Microaggression, Over Sensitive or Learning Opportunity

[LoveLifeTravel]

I have been a nurse for several years and have spent the last few years travel nursing. Needless to say, I have worked at many hospitals and they all have their good and bad but I have enjoyed every hospital. Recently, I took a permanent position at a top-rated medical facility in a Cardiac ICU. I took this job because of the learning opportunities available. I love learning new things, new procedures or new medications. Overall, I really like my new job, the unit, and I have made some amazing friends.

But I continue to have a recurring interaction with a variety of staff and it is starting to feel like the unit norm/culture. It usually starts when I identify an issue (runs of SVT, critical lab value, neuro status changes). I address the issue and the staff member becomes visibly tense and addresses my concern in a harsh and condescending tone - usually in a form of questions. It started with random preceptors and now has progressed to nurses at change of shift, advance providers and physicians.

For example, I had a patient who had a central line that we were not using and he had other IV access. I asked the PA if we could remove the line as I was concerned for infection risk and we hadn't used it in 3+ days. The PA said “He has a name. What’s his name?” I then asked the question using the patient’s name even though he knew who I was talking about as we were in the patient’s doorway. He then said “Can we remove the line? You tell me. Why would we remove it?” in what I perceived as a hard tone and tense body language. I was so confused so I repeated my concern for infection. He said “No we might need it to drop pacer wires and let that be a lesson. I am trying to teach you”.

Ten minutes later, my patient started to have a bizarre intermittent tachy-brady rhythm, was competing with his temporary pacemaker and having inappropriate V pacing. I tried to troubleshoot by over pacing and under pacing but it continued. I got my charge nurse (who use to work in a pacemaker clinic and knows a ton about pacemakers) and we made some more adjustments that appeared to solve the issue and he was V pacing 1:1.

I printed off strips and the charge nurse went to tell the provider as the PA was on the phone. The provider storms into the room and looks at the pacemaker. The charge nurse tells him the changes we made and he says “Why would you do that? Now it won’t pace.” again in a harsh tone and tense body language. He leaves and then comes in less than a minute later. He points his finger at me and said “You. Tell me what happened”. The nurse two rooms down can hear him at this point. I proceeded to tell him what happened and he keeps stopping me mid-sentence and repeating what I said in the form of a question. I just look at the charge nurse helplessly. He said “This strip tells me more than the words coming out of your mouth. This is a cardiac ICU. You need to know this stuff”. He then pulls me out to the nurses' station and I realize he is possibly trying to teach me something. At this point, I start tearing up and feel humiliated. I truly appreciate him trying to teach me something but by this point, I feel defeated and am retaining nothing.

Things like this don’t happen every shift but there are episodes like this multiple times every week over the last 5 months. I would like to think part of it is learning style. I learn best by conversations, working through problems and being given examples. I know I don't learn best by being quizzed in front of everyone (peers and patients alike). Initially, I would tell my preceptors/peers that I didn’t learn well like this but now I feel so defeated and exhausted. I think the other part is the harsh/condescending tone and body language. Half the time, I don’t know until several minutes into the conversation that they are “teaching me”. It never feels like they are trying teaching me. I feel like it’s an ego thing. I try very hard to stay positive and think of it as helpful to know and be grateful for the opportunity to learn. But I feel like I have reached my limit. I know that others in my orientation group are going through very similar situations and that helps.

Am I being oversensitive and overreacting? Is my aversion to being quizzed in front of everyone preventing my learning? Or is this a form of microaggression? And what do I do about it?

[Ruby Vee, BSN]

11 hours ago, LoveLifeTravel said:

I have been a nurse for several years and have spent the last few years travel nursing. Needless to say, I have worked at many hospitals and they all have their good and bad but I have enjoyed every hospital. Recently, I took a permanent position at a top-rated medical facility in a Cardiac ICU. I took this job because of the learning opportunities available. I love learning new things, new procedures or new medications. Overall, I really like my new job, the unit, and I have made some amazing friends.

