Nurses belligerent towards MDs

[FireStarterRN]

I was talking to one of our hospitalists yesterday. He and another doctor were talking about different experiences they had had elsewhere. This hospitalist said that when he was back in Philly, the nurses were the dominant force in the hospital and routinely yelled at and intimidated the doctors. This was a new twist on things because when I read here, it seems to be nurses complaining about abuse by MDs.

I'm very thankful for the relationships we have with the MDs where I work, which are based on mutual respect and congeniality (usually). Has anyone here experienced what this doctor describes?

[SharonH, RN]

Okay....

I just wonder though, why you blasted the one poster who compared the attitudes of dismissal of these issues as the same that were reminicient of days gone by with rape victims....and then me when I also concurred that these same attitudes exist in many other areas of human experience, ie genocide, etc....I am thankful that you didn't take from my comparisons that there was some personal slant on you...because clearly there isn't.....I wonder what your resentment is about....why would you resent that comparison? It has nothing to do WITH YOU....it is comparing a similar, if not exactly the same, attitude....I do not understand your resentment of that, or even it's discussion....

For some of us here, who have been on the receiving end of bullying, mistreatement, victims of vicious gossip, it's helpful to not only understand the core of where this comes from, but it helps to be able to recognize it's tentacles. It is far reaching...

I don't understand why you would resent the comparisons....it isn't to diminish the trauma or the pain a rape victim experienced above that of someone who has experienced workplace belligerence...it is to try to help people see that many of the attitudes that people employ to control or dominate others is rooted from the same basic place....I don't understand why you would find that something to resent...

I look back on the many many many times that Doctors took the time to nurture me....to encourage me in my quest to become an RN and beyond....they didn't just do the minimum requirement....in fact, one physician group actually financed my last year of nursing school as a gift....I guess I feel differently about giving back....I was nurtured...and despite some of the bullying, many along the way were very very good to me....and, for me, I am not only happy to help a resident, new doctor, or even an older one with whatever it is that they need, but I am happy to stick up for them if someone is being really mean with their words or actions toward them....

I know this breeds good collaboration between us, and it ultimately provides good care for our patients.....

crni

Why am I so resentful? I had to take a moment to cool off and think about that actually.