Long term care medical director is a jerk!

[missourinurse2b, BSN, RN]

I am the DON of a small rural facility and the medical director has been there for several years. As a result,  he literally does whatever he wants and is very rude and downright disrespectful at times.  The biggest problem is that does not like to be called at home or on weekends...ever. about anything. Period.                                                                         One of the new nurses called him at 1:30 am to let him know she sent a resident out to the hospital for a laceration. The facility policy states physician must be notified immediately by phone if the resident is injured. Otherwise it can be the next morning. He told the nurse never to call for that, to just do it. Also he yelled at a nurse for calling him while he was at dinner and told her she was stupid to call him for " stuff that isn't that important " and that she ruined his dinner. He yelled at a night nurse and made her cry then called right back to yell at her some more.                                                                  I really don't know how to handle this other than take it to the administrator.  Any ideas on how to approach this matter? Apparently this has been going on for quite some time but I feel my nurses should be able to call if they need to without fear of being yelled at! Where is a good place to start? A meeting with him, the administrator and me perhaps? Thanks for any advice.

[egglady, LPN]

I as the nurse dealing with this would chart  " Dr. Ahole advised of laceration, per policy.  Dr. Ahole said " I don't care,  don't bother me at night".   No further orders received.  

[missourinurse2b, BSN, RN]

?

[egg122 NP, MSN, APRN]

Can you find a new medical director?

[CapeCodMermaid, RN]

I've run into a few docs like that-and NPs too. I just tell them I'm following policy, protecting my license, and suggest they protect theirs. Then I ask them to repeat what they said so I can accurately get the quote for my nurse's note.

[amoLucia]

On ‎11‎/‎2‎/‎2020 at 8:58 PM, egglady said:

I as the nurse dealing with this would chart  " Dr. Ahole advised of laceration, per policy.  Dr. Ahole said " I don't care,  don't bother me at night".   No further orders received.  

I have NEVER charted such negative comments by another provider. Although I may feel like it WAS warranted! I just don't think  2 wrongs  make it right to point out what a dipstick the person was.

I'd pass it on in verbal report. And I'd let higher uppers KNOW if it was really something offensive to be followed.

Think about it, what would that type of note really accomplish? As the staff nurse, I'd have charted as is without the bolded comment. Just me.

But as the DON, I know the Administrator needs to be apprised of the Med Dir's abusive behavior. If a negative pt outcome were to occur because of some nurse's reluctance/hesitancy to call MD, then big liability ensues. No one will want that.

 

[whatintheworld]

Put in quotes 

 

Can nurses just call the residents attending MD or on call doc who has an answering service 

[amoLucia]

Well .....  In LTC, you just call the attending (the ans serv). They call the on-call doc themselves. Ans services usually make the call right away - but the delay often comes with whichever doc is returning the call. I always asked who was on call - SOME practice partners HATED covering for the NHs. So after a while, you just knew who'd be calling right back or who'd call WHENEVER.

But a particularly disturbing problem arises if there's a no return call. Usually the facilities 'protocol can have the Medical Director be notified UP-THE-CHAIN if nec. I have done it when I couldn't reach an attending.

Now if the pt's prob is life-threatening, we'll always just 911 them out. No issue! But if the Attending is the on-call person AND the Medical Director, therein is the PROBLEM! Sadly, it does happen. It is freq in the facility's contract with the Med Dir to take that ultimate administrative on-call if nec.

[hibiscus6, BSN]

Sorry your facility is having to deal with that. Perhaps your administrator needs to consider firing him  for not fulfilling the terms of his contract (administrative on call) If you can find a replacement. 

[litbitblack, ASN, RN]

I see it as he gets paid for his position and it is his job. I have documented exactly what is said. They will cover their *** if *** hits the fan later on so you have to cover yours. I happen to now have an awesome medical director but have been yelled at for calling in the past. Even when I worked in the hospital and a doc told me not to call. I stated "Your on call and we have an order to notify of such and such. Good bye! " and hung up on him. I don't play. We are professionals and they don't need to act like they are above any one else.

[TheDudeWithTheBigDog, ADN, RN]

 

On 10/21/2020 at 12:23 AM, missourinurse2b said:

He yelled at a night nurse and made her cry then called right back to yell at her some more.                                                                 

I really don't know how to handle this other than take it to the administrator.  Any ideas on how to approach this matter?

First bring this whole issue up with the administrator.  Then, make sure your nurses know that if that ever happens again, that he calls back after the call is over and he gave instructions already just to yell at them again for calling him during dinner, have them put him on hold and just never pick back up.  If it's ever the first call when they have to notify him to get an order of how he wants it handled, tell them to just let him yell, and when he's done, just calmly ask him about any orders he wants to put in, acting like his little tantrum never happened.  If he doesn't give an actual order, put it in the note, that he was notified, and no new orders were given.  DO NOT put in any order that wasn't specifically ordered by him.  Then call the administrator, and complain about calling him with a patient care issue and he refused to address it.  The next time it happens after that, report him to the state for refusing care to his patient that he was responsible for.

[missourinurse2b, BSN, RN]

Thank you for your response and advice. The medical director has been a little more professional lately since we have a new administrator that will not tolerate his behavior or disrespect to nurses. He still isn't particularly cordial but I can deal with that.