I am a new nurse trying to figure out how to get a doctor to stop bullying me at work.

ottersloveoysters · Oct 21, 2016

Can you give an example of something he has said?

cleback · Oct 21, 2016

Without knowing details, the only advice I have for you is to call him on his behavior--be specific when you do so-- as soon as it happens (maybe not in front of patients but it needs to happen right after). Sometimes people need some "active reflection" to play nice.

Mississippideer · Oct 22, 2016

I was taking care of a post op VAT pt and called him(Cardiothoracic surgeon) to report abnormal ABGs(pCO2 of 57) Instead of giving me an order for Bipap or pain meds he told me to call Anesthesia. The anesthesiologist then gave me an order for pain meds. The surgeon went through the roof and yelled at me saying the patient would end up re-intubated due to my stupid mistake(giving pain meds). He then called my nurse manager at home to tell her I was incompetent and should not be caring for post-op surgical patients if I didn't know any better. The anesthesiologist backed me and said the patient was a healthy 33 year old that just need to breath deeper but wouldn't do so because of the pain and so he decided to treat the pain. The surgeon thought bipap was the way to go. The patient did end up on bipap within minutes but would not have tolerated the bipap without pain meds. The surgeon then commented to my boss that he had a beef with anesthesia and was trying to make a point to them by having me call them but he was mad that their first step was pain meds then bipap when what he wanted was bipap. My thoughts are that if he has an issue with anesthesia, he should follow the proper channels to resolve it rather than use me as a pawn in his game and then blame me when anesthesia doesn't do what he wants. This was the beginning. We've had three run ins over the past two weeks since this. It feels like he's gunning for me and several coworkers, even another dr has noticed and told me to write him up and stand my ground.

mimibrown, ADN, BSN · Oct 22, 2016

I have never dealt with this specifically, but is there any way you can pull him to the side and ask him what's up with his behavior? Obviously, in a professional way. I would try to see if something about you specifically is "setting him off" , or if that is just the way he communicates. If he is like that with everyone, I'm not sure what you could do.

Jolie, BSN · Oct 22, 2016

You are 100% correct that he used you as a pawn to avoid directing his concerns to anesthesia. He did that because he is weak and unsure of himself. Most bullies are, and compensate by acting tough toward anyone they believe they can manipulate. You have unfortunately become that "anyone." It won't stop until you stand up to him, and in a somewhat public way. By the sound of your post, I believe that you are up to this challenge, but you have to be smart about how it is done so he can't claim that you have acted inappropriately towards him.

Please seek the support of your manager and/or a respected nurse on your unit. Once you have their back-up, be ready for your next interaction with Dr. Jerkface. If he says or does anything inappropriate or threatens you, remain calm and inform him that you will continue your conversation at the nurse's station, then walk away. Once there, and with your mentor present as a witness, firmly but politely state that you will not be spoken to in a threatening manner. Suggest that he take some time to re-word his message to you. He will either get the message and knock it off, or he will explode in front of witnesses who saw you acting professionally. Either way, you win.

As tempting as it may be to ask someone to intervene on your behalf, in my experience, that shows the bully that you are afraid, and the behavior grows worse. If you stand up for yourself, he will either give up or explode. Either works to prove your point. And as long as you have witnesses to confirm that you acted professionally, you will be able to defend any claim he might make that you incited his behavior.

Personally, I prefer to get them in private and tell them to go to hell, but that's risky :) Good luck! You have a good head on your shoulders and are an asset to your unit.

nutella, MSN, RN · Oct 22, 2016

Don't get caught in the middle.

I worked cardiovascular surgery CCU years ago and it even back at that time there were some conflicts between surgeons and anesthesiology. I also worked as a nurse in anesthesiology and there was a lot of tension between surgeons and anesthesiology. The reasons are competing interests, competing egos and unclear responsibilities.

It is relevant to find out who is actually in charge of post operative management. That can vary and depends on the hospital. Most cardiovascular CCU I worked at were managed by surgery and their mid-level providers. But once in a while there is a unit that is managed by anesthesiology or intensivists and their mid-level providers.

Surgeons and anesthesiologists do not always agree on an approach, which is why it is important to understand who is actually the one giving orders. But there is also the responsibility of the primary nurse to question orders that seem questionable, which is part of the culture of safety.

Of course a CO2 of almost 60 is not great after surgery and should result in some assessment and investigation of what is going on especially if that patient is young and does not have a history of COPD.

As you know, depending on how the patient is doing, narcotics can further impair breathing and lead to a re-intubation. Sometimes patients seem ok and ready to extubate but after have some problems. Of course most procedures in the thoracic area is painful and requires pain medication. Back in the days when we did not extubate cardiac and/or lung surgery patients until next morning after surgery we did not have a lot of re-intubations in routine cases.

Surgeons are very concerned about their success rate and outcomes.

However, there is a standard of behavior and it is expected that surgeons, like other physicians, adhere to it. That includes not to yell, intimidate, harass, or otherwise display threatening or violent behavior. It is not acceptable to insult people, throw stuff and so on and forth.

Since you have noticed he seems to target you it is probably best to bring it to your manager's attention and HR. If your hospital is pro culture of safety and does not accept this kind of behavior they will address it. But sometimes hospitals are more pro- MD and not much happens to the physician but the nurse gets written up for something. You know your hospital and have an idea how they handle those things.

In the meantime protect yourself :

- make sure you are not alone with that MD. If you happen to find yourself alone in one room and he wants to talk to you tell him that you feel uncomfortable and will talk to him in the presence of a third person.

