Is it ever ok to stand up to a doctor?

Asystole RN · Sep 8, 2012

Personally I would have shown them where the supplies were, not retrieved them, something about fishing and feeding comes to mind. Upon reprimanding them, you were in the right to demand that they respect your patient's room and leave it as they found it but you cannot do that in front of everyone at the nurses station, it is extremely disrespectful of anyone to do that. You would not like it if it was done to you, do not do it to others. Talk to them in private, professionally, and all would be good.

llg, PhD, RN · Sep 8, 2012

I agree Asystole RN. If doctors made a big scene at the nurses' station like that, the nurses would accuse them of "bullying" and "abuse." You had a good reason to be upset, but you need to learn how to handle such situations diplomatically -- without adding to the problem relationships by behaving badly yourself. As the old saying goes, "2 wrongs don't make a right."

I suggest you find a mentor -- senior staff member, educator, manager, etc. and discuss other ways you could have handled this situation.

Art_Vandelay · Sep 8, 2012

I agree with the previous posters, although I would have probably grabbed the supplies for them once, and then the second time shown them where they were. I would just like to add that it is definitely OK to "stand up" to doctors (or anyone for that matter) that demonstrates *****ish behavior, but as previously stated you have to go about it the right way.

hiddencatRN, BSN, RN · Sep 8, 2012

Of course it's fine to "stand up" to doctors and to advocate for patients. But from what you describe, it sounds like you went from 0 to nasty in no time at all.

meanmaryjean, DNP, RN · Sep 8, 2012

I would say imagine yourself being spoken to in the tone of voice you used when YOU were a just-learning-to-do-things student. How would you have felt?

If you have opportunity, approach them again, and explain the safety issues with leaving the patient in the condition they did, and offer to help them gather supplies next time so they are sure to have everything they need. You will do much toward getting their cooperation next time if you offer to teach, rather then chastise and embarrass.

kakamegamama · Sep 8, 2012

Yeah, giving them a piece of your mind in front of everyone wasn't cool. Being concerned for your patient's safety was definitely okay. Yes, they should have cleaned up after themselves. Professionalism means that sometimes we have to hold our tongues, or at least cool down, then approach the ones who are at fault, calmly talking about what happened, etc. I remember once when I taught at a huge public facility in the OB area. One day one of the students borrowed a chart & the chief resident threw a fit when he couldn't find it (she had been given permission to use the chart, just to be sure to not stray far, which was what she did--she was standing near the chart rack when he went balistic). Poor student was in tears and I was called to the unit from the OTHER unit I was on with students. After I was told what happened I was quite irate with the resident (Mama Bear instinct--NO ONE messes with my students!). Anyway, I located him in the group of junior residents and interns and requested to speak with him before he left the floor. (That pause in time gave me a chance to cool down.). When we met, we went to the break room, unoccupied by others, and I explained to him how unprofessional he was in front of the docs as well as to my student, etc. He then began to berate me that his mother & wife were nurses and they would NEVER talk to a doctor like that. We didn't reach a compromise that day, but I did stand my ground on working together in a nice way, and the next time we met, he was actually cordial. Never apologized, but I wasn't in search of an apology--I just wanted him to know that messing with students was not cool.

Ruby Vee, BSN · Sep 8, 2012

A team of doctors walked into my patient's room and closed the door. Me being the good nurse that I am I asked what they were doing. Of course they were 2 interns and 2 residents teaching each other how to put in a central line. The problem wasn't the fact that they never told me what they were going to do but one of the interns kept walking out of the room to ask me for supplies. I obliged once, twice but the third time I said, 'no, I'm busy gather your supplies before going into the room'. She gave me a look like I was speaking in a different language so I walked away. Was that rude? (I don't think so) Finally, they left the room looking like a thunderstorm hit, 4x4 everywhere, wrappers everywhere, the central line kit in the bed, patient bed at the highest level and the side rails down. I was livid walked over to the nursing station and told all of them to clean up their mess and that I was not their maid. Later I was reprimanded for being rude. What should I have done differently?

Yes, it's OK to stand up to a doctor. But you should do it politely. If you can manage it, do it with humor. I would have wanted to know what four doctors were doing in my patient's room with the door closed, and would probably have asked one of them. When they said they were putting in a central line, I would have asked them if they had everything they needed. Our regular providers can get into our Pyxis system to gather their own supplies, so I probably would have said something like "OK, the central line kits are in the third tower on the left, about waist high" or something to that effect. And when they came out to ask for supplies, I would simply have directed them to where the supplies were located.

Getting angry and telling people off for leaving you with a mess to clean up is understandable, but it would have been more effective to have simply reminded them nicely that they had a mess to clean up.

SHGR, MSN, RN, CNS · Sep 8, 2012

They left a mess, what else is new, no big deal. Leaving a patient in an unsafe situation is a different matter entirely and they do need to be taught that. If the patient had fallen, they likely would have blamed "the nurse" for not preventing the fall, correct?

Also, sure they should have gathered all necessary supplies before even starting- that is common sense, good practice, and it was on every nursing skills test we took in school. Right along with "wash your hands." A gentle (even jokey/collegial) reminder that this is just good practice (hello, sterile gloves and field) - as you walked with them to the store room to show them where the supplies were kept- would have sufficed and may have helped you develop good working relationship.

Short answer- yes it is ok to stand up to a doctor. Pick your battles!! Unsafe? Wrong med? You bet I will stand up to them. Your patients depend on that.

