doctors repeated rudeness..trouble coping

[sleepdeprived1]

So, I have been an RN for little more than 9 months. I remember the talks in nursing school from our professors regarding expectations of doctors yelling at us, cussing us out once we became an RN..I always thought 'I dont care,it won't bother me' I am typically not one to allow others attitudes affect me this way-and know its many times not personal.

So, during my orientation period/training other RN who trained me NEVER got chewed out by Doc or was NEVER rude to her..and while she was there I never had any issues with rude docs...but..soon I was on my own..only RN for unit..I learned quickly and have grown in critical thinking skills and grown in ability to anticipate what will be needed for the patients care..I do get frustrated when I see other nurses doing stupid things like missed orders, not following mds orders, ordering duplicate excess meds..soo

What I am tring to say is that although I am NOT perfect I feel my competency is not the issue for Docs lashing out/rudeness to me.. and I am very selective in what I am paging the Doc about I have seen other RNS page for EVERYTHING -that is NOT me-I try to respect docs esp. since i work nights.and know they are prob. sleep/ If not crucially imp. will leave note for doc on chart and tell patient.

Well we have protocol on who to call and for what and maybe I need clarification on this? We have the on call Docs who are on call other times you only call the attending for things and we have one doc who takes calls on his patients all days of the week no matter what, and weekend on call Docs,so yeah it can be confusing. so this one doc has been getting super snappy with me and this past weekend was prob. the 6-7th time he refused to listen what i was calling about and interrupted me and very rudely raised his voice in rude tone said "why are you calling me-you need to call this doc" I have called this doc for important issues like prolonged dudrug induced seizures, violent patients attacking staff and psychosis becomeing danger to themselves others altered consciousness in patients decline in condition abnormal critical vitals and many times doesnt give me chance to even say what im calling for how would this not worry him-what if one of his pts. were dying woudldnt he care sso this past wkend when i called for something he cut me off short and went off ..after call i started crying and needed to leave the unit..i felt hurt that i am trying to do my job but he doesnt care..i told my manager in morning (i never told her about doc before) she said she would talk to him-but "in a way so he doesnt know i told so he wont take out his "wrath" on me" next night another doc ive never had issue about i paged cuz on call doc.didnt return page and after consulting with 3 other rns i trust on other units (I was scared to page cuz of this other doc always goin off on me) they recommend/said they would page attending so i page attending-he returned call fast in like 5min. i stated im calling on his patient (name),,he stopped and cut me off right there (just like other doc has been doing to me) in rude tone said WHY ARE YOU PAGING ME AT 3 AM I DONT PAGE YOU AT 3AM " I was soo upset that he insinuated i was doing something wrong..i was like well "Dr. so and so last night informed me ...page attending..he was like no dr. on call covers for wkend..i stated well no order written in chart for transfer of care ..was told to call you..he didnt even know what i was calling on..repaged other on call and did return page and deal with patient issue(which could have been serious-decline alter patient condition)

ok sorry for rambling my issue now is i dont know how to get over this and not allow this to affect me personally i have been upset the past two days crying excessively, and feeling extremely sad and anxious scared for when i have to page the docs in future..im sooo distraught because i care so much for my patients but these docs that cut me off make it hard for me to do my job and provide good care-arent these docs even worried that maybe i am calling for something serious (thats typically only time i do call)

i plan to get written protocol from my mgr. for who to call when and if dr. doesnt call back who to call next......so I know EXACTLY ..i am upset with myself for not being direct with docs and passive and i think this is why i am crying so much and feeling so down..anyone got any other advice on how to move forward?? how to let these past incidents go?? I think its too late to directly address these past issues and that is what is upsetting me soo much.

*Also just to clarify the doc who has gone off on me 6-7 times was either the doctor on call for the night or the patients attending doctor

[SaoirseRN]

I think it seems as though the procedure for calling doctors is unclear, and it would be a good thing to have this explained to you, or put into writing if it isn't already.

I get the frustration when a doctor who is not on-call gets called. They are trying to have a night off, and you have interrupted them. I believe they feel that you should know when to phone a different doctor -- which is where your facility's call schedule/procedure comes in.

Ask somebody to show you how to find this info and explain until you understand it. If in doubt, ask someone who to call. Not calling doctors who aren't on call will prevent a great deal of those grumpy calls.

And when you HAVE called the right doctor, even at 3am, you'll be able to say, "You are on-call, and I have this concern about this patient that could not wait until morning..."

[Altra, BSN, RN]

Agree with SaoirseRN's points above.

I'm curious why you consulted with "3 RNs on other units I trust". What they do on their unit does not necessarily apply to yours. The game of who-to-call can indeed be confusing when you're new to a teaching hospital, but it certainly should have been communicated to you by now. Make yourself a cheat sheet to refer to. Many units actually print something like this weekly or even daily, or have it available online on the hospital intranet. If you're unsure, ask the charge nurse on your unit before you make a call. When you start your shift and get report, ask who is the resident who is taking care of / writing orders for the patient now.

