Getting yelled at by a doctor for the first time....

[NewbieNurse93]

So, I've been a nurse for about 6 months now and have been off orientation since the end of October, so I'm still pretty new and still learning new things. Today, I had a doctor yell at me for the first time.

Long story short, the attending dr and the consulting dr both agreed to discharge my patient. However, none of them were able to write a pain script for discharge. When brought to the attention of the attending that rounded that day, he basically said, "oh, well, she'll just have to stay another night and then go home tomorrow. I'm home now and won't come in to write a script."

The patient was devastated and stated her frustration with this. She also lives hours away and told me about having to get her son back home so he can get back to school. As her advocate, I did my best to try to make her discharge happen, because I feel like staying another night for just a pain script is a pretty poor reason to have to stay. I had called a partner of the attending who was also rounding that day, but was not the "on-call" dr. I didn't think anything of this because this dr was rounding with the on-call dr that day, and made the mistake of thinking that he too was on-call for that group. He was more than happy to help discharge the patient. The patient was so happy and thankful that I was able to get her out that day and I felt good that I was able to help her and her son.

At at the end of my shift, I had received a call from the on-call dr who had called me just to yell at me over the phone about the patients discharge. He said things like "How DARE you go behind my back and call another dr!!!" and "you better NEVER let this happen again." I've never had anyone speak to me the way he did and I kind of froze on the phone. I apologized to him for any mistakes that I had made and he hung up on me.

Has as anyone else experienced this? How do you deal with this? I was feeling so good and finally starting to feel like I'm doing a good job at work, now I feel like a horrible nurse....

[joe007]

For those of you excusing or justifying physician yelling; it is not OK to yell. Never is it OK to yell. It is abusive and demeaning. It is creating a hostile work environment. It should be an HR issue. And if it continues and management ignores it; document the yelling, record it, and take it to a lawyer for harassment/hostile work environment.

[Jennerizer, ASN, RN]

You are not a horrible nurse. Some doctors are big babies that have social deficits. You are an advocate for your patient. Not for the lazy doctor that forgot to write a script. I think what you did was perfect...contacted the MD who was in the hospital and able to write the script.

You'll get yelled at for many silly things. Don't take this to heart. I've gotten yelled at for calling critical cardiac enzyme results in the middle of the night, for arranging an emergency helicopter transfer, for requesting meds that the doctor told the patient he was going to order...the list goes on & on. At the hospital I'm at now...they do not tolerate doctors who act that way. Just remember...you did the right thing. Don't apologize for it. As you gain experience, you will grow a thicker skin & less tolerance towards people who act like jerks. Let go of the guilt!

[PCnurse88]

I once had a fellow yell at me in the patient's room, in front of another nurse and the patient's family. At the time I was too shocked to do anything for various reasons -in front of a patient and family? yelling? and it ended up being the doctor reading the patient's telemetry monitor totally wrong (didn't know what all the numbers were, I guess). She RAN from the unit as soon as I calmly explained to everyone what the numbers were and that the patient, WHO LOOKED TOTALLY FINE, was in fact totally fine. One of the other providers yelled at her for me since she literally bolted away. If it had been an intern or even R2, I wouldn't have been as upset, but a FELLOW? Hell no.

[FolksBtrippin, BSN, RN]

The nerve of that doc to think that a patient should stay an extra day costing many thousands of dollars because he didn't feel like writing a script.

He was 100% wrong. Thank you for being reasonable and finding a solution.

Don't let his behavior stop you from doing the same for your next patient. This may be difficult, because you may feel a reluctance next time.

You must be very strong and have ethics of steel to be a great nurse.

[Uniquern]

Pride is a terrible monster. Don't let the weak man who felt put down by your question, which was ultimately in the patients best interest make you feel anything.

Im sorry this happened but honestly... it will happen again.

Weak men yell. There is not other explanation. You've totally got this.

[Cindy Wang]

Reminded me of my experience. I once had a pt who was being transferred back and forth from BC to our unit(antepartum) since she was having on and off contractions. Now since these are two separate units in my hospital, by protocol the doctor needs to rewrite the order everytime the pt is back to my unit. So that day I got back the pt again (although she only left for a few hours), and off course there was no order, so by protocol I called the doctor to ask him to come and rewrite the order. He yelled at me over the phone, said that he doesn't understand why he has to do the same things
over and over again, and that I should just continue doing the things they were doing in the BC and gave her wharever the medication she was on before. I mean I understand his frustration but I was shocked by his attitude and the things he said. I think I frozed and just said that this is the protocal we have to follow otherwise I can't give anything to the pt... He showed up later to write the order, but complained again and was still in a very bad attitude. I didnt want to escalate the situation, so I simply sighed and said this is the protocol and there is nothing else I can do. But to be honest, his attitude really hurted me and I am mad at myself for letting him talk to me like that. I am shy and overthinks a lot, English is also not my first language so I find it hard to "fight back" at the moment. This situation plays back in my head over and over again and i keep thinking what should i have said. I hope next time I will talk back properly and firmly. Plz leave comments on how will you respond the doctor, I would appreciate some suggestions as well.

