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!!

[Tweety, BSN, RN]

Thread closed for review and time out.

[Vito Andolini]

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.

again, nasal spray is not something for which to wake up someone who is on a very, very long stretch of duty. wake docs up a lot for non-urgent, non-life threatening stuff and i expect you will be reported and not well liked. you might even be shown the door if you don't learn to discern what needs immediate attention and what doesn't. don't forget who holds the power - docs, not nurses. for real. i do understand you want patients comfortable. but a little water, some vaseline will help and you can get the order for something else at a decent hour. if you are a student, i understand you might not have worked nights yet or learned how to try to keep a peaceful relationship with the doctors. if they know you are trying hard to let them catch some sleep, they will likely be grateful and not so upset when you do have to call about urgent matters. a good thing to do is to check with your charge nurse or supervisor before waking a doc up unless someone is absolutely crashing. if i happen to know the on-call doc is awake, i will go on and call for less urgent things or walk over and see him in person, chart in hand, if he's down the hall or on another floor close by.

a wise doctor will call each floor before trying to bunk out for a while and ask each nurse if anybody needs anything. and he or she will be sure that everybody has orders for pain, constipation, sleep, etc. before turning in. if staff get used to the doctors calling before retiring and/or calling every few hours, they will try to hold non-urgent matters for those phone rounds. at least, that's what we do.

and of course it's different if doctors are calling to give orders to night staff. let's hope they are not waking up nurses when they call. lol why does a doc doing this upset you? i'm confused.

[Vito Andolini]

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.

I don't think you should have been the one to hold pressure for an hour, either. Where was the aide?

Give yourself time. You will be a great nurse but it takes more than 2 months. You need at least a year to feel and be more able to fully function in your first job.

[Scrubby]

hollyberry-Kudos to your for being willing to stand up for yourself. I firmly believe that when a doctor misbehaves then it needs to be deal with at the time and they should not get away with rude behaviour. From my experience if you make it clear to a doctor that your one of those nurses who won't just stand there and take their crap, it doesn't often happen again.

My advice is if you know a doc is at home, don't wake them up over low priority issues. From reading about the ocean spray it's clear to me that you want to advocate for your patient BUT there are times when the low priority things just have to wait until a more civilised hour. I don't want to sound condescending here but when you gain more experience you will learn how to prioritise a lot better and little tricks (like vaseline instead of o.s) to manage without an order for something.

[Equinox_93]

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.

So- would you call if the patient *asked* if someone could be called and they didn't want to wait until morning? Or would you only wait till morning if it were something you were considering offering on you own initiative? (I'm not a nurse yet- thus the curiosity )

[lpnflorida, LPN]

Hollyberry, I think you did the best you could given that you are still a novice nurse. It will get better, we all have learned when and when not to call based on doing some of the same things. We have all learned what dialog works best with Doctors to obtain the best results for our patients.

I use this as a gauge when I have an issue and think I might need to call a doctor. If I were sound asleep would I want to be awaken with this issue?

I know that sounds dumb, but it gets us to stop and think. Look at are there things we can do to make a patient comfortable or are there orders already in place for just this type of situation. I always bounce off my charge nurse or nearest Rn what do you think? Again two heads are better than one.

Many people have offered great suggestions. Constructive criticism is something we learn to listen to. It is how we grow. It is never against us personally and for myself I try to never personalize it.

Yes, docs can be irritable and trying, but they are less so when we have the answers they are looking for, then their irritability turns from irritation to respect.

I wish you a great career.

[lpnflorida, LPN]

True story,

A few years ago my darlin was on call. After midnight there were no less than 4 phone calls regarding one patient from the same nurse. After call number 3, my loved one after getting off the phone turned to me as heck I was awake at that point and asked? Aren't nurse taught to do such and such? My reply was, it sounds like you have a nurse who is new to the profession and she has not yet learned what is important and what can wait. Well , within 1 hour and it was now 4 in the morning. The fourth phone call, I heard him still in a calm voice rattle off what sounded like a page of orders. He got off the phone, turned to me and said" Well, that sound keep her busy for awhile now maybe we can get some sleep" He was chuckling to himself, I tried to go back to sleep couldnt. He has surgery in the morning to be to. I had to be to work at 0645. I have never forgotten that night. ( I learned to go sleep in the other bedroom when he was on call) Dang that was a hard day at work for me with little sleep.

Mind you this whole issue had been over some blood in a foley after a TURP and already had the 3 way cath and irrigation running. Nothing he would tell her would reassure this poor nurse. I often wondered what would have happened to her ears if she had called an unreasonable sob DR. P.S. when he saw this patient at 7am what he saw was customary and usual to see after a turp...

