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Help! Rude MDs or is it me?

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I am new to this position on a hispital unit in a county hospital. All is generally well except for the below incidents recently. I did last night email my nurse mgr about them, but hate to "be a complainer", though really think this behavior is unacceptable-- waht do you guys think? Please give me your opinions, help, and what I should do.

There have been 3 separate incidents recently where MDs have been 'angry', and what I consider innapropriate, during nights.

1. Yelled at by an MD on nights at 0400, during a busy night I hadnt even sat down for 1 minute yet, immediately previously holding pressure for an hour on a pt her intern had instructed me to (and I called back after 20 minutes, and he told me that is all I can do is to hold pressure, so I was in there for an hour), she (MD) was standing in pt rm, I went in and she yelled, " How long has it been since anyone was in here" (should be in caps), with an angry tone which to me insiuated I was ignoring patients, when in actuality I had been diligent all night, had spent the majority of the first two hours here with this pt, and she was sleeping and her VS were fine. The resident had shaken her and she didnt wake up, and the resident stated she might have 'hypercapnea' and should be tx to CCU frantically. The resident did wake up, she had been in a deep sleep.

I am not used to this treatment, I had hoped for more copperative/collaborative teamwork, I felt it was insinuated (by her question/s tone of voice) that I must not be doing my job, nor was I apologized to, nor do I think they cared. I let it go.

2. A patient 4 day post cabg has low uop and poor po intake and is c/o dry mouth I am wondering if they need a maintenance iv till their po intake improves. pt listed as being cvts, I page operator as there is not a listing for that person on the board, they tell me surg resident, Dr "X". I page him, he telles me he is not covering this pt "it must be team b". He calls back right away and says he is, I tell him the situation (My intentions are good- to help this pt), and he declines orders.

Later at ~0400, pt goes into rapid afib (like he had previous night). I call him, Mary RN answers callback, and he tells her he ISNT covering him, to call another MD but leaves the #. I page this new MD x3 with no callback. I am concerned that time is going by with no response, so I page him again. Megan again takes the call. Then the MD he referred me to calls back. The first MD Dr. "X" comes down looking very angry. I asked him about this, and he mumbled angrily something like, well I dont see how the other MD wasnt paged, ect It was noticed/witnessed by Mary RN and Mike NA. I did speak to the MD later and said that it appeared that he was angry, and that that affects people when they are trying to take care of a pt problem. Mary RN stated she was "glad I had said something",

3. Tonight I called the on-call for team b because a pt was vomiting in the room, stated he had "been vomiting all day" and that the PRN reglan and Zofran were not effective for him. I called with the intention of seeing if there were another anti-emetic he could try. Resident was (again) very angry "well how many times has he vomited? (in angry tone) I said, "he vomited since I got here, but I have only been here since 2300, and he stated to me he has been vomiting frequently today, with no relief of ordered anti emetics" "how many times (should again be in cap)!!!!! You MUST know HOW MANY TIMES, NOW what is it, how many times!!! She continued to talk to me like that. I interrupted her and said, the way you are talking to me is innapropriate, "now you are complaining more that the patient! Are we here to talk about the pt or your complaints?' I had also told her the pt was now reporting a productive cough (as long as I was talking to her). She had the same types of questions, grilling me. she ordered a sputum cx, and a routine cxr. LAter (15 minutes) she came up to see pt, and glared at me, I went into pt room with her while she asked pt questions. She turned to me and angrily said, have you obtained the sputum cx? I said 'no-- it has been 15 minutes, and I am just still doing initial assessments on patients'. She told me it should have been done by now, and that it had been put in as an order, and have I instructed the pt on this or brought the cup in'. I asked to talk to her in the hall when she was through. When she was through in the room, she walked out without speaking to me. I tried to talk to her, and she told me I was wasting her time, basically, and that I am "too concerned about things that are not pt care".

4. Pt unable to sleep d/t "dry nose" Kleenex on bedside table has small spots of blood from dry nose. Pt stated she was very uncomfortable from this. Pt on room air. I paged on-call intern for ocean spray. Got call back stating she would "order the ocean spray when she got up from sleeping". Waited about 45 minutes, decided to page back statiing pt uncomfortable, need order for o.s., thanks. Did get order.

PLEASE HELP! My attitude is rapidly going downhill!!

Don't wake doctors up for Ocean Spray. The pt can use a little vaseline or just some water in the nose. Ask Days to get an OS order. You would not call a doctor if you had a dry nose, would you? Why wake up a doctor for something like this? Reserve wake-up's for urgent, serious problems.

