How do you deal with Doctors that insult nurses?

macawake, MSN · Jul 20, 2016

I am a new nursing grad working in an acute care setting. My job specifications require me to call MD's at frequent intervals for lab results and change in health status of my patients. I have since found out that most of the MD's that are attached to the facility where I work get upset whenever you contact them about their patients, leading them to be rude in the way they address nurses.
There's is this particular one that all nurses in the facility dread to call even in critical situations. I have been seriously bothered by this situation that I began to wonder if I am in a wrong profession. I am not used to being disrespected and I think I may snap one of these days.
I just need your candid advice on how to deal with situations like this.

I might not be the best person to offer advice since I've been known to do what you fear that you might do, i.e. snap at a rude person.

You might already be doing this but I'll include it in case you aren't. First of all, see to that you have all your ducks in a row before calling the physician. I like to report in the SBAR format. It's clear, concise and an organized way to convey the important/relevant information. Also if at all possible, try to "cluster" the calls (especially during nighttime). What I mean is if you need to call regarding several patients, don't make several seperate calls ten minutes apart (unless it's absolutely necessary). It can also be a good idea to ask your coworkers if they have something they need to talk to the physician about before calling.

If I think that the physician will react in a way that's to the detriment of the patient if I tell him/her what I think of their behavior, I'll try to bite my tongue for the time being. However, I will tell them at the first opportune moment that in the future I do expect them to treat me with common courtesy and I'll do the same for them. Me calling them and them taking my calls is part of our respective job descriptions. It's for the good of our patients. Sometimes a gentle reminder about that fact will suffice.

I haven't had a problem with most of the physicians I work with. The few that have had an "attitude" were sometimes acting that way due to stress/sleep deprivation and others just due to generally cranky/nasty personalities. They have all improved their demeanor after a semi-stern, straightforward talking-to :)

There's is this particular one that all nurses in the facility dread to call even in critical situations

While I personally prefer to talk to a physician who behaves rudely "one-on-one", as one adult to another, the situation that you describe might warrant a different approach. If it's a problem with an individual physician and it's severe enough to actually threaten patient safety, it should in my opinion be brought up the chain of command. Have the nurses who fear/dread calling this physician made the physician aware that his/her behavior is unacceptable? Have they brought it to the attention of the nurse manager so that s/he can take further appropriate action? Perhaps, depending on what has happened, incident reports needs to be written?

Good luck!

KatieMI, BSN, MSN, RN · Jul 20, 2016

In addition to the excellent post above:

- when you actually see docs, present yourself as a competent, intelligent, calm person who knows what she's doing and genuinely concerned about patients. Ask them questions - many physicians love to teach.

- when you speak with different physicians, take cues of how they like to hear the information. I now do my NP clinicals and so now know that the way the RN presents the info affects my reaction and my judgement. Docs have some individual patterns, so sometimes it can be even appropriate to ask them directly (of course, not over the phone at 3 AM).

- if there are parameters, follow them. If there are none, ask for them and remember that you treat Mr. Jones, 56, not your policy book. It is totally fine to ask: "Dr. Jones, how low BP for Mr. X you want to be informed about"? If there is such requirement from physician,ask to make it as "nursing communication" order to superimpose your policy book.

- know your baselines. I cannot emphasize it more.... know them. If BP was 90/60 baseline, nothing goes on and nothing else changed, it wouldn't be seen as ok to call doc at 3 AM with BP now 88/56.

- keep chart open, paper ready, latest labs near and latest set of vitals not more than 30 min old.

- ask older nurses who might develop better rapport with particular docs. Some of them can even sit with you once in a while for moral support:yes:

emmy27 · Jul 20, 2016

If the problem is truly egregious (ie, not merely a cranky tone, but actively insulting you, refusing to address a serious change in condition because they're busy throwing a tantrum over being called, or hanging up/refusing to return calls), then it needs to go up the chain of command. If it's borderline- not truly a patient safety issue right now, but so unpleasant to deal with that it's making it hard for you to objectively deal with future interactions with that doctor, discussing it calmly with a charge nurse might be appropriate. They may be able to give you tips for dealing with that particular doc, or they may be able to identify a pattern of inappropriate behavior that can be escalated to higher authorities.