KelRN215, BSN, RN · Sep 8, 2012

It is both ok and necessary to stand up to doctors but it's not ok to be rude.

I ran into the situation many times where a doctor would come find me to say "I need xyz." If it was a regular resident, I would simply say "they're in the supply room on the left when you walk in" because those residents knew perfectly well where to get things. If it was a covering resident (depending on the services, we sometimes had residents rotate though for a few months at a time and sometimes just had them covering overnight for a few weeks), their ID badges usually didn't get them into the supply room so, if I wasn't busy, I'd just get the supplies for them.

Leaving the bed in the highest position and the side rails down was NOT ok and obviously a safety risk, but I'd bet that they didn't even realize they had done it. You could have pulled the doctors aside and said, "were you aware that you left the bed in the highest position with the side rails down?" Fall risk is something that nurses have at the forefront of their brain, but I doubt it's something that residents eager to place a central line are that worried about. A simple reminder "it's hospital policy to keep the bed in the lowest position and locked with at least 2 side rails up at all times to minimize the patient's risk for falls" would have probably done the trick.

The doctors not wanting to get their own supplies was probably them being lazy. I used to encounter this kind of stuff all the time when a doctor would come in the back room and yell out "Who's taking care of Suzy in Room 3B?" and we'd all just kind of look at each other and say "check the board". Inevitably, said doctor would return 4 seconds later and say "Where's Nancy?" and we'd all say "she has a phone number, it's next to her name on the board." If you enforce good behavior enough, it will eventually sink in.

I worked in a very large teaching facility where residents changed by the minute. The surgical service utilized "pre-residents" which were most often doctors trained in foreign countries who did not yet meet the qualifications to enter an official residency program. They overworked them and paid them close to nothing. Many of them came from countries where nurses were expected to just not question the doctors and women, especially, were not supposed to question men. It took a long time to train them that that attitude wasn't going to fly in the Northeast US. I did once have to speak to an Attending about a resident because he was refusing to order appropriate post-op pain medication for 2 patients. One was a patient who was less than 24 hrs post-op for a full VP Shunt replacement after removal of a calcified shunt who had required morphine, dilaudid and oxycodone overnight to keep her pain under control and he insisted that post-op shunts "never go home with anything but tylenol". This child lived far outside of the city and it was a weekend...there was no way I was going to discharge her and say "just take tylenol because I'm sure it doesn't really hurt to have your shunt just yanked out of your neck" and after several hours of requesting a script for oxy prior to discharge, I finally got one thrown at me after I went above his head and called the fellow. The other patient was a patient of the same surgeon who was 24 hrs post spinal surgery for tethered cord release. These kids tend to do really well on Toradol. For some unknown reason, this resident just refused to order Toradol saying "just give her the Valium and Oxycodone". After spending nearly 10 hrs arguing with him about it, I finally got the Toradol ordered at 6pm. I came in the next morning to find out that the child had required no additional PRN medications overnight and was doing fantastic on the Toradol. I spoke with the Attending about the situation and requested that he address it with his resident. After that, I had a much easier time getting this particular resident to order appropriate pain medication for post-op patients.

Another time I had a patient (2 month old with hydrocephalus whose EVD was clogged because of blood in her ventricles) who was exhibiting all the signs of increased ICP with a HR in the low 80s. The on-call resident (an adult resident) told me that it was "fine because she was asleep." Her baseline HR was something like 120 and she most definitely was NOT fine. Within an hour or two she went into status epilepticus and we were wheeling her crib directly into the OR.

You most definitely HAVE to stand up to doctors in certain situations, you just need to do it the right way.

sauconyrunner · Sep 9, 2012

You must MUST correct physicians. BUT, just as you would expect them to not dress you down at the nurses station for something, you shouldn't either.

What you said in quotes was actually very rude. Imagine, you are floating to a floor, and you need to put a foley in. You don't know where the foley stuff is, so you ask one of the CNA's to help you get it, and she responds "no I'm busy, get it yourself"

Lots of ways to handle this have been discussed. It is only September, so its seems you have some still new residents/interns. They don't know much.

I would have either discussed it with them in a polite way, "I'm sure Dr Smarty pants you didn't mean to leave that patient way high in the bed like that, and I'm sure you are going to clean up the room, since it looks like a tornado blew through!" If they still behave badly, I would bring it up with my manager and the attending if you have access to the attending/chief resident. They can not fix what they don't know about.

You, by creating a scene at the nurses station have lost all bargaining chips because you were actually rude. They were wrong, but probably did that out of ignorance, and greenness. You on the other hand, can't really claim that. And of course, they won't be able to either in a few more months.

Giveyourall · Sep 9, 2012

To everyone that said it was rude in hindsight maybe it was but there was only the doctors I spoke about and a clerk in the nursing station. I would have never have approached them in that manner if the nursing station had more people. This situation happened on a weekend. We were short staffed and overworked with no CNAs to help.The complaint came from the 3rd year resident that felt like I should never speak back to him...ever. I will take all of the advice given and try to approach them in a different manner but I find it impossible to speak to the doctors in NY. For instance I was approached by a doctor who wanted me to do a Culture for him and when I declined stating it was not in my scope of care he went off on me about the needle going into the same vein as a regular lab work. Although this is true that the needle will go in a vein the difference is Cultures are not in my scope of care. Later that night another nurse performed the task and told him to keep it secret. When I asked my Supervisor to speak to him about what our scope of care was to avoid conflict she suggested I help him through everything but putting the needle in the bottle. I feel like sometimes even being tactful will not help if there is no support from Managers and Supervisors.