It still bothers me.

FunkyCat · May 30, 2011

I don't think you did anything wrong, you were honest about both outcomes and encouraged the family to be optimistic whilst being realistic.

Have you thought about talking to the Dr? Perhaps the Dr was having a bad day but that doesn't excuse the way she treated you and undermined you in front of a patients relative. Maybe if you talk through the situation with the Dr you could understand where they were coming from and would be better able to work with them again?

Trauma Columnist · May 30, 2011

How frustrating.

Can I ask what your role in the pts care is? I'm gathering you aren't a nurse?

The only reason I'm asking is that might help us to decide what advice to give.

chicookie, BSN, RN · May 30, 2011

How frustrating.
Can I ask what your role in the pts care is? I'm gathering you aren't a nurse?
The only reason I'm asking is that might help us to decide what advice to give.

I'm an RN. I work for a bloodless medicine and surgery program. What I do is be an advocate for patients that refuse blood. I was called when she was transferred over because at the other facility, they didn't want to treat her because of that. I also tell the nurses and doctors what the patient can and can not take. Because I had the time or when I see my fellow nurses in trouble or need help, I usually will step in talk to the patient, educate the patient, be person they can talk to. I do alot of hand holding in my job.

chicookie, BSN, RN · May 30, 2011

I don't think you did anything wrong, you were honest about both outcomes and encouraged the family to be optimistic whilst being realistic.
Have you thought about talking to the Dr? Perhaps the Dr was having a bad day but that doesn't excuse the way she treated you and undermined you in front of a patients relative. Maybe if you talk through the situation with the Dr you could understand where they were coming from and would be better able to work with them again?

That is what I thought. I just want some insight to make sure I was doing the right thing.

I have tried talking to the doctor but she won't even look at me. I've said hi to her and tried to be friendly to her. The only actual communication I have had with her is through notes I have left in the charts asking to see if certain alternatives are applicable to certain patients. She won't even respond to them, she will usually just order or not. Or call my coworker for more information. *shrugs*

Trauma Columnist · May 30, 2011

Got it now.

I have an MD who I work with frequently and we don't have the best relationship either.

From what you are telling us, you did the right thing.

What I do to deal with my particular doc is:

1. I email/electronically attach any info I need to share with him. This covers me (I'm the APN) and also gives him time to answer me without a knee jerk reaction.

2. That said, I try to find out from the pts what Dr X had told them so that I don't inadvertently say something that doesn't agree with what the doc has told them. I try to reinforce what the MD says but add any info I feel the pt/family needs.

3. I do not engage this doctor unless its official and documented. No need to be friendly. We are co-workers, not pals. That said, if he's in a good mood and says hello or otherwise engages me, I'm very polite and agreeable.

4. Did I say I document every encounter in the pt chart? Again, always CYA.

chicookie, BSN, RN · May 30, 2011

Got it now.
I have an MD who I work with frequently and we don't have the best relationship either.
From what you are telling us, you did the right thing.
What I do to deal with my particular doc is:
1. I email/electronically attach any info I need to share with him. This covers me (I'm the APN) and also gives him time to answer me without a knee jerk reaction.
2. That said, I try to find out from the pts what Dr X had told them so that I don't inadvertently say something that doesn't agree with what the doc has told them. I try to reinforce what the MD says but add any info I feel the pt/family needs.
3. I do not engage this doctor unless its official and documented. No need to be friendly. We are co-workers, not pals. That said, if he's in a good mood and says hello or otherwise engages me, I'm very polite and agreeable.
4. Did I say I document every encounter in the pt chart? Again, always CYA.

Very good tips, some which I actually do. I'm friendly to her as in saying good morning/afternoon and not hitting her with a chart like a want to.

My main concern was/is she was right and that I gave the patients' family false hope. I don't know why but that part is what really really bothered me. I thought I was being realistic without being pessimistic. So now when a situation pops up, I don't want to say the wrong thing. I would hate to be doing that to a family.

Katie5 · May 30, 2011

. I will keep checking up on you as well. The daughter thanks me, and I am about to leave feeling good that I at least managed to calm her down. . :)

Hubris.

It bothers you because somewhere at the back of your mind, there is a nagging doubt that perhaps you could have handled the situation much differently.

The doctor was probably not having a bad day- she was perhaps piqued that you did not defer toher.

PS_ It bothers me when you use past and present and present participle tenses all in the same narration.

chicookie, BSN, RN · May 30, 2011

Hubris.
It bothers you because somewhere at the back of your mind, there is a nagging doubt that perhaps you could have handled the situation much differently.
The doctor was probably not having a bad day- she was perhaps piqued that you did not defer toher.
PS_ It bothers me when you use past and present and present participle tenses all in the same narration.

You are 100% correct. I keep playing it over in my mind to see if I should have done something different. I just can't think of anything.

Sorry about that. It was my biggest flaw in English class.

Whispera, MSN, RN · May 30, 2011

From what you wrote, it doesn't seem you said anything wrong to the patient's family member. It seems your words were calming and gave her hope. That's good! There is always hope, and helping someone recognize that can have a positive effect. If you have no hope and feel certain things will go one way, I don't think there's much of a chance they can go the other way. Maybe positive attitude had a big influence on the patient getting better. Maybe without some positive attitude coming from her family, the patient wouldn't have had as good a chance.

Maybe the doctor didn't hear everything you said and just caught the encouragement but not the other side. That doesn't excuse her from giving you a hard time, especially in front of the patient's family or other staff members.