But I continue to have a recurring interaction with a variety of staff and it is starting to feel like the unit norm/culture. It usually starts when I identify an issue (runs of SVT, critical lab value, neuro status changes). I address the issue and the staff member becomes visibly tense and addresses my concern in a harsh and condescending tone - usually in a form of questions. It started with random preceptors and now has progressed to nurses at change of shift, advance providers and physicians.

For example, I had a patient who had a central line that we were not using and he had other IV access. I asked the PA if we could remove the line as I was concerned for infection risk and we hadn't used it in 3+ days. The PA said “He has a name. What’s his name?” I then asked the question using the patient’s name even though he knew who I was talking about as we were in the patient’s doorway. He then said “Can we remove the line? You tell me. Why would we remove it?” in what I perceived as a hard tone and tense body language. I was so confused so I repeated my concern for infection. He said “No we might need it to drop pacer wires and let that be a lesson. I am trying to teach you”.

Ten minutes later, my patient started to have a bizarre intermittent tachy-brady rhythm, was competing with his temporary pacemaker and having inappropriate V pacing. I tried to troubleshoot by over pacing and under pacing but it continued. I got my charge nurse (who use to work in a pacemaker clinic and knows a ton about pacemakers) and we made some more adjustments that appeared to solve the issue and he was V pacing 1:1.

I printed off strips and the charge nurse went to tell the provider as the PA was on the phone. The provider storms into the room and looks at the pacemaker. The charge nurse tells him the changes we made and he says “Why would you do that? Now it won’t pace.” again in a harsh tone and tense body language. He leaves and then comes in less than a minute later. He points his finger at me and said “You. Tell me what happened”. The nurse two rooms down can hear him at this point. I proceeded to tell him what happened and he keeps stopping me mid-sentence and repeating what I said in the form of a question. I just look at the charge nurse helplessly. He said “This strip tells me more than the words coming out of your mouth. This is a cardiac ICU. You need to know this stuff”. He then pulls me out to the nurses' station and I realize he is possibly trying to teach me something. At this point, I start tearing up and feel humiliated. I truly appreciate him trying to teach me something but by this point, I feel defeated and am retaining nothing.

Things like this don’t happen every shift but there are episodes like this multiple times every week over the last 5 months. I would like to think part of it is learning style. I learn best by conversations, working through problems and being given examples. I know I don't learn best by being quizzed in front of everyone (peers and patients alike). Initially, I would tell my preceptors/peers that I didn’t learn well like this but now I feel so defeated and exhausted. I think the other part is the harsh/condescending tone and body language. Half the time, I don’t know until several minutes into the conversation that they are “teaching me”. It never feels like they are trying teaching me. I feel like it’s an ego thing. I try very hard to stay positive and think of it as helpful to know and be grateful for the opportunity to learn. But I feel like I have reached my limit. I know that others in my orientation group are going through very similar situations and that helps.

Am I being oversensitive and overreacting? Is my aversion to being quizzed in front of everyone preventing my learning? Or is this a form of microaggression? And what do I do about it?

It sounds to me as though you're working in a teaching hospital. Ever watched the cardiac surgery team round? This sounds like the way they teach their medical students and residents. I'm not seeing micro aggression here. It stands to reason that the providers would teach you this way -- it's what they know. They may not be able to teach any other way.

Newer preceptors who haven't yet developed a good teaching style may default to the teaching style they see demonstrated around them. I'm not saying it's right or desirable. It may even be an ego thing -- especially among those who are relatively new to nursing or who are inclined toward more direct communication styles. I wasn't there to witness any of this, but perhaps you are being a bit oversensitive.

With the providers, the best thing to do is have all of your ducks in a row before you call them, or before they show up. Be ready to answer the questions they are most likely to ask. When placed on the spot, take a few seconds to think through how you want to answer the question. This sort of quizzing usually tapers off as the providers get to know you and trust your judgement.

With preceptors, if you know them well you might choose to invite them to coffee and have the conversation with them. Most preceptors want to do well as preceptors and want you to do well. They don't want to scare you away from the unit. Newer preceptors may not realize how they come across.

