disrespectful/unprofessional MD/PA's and how to dealw/ them

[blinky, ASN, RN]

I've been working for two years + in LTC. Been chewed out by families, co workers, patients i've handled it and let it slide/ ignored it what have you.

But what gets me are these arrogant disrespectful Doctors/physician assistants who seem to lack professionalism and want to chew out any person who brings any annoyance their way.

scenario #1 patient had narcotic in our lock box to be given in the morning of my shift, what was in my EMAR was different than what narcotic was in the patients narcotic box.

SO i'm not going to have a narcotic med error when i have a discrepancy. Checked the pt's chart no written order for it to be changed.next step call MD to confirm which one is to be given. PA chews me out and goes on about how im [ saying it without saying it] but ie incompetent for not following the order.

scenario # 2 Same PA last night re-admit pt comes in. Day RN calls PA leaves msg makes progress note about it. Pt is hopsice so hospice RN also cals PA and leaves msg to call him back. hospice not writes typical comfort care orders roxanol ativan etc, needs C2 she can't write it had to be by the pt's MD/PA. PT on admit and till 3am was stable. long story short by 6am she had resp distress but the hosice RN did not want to send her out but to give roxanol had no c2, made c2 form and faxed to PA then called PA and left msg regarding situation, waited 30 min nothing called PA again, 10 min later after that PA calls back and states no one called him about a new pt or any c2 forms,i stated that the day RN and hospice nurse did and had made progress notes related to it, he then backs his story and changed topic to why wasn't the c2 form taken care of on the pt's admit. which when i spoke to the hospice nurse base don pts condition at the time it could wait. Turns out he chewed the hospice rn out as well as me when i spoke to her last.

basically how does one handle these types of PA's/MD's?

. I'm of the mind give it a night or two to let it slide, but both situations were uncalled for, un professional and will continue to happen which is stress chewing out that i just dont need or should have to deal with.

whats worse is he is threatening to complain to my "supervisor" after asking to speak to my supervisor and i told him All nurses are supervisors here.

[tyvin, BSN, RN]

They are referred to as PAs, they that work under an MDs license is known though they have their own license. Many PAs are smart and some are dumb as bricks but that's with all populations. I had an RN who was studying to be a PA almost knock me out of a chair once when I disagreed about something and it was my call. As I said, it's in all walks and professions. Personally I don't see why the PAs want to work under another person's license in regard to Rx authority, Dx decisions, etc... NPs in many states work entirely on their own.

We need to understand that people have bad days, some are just not people persons, some can't handle the stress. Be the better person and don't revert to their level.

If they threaten to speak to supervisors I would go directly to my superior and tell them what happened. You need to protect yourself and some things can be made to be blown up to be big bad things.

[ceccia]

I actually had the same situation as you OP - difference in med dose between what was on the order and what was in the pt's box; called to confirm, got yelled at and insulted. i let him rant without saying anything, and when he finally ran out of steam i told him i don't have the patience for your crap; confirm the correct dose. he stammered a bit, then confirmed, then i hung up.

i can't recommend you do that, but i can say he never spoke to me disrespectfully again. MDs on power trips are used to other people cowering and being subservient and falling all over themselves to apologize for things that amount to actually making the physician do his job. don't act like that. you are his/her equal. bring that mindset to every interaction you have with doctors.

[firstinfamily, RN]

As the nurse you are the ears and eyes for the MD. For the MD. If there is some conflicting order it is up to you to clarify it period. It does not matter how upset the PA was, you were doing your job. I would not take the "threat to tell supervisor" as a threat, I would have just said "she/he is already aware." I would report the two situations to the ADON or DON so they know there are some communication issues with this particular PA/MD. It might prevent future occurrances and there is no reason why any nurse should tolerate verbal abuse from an MD, those days are gone, and there should be some communication policy in place. Effective communication has to occur to meet patient needs and if nurses are going to be afraid to call certain PA/MDs due to their lack of ability to communicate (the PA/MD), there are going to be bigger issues eventually. As long as you have a definitive reason to call the PA/MD you need to call, tolerating their rantings is not part of the job description. They are adults and need to understand that nurses are helping them meet their patient needs. It sounds like the PA was just annoyed, probably he was busy doing something when the call came through, oh well, he is a PA/MD that is part of their job. Use SBAR communication to keep the message succinct.

[blinky, ASN, RN]

appreciate the responses.

SBARs? PA's and MD's don't even look at let them, let alone their own forsaken charts, i take it back some do read and respond to their charts still surprises me every time thoguh.

2+ years experience im no longer afraid intimidated by PA's MD's just annoyed at this disrespectful rude one, who could have easily said hey thanks for clarifying a NARC order and avoiding the whole DEA coming down on the nursing home/me/us blah blah. I know they are caled often and asked plenty of stupid things but thats what they get paid big $$ for.