Since it seems both of you are dancing around the proverbial "elephant in the living room," I'd vote trying to talk to the doctor about it, to work through it. While you surely don't have to have a friendship, it would be nice to be able to feel like team-mates rather than separate entities, wouldn't it? Would talking to her make it worse? I think it has a better chance of making things better.

chicookie, BSN, RN · May 30, 2011

From what you wrote, it doesn't seem you said anything wrong to the patient's family member. It seems your words were calming and gave her hope. That's good! There is always hope, and helping someone recognize that can have a positive effect. If you have no hope and feel certain things will go one way, I don't think there's much of a chance they can go the other way. Maybe positive attitude had a big influence on the patient getting better. Maybe without some positive attitude coming from her family, the patient wouldn't have had as good a chance.
Maybe the doctor didn't hear everything you said and just caught the encouragement but not the other side. That doesn't excuse her from giving you a hard time, especially in front of the patient's family or other staff members.
Since it seems both of you are dancing around the proverbial "elephant in the living room," I'd vote trying to talk to the doctor about it, to work through it. While you surely don't have to have a friendship, it would be nice to be able to feel like team-mates rather than separate entities, wouldn't it? Would talking to her make it worse? I think it has a better chance of making things better.

Thank you. Your kind words make me feel better. I think I wouldn't have felt as bad if someone would have at least told me you did the right thing or maybe next time word it like this so there is no misunderstanding. At the time, everyone that I vented to sided with the doctor and kept stressing how "good" this doctor is.

MassED, BSN, RN · May 30, 2011

I don't know why but it still does. I still feel like I did nothing wrong and it still makes me super mad. This happened about 2 months ago.(*warning* long post/ story ahead)
We had a patient transferred from another hospital because they didn't want to treat her due to her refusal of blood products. She has sepsis, is on the vent and is going into multi-organ system failure. I talk to the patients nurse and she tells me its been really hard to tell the family members anything, the daughter of the patient is very distressed. So I go in there and I start talking to the daughter who is hysterically crying. I tell her that we will do what we can here, she sounded a bit mistrusting of the doctors and nurses especially with what happened at the other hospital so I told her (which was the truth) that she had the very best doctors this hospital has to offer and the nurses here are great, I honestly couldn't pick a better team. Then I said your mom is in critical condition, but I think we should be as optimistic as we can be and take it one day at a time but at the same time be ready for worst. I didn't say she is going to make it or she is going to die. I don't think I gave her any false hope at all. By then she has calmed down and was actually listening to the nurses. (I was in there for almost an hour and a half)
So I decide ok enough, I can leave now. We step outside as the nurse need to do stuff in the room and asked us to leave for a bit. I hugged the daughter and told her Remember baby steps, Ok? I am very optimistic of the care she is going to receive. I am sure that the doctors and nurses here will do everything they can for her. I will keep checking up on you as well. The daughter thanks me, and I am about to leave feeling good that I at least managed to calm her down. One of the doctors is sitting at the nurses station, stops me and says in a very angry reprimanding tone: You just set us up for failure. What you did guaranteed that the patient will not make it. She is in a very critical condition and she is going to die. The family will suffer more because of you.
The patients daughter is not even 3ft away from us, heard her clearly and starts to cry. I feel myself turn red, and I snapped and said: if I did something to offend you first off I'm sorry but next time you have something to say to me you make sure that the family members aren't right behind you. The doc turned around to see the daughter crying again and looks at me and says she didn't hear me. Refuses to look at me again. I go hug the daughter take her to the waiting room and calm her down again. I'm still super mad, so I tell my boss what happened in case this doctor says something. My coworker is good friends with this doctor and tells me oh well she was just having a bad day, she really is super nice. I told my coworker that is no excuse. You don't talk to me that way and second you don't reprimand ANYBODY in front of a patient or their family members. I've talked to a nurse and my parents about it because I was so upset, and everyone defends the doctor. My coworker says she called him but I am pretty sure he called her and he told me that yeah she was having a bad day, and that she was SURE the daughter didn't hear her. Also that she was going to call me to apologize. Surprise surprise she never called me and when I see her around she pretends I don't exist.
Fastforward 3 weeks: the patient walks out of the hospital. Goes home and is doing well. -____- She looks good dead.
I don't think I did anything wrong. I feel like I did though. Did I give the patients' family false hope? I don't think I did and I am sure I didn't set anyone up for failure. I just said that she was going to get the best care possible here. I even told the daughter to prepare for the worst. Should I have said something different? I had to deal with a similar situation recently and I found myself at a loss of what to say.
That concerns me more than that stuffy doctor. She can shove it. I just hate that she made me feel so unsure of myself. Any insight would be helpful. Even if its the doctor-was-right but as another warning those will make me . Thanks. :)

YOU did the right thing and actually took the time for the daughter. EVEN if it was false hope (it was not, it was a balance), it was hope, and you supported her in her moment of need. Nevermind the nincompoop doctor, she will learn from YOU, whether or not she ever talks to you again. The point of this event to the doctor is that you never know. Medicine is never a guarantee or health or death.

Don't feel bad. You know you did the right thing, you seem to be upset over it because that doctor was caught saying something within earshot of the family. That was her mistake, not yours, so don't let her take that out on you. Believe in yourself and your ability to do your job. You have evaluated your approach and what you did and how you can improve upon your performance in each situation, and you are the only one that knows what you need to do for your job. Great job and keep doing what you do, because you sound like a great, caring, knowledgable nurse.