Most large, top rated teaching hospitals have an enormous turnover and CT surgery especially is a feeder unit for anesthesia school. There may be relatively inexperienced nurses drafter to precept, and they may or may not be good nurses or good preceptors.

I had 27 years of experience when I started my last job, and the preceptor they assigned me had less than two years. She used to brusquely order me to do something (hang KCl, draw a lab, whatever) and then immediately open the chart and chastise me when I hadn't done it yet. I was at my wits end, in tears as I drove home at the end of each shift, ready to quit. Then one day a patient needed nitrates for chest pain. The order called for a "Tridil drip" and I approached the ICU pharmacist for the stat order. He printed out a stat label and handed me a premixed Tridil drip, slapping the label over the manufacturer's label. I hung the drip, titrated it and was calmly charting the patient's response when the preceptor and my manager approached me.

"Sally says you hung the wrong drug," my manager told me.

The pharmacist had labeled the Tridil drip correctly as "nitroglycerin", and I had charted a "nitroglycerin drip." The preceptor didn't realize that nitroglycerin is the generic for Tridil. She kept insisting that I had made a major drug error, was incompetent and needed to be fired. The pharmacist got involved. The preceptor had written an incident report, and the pharmacist wrote one as well.

The preceptor transferred to an out-patient position closer to her home. The pharmacist and I worked together for many years.

I guess the point of this story is to bide your time until you're off orientation . . . things do get better.

[JKL33]

4 hours ago, Ruby Vee said:

I was at my wits end, in tears as I drove home at the end of each shift, ready to quit. Then one day a patient needed nitrates for chest pain. The order called for a "Tridil drip"[.....]

I knew right where this was going.

Hate to admit it, but sometimes it is quite sweet to just play it cool and wait for know-it-alls to showcase their "talents."

[JKL33]

17 hours ago, LoveLifeTravel said:

The PA said “He has a name. What’s his name?” I then asked the question using the patient’s name even though he knew who I was talking about as we were in the patient’s doorway.

? ?

Please. I have nothing but disgust/disrespect for those kinds of moves. This is 2019 and many of us (including providers) have acknowledged that we do not need to speak to each other this way. This is an absolute you-know-what move that serves zero useful purpose in this case/setting. Zilch.

17 hours ago, LoveLifeTravel said:

He then said “Can we remove the line? You tell me. Why would we remove it?” in what I perceived as a hard tone and tense body language. I was so confused so I repeated my concern for infection. He said “No we might need it to drop pacer wires and let that be a lesson. I am trying to teach you”.

If I had a knowledge deficit I would stay engaged and try to get any additional relevant info he might want to share. And yeah, I would probably say thanks for helping me understand.

17 hours ago, LoveLifeTravel said:

He points his finger at me and said “You. Tell me what happened”. The nurse two rooms down can hear him at this point. I proceeded to tell him what happened and he keeps stopping me mid-sentence and repeating what I said in the form of a question.

Another NO. That BS is aggressive, yes. It is meant to humiliate via thinly-veiled mockery and there is not one single other legitimate use for this. I will assume this person understands the language being spoken just fine, so I would never buy any suggestion that this person is legitimately trying to clarify.

No one legitimately has this kind of "teaching style," even though it is indeed possible to learn from these people. The fact that someone chose to learn doesn't mean that someone legitimately tried to teach. I will put forth every effort to try to learn from someone whom I know has knowledge. That doesn't make their conveyance of information appropriate.

17 hours ago, LoveLifeTravel said:

Half the time, I don’t know until several minutes into the conversation that they are “teaching me”. It never feels like they are trying teaching me. I feel like it’s an ego thing.

Of course.

17 hours ago, LoveLifeTravel said:

Am I being oversensitive and overreacting? Is my aversion to being quizzed in front of everyone preventing my learning? Or is this a form of microaggression? And what do I do about it?

Some of the people best at their crafts are also very rough to learn from. I can take that. But I also need them to know that I'm not an idiot, and I do not exist to help fulfill their need for daily reassurance that they know more than someone else in the world.

