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?

[maelstrom143]

I would have addressed the issue about the safety hazards they created, more so than the mess, but definitely addressing them in private as one would like to be if in the same position. Had the patient attempted to leave the bed or rolled sideways and fallen off and to the floor, he/she could have been seriously injured. As to the mess, yes, not cool, but they do it all the time and some of them feel entitled to do it. I usually attempt to place garbage cans at bedside as a reminder, mentioning to them in passing that I have placed the containers within reach for their convenience, and pick up afterward if needed.

[BlueDevil,DNP, DNP, RN]

I agree with the suggestion to show them where the supplies are and leave it at that. If they leave a mess, I'd go find them and say "hey guys, you forgot to clean up after yourselves in 104." If they still don't do it, you let the attending know.

[PMFB-RN, RN]

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

*** I have done so a number of times and will do so again if I need to. I don't do it lightly but I WILL protect my patient. Just a little while ago I called a halt when an intern picked up a needle off the non sterile bedside table where it had been dropped and prepared to insert it into my patient's basilic vein.

It's easy. Just tell them to stop and explain why you told them to stop. If they don't then in my experience attending surgeons very much appreciate being informed when their intern or resident is attempting to harm a patient. Obviously calm and professional communication should be used at all times.

[KelRN215, BSN, RN]

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

It is your JOB to get them to halt any procedure if they are not following the proper protocol. I have had to stop doctors from pulling drains, stitching, doing shunt taps, doing LPs, etc. in the past due to inadequate medication, parents not being present, lack of consent, etc. Actually, when I was a student, I remember a nurse in the MICU stopping 2 interns from placing a central line because they didn't have consent. They then wanted to leave the open tray in the room until they got consent because "it was sterile". I have gone above residents' heads and pulled in my Clinical Nurse Specialist or called the Attending when they'd already tried for an LP multiple times without success. I have refused residents' orders for sedation because they weren't sedation credentialed providers. I've done it before and I'd do it again if I were still working in that environment. For procedures done on the floor, the nurses were always the safety enforcers... do you think residents would ever do a "time out" before a procedure if we weren't in the room?

[sauconyrunner]

You say you aren't bitter, and I am sure you don't think you are, but you come across as bitter and frustrated. If you come across that way just writing, you probably come across similarly in real life.

I have halted many many procedures at many "Big Name" medical centers. I'm there for the patient, not for a physicians ego.

If you do not halt procedures when devices are contaminated, etc, you are taking part in harming a patient, and that is not acceptable.

To me, I think you could seek employment elsewhere, asking many many questions regarding how physicians and nurses work together. the other option would be to try to bring in a cusp project: Using a Comprehensive Unit-based Safety Program to Prevent Healthcare-Associated Infections

They have had excellent success at Johns Hopkins and other places...

[JZ_RN]

I would have said, the supply room is over there, and make sure to clean up after yourself and lower the patient to safety.

I've flat out told doctors, I'm no slave or servant. I am there to help but I am educated and skilled and won't be treated like a maid, and I demand the same respect I give to them.

With our new doctors I usually discuss issues privately. But if someone is nasty to me at the nurse's station I'll let them have it right there. Luckily that only happened once, and I've never had anything as ridiculous as this happen.

[Esme12, ASN, BSN, RN]

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 Harvard 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.

Welcome to AN! The largest online nursing community!

It depends on where you work. Before I moved to New England.....I would have taken them to a back room and notified their attending. The first time I would have shown them where the supplied were. The second time I'd call the attending. When they are travelling in packs, they can look after themselves. If they left the room a disaster they attending himself would call them back to the room to clean it as it was....it was apart of policy that they dispose of their own mess to decrease exposure risk to the nurses.

NOW....I moved to New England and the attitude was different. The good ole boy club is alive and well. The nurse is to be seen and not really heard. I remember at one facility It was expected to follow the attending on rounds with the pack of residents, interns and fellows firs thing in the morning.....bring the chart and have everything ready for the "Team" labs, x-rays, vitals, I/O totals. "The Attending" at one pint said ....."any ideas?" I committed the unforgivable act of speaking. "The Attending" ever so slowly turned his head as there was an audible gasp in the room as he spoke....."You must be new....." as he looked at me like I was a bug on the windshield. I looked at him and said.....obviously it wasn't "my accent that has you dismayed" but after working all night long if my only purpose on the "team" and hour past quitting time is to carry the chart....I need to find another job.

I went to the manager and resigned. Funny this was a surgical critical care unit.

What I have learned here in New England.....I would have approached them by leading them to the supplies closet so they can help themselves. I would have taken the resident aside and told him that they trashed the room that I spend a ton of time keeping my patients and rooms clean and I have a ton of stuff to do other than cleaning you after them. However, if it is the culture there than this is the norm....you might need to find another position or ignore it for fighting the system...rarely works.

I wish you the best.

[mariebailey, MSN, RN]

This post brings a great quote from a very wise man to mind: "Sometimes I think you have to march right in and demand your rights, even if you don't know who you're talking to, or what you're talking about. Then, slam the door on the way out." ~Jack Handey

[Been there,done that, ASN, RN]

Although it takes time from your already overloaded schedule, your patient is having a bedside procedure being performed.

Your patient needs a nurse during this time. You need to assist, stay at the bedside , observe and comfort the patient.

Run for supplies, use this as a teachable moment for the physicians.

Of course, you don't WANT to clean up the mess. However, stating at the desk"you are not their maid" is inflammatory and counter productive to any future teamwork.

If you were to have stayed at the bedside during the procedure( I surely would appreciate my nurse during something as invasive as a central line placement)... a simple.. good job docs.. I must dash to take care of the rest of my peeps, don't forget to clean up..

would have worked wonders.

Live.. and .. learn.

[Creamsoda, ASN, RN]

Yeah I think a simple " uh residents, next time when your finished can you please clear you sharps and leave the room/patient as you found it?". Also help set them up for sucess, help them gather the supplies, as theyre setting up, place the trash can next to them ect. Theyre learning and the last thing they need is that nasty RN going off on them on her high horse because thats what it sounds like to me. You want to have a good relationship with them now and in the future. Or even a joking " when did the hurricane hit Mr X's room" might drop the hint.

[cbsncmom]

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.

My parents were unavailable to me when I was 16. I had to drop out of school to take care of my little sisters. I went and got my GED, and made sure my sisters finished high school AND went to college. I am just now starting college at 41 years old, and pursuing my dream of being a nurse. I did the best I could with the cards I was dealt. Just because someone has a GED does not mean they are uneducated.