Do speak again to this doctor, when she is more rested. Tell her you're sorry that you and she seem to have gotten off on the wrong foot, stuff like that. Let her know your concerns. If she is still rude, tell her you will not tolerate her rudeness and disrespect and tell her she is forcing you to go over her head, which you would really not prefer to do. If she still is unresponsive, write her up. You don't deserve to be yelled at, even if she's tired. She wants to be a doctor, she needs to accept the rough path that requires and learn to show respect to you and other staff.

Before you page a doctor, especially to wake her up, get together the information the doctor will need to intelligently respond to your concerns. How is she supposed to figure out if fluid replacement is needed or a different med is needed if you don't give her facts? Know what has been tried, when, allergies, pertinent labs, VS, how much emesis, its characteristics, etc., all the stuff you were presumably taught in school. Think of what YOU would want to know if you were the doctor.

ghillbert, MSN, NP

Specializes in CTICU. Has 20 years experience.

If it's a multitude of drs complaining about the same issues with you, then you must consider that you might be contributing to the problem. I agree that you don't have to tolerate being yelled at for ANY reason in a professional environment.

I would make sure I had my ducks in a row before calling a dr to request pt evaluation. How can they make decisions if you don't give them required info? I would not call for nose spray overnight.

Perhaps you could ask for more clarification as to who is on call though - that annoys everyone when you have to chase various people around to find the covering doc.

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

Wow. I think it's reasonable to email your manager about the crappy behavior of these residents. Sounds like their attendings need to step up a little and teach them how to play nice. There is no reason to be treating the nurses like dirt.

Thanks for the replies. Well, the person who needed the ocean spray was really uncomfortable, and it was keeping her awake, and her nose intermittantly (shortly) bled due to sryness, I just thought if you were on call, you were there to answer to pages when a patient needs something. I might could have wet her nose, you are right.

But with the other things, I thought that we are supposed to report patient changes. the person who asked how many times this person vomited that day (I did not ask count) focused on me answering the questions she barked at me withoutgiving me a chance to give her information.

Anyway, maybe I am not cut out for nursing.

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

Remember that resident physicians are working under the supervision of an attending. They are not independent practitioners yet. Part of learning how to be a doctor is learning how to get along with hospital staff. I think you just need to grow a backbone and stand up to these jerks, and continue to report inappropriate behavior to your manager.

That being said, there are situations where it's understandable that the resident would be angry, like a nurse calling about a problem but not having all of his or her ducks in a row. Do not make that phone call until you have gathered all of the pertinent facts, and when you get the call back, have the chart and a computer in front of you so you can quickly look up things you can't recall off the top of your head.

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 20 years experience.

Virgo makes a very good point. Have all your info handy so it is there if needed. Rudeness shouldn't be tolerated.

Was the pt with the nose bleed on oxygen? Try humidifying it if they were. That helps tons. If the resident does rounds (like they should through the night) I would have waited to ask until then.

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

She stated the pt. was on RA. I wouldn't have felt comfortable calling in the wee hours for nasal spray either. I probably would have offered a damp cloth or a pink squirt.

no, the patient was not on O2, was on room air.

Thanks for the replies, does it sound as I described it, that these mds were rude, or am I being "too sensitive". I did email my mgr. almost verbatim my initial message, and I hope she is understanding. I am here only 2 months, and already feel dejected!

I would DEFINITELY page the on-call for nasal spray if I felt it was important for the patient to have it right then. The on-call doctors, at least at our hospital, are there for this very kind of thing (in addition to emergencies) so that you DON'T have to call the MD at home. Doctor's don't think twice about calling the night shift and making order. Our hospital runs 24 hours a day.

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

Thanks for the replies, does it sound as I described it, that these mds were rude, or am I being "too sensitive". I did email my mgr. almost verbatim my initial message, and I hope she is understanding. I am here only 2 months, and already feel dejected!

Okay. Honestly? I think you're giving these people way too much power over how you feel about yourself as a nurse. To put it simply, it's like wearing your heart on your shirt sleeve. As they say, nobody can make you feel inferior without your permission.

Okay, thanks Virgo, how would you have handled these responses (from residents/mds)

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 20 years experience.

Holly,

You will find no matter what some MD's will be rude. You will also learn what can wait to be called. If I were at a non teaching facility you bet that call for ocean nose spray would wait until the morning. Like I said if the residents come through the units and check on patients then it is appropriate to ask them then. I work ICU so I don't know if your docs round every few hours or not.

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

What nrsang97 said. Some docs are just rude. Some seem like they are never happy. We have one cardiologist that I've nicknamed (in my own mind only) Dr. Rayosunshine due to her grouchy demeanor. How I deal with these ones is I just remain calm, keep my cool, answer their questions directly, matter of factly, and as concisely as possible.

Other doctors are more personable and you can afford to be a little more chit-chatty with them. Some are pretty much unflappable and will be polite no matter how much of a blithering idiot you sound like on the phone.