I've known of one outside doc who lost admitting privileges and one hospitalist who was fired over consistent abusive treatment of nurses that endangered patients, and more than one resident who it was widely assumed got a little attitude adjustment from higher after multiple nurses brought their terrible behavior to light.

Doctors, as profit centers for hospitals, get treated with kid gloves to a certain extent, and there are plenty of situations where your only choice is to let it roll off your back and realize that it's not personal- they're humans under intense pressure, or that perhaps you could change your approach (ie, don't call without all the information and an inkling of what you want from them- or with a ready response of "I have to inform you of this under policy." But if it's not just you or just an occasional thing with a specific provider, there does come a point where management will intervene for the good of patients and staff retention.

meanmaryjean, DNP, RN · Jul 20, 2016

If it's truly just a matter of you feeling 'disrespected' (how I loathe that term)- get over it. He/She is a voice on the phone. He/She likely treats all persons like this. There are people like this in all walks of life. Give up your career over junior high behavior? Grow some thicker skin OP. You'll last longer.

roser13, ASN, RN · Jul 20, 2016

I agree that you may just have to grow thicker skin. Easier said than done, I realize. But to question your entire career over rude folks? There are rude folks in every career.

RobtheORNurse · Jul 20, 2016

Having a thicker skin is necessary for nurses but having worked for surgeons especially, many times a nurse calls and asks for a med dose or direction on what to do for a fever over 101 etc. Circulator nurses often take these calls because the surgeon is scrubbed in. It is astounding the lack of information received from the floor nurses sometimes. Make sure you have all of the information before you call, recent vitals, not an hour old, any recent lab tests in case the doctor asks and a list of their meds. Surgeons often are operating and taking these calls at the same time so be brief and concise on what you are calling for and check current orders, many times the issue was addressed in orders and not followed through on before the call. When possible, meet the doctor face to face as they round, they are less likely to snap at someone they can identify and then they know you are trying to help them care for the patient.

TheCommuter, BSN, RN · Jul 20, 2016

In the past I've said, "The ball is in your court, Doctor. How do you wish to proceed?"

It is a not-so-subtle reminder that he/she is responsible for the patient's medical management and treatment decisions. It is also a good way to redirect a cranky physician who is ranting about something else, like his dinner being interrupted by my phone call.

CNAtoMD · Jul 21, 2016

You absolutely should have the following when contacting the on call physician. 1) a quick history "Mr. Jones was admitted with x" 2. the reason you are calling "Mr. Jones blood pressure or lab value is X" and 3) the chart open to answer my questions. If you have done that you really have done your job. Sure I don't work in a specialty that gets woken up in the middle of the night anymore but I did in residency. If you have done the above three 95% of the physicians won't yell at you. The other 5% will and nothing you can do will change that. Not calling because the physician will yell at you is not an option when it comes to patient care. It sucks but either you can report them or let "thick skin" prevail. My opinion is that they shouldn't be practicing medicine or maybe you should page them q10 min when they are on call and "update" them on the normal BP or normal lab values.

LaneyB · Jul 21, 2016

It is the culture of the hospital unfortunately. I worked at one of the top hospitals in my state, and that type of behavior was not tolerated. On the rare occasion it occurred the perpetrator would be informed by both nurse management and the physician in charge that it was not acceptable. I really wish every place would have those safeguards in place. I have also worked in hospitals where physicians acting rude was the norm.

I had a physician yell once, and the next time I saw him I just pulled him aside and told him he owed me an apology. He did apologize, and even though he continued to act like an insane jerk to other people he never did it to me again. I figure he didn't want to have to apologize again.

I decide what I will accept from people, and I do not accept abuse in any form. I just state that in a matter-of-fact way, and I have never had it continue. I don't make a big deal, or let it bother me but I do put an immediate stop to it.

RNdonut · Jul 21, 2016

All of the above advice is great. Also remember that they are people, just like you and me, and they had to build their career from knowing nada just like us. They are not God! Plus, if you don't call and report those values, it's your a**, not theirs! :yes:

NurseOnAMotorcycle, ASN, RN · Jul 21, 2016

And don't hesitate to look that provider square in the eye and quietly say, "Don't. EVER. Speak. To. Me. Like. That. Again."

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