Dr mad at me/I am upset, dont know hat to think

[hollyberry678]

Hi, I am a relatively new grad, and work on a stressful station here many shifts people often stay late 1/2-2 hours after the shift is done to finish charting (no time during shift- is this usual?)

Anyway, last night shift I had a patient who had a percutaneous tube site leakage. I did many dressing changes during the night to keep the area as dry as possible, she has reddened skin and pain to the area (receives pain meds for it). when I was doing the cleaning, there was blood on the gauze, coming from the tube site area, which I didnt see the night before, and I was afraid her skin was going to break down further.

I decided to 'notify' the on-call MD, just so they could look at this/be aware. I put three pages in to the on-call pager # (an intern or resident assigned to cover overnight). No response. Since it wasnt any sort of urgency, I let an hour pass btwn pages. Finally I decided to call the operator, was put on hold, and a call light went off (we have no aides during the night) so I hung up, next thing I know it's morning.

I saw the MD go in her room, I followed (they are gone in a flash) and told him I wanted to talk to him about her skin, I had tried to call during the night and no one responded. He then criticized my dressing (too much tape-- over the gauze) and how I should do xyz. I said he should write this as an order so its in the kardex, he said no one follows that, I said I would. Outside of the room, he yells at me 'here is thenight coverage person, you should have called the operator if it was so important you had to bring this up in front of the patient so that she loses confidence in us (MD), ect., ect, just really mean about it. I said, oh, sorry thanks so much (sarcastically) and walk away. I was so embarrassed!

I feel like no matter what you do, there will be something wrong. He did have a point not to say that in front of the patient, but I wasnt thinking, I was tired, I wanted to give hiim the information, and I was more focused on telling someone about the problem, and I didnt think 9I was also frustrated at having to repeatedly page). but his reaction was way out of line, and I felt really horrible, esp after working so hard and being concerned about this patient all night.

Can anyone give me insight?

I spoke with my nurse mgr who said that this MD had always been nice, so she was surprised...and basically told me to buck up, and to run things by the charge first (she didnt say this DR was out of line or anything like that which I wanted to hear!!)

Anyway, help please!! Thanks. I dont want to go to work tonight. Something else might happen, of course...I dont know what to do, if this floor is too stressful, if its me, or what. thanks.

[caliotter3]

These things happen, new nurse or not. You have to learn to roll with the punches or it will get the better of you. Take your mgr's advice. From now on, try to run things by your charge nurse first or a more experienced colleague. She should be able to give you the insight on what is worth calling a doctor about at night and what can wait, as well as a lot of other pointers. Just try to get some rest and relaxation. Rested, you will be able to see this in a different perspective.

[jessiern, BSN, RN]

Problem #1: If a MD is on call, they should answer their calls. 3 pages, and no answer is unacceptable IMO. If he was busy, the least he could have done is have a nurse/sec on the unit he was in phone back to see what was wrong. That is were the whole problem started.

Problem #2: I agree with the doctor on one point. I wouldn't have told him in front of the patient that the on call MD had not responded. Might create undue stress on the patient. "What if I have a massive heart attack, and a devestating stroke, and the doctor doesn't call back".

Problem #3: Even nice docs have bad days, with even worse moods.

But, at the end of the day, you did your job. You got the patient the attention she deserved, and that is what matters. So brush it off. We work in a very stressful environment. Doctors have snapped at me, and joked with me the next. And I have been stressed and snapped at people and regretted it. Just remember it, and don't do it again if it bothers him.

[steelcityrn, RN]

Unless Im missing something, you said the patient had pain there,which was already being treated with pain meds, and increase redness with some blood on the gauze. If this was found late at night, I would have documented it well, checked on it , then told the doctor to check it on his rounds in the am. This is one of those critical thinking issues that you will develope over time. If your ever in doubt, like the doctor said, just have the charge nurse assess with you.

[TheCommuter, BSN, RN]

Outside of the room, he yells at me 'here is thenight coverage person, you should have called the operator if it was so important you had to bring this up in front of the patient so that she loses confidence in us (MD), ect., ect, just really mean about it. I said, oh, sorry thanks so much (sarcastically) and walk away. I was so embarrassed!

At my previous workplace, the medical director (a sports medicine doctor) would negatively criticize the nursing staff while family members, patients, coworkers, and other people were within a clear earshot. He would make comments such as, "Why are these nurses always notifying me about crap?" or, "The nurses at this facility call me too dang much!" My favorite statement was, "This place needs to ensure that nurses are competent before they get hired!"

I can readily accept negative feedback, but the professional approach is to exchange the feedback behind closed doors, or at least outside the earshot of other persons. If something was not done, the doctor or nurse should never mention it while in the presence of the patient.

[Dolce, RN]

Don't stress yourself too much about this situation. In time you will learn what and what not to call an MD for (esp. on night shift) but in this situation you did feel uncomfortable and you wanted to notify the MD. This situation sounded like a "gray area" to me--some people might not have worried about it, some people might have. In other words, you weren't wrong to call if you felt concerned.

IMO what you said in front of the patient might not have been the most professional thing to say but it sounds very much like something I would say accidentally. Unfortunately we are not perfect angels in every aspect of everything we do and say. He had a rude response to you that more than made up for your "inappropriate" comment in front of the patient. Please don't spend your time wondering and worrying about what doctors or other coworkers think about you because it is a big waste of time. You sound like a very good nurse who is just trying to find your way in the wide, wide world of being a new grad. Keep up the good work!:icon_hug::flowersfo

[BrokenRNheart]

All very good replies. You will learn by these experiences. We all get chewed out by doc's, especially on night shifts and especially new nurses.

You already learned something about not bringing it up in front of the patient. At the same time, he shouldn't have belittled your dressing in front of the patient either. But you will never change that about him.

The best thing to do is find someone you can trust whether it is the charge nurse or a co-worker and get their input on that. Some nurses will get input from everyone on shift at night. Sometimes the night shifts are very cohesive. I have found a lot of night staff tend to stick together. Find your place in that.

I probably would have stuck a note on the chart and tried to catch the doc in the morning on that one. But that is NOT to make you feel bad. Remember that even experienced nurses walk away unsure of the choices they made or feeling belittled by doc's.

You have graduated! Join the bunch! :grad:

By the way, if her skin was getting irritated a barrier might help there. The spray used with ostomy care is popular.

For your approach on that order, you might want to ask him to specify what he wants you to do since it is leaking and bleeding. Chances are a wound care nurse might be helpful - they will put an order in for you.

Hope that helps.

[Virgo_RN, BSN, RN]

Gotta take your lumps! Pick yourself up, dust yourself off, and move on having learned something.

[Scrubby]

Yes you probably shouldn't have brought it up in front of the patient but he was out of line yelling at you like that. It's unprofessional and you were only trying to advocate for your patient.

[crb613, BSN, RN]

ya know this really burns me up! It seems it is accepted & expected that doctors are going to "yell" at nurses.. So we should just buck up & take it......absolutely not! We are all going to make mistakes doctors included....being yelled at is unacceptable..I don't care who is doing the yelling. Come on people we are adults & professionals....I expect to be treated as such.

[RNperdiem, RN]

Nursing school does not teach you these things. The many things to know before calling the doctor is learned on the job.

Does your facility have text paging? I have found text paging to be useful to bring things to the doctor's attention to changes that are not urgent but still important.

[Jo Dirt]

I'm sure he'll get over it. Personally, I couldn't stand the stress of being a doctor. At least you get to finish your shift and go home.