But, as I said, for the crabby ones, I just keep my cool and be concise. I have never been shouted at, but I imagine that if I were, I would simply stop in my tracks, turn and face the person, look them directly in the eye, and say nothing, giving them the opportunity to realize what an ass they are making of themselves. And of course, I would file an incident report. Doctors are not allowed to shout at nurses at my facility. Such behavior is verboten.

Edited by Virgo_RN

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

The criteria for contacting an MD in the middle of the night is different than that of calling in the day. Nasal spray is something that warrants a nursing intervention first, such as the normal first aid treatment for a nosebleed. Normally, a note on the chart would be my course of action. If the bleeding became out of control, then a call to the doctor would be in order.

It's a tricky thing learning when and when not to call and what info to have ready. If you're getting a lot of negative feedback, then that's a signal that you need to improve that skill. If residents are acting like belligerent SOBs in response to your lack of skill in that department, then they, too, need improvement!

Vito, you are so well spoken... you can see both sides well. Thank you for your insights. :redbeathe

heron, ASN, RN

Specializes in Hospice. Has 40 years experience.

I would DEFINITELY page the on-call for nasal spray if I felt it was important for the patient to have it right then. The on-call doctors, at least at our hospital, are there for this very kind of thing (in addition to emergencies) so that you DON'T have to call the MD at home. Doctor's don't think twice about calling the night shift and making order. Our hospital runs 24 hours a day.

I disagree. It would depend on the time of night the problem came up. You didn't say whether yours is a teaching hospital with house staff acting as on-call or if your on-call docs are moonlighters. Where they are house staff, we need to bear in mind that they are frequently working 24 hours straight or more when on-call and usually have a huge patient load as well as admission work-ups. A 3AM call for something I could solve myself without an order or that can wait until morning is inappropriate, IMHO.

Yes, yes ... I know they chose to go to med school and this is part of the dues they pay. However, you can't demand respect for your time without giving it as well.

Read a few of these threads complaining about "trivial" requests from pts/families and their seeming inability to understand the demands on our time. What's good for the goose ...

I'm a long-time night nurse. My docs pay attention when I call because they know I don't call without a very good reason.

Penelope_Pitstop, BSN, RN

Has 13 years experience.

i would definitely page the on-call for nasal spray if i felt it was important for the patient to have it right then. the on-call doctors, at least at our hospital, are there for this very kind of thing (in addition to emergencies) so that you don't have to call the md at home. doctor's don't think twice about calling the night shift and making order. our hospital runs 24 hours a day.

i respectfully disagree.

first, i must say that a lot of times, our on-call doctors are at home, unless they're affiliated with a teaching or hospitalist service. i don't know if that's weird for a hospital, or what, so i just wanted to add that.

one has to remember that these on-call physicians are on-call for several patients. some of these patients may not be on one's floor, nor at one's hospital! therefore, it isn't possible to know what the on-call is dealing with at any given moment. there might very well be an emergency, or something more urgent than ocean spray. imagine what the nurse awaiting a callback for a more pressing issue is experiencing while that physician is figuring out what to do with a more trivial dilemma.

i'm not intending to jump on anybody here. i don't think the op is silly. i'd rather be safe than sorry. i do think these situations present an opportunity for learning, though.

as for advice on how to deal with this kind of behavior, i don't know if anyone should ask me and want the answer! i had a reputation on my old floor of "schooling" the new residents. i wasn't rude, arrogant, or mean to them; actually, i was rather friendly with all of them, even the mean ones. i think my refusal to stoop to their level and desire to advocate for my patients overcame my fear of a doctor yelling at me or whatever. also, after i had (respectfully although sometimes a bit harshly) questioned a resident, he or she tended to respect me a lot more.

it worked for me because i had the correct balance between knowledge and respect. i didn't bow to anyone, nor expect it.

and, please know exactly what you're going to say to the doctor when he or she does call. if you're unsure, ask a more experienced nurse how to do it. i've written "scripts" for newer or more nervous nurses. "hi, doctor moohead. this is morgana from heavenly health hospital, and mr. hideous man is running a temperature of 39.2. he's not had any fevers during his admission and doesn't have tylenol ordered or any blood culture parameters. i wanted to let you know and also hoped you could order some tylenol for him." or "mrs. elbow grease's blood pressure is 200/120 and i don't know why. what do you suggest we do for her?" if you don't have a suggestion or more pertinent information. and, when obtaining a telephone order, write it down, then repeat what you've written. don't repeat then write. it's a "readback," not a "repeat."

and...at the very least, have the patient's chart and mar at hand, as well as something to write with (and on!) and a set of vital signs taken within the last hour.

uhh, i didn't mean for that to be so long!

*~jess~*

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