Help! Rude MDs or is it me?

[hollyberry678]

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!!

[nrsang97, BSN, RN]

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]

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.

[FireStarterRN, BSN, RN]

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!

[netglow, ASN, RN]

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

[heron, ASN, RN]

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]

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~*

[diane227, LPN, RN]

How long have you been a nurse? Don't you have a charge nurse who can assist you before you have to call one of these doctors, someone you can run it by before you make a call? You have to have all your ducks in a row any time you call a physician. They do get upset when called in the middle of the night so it should be reserved for something that just can't wait.

Nasal spray is NEVER an emergency. You can use those little saline poppers that RT uses to give a resp. treatment. Don't try to explain yourself to these doctors. As with the sputum, she does not care that your shift just started. When she wants the sputum because it has not been done, just say "I'll get right on it" and leave it at that. Plus, if this patient was vomiting "all day" why did one of the nurses on the previous shift do something about this. She should never have been left for the night shift. These doctors do not care if you have not sat down. They probably have not either. If they say something that make you angry, address this with them in private. What kind of unit are you in? Why are you holding pressure on some pt for an hour? This just does not sound right. More details please.

[hollyberry678]

Wow, everyone is so focused on the ocean spray incident, which I believe I addressed in response, that they have not focused on the bulk of my concern. I am sorry that I brought that incident up.

[BroadwayRN, ASN, RN]

1.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.

2. 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.

3. Are we here to talk about the pt or your complaints?'

4. 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.

It sounds more to me like you have the wrong attitude towards physicians. They are people. Yes they can be beligerent and then you should write them up to the administration but let them handle it. If a physician yells at me. I let him/her get it out of their system and then ask for the order. Don't challenge the doc.

1. The resident had every right to be concerned about a patient he/she couldn't wake up. This resident didn't know and doesn't care how busy you've been. His/her only concern was that the patient couldn't be awakened.

2. You tell a doctor it appeared that he was angry and chastise him? Please, you were out of line.

3. Again, you were out of line.

4. I would have been mad too. Outrageous call there.

[hollyberry678]

remind me not to post here again.

[ghillbert, MSN, NP]

Holly, in your post it appeared you were asking for input as to: "is it them, or me"? You have been given some input from nurses with varying experience. Take it, read it, use what you want. There's no need to get upset just because you didn't hear what you wanted to hear.

[FireStarterRN, BSN, RN]

remind me not to post here again.

You do have a problem here, as evidenced by this post. You posted that you were having trouble with the responses of some doctors, gave an example of calling for nasal spray in the night (I thought ocean spray was a cranberry juice company, but I digress). You obviously thought that we'd all jump aboard agreeing that you were an excellent advocate for your patient and had every right to call for anything the patient might need in the middle of the night. But instead you got some very balanced responses that told you that you need to become more discerning as to when or when not to call a doctor, reminding you that they, too, are extremely busy. You also got feedback that, although they are busy and feel irritated, that these residents also need to learn that they can't yell at people.

Now you are 'sorry that you even brought up the nasal spray story'. Why, because it showed that you are, indeed, annoying busy doctors with trivial calls? And now you're not going to play in the sandbox anymore and are taking your toys home?

My advise is that you need to take a more mature approach to these sorts of problems.