friction with a provider

[eyeshadow&epi]

I am about a month into my new ER position, (coming out of med/surg 2 yrs), and have having some tension with one of the providers. It is no secret I am new, with limited experience in some areas and most staff have accepted this fact, and I am willing and eager to learn. I know its hard to adjust anywhere, and coming into a close knit department, I was bound to encounter a family dynamic so to speak, but it is just one person. Everyone else has been great. It is hard to care for your patients when the provider leaves you out of the care, will NOT speak to you. The old "tell mom to pass the salt" act. It makes it difficult to advocate for pain management, nausea meds, lab work, anything, when its the doc dismisses you. I want to scream this is about the patient, not me! the other day we had several patients being transferred out, and the phone was held out for report on "bed 2", a critical patient i deferred to a senior nurse. Turns out the report was actually for my patient, this senior nurse knew nothing about, and i was humiliated, as he turned to ask me questions about them and the provider cut me off to answer like i wasn't standing there or knew. This was my patient for the last 7 hours.

I do not know what I am doing wrong. Everyone else loves this person, finds them hilarious. It is the common consensus that they are the favorite one of the providers i'd say. I have tried being as nice as possible, professional. I've tried joking around and that worked a few hours to lighten the mood but it was back to ignoring and patronizing comments. Every day I work with them, I wonder if it'll be another whisper of "are you going to make me cry again today?"

[CX_EDRN]

Why not talk to the provider directly? I've had my issues with drs over the years and the best way to tackle these sorts of things is head on. Yes, you are new. Yes, you have a lot to learn. But no, no one gets to treat you with such blatant disrespect. Go up to this person, ask if they have a minute and address it. If the provider blows you off again then know you have more avenues to explore. Go above his head because as you said, it's not about either of you. It's about the patients. I hate the whole "you have to prove yourself" mentality when it comes to new ED RNs, it's a stressful enough environment without that crap. We're a family and we support and hold each other up. Good luck and hang in there.

[Armygirl7]

Why not talk to the provider directly? I've had my issues with drs over the years and the best way to tackle these sorts of things is head on. Yes, you are new. Yes, you have a lot to learn. But no, no one gets to treat you with such blatant disrespect. Go up to this person, ask if they have a minute and address it. If the provider blows you off again then know you have more avenues to explore. Go above his head because as you said, it's not about either of you. It's about the patients. I hate the whole "you have to prove yourself" mentality when it comes to new ED RNs, it's a stressful enough environment without that crap. We're a family and we support and hold each other up. Good luck and hang in there.

Yeah this!

An ice breaker I have used many times with MDs where I feel like there is an unexplained tension or hostility or with grumpy pts too where things are going poorly - I just say "Hey, Dr. Zhivago, I sometimes wonder if you and I got off on the wrong foot?" It's a conversation starter.

Also just keep improving and doing your best - it's tough to be a newbie. But there may always be that one haughty or difficult to get along with colleague - if you're doing your best then just try not to take those people's attitudes personally.

Good luck.

[~Mi Vida Loca~RN, ASN, RN]

I agree with the others, sometimes whether right or not, you're gonna be tested. You have to have a pretty thick skin in the ER. Situations can be tense and and people can get snappy and some people want to see if you are gonna cut. Sometimes people like this will actually respect you if you stand up for yourself. Could be various dynamics going on and so your best bet is going to be to talk to this person head on. Doing it tactfully and privately. You can say "Dr. so and so, can I please speak to you for a minute" obviously when there is a little down time. Flat out tell them that you feel like maybe you guys got off on the wrong foot and tell them why.

Even if this person just doesn't like you, calling them out and letting them know this is a problem sometimes will get them to be a little more mindful of how they are treating you. Regardless I am a very firm believer that your first step should be with the person at hand.

[Lunah, MSN, RN]

Definitely have that direct one-on-one (in private!!!) with the provider. Ask how you can improve and ask for suggestions — make them an active part of your growth as an ER nurse. But realize that people are not always going to be your besties — it might just be a chemistry thing, but at least reaching an agreement to work together as professionals is desirable. I've worked with some nurses new to the ER from the floor, and my ER doc besties couldn't stand them, but you wouldn't know it by the way they worked together. Usually it was just frustration that the nurse couldn't handle multiple sickies, was poor at anticipating next steps/orders, or could not prioritize tasks or care in a non-floor-nursing manner. Those things come with time and experience.

When you realized the call was about your patient, you should have insisted on being handed the phone. Period.

Best of luck! Hope you can come to some sort of resolution.

[amzyRN]

Agree with everyone, speak with this doc privately, "when you did/said this, I felt ...., we are on the same team, I am trying to help the patient, etc" "in the future, could you please ...." See how that goes. I would find it odd and troubling if they were not responsive to that. Most ED docs I've worked with, even the rare Ahole always speaks with the primary nurse for the patient. It is extremely rude not to do so. In fact, I might say in a clear and direct voice, I'm the primary nurse on this, please speak with me directly. We are all adults, professionals, co-workers in fact. We all have a job to do and we need to treat eachother with respect and act like adults. Do unto others, etc.

It is hard to have these types of direct conversations, but they are necessary for professional and personal development. Transitioning from the floor is tough, a totally different thinking process, nevertheless you are still an experienced nurse, an adult worthy of respect. Some personalities in the ER are a bit rough around the edges and you've got to try to not take in occasional aggressions, confront them with respect and ask that they stop. You don't have to tolerate rudeness, but don't let it sink you and knock down your confidence. I had a nurse in my department interrogate me and try to degrade me in front of patients none the less, and I stood up to her and she stopped. She left me alone after that and in fact tried to be really sweet the next shift because she probably knew she was wrong and that I wasn't going to put up with that crap. I am still respectful of her and she is still a team member and I will help her, but I won't tolerate blatant disrespect.

[eyeshadow&epi]

thank you to everyone for their responses. I am going to see how the next couple of shifts go with this person, and address it from there.

[JKL33]

Does your preceptor have any helpful insight about this? And what is his/her influence on the situation?

I agree with our colleagues, I would not let this situation continue. I really like "I'm concerned that we got off on the wrong foot" as a conversation starter because it avoids both "you make me feel..." AND "when you do x, I feel y"...both of which just seem a little too cumbersome for the issue at hand. I would also say something like 'I know I have a lot to learn as an ED nurse, I'd like to count on having your respect as a person and as a nurse who's excited for this opportunity'. Keep in mind these types aren't necessarily bad people - the ones I've seen are a little high strung and yes, they feel uncertain/anxious when they see a new face. Knowing that the new person cares and is working on learning often goes a long way with them. Regardless, they still have to be respectful.

I advise not waiting to see how the next couple of shifts go. Things will go much better if you can have this conversation NOT 'in the heat of the moment' or on the same shift where there has been a conflict. Plus, there's no sense waiting to get started on a better relationship with this person!

[WKShadowNP, DNP, APRN]

In addition to opening dialog with acknowledging the "wrong foot" issue, find a way to humbly ask for ways to improve or the provider and team's expectations.

Hope it continues better and with positive results!