Is it ever ok to stand up to a doctor?

[Giveyourall]

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?

[Giveyourall]

There is no mentor I feel like I can speak to about this manner. The nurses that have been there for 15 yrs or more will promise the doctors that they will basically do their job just to avoid conflict then pass it off to the next nurse.

[Giveyourall]

Actually the CNAs do say that whether you are on your floor or floating. There may be 1 or 2 that you can actually see on the floor every hour on their shift. They come in, take their vitals, change one or two patients, hide until lunch then they resurface to do their I&O at the end of the shift. At the end of the day I guess I felt like for 6 years I've been polite only to be disrespected everyday by someone new. I guess I have to learn to bite my tongue and pass the buck like the rest of my coworkers until I retire.

[KelRN215, BSN, RN]

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.

You're not allowed to draw blood cultures where you work? Are you kidding? I drew blood cultures every day of my life when I worked in the hospital.

Actually, I believe it... facilities have stupid rules about certain things. At my old hospital, there were certain meds that had to be reconstituted by "pharmacy". You can bet your life that it was some tech with a GED who was actually doing the reconstituting but it was somehow too complicated for nursing to do.

[tokebi]

At the end of the day I guess I felt like for 6 years I've been polite only to be disrespected everyday by someone new. I guess I have to learn to bite my tongue and pass the buck like the rest of my coworkers until I retire.

Is this the true issue?

Step back and analyze yourself a little bit. Do you think maybe things were building up inside you and the doctors were the last straw? Emotional confrontation is never a good idea, and definitely not the way to earn respect.

What you need is learning to be assertive without being rude, and to take care of your anger and bitterness.

[Giveyourall]

Yes we have silly policies but of course you know we have to adhere to them or we lose our job. Yes the pharmacy issue baffles me also. At the end of the day I will do what's in my scope of care to avoid losing my job, license and being stuck with over 40,000 in student loans.

[Giveyourall]

I am neither an angry nor bitter person. I think if you had one day in my shoes you would be surprised. These doctors were the last straw but not because I was trying to project from another situation but they are the same people performing different errors along with many others (mostly doctors). Every nurse tells them to clean up after themselves but at the end of the day they say oh that will be done by the nurse or the CNA leave it there. Your opinion of analyzing myself sounds great for a forum but when you're working on a floor with doctors that see the patients as a learning experiences and the nurses as maids that should do as they say whether it is ethically correct you would react differently.

[PMFB-RN, RN]

Wow, you allowed interns and residents to teach other to insert certal lines on your patient and didn't feel the need to be in the room with your patient? I would not allow such a thing on one of my patients. I am my patient's advocate and protector. More than once I have called halt to some procedure being preformed by an intern or resident while I paged the attending to come and sort out their baby doc.

Not only is it OK to stand up to physicians, its our responsibiliety to do so in the name of protecting our patients, ourselves or our coworkers.

Yes you should have stood up to the docs by insisting on being there for your patient. Baby docs like that very often forget things like sterile procedure, hand washing, pain or sedation meds, or to properly explain the procedure to the patient. It's our job to observe and remind them if such things are missed or forgotten.

Your actions seem much more about you being inconvenienced than about being your patient's advocate.

[tokebi]

If their behavior is consistently dangerous to patients and disrespectful towards nurses, then they must be made aware of that and suggested of better way to do things. Exploding in their face only aggravates the problem. Some hospitals have councils or committees with specific purpose of improving nurse-physician working relationship. Is there anything like that or person at your work? If there is no way to improve situation and you feel like you have to bite your tongue forever, then obviously this place is not good for you. Not all hospitals are like that.

[Giveyourall]

The only 'council' we have is our Managers and Supervisors but they are more worried about having a big platter for breakfast for the doctors. I think because most of the doctors have Havard under their belt we are only allowed to say yes. I think I need to discover another floor maybe Medical offers more than a Surgical unit.

[Giveyourall]

Ha...good luck calling a halt to any procedure.

[Meriwhen, ASN, BSN, MSN, RN]

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?

I can't speak for how the OP would have felt. I know if it had happened to me, I'd probably feel that this person was being very rude and was out to embarrass me (whether they meant to or not). And if this had happened to a student nurse or new grad, I can hear the cries of, "nurses eating their young!" firing up.

OP: you were right in theory but wrong in your approach. Yes, they were not concerned with the patient's safety. Yes, you were right to address the matter. But no, in front of everyone at the nurses' station was not the time or place to deal with it. In a private area would have been better.

But live and learn. I'll be the first to admit I'm no saint: I put my foot in my mouth more than enough times or not handled things the best that I could have (and have attracted my share of MD ire), so I do sympathize with you. I just keep learning (trying to, anyway) from my mistakes.

I know doctors frequently act like this. Does that excuse them? No. Unfortunately the powers that be let them get away with this behavior, where they are quick to penalize nurses. But that doesn't mean it's still an OK behavior for anyone to do.

[caroladybelle, BSN, RN]

It is perfectly okay to stand up to an MD, when appropriate and indicated.

It is never okay to be an unnecessarily rude person.

So there were issues on both sides.

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The interns erred in: not speaking to you about an essential part of caring for your assigned pt, not being prepared for the procedure and for leaving the room dirty.

You erred: in being rude and inhospitable.

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Let us take the MD and the nurse out of the equation for a minute. Staff member A walks into room to do a procedure on someone Staff member B has responsibility for, and doesn't bother to discuss this with Staff member B. Rude as wll as inadvisable. Staff member A collects items to do procedure, on a unit that they are unfamiliar and does not prep adequately. A common error of newbies and one in which if they had initially talked to staff member B, they could have received advice regarding necessary material. Staff member B finds themselves lacking, at a time when sterile procedure is needed, and asks for help, and wonders why it is rude. then leaves area a mess.

Yes, you are right to be upset, but need to temper that with tact.

I will lay odds that most of us will be floated, travelers, or in an area unfamiliar when working as a nurse. We often meet with snottiness and annoyance from regular staff in that area when we cannot find the usual supplies without help, do not know "their" important protocols and givens, and go iinto "their" procedures with the appropriate measures taken an what they consider expected supplies. Thus we often avoid them, trying to stay out of trouble, but often finding ourselves in need of assistance, only to meet even more derision.

It is early September. Many interns have been in the hospital maybe two monthes - they probably barely know the computer/charting systems, where buildings are, are getting started with new procedures, and often scared....much like new nurses. And if residents, they have moved into their new positions and responsibilities within the last two monthes. But unlike nurses, they often have greater pt counts, have to work 80 hrs a week, often be on for 30 hrs straight, and every 10 days/two weeks move to entirely new dept with all new rules, protocols, people, attendings, and "givens".

Next time, introduce yourself, ask if they know where supplies are, and suggest items that may be needed beyond what they have (newbies always get one set of basic stuff and neglect dressing, extra gloves, gauze, claves, etc that they invariably need - much like new nurses). Show them where supplies are, and make sure to place some disposable chux, telling them that they are for collecting the used non sharps that they will need to dispose of, as well as to keep the bed clean. Show them where they need to dispose of sharps.

The more rudeness that they encounter, the more reluctant that they are to interact with nurses when they really need to, and the more headaches you will encounter dealing with them. A vicious self perpetuating cycle.

You are also teaching them how to behave with nurses in the future. And if their encounters are unpleasant, that will carry over to when they have actual power in a hospital.

One question. Does your facility not require a nonMD staffer to witness consents or do time outs for procedures, or to monitor the sterile field as an unbiased observer? Many teaching hospitals do.