How does one become assertive in the nursing field?

RedhairedNurse, BSN, RN · Apr 22, 2008

I have been a RN for 4 years now. You would think by now I would be comfortable with speaking with physicians. But I am not. I hate speaking to physicians because they are so disrespectful. They talk to nurses like we are scum. It bothers me so much that I get nervous before I call them and most of the time I don't say everything that I intended on saying. I have thought about leaving nursing over this issue. Can anyone offer any advice?

Are you familiar with the SBAR technique? Situation, Background, Assessment, Recommendation. Google this to learn more, then use this communication tool next time you have to call a physician. And get your information down in this format before you call him. They are telling us to use this at my new job.

You being a nurse for 4 yrs, you may know this already. So sorry if I'm off base here. Here is a link on SBAR:

http://w3.ouhsc.edu/pcep/documents/SBARWorksheet.pdf

MzMouse · Apr 23, 2008

1. Have your story and the details straight.

2. Keep it short and to the point.

3. Remember you are informing them for the patient's well-being and to cover both your behinds. Becoming a better patient advocate has made me a lot more assertive when confronted with a difficult physician.

amy0123, BSN, RN · Apr 23, 2008

HA humble Drill Sergeant comes to mind.

I have trouble with assertiveness at times. It just has to come out when necessary.

rnmi2004 · Apr 23, 2008

Ask yourself this...am I a nurse to take care of my patients or to pander to physicians who don't like to be bothered? What helped me when I was a brand new nurse was coming to the realization that my timidity about being assertive with doctors about my patients' needs was ultimately harming my patient.

At the end of the shift, I want to know that I took the best care possible of my patient, even if that means waking up a doctor at 3 in the morning.

RNcDreams · Apr 23, 2008

Being in the ER from the get-go has been a blessing for me.

The MD's are either at the computer next to me or at the station behind me. They never get angry if I ask them to explain something, and they are generally thankful if we inform them of a patients pain or change in status. The department can get really out of hand really fast, so we must rely on each other.

As a result of you informing them of their patients needs, all three of you are in the clear-- your patient is comfy and safe, the doctor is updated and you are able to take pride in your ability to think critically and advocate for the patient.

As for them treating you like poop?

Your responsibility is to inform them of the change in pt status, give them pertinent information, and the voice your concerns/requests-- in a concise, polite, professional manner.

"Hi Dr. ______ This is _____, I'm the nurse taking care of ________ tonight. I'm calling because she's having severe nausea/pain/etc. her vital signs at 0100 were __________. (Insert other pertinent assessment data here). What can we do for her?"

After that, the ball is in their court. If they want to behave like a child, that's their deal.

Bad behavior comes back around, sooner or later...... :)

SoundofMusic · Apr 23, 2008

I'm a newer nurse, but an older mom, and boy, I NEVER let these docs intimidate me. They do NOT know everything. I have fought with enough pediatricians as a mom, that I just sort of transfer that to my job in a way.

If I've made my best effort to provide the SBAR info, and am calling for a good reason, I've done my job and they need to then do theirs.

If they get short, I get short right back.

Actually, rude docs don't bother me as much as rude nurse/co-workers. I feel the hospital docs, residents, etc. really do have a hard job and I can understand why they get exasperated. Why co-workers have to be so rude at times, I absolutely cannot understand.

Long Term Care Columnist / Guide · Apr 23, 2008

I've always said, if MDs don't like taking call, they shouldn't be making the big bucks.

Actually, it took me a number of years to feel completely comfortable with asserting myself with physicians. Some can indeed be intimidating; at the hospital where I used to work, our worst nightmare was this gastroenterologist whose ego was inversely proportionate to his five-feet-four. He was also notorious for screaming at nurses and putting them down, so I wasn't looking forward to calling him the night his patient accidentally yanked on his chest tube and started bleeding..........and bleeding............and bleeding.