- make sure to document timely and all relevant things plus who you notified and when.

- if there is a question about patient safety make sure to alert the charge nurse/supervisor (whatever applies) to get backup.

- Stuff like you just mention - write it down and keep that notepad somewhere in case months from now there is another issue or you want to bring it up to HR.

- Make sure you understand and know all relevant policies and procedures.

- If he approaches you in an aggressive manner make sure you have witnesses and tell him in a calm manner to stop yelling/insulting whatever applies as it is not appropriate.

- start looking around for jobs just in case it gets too crazy and you want to find a different place - you never know.

Years ago I was targeted by a mid-level provider who gave me a hard time with everything. I complained about her because it was more like harassment. Go figure - she had complained about me and she was friends with the nurse manager (which I did not know until that point). On the same floor a physician yelled at me for sitting at a computer that he felt was "reserved for him" - I complained about him because he yelled for an extended period of time and refused to apologize. The nurse manager also did not feel the need to address this yelling (perhaps they were also friends - who knows). So I did not talk to him for the remainder of my years at that place.

Don't get caught in the middle....

blondy2061h, MSN, RN · Oct 22, 2016

I would make sure you're documenting everything clearly: "Notified Dr. Jerk of CO2 result, requested anesthesiology be notified. Anesthesiologist paged. See new order from Dr. Sleepy."

TriciaJ, RN · Oct 22, 2016

I was taking care of a post op VAT pt and called him(Cardiothoracic surgeon) to report abnormal ABGs(pCO2 of 57) Instead of giving me an order for Bipap or pain meds he told me to call Anesthesia. The anesthesiologist then gave me an order for pain meds. The surgeon went through the roof and yelled at me saying the patient would end up re-intubated due to my stupid mistake(giving pain meds). He then called my nurse manager at home to tell her I was incompetent and should not be caring for post-op surgical patients if I didn't know any better. The anesthesiologist backed me and said the patient was a healthy 33 year old that just need to breath deeper but wouldn't do so because of the pain and so he decided to treat the pain. The surgeon thought bipap was the way to go. The patient did end up on bipap within minutes but would not have tolerated the bipap without pain meds. The surgeon then commented to my boss that he had a beef with anesthesia and was trying to make a point to them by having me call them but he was mad that their first step was pain meds then bipap when what he wanted was bipap. My thoughts are that if he has an issue with anesthesia, he should follow the proper channels to resolve it rather than use me as a pawn in his game and then blame me when anesthesia doesn't do what he wants. This was the beginning. We've had three run ins over the past two weeks since this. It feels like he's gunning for me and several coworkers, even another dr has noticed and told me to write him up and stand my ground.

There's a start: start documenting every incident of inappropriate behaviour. He has a beef with anesthesia and finds a way to draw you into it. He told you to call anesthesia; you called anesthesia. They ordered pain med, you gave pain med. The pt improved. If he thought the pt needed a bipap, he should have ordered that when you called him. Clear case of pt care being thrown under the bus so he can feel superior to others.

If you have a union, it would be a good idea to get them on board. Once you have documented a few examples, they should be shared with your state medical board. If the powers that be in your hospital are already aware of his behaviour, what are they doing about it?

Mississippideer · Oct 22, 2016

There's a start: start documenting every incident of inappropriate behaviour. He has a beef with anesthesia and finds a way to draw you into it. He told you to call anesthesia; you called anesthesia. They ordered pain med, you gave pain med. The pt improved. If he thought the pt needed a bipap, he should have ordered that when you called him. Clear case of pt care being thrown under the bus so he can feel superior to others.
If you have a union, it would be a good idea to get them on board. Once you have documented a few examples, they should be shared with your state medical board. If the powers that be in your hospital are already aware of his behaviour, what are they doing about it?

I've heard that he tends to target anyone who will allow him to do so. I'm the most recent hire and a new nurse so he's marked me with a double bullseye. I heard that his entire CVOR team wrote him up after one of his temper tantrums but haven't heard what the end result was and haven't asked because I try to stay away from the gossip circles. I'm just unsure if I should confront him with my nurse manager as a witness or ignore his behavior and just remain cool, calm, respectful and professional in hopes that he will get bored with the game if he thinks he can't rattle my cage? I'm hoping to hear how others have handled this and what worked as well as what didn't work or made the situation worse

kakamegamama · Oct 22, 2016

[COLOR=#000000]OP--this is a good thing to put into words, to him. If your manager is supportive of YOU, you might consider pulling her in as a witness. "My thoughts are that if he has an issue with anesthesia, he should follow the proper channels to resolve it rather than use me as a pawn in his game and then blame me when anesthesia doesn't do what he wants." Tell him the above----rather than allowing him to use you as his pawn. Sometimes, you have to fight fire with fire. Be professional, factual, without letting him get to you.

Good luck![/COLOR]

Buyer beware, BSN · Oct 22, 2016

I would make sure you're documenting everything clearly: "Notified Dr. Jerk of CO2 result, requested anesthesiology be notified. Anesthesiologist paged. See new order from Dr. Sleepy."

I remember the days when the cardiologists used to suck up to the cardiothoracic surgeons for business. Today it's the other way around. With interventional cardiology the innate nastiness of many cardiologists has superseded the the off-the-wall heart surgeon's natural inclination towards nastiness and violence.

It is a laugh, and I do so in a mocking way, how the heart miscreants troll the cath labs sucking up to the cardiologist subspecialty who only years before they considered not their equal.

It truly is the world turned upside down. But for the most part, not entirely, a surly bunch if there ever was one.