[KatieMI, BSN, MSN, RN]

As a provider AND a nurse....

Yes, I know how it sounds. Frustrated and angry patient who gets onto your neck every 5 min. Who has her own issues, and you have yours too, plus other 6 patients to take care of. And the whole hullabaloo is about one miserable "pain script" which can be written in 30 sec, you saw it done. So, WOW!?

I was there, for so many times. But, before that, I was on the other side, and now I am back there.

So:

Those miserable "pain scripts" are bigger issue than so many nurses can even imagine. There are states where a physician can get criminal charges for writing one at home and faxing it to hospital. There are hospitals and practices which will throw you out in a second for the same, and you 'll be lucky if the issue doesn't get escalated to Boards.

When, being a provider, you are NOT on call, you MUST NOT do anything at all. Period. No decisions, no orders, no reports or updates taken and, for the sake of Lord the Great, no scripts written, ever, under no circumstances. Even if "it is your patient!!!" You are legally responsible for everything you do, therefore, if you write down that miserable script while not rounding that day on that particular patient (even if you rounded at the unit), should something happens, you will be the only one responsible, with all the sequela. This is the rule written by tears and blood on the shreds of licenses lost for just once caving for those incessant calls of attentive, dutiful, task-oriented nurses who "just wanted to advocate for the patient".

It is, unfortunately, not a joke. There were multiple precedents of providers and practices losing everything because one phone call of someone who "just wanted to update" someone about something but did it wth the wrong person and/or at the wrong time and thus started medical-legal avalanche. BTW, should something happen, the dutiful, task-oriented nurse could be also dragged to Court at least as a witness.

Of course, the rule above leads to the "ownership" phenomenon. Many physicians take it extremely seriously. But in that case it was likely not an issue. The issue was the discharge summary for patient X written by Dr. A., and controlled substance script or the same patient written by Dr. B. who, apparently, had not see the patient that day. That constituted a serious offence in the eyes of DEA, which could then prosecute both doctors but Dr. A would get the first blow because he must not allow that happening.

The doctor who benevolently wrote down that script was either very new or really did not care about anything at all including, of course, you and your patients. It was HIS mistake to cave for your request and write the script and in every well-run practice he would pay dearly unless he was his own boss. If he was not, he would likely be torn to pieces alive by the doctor who did not write the script, and that would be the right thing to do. After what he would be haphazardly stitched together, sent to hospital "drug board" and torn to pieces again there.

Last but not less, we providers are people, too. When we go home, we go home. It is just as unrealistic to demand a physician to come back in order to make your life easier by sending that patient out as to call you 3 h after end of your shift and ask to come back to put a Foley even if you're the best cath hand ever being born.

Overall, I do not tell that yelling at you was right. It was unprofessional behavior (that's the proper name for the physician's action and it goes unnoticed in 99.9998% of time unless it happens constantly). But I am not sure if you would prefer alternative variant - being called into your manager's office 3 weeks later and let known that you're terminated for "unsubordination" (this is the proper name for your action, which is also unprofessional behavior and noticed even if physician complains only once). See the difference? You may say that it is sorely unfair, and I at most personally share this opinion. But it is what it is.

"Advocating for the patient" is not one-size-fits-all justification for everything a nurse might want to do, whether in order to really help someone or to just make her own life easier. And even if done with intentions all pure and honest, it should not cross some borders - and push others to cross them, for their own perils.

[Closed Account 12345]

Great job advocating for your patient!

My one piece of advice would be never apologize to a provider who is actively berating, disrespecting, or yelling at you.

If they are on the phone, say "Are you willing to talk to me respectfully as a professional? If not, I need to hang up, and we can continue this conversation when your ability to remain professional returns." If they carry on, you hang up. Notify your charge nurse and manager because if a doctor can't effectively communicate with a team member, it becomes a patient safety/care issue. Someone needs to follow up and let them know they were inappropriate. Same thing applies in person. You are an adult and a healthcare professional; you do not need to stand around while someone yells at you.

Can you imagine the response if any time you disagreed with a provider's actions you called to rip them a new one, yell, and try to disrespectfully break them down? It would not be well received, and this is no different.

Your duty is to your patient. You have no duty to please physicians.

You did a great job helping your patient. There is no reason your patient should suffer because the doctor forgot to write a script initially and was too lazy to fix it.

[Nunya, BSN]

On 1/17/2018 at 4:12 PM, cinnamonlove said:

NurseCARD, I agree with your advice but not with your insult. Please avoid to judge people. So, if a patient gets mad at you and yells, are you going to call him also a .....? I really feel sad about your judgment.

A doctor who does this IS a jerk. NurseCard evidently calls them as she sees them. Trust me, not all doctors are good people.