Nothing I did would stop it. I changed dressings every 10-15 minutes. I put pressure on it. I kept pressure on it. But the pt was on both Coumadin and Lovenox, and he just kept oozing, so I finally put the aide in with him to keep pressure on the site and phoned Dr. Bantam Rooster. I knew all the pt needed was a suture to keep the chest tube in place and some Vitamin K, but the doc did NOT want to come in and he yelled over the phone "Keep pressure on it!!"

I was tempted to retort "Well, gee, Doc, I didn't know I was supposed to do that", but restrained myself. I told him I'd BEEN doing it for half an hour, but he told me to just keep the pressure on and hung up. Good lord, I had five other patients---what was I supposed to do, ignore them all night and sit there trying to keep the blood in this gentleman's body? Well, I called that doctor right back and told him he needed to come in and check it out himself, as the pt. by now had probably lost close to a pint of blood and was continuing to ooze. Doc barked into the phone, "I don't think it's necessary, but have a suture kit opened and ready for me in fifteen minutes!"

It was closer to an hour before he arrived, but I not only had everything ready, I'd premedicated the patient and had a bag full of saturated dressings to show him. He took one look at the chest tube insertion site and said: "Let's get this done NOW". So I assisted as he quickly sutured the site, stopping the bleeding almost instantaneously, and redressed it, all the while chatting with the patient and looking oddly sheepish. I started cleaning up, then was called into another room while the surgeon was washing his hands.

When I came back, I was astonished to find Dr. Bantam still in the room. "I took care of the sharps for you", he said as he tossed the last of them in the sharps container. Now, he never said I was right, and he never said "Thank you", but the fact that he cleaned up after himself was all the validation I needed. In fact, for a short time I was the envy of the floor, because Dr. Bantam had never in recorded history cleaned up after himself, and as such it was a mark of respect that no other nurse on our unit had ever received.

Of course, it helps to be older........it's almost impossible for me to be intimidated by a thirty-five year-old hotshot, even if he IS a doctor.

Grace Oz · Apr 23, 2008

Assertivness becomes easier as we grow as individuals and professionals.

Life experiences help build confidence and empowers us to be assertive in situations which demand it.

My tool for always putting ignorant jerks in the place they belong is to imagine them sitting on the toilet, dying, scared, in pain etc etc.

Usually, jerks are actually insecure and uncertain individuals.

Often thay are also abusers and bullies.

Under no circumstances should you ever relegate yourself to being a lesser being than another being.

The most arrogant of people are usually the ones who actually love themselves the least!

Give yourself the gift of loving you and refuse to be treated poorly by anyone! This includes doctors who might delude themselves into thinking they are more important!

No one is more important on this planet than any other being! EVER!!!!!

There's some good advice posted here. You can learn much from what others have shared and suggested.

I hope you soon gain the confidence and strength to be assertive, both professionally and personally.

I wish you every happiness and success.

RNOkie · Apr 23, 2008

I am so happy to see that I am not the only one with assertiveness issues. Except mine are more prevalent with the nursing staff due to the fact that as an LPN, I don't have as much personal contact with the MD's. I was taught to respect your superiors; you may not have to like them, but you do have to respect their authority. However, in the rural hospital that I am currently employed, it appears to me that the techs have more authority than the LPN's or RN's, for that matter. A recent incident involved 2 LPN's that simply ignored and refused the RN's instructions to mix an insulin drip and add KCL to fluids WHILE IN AN EMERGENCY situation.(Pt was in DKA). Unfortunately, these 2 have got managment in their pockets and nothing was done about it. So, long story short, I have never, in 12 years of nursing, seen the insubordination and absolute disrespect that are exhibited in this facility. Am currently in RN school and would like to know, for future reference, how to handle this type of situation. "Charge" nurse is an oxymoron in this place. Not only are my techs insubordinate to me, as their LPN, they are also insubordinate to my and their superiors alike. Management apparently has no problem with this....What do I do????

deezRN · Jul 12, 2011

Im interested in hearing how your situation turned out. We have the exact same problem. Nurse aides who refuse to vitals, glucometer checks, etc on patients unless its for the nurse that they like. Then they act all innocent like, "oh, dear me, did i do that?"