[I should acknowledge that the number of times I have been treated poorly are very, very few. I've noticed more overtures that suggest someone might mean to rankle me, but I usually make quick work of that and have only moved to full-on "war" a few times, ever.]

My responses are always nuanced to the multiple specific details I know about the situation and the person (history, position/role, words, body language, my own confidence in my actions, etc., etc.). So there is really no one magic bullet for all situations, but here are a couple of useful principles:

- Make one move to develop a legit rapport no matter what kind of tantrum they are throwing. This goes along with/can often be accomplished by the next bulllet point:

- (I choose to) Stay calm and absolutely refuse to let them see me sweat. Maintain good eye contact and a pleasant/open facial expression, don't fidget, stay engaged. Don't feel like you aren't defending yourself if you don't give them some sort of smack talk back!! Refusing to get rankled is winning, and has multiple other benefits like allowing yourself to learn what there is to learn, avoiding making things worse, refusing to play dumb games, etc., etc.

- NEVER, never, never roll in the mud with pigs/reply in kind/stoop to their level/engage in similar despicable behavior. It won't work and it destroys the soul. This includes not trying to play the dumb game of defending your own honor. To do so is to broadcast that you've been insulted. Meh.

- I never get into reporting people's interpersonal issues. I don't really care what the nursing hype is, it does not work long term and I have watched multiple people try to address things this way. It devolves into he-said-she-said in the blink of an eye and is one humongous adult tattle-tale game.

Bottom line:

IMO you are spot-on with regard to your observations. Answer: Carry on.

[Wuzzie]

18 hours ago, LoveLifeTravel said:

I proceeded to tell him what happened and he keeps stopping me mid-sentence and repeating what I said in the form of a question.

I had a surgeon do this to me more than once. One day I had had enough and I, not caring if I got fired, said to him “if you’re having trouble hearing me I’ll wait while you adjust your hearing aids”. The look on his face was priceless. I did not get fired and while he was still an arrogant Richard that I couldn’t stand he never did that to me again. I wouldn’t recommend this approach necessarily but it worked for me. And i was a bit of a legend after that. ?

[Ruby Vee, BSN]

18 hours ago, Wuzzie said:

I had a surgeon do this to me more than once. One day I had had enough and I, not caring if I got fired, said to him “if you’re having trouble hearing me I’ll wait while you adjust your hearing aids”. The look on his face was priceless. I did not get fired and while he was still an arrogant Richard that I couldn’t stand he never did that to me again. I wouldn’t recommend this approach necessarily but it worked for me. And i was a bit of a legend after that. ?

These are the kinds of things that just pop out, though. You can't plan them ahead of time.

Years ago, when I worked in CCU, we had a nephrologist who was notorious for his nastiness. When we saw a renal consult ordered on a patient, we'd all get anxious, wondering if it would be *that* nephrologist. I remember one morning I was at work 15 minutes early and was assigned to a patient with a renal consult ordered and asked to "go help out the nurse so she can finish on time."

The nurse was able to finish and left by 7:02 or so, and at 7:05 the nephrologist popped into the room. Let's call him Dr. Richard Wad. "I asked for an hour's worth of urine to take to the lab? Where is it?" (The order was placed at 6:43.). "YOu've got the Foley clamped wrong." "Where are his vital signs for last night?" (Paper flowsheet he was holding in his hand. Meanwhile, I was "charting" on a paper towel, since he wasn't sharing.). "How come I wasn't consulted earlier?" "The blood pressure range that is ordered isn't conducive to supporting the kidneys." "Why haven't you done this? What have you been doing all night?"

Before I even realized what I was saying, I heard the words coming out of my mouth. "Look. Dick. I'm sure the cardiologist ordered this consult specifically to ruin both of our days, but let's try and make the best of it."

Utter silence. Then he surrendered the flowsheet to go look at the labs, and for the rest of the day he was pleasant and respectful. And every time I worked with him for the rest of my tenure at that job.

I couldn't have planned that, and if I had thought before I opened my mouth, I wouldn't have opened it. Worked like a charm, though.