[CoffeeRTC, BSN, RN]

How about bouncing your calls off the Charge nurse before you call?

Another poster mentioned having a scrip written, have all your charting in front of you to refer too before you place this call. If I was the doc, I'd wonder why I'm getting called in the middle of the night if the pt was throwing up all day long.

The ocean spray thing is just something you learn about. Nursing interventions first a few hrs later the doc can deal with it when they come in.

[nrsang97, BSN, RN]

So- would you call if the patient *asked* if someone could be called and they didn't want to wait until morning? Or would you only wait till morning if it were something you were considering offering on you own initiative? (I'm not a nurse yet- thus the curiosity )

I work in a teaching facility and would have waited until the resident rounded. They come through ever few hours. However we also have those respitory bullets (those pink things filled with saline), I would have offered the pt with the dry nose that. IF they were on oxygen I would have humidified it. I also would have given vaseline if not on oxygen. There is plenty of something I can do in the meantime.

If the pt insisted that I call someone, and this was a non teaching facility I probably would have done all of the above and tell the pt that the doc will be notified before I go home in the monring, but not at say 0200. What would they do at home? Would you call your doc at home if you had a nosebleed at 2am? Probably not. But if the house MD happened to round I would mention it then, if they weren't doing something emergent.

[diane227, LPN, RN]

Sometimes you just have to tell the patient that it is not an emergency but you will take care of it in the morning and see if you can find some alternative to help them until then. Many of our patients are cared for by their private physician. Often, they make rounds early in the morning while the patients are half asleep. I try to get to their needs by no later than 9 pm so I can get the doc before he/she goes to sleep. Sometimes no matter what you do, the doctor is going to be an ass. You have to stand up. You might not address the issue then, but you should later so they know you are not going to lay down.

From another perspective, I have a VERY GREEN LPN on my shift and she is so afraid to call the doctor that she breaks out in a sweat. When she does call, she just stumbles all over herself. She is never going to learn how to properly call the physician, (having the lab results, chart, mar etc at hand) so she can answer questions. I am trying very hard to help her but I fear it is going to be a long hard road.

[Vito Andolini]

So- would you call if the patient *asked* if someone could be called and they didn't want to wait until morning? Or would you only wait till morning if it were something you were considering offering on you own initiative? (I'm not a nurse yet- thus the curiosity )

I would tell the patient he could call and give him the phone number if he wanted it but I would not wake up a doctor for anything that was not life-threatening, limb-threatening, totally essesntial. The doctors need their rest, too, if for no other reason than to be half sane while caring for other patients, and waking them up for nasal comfort or something else that is just not that serious is wrong. If there is a visitor present who can run out to an all night store and buy some nasal spray, well, what we don't know won't hurt us. I know some nurses who won't give a cold pack, a bandaid, a hot pack without orders. Some won't use peroxide or even saline or soap and water to wash a minor scrape. A lot depends on the level of experience of the nurse.

The guide to use for waking up a doctor is whether or not you'd personally call your own doctor if you were at home.

Believe me, if someone's level of consciousness is dropping or their mental orientation is deteriorating, if someone's VS or urine output are messing up, if I can't control pain or bleeding, if someone is itching severely, if limbs or digits are losing sensation, color, pulse, or movement, doctors will be called.

[Vito Andolini]

I would tell the patient he could call and give him the phone number if he wanted it but I would not wake up a doctor for anything that was not life-threatening, limb-threatening, totally essesntial. The doctors need their rest, too, if for no other reason than to be half sane while caring for other patients, and waking them up for nasal comfort or something else that is just not that serious is wrong. If there is a visitor present who can run out to an all night store and buy some nasal spray, well, what we don't know won't hurt us. I know some nurses who won't give a cold pack, a bandaid, a hot pack without orders. Some won't use peroxide or even saline or soap and water to wash a minor scrape. A lot depends on the level of experience of the nurse.

The guide to use for waking up a doctor is whether or not you'd personally call your own doctor if you were at home.

Believe me, if someone's level of consciousness is dropping or their mental orientation is deteriorating, if someone's VS or urine output are messing up, if I can't control pain or bleeding, if someone is itching severely, if limbs or digits are losing sensation, color, pulse, or movement, doctors will be called.

In some settings, where you work with the same doctors for a long time and they trust your judgment, nurses might give nasal spray, tylenol, whatever without an order but then the doctors come in and write the order for it, which covers nurses for having practiced medicine without a license. No, I've never done that and don't recommend it but I know of at least one setting where that used to happen many years ago. Probably happens more than we might think.