And please do not personalize a doctor's frustration and allow it to interfere with your functioning. Work towards strengthening your own personal demeanor -- you are a professional, there to do a job. Interpersonal stuff is WAAAYY secondary.

[SionainnRN]

Try not to take it personally. I can guarantee that none of the docs know who you are. All they know is someone from your unit is calling. I've worked face to face with docs for years in a small unit and I'm pretty sure they wouldn't know me on the street. Hang in there and make sure you have all your ducks in a row before calling.

[anotherone, BSN, RN]

what a mess! there needs to be a list of who to page at all times and algorithm also for chain of command. this is a little ridiculous!

[SaoirseRN]

Our call list is available on my facility's intranet, as well as the vacation schedule for physicians and who is covering for them (our GPs look after their own admitted patients). It is very easy to look quickly before phoning to make sure you have the right doctor. Does your facility have something like this?

[sleepdeprived1]

Our facility does post the on call schedule for the week on the unit and on the intranet. I always check it before calling (usually check like 3 times just to be sure)and they also post who is on vacation and covering...

One example where this did not help me was a past incident where my patient on detox started having multiple seizures and decline and paged the on call (i had no standing orders to give med to stop seizure if didnt stop on own....)so on call called back and of course it was this particular rude doc who did not give me any orders for patient and did listen to part of story on patient he told me to call the attending so I call the attending who gave med. orders and told me to page the on call to have patient sent out to med. hospital. Attending said on call should handle that since he was on call that night. so I paged the on call back and when he called back and I told him attending wanted him sent out to hospital he was like WHY ARE U CALLING ME? I told him per attending ...he refused to told me call back attending to take care of transfer to med hospital (do doc to doc report) so i called attending back who was ****** at this doc..but took care of patient...

Also the 3 nurses I consulted 1-was the other rn that i switch units with every week (we have two units in our dept) and this rn KNOWS WHO to call and has never been snapped at like I have..maybe because he is a male?? other rn works on my unit pool rn, and other rn doesnt work on unit but has in past..

As far as asking the charge nurse who to call -one time in past we had an escalating patient code situation violent so she told me page this doc (he was either the on call or attending cannot remember) but i do remember being hesitant cuz this doc has gone off on me before but she was firm -"You call him, that is his patient, he needs to deal with this" (or something like that) so I did and of course he didnt handle the situation and got ******..

[HouTx, BSN, MSN, EdD]

HANG ON HERE!!!! I am assuming that this is occurring in the US - if not, please disregard my rant.

In recent years, there has been enormous attention paid to the problem of disruptive physicians. This has been found to be a HUGE problem with patient safety and quality of care. The Joint Commission has standards which require accredited organizations to enact policies and procedures that address them. http://www.jointcommission.org/assets/1/18/SEA_40.PDF This. Behavior. Is. Not. Acceptable. Here is a study and paper published by the American College of Physician Executives that provides a comprehensive overview of the problem and proposed solutions. http://www.quantiamd.com/q-qcp/QuantiaMD_Whitepaper_ACPE_15May2011.pdf There have already been some very hefty legal judgments against the disruptive docs and facilities that allowed it to happen.

So- if not only accreditation & regulatory agencies but also the medical profession itself has said "Not Acceptable", "hurts patients", "interferes with quality"... why is the OP's organization not taking action? Look up your policy on disruptive physicians. Make out an incident report! Go up the chain of command until someone pays attention. In the meantime, I'd be looking for another job with an organization that has greater respect for nurses and more commitment to quality patient care.

[sleepdeprived1]

HouTx,

Thank you soo much for this!! I was looking on the Internet for exactly this and could not find it! I knew there had to be standards/expectations...I have printed out a copy for my own reference and I am thinking about hanging up a copy at work for staff. I have since put the issue of rude doc behind me but in the future I will not be passive and stand up for myself(really my patients) and do an incident report. All of us nurses have to stick together. Thanks again for the info!

[sleepdeprived1]

RECENT UPDATE:

This Doc who gives me a hard time had another nurse speak to me and tell me I was "calling him too much" I could NOT believe it! I NEVER page for meaningless crap. EVER I am VERY mindful for what I page for..and since I last posted this he was on call and covering all patients and my patient had a change in status (abnormal vitals,etc....)so I was paging him for over 3 hours before I got a return call but during those 3 hours I documented/charted in computer every time I paged him and the time and update on patient condition..charted notified supervisor,....until he finally returned page..WELL he told this nurse to ask me to NOT chart when I page that he didnt call back or return page.......SERIOUSLY?? Is he kidding?? now if something DID happen to patient is he gonna take the fall if I dont document how many times I contacted him...I dont think so!! iM SOO ****** off about this...Im thinking of looking for a new job

[jadelpn, LPN, EMT-B]

This needs to go to administration to straighten out. It is not your fault nor your issue if the Docs can't get it together as to who you are to call when. And if who you are supposed to call tells you to call the other doctor, then I would defer to charge to take it from there.

And be sure that when the doctors round, any and all questions that you may have (ie: meds for a seizure in a withdrawing patient) are discussed, and documented accordingly, especially if there are "no new orders".

Sounds like a hot mess. And not sure in any other acute care setting it is much different.