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.
Specializes in onc, M/S, hospice, nursing informatics.
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.
:yeahthat:
From time to time, we all experience doctors who will snap at you... whether you deserve it or not. That part may or may not get easier, depending on your personality (for me it still is not easy, and I'm not a young new grad). But you deal as best as you can.
From a charge nurse point of view, I must say that you have to communicate with your charge nurse! It is imperative for your own growth as well as the CN and her liability that you let her know of concerns you may have throughout the shift. I have had way too many new grads who call MD and deal with things all night long... and I have never known about it... and often these are things which would not have needed calling or maybe could have been dealt with. Then there's this nurse who has been there 20-ish years who comes to me with everything! I'm not criticizing you, just saying that you need to talk it out with someone more experienced sometimes. It often helps to hear things out loud. I do it still!
I would not have called at night. I'd have notified him in person if I'd seen him, as you did. In front of the patient? Hmm, well, I guess it would be better not to do that. It might worry the patient. If the condition was new, though, the doctor should not be offended that you cazlled it to his attention. People can be very touchy, eh? You never know how someone will take something or what people really are thinking, how they are receiving what we say or do, what they really think of us.
You were good at advocating for your patient. If your manager isn't upset and says to run it by the CN, please don't worry and just run it by the CN. That's why you have a CN, a resource person. And do try not to call docs at night if the person isn't truly in crisis. They do need some sleep.
Specializes in CNA, Surgical, Pediatrics, SDS, ER.
In the begining of being a new nurse you agonize over these little things and yes getting yelled at by a doc is embarassing but don't take it personally. He did not need to yell at you but reality is it happens & this won't be the last time. This encounter will stick w/ you and you probably won't do it again. I know becasue I've had my fair share of lashings and I have not ever repeated those actions. You will learn what to call about in the middle of the noc and what can wait until morning.
You live & learn. Now you know to check w/ the CN if you are questioning if the MD needs to be notified or not so you learned something new and you will apply it to your practice. You made it through that shift and you'll make it through many more. Get some rest & take care of yourself.
It's not unusual to stay late charting, but hopefully as time goes on the 2 hours turns in to 30 minutes more often. So hang in there with that.
Sometimes we just have to allow docs, whom are normally reasonable, to have their "moment". Give him credit for holding it in and waiting until you left the room to tell you. They are human beings too with feelings. From his perspective you criticized his service and did a sloppy dressing.
However "yelling" is never appropriate or a professional way to talk. Was he really "yelling", or was he just mad. I've seen situations where a nurse said "Dr. Smith was off the chain yelling at me......" when I was a witness and it wasn't what I consider yelling. If someone truly yells then you don't listen and walk away, end of discussion.
Hmm... Staying up late for charting is not really something I would do now. Maybe then when I first started out. I don't really know what it is that you need to do, but I hope you can do it faster by time. It's not really worth having extended time more than you need to, because work will never finish. I just hope burn out will not get to you and tear your soul off. It happened to me. Work finishes in the ward.
I used to work in a place where I had to call a lot of people on call - radiographer, lab technicians, specialists at the oddest hour and found it really funny that I had to deal with these kind of issues when I had to be focusing on nursing care. There was one time where I really had it with this orthopedic doctor who screams at me when his patient has not had his archilles heel xray done, when my colleague has just phoned the technician a few minutes back on. Can you expect things to happen in a flash? Unfortunately, I was starting a shift when it happens that I was just there and he vent it on me.
I snapped and told him off. Words flying all over the place. And in front of his patient. It really made him bad, and I was a bit remorseful. But a minute after that I was there in the room and taking his orders like nothing happened. Things that take place in the hospital.
Well my motto is and always will be. He/She will get over it or they will die mad at me. Chalk it up to a learning experience.
As others have mentioned. Unless you feel someone is going to deteriorate to a condition that requires some serious drugs/treatments etc. to keep them alive, I would have checked with the charge nurse to see if anyone else needs to speak with the MD. If not it can wait, if so then you cover it all in one call.
I like to thank my doctors for their thoughtful constructive criticism when they raise their voice to me. It either a.)makes them madder at me or b) realize they were an a** for raising their voice to me and apologize. Either way im ok with it. I have a job to do and so do they. When mutual respect is earned patient care and satisfaction rise tremendously.
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mom4josh
284 Posts
:yeahthat:
From time to time, we all experience doctors who will snap at you... whether you deserve it or not. That part may or may not get easier, depending on your personality (for me it still is not easy, and I'm not a young new grad). But you deal as best as you can.
From a charge nurse point of view, I must say that you have to communicate with your charge nurse! It is imperative for your own growth as well as the CN and her liability that you let her know of concerns you may have throughout the shift. I have had way too many new grads who call MD and deal with things all night long... and I have never known about it... and often these are things which would not have needed calling or maybe could have been dealt with. Then there's this nurse who has been there 20-ish years who comes to me with everything! I'm not criticizing you, just saying that you need to talk it out with someone more experienced sometimes. It often helps to hear things out loud. I do it still!
Hang in there... it will get better!