and let the other person flail and bluster and look like a fool. Then, when they're all hot and bothered, you can let them know that you'll gladly talk with them about whatever has them so worked up whenever they can speak quietly.

Nine times out of ten, anger is a misdirected and inefficient emotion. You can decide that you deserve decent treatment just because you do. Getting angry might intimidate someone else momentarily, but it can also leave you feeling rattled.

You demonstrate genuine power when you can stick up for yourself without blowing a gasket. Of course, if that's the only way you can do it, better that than letting yourself be a doormat. But hopefully that's just a transitional stop on the way to calm confidence.

[BrnEyedGirl, BSN, MSN, RN, APRN]

When I worked cardiac-step down we had an Oncology Dr that would occasoinally have to come to our unit to see pt's. It was well known that he didn't like his pt's on our unit, as soon as possible they were to be transfered to the oncology floor. For many of the treatments we had to have an RN from Oncology come to our unit to help, we were a cardiac unit,.we know next to nothing about oncology meds,.and many of the meds per hospital policy must be given by an oncology nurse with special training. So to a point we understood and agreed that these pt's should be transfered ASAP,.BUT pt's with cancer occasionally have MI's,.the oncology unit was no more prepared to take care of an acute MI than we were to give chemo,.so we helped each other and did the best we could. This Dr however insisted on making it very clear to anyone who would listen that he felt his pt's would get better care on the oncology unit,..we couldn't do anything right,.his big thing was to call ahead for "competent staff and supplies to insert a central line,.have them in the room at 0600",....I'm sure the staff on the oncology floor knows exactly which cath he wants, what size gloves, where he likes to stand,.and just how he does things,..we of course didn't (and god forbid he tell us when he calls his orders),..so,..one morning, after already having a run in myself with this Dr and hearing about dozens more,.I'm the one in the room at 0600 with Dr perfect,.he walks in,.says "I hope this doesn't take all day like it did last time I was here" I say " I can't imagine it would take all day for you to put in a central line",..he starts looking at everything that's out for him,.."Good grief,....are you a nurse? The betadine is supposed to be in the large cup,.and just how many flushes do you think it takes to do this?" The poor pt is just looking at us,..I very calmly,.said "If you'd like to do this yourself I do have other pt's that need me",..he finished the central line and never said another word to me! I expected to get a nasty gram from my nurse manager,.so I gave her the heads up,.he never said a word!!

[sharona97, BSN, RN]

What great advice from all of you! When I've had charts thrown at me or when a Doc has questioned my work, I do respond. Once I threw the chart back at her and said nothing but totally unacceptable and walked away. The other time a Doc wanted to have me do something I already was doing, I calmly asked him, assertively, what EXACTLY would you like me to do. He backed off. I take unkind words and stabbs personally and I let it be known my own family doen't speak to me like this and I won't tolerate from you either.

Practice makes perfect. It is a hard thing to stand up for your self or just simply keep your own grace in check, but once you've done it, it becomes easier and easier to do and accept what you have to do.

Of course there will always be the jerks, the incompetents who have no clue or confidence and want to bully. But you know you are right to defend yourself. Stick to your moral courage and brave the pain and know you are a great nurse who has compassion for the sick and needy. And sometimes that might mean even for a doc, DON, manager, ect. Hang in there, you are needed!

[springing]

My whole life whenever people have tried to make me feel bad about anything, I just laugh derisively as if what they just said was so amusing it does not even dignify a real reply. Complete silence could say that but it could also say "doormat", and getting riled up right back could make you really lose your cool. Laughing a little turns the shame back on them.

[GeminiTwinRN, BSN]

Two days ago I had a pt on my step down unit who was a 4 ppd smoker. He had suffered a horrid injury when a huge tree limb fell on his leg. His foot had necrotic tissue, he had a minimal sensation as well.

The pt. was requesting a nicotine patch. He was trached and aggresively trying to pull out lines, trach, etc. Since we are attempting to place him in a rehab bed, we could no longer restrain or have a 1:1 sitter. He simply wanted a ciggie.

Anyway, I knew the answer was going to be no, but I paged the doc anyway per the request for the patch. The dr. called back and was extremely rude. "no, no, no! absolutely NOT! this pt. is likely to lose his foot, and he absolutely cannot have a patch. he needs all the blood flow he can get, and the patch will impede it!" typed out, this doesn't sound so rude, but it was his TONE and LOUD SHOUTING that set me off. I said "I understand" and hung up the phone.

A few minutes later, the dr. appears in front of me. He is on his cell phone, but commences the shouting and shook his finger in my face. I immediately asked him to stop shaking his finger at me! I told him I understood exactly what he was saying, and there was no need for further conversation between us about the situation, but that I would appreciate it if he would go to the pt's room and explain it to the pt. and his family. He told me that "I am very busy, I have lots of IMPORTANT things to do, and I have no time to go speak to the pt."

I just looked at him. I said "you mean you are refusing to explain to the pt. and family the reasons why he cannot have a nicotine patch?" He answered yes.

That was it. I just removed myself from him, and went to the pt's room to explain it. It was over, just like that, but I had not allowed the dr. to shake his finger at me and speak to me like that. There were a few other things said, but he didn't do that again.

I just never understand why in the world a dr. can take the time to answer a page, then come up to the unit and NOT make time to go in the pt's room for the 20 seconds it would have taken to explain to the pt. Never have, never will understand that.

Put your game face on, and don't take abuse in any form. If a dr. is shouting at you on the phone, hang up or inform them if they don't lower their voice, you will hang up. If they are shouting at you and shaking their finger at you, simply tell them you won't tolerate it. Walk away, or do what I did.

Believe me, I went on about my day. I had done what I was supposed to, which was to make the request known to the dr. I had my answer, and that was it.

Good luck!

[RNperdiem, RN]

I have found in the rudeness and harassment issues, doctors are not the big offenders. They are way outnumbered by patients and their family members. Nurses I think are more intimidated by Docs-at least early in their careers.

What worked for me was my responsibility to be the patient advocate. Sometimes you have to be a little pushy to get what you need from the docs. It is nothing personal, just doing what I have to do for the patients.

Give it time. A thicker skin comes with increased self-confidence. Increased self-confidence is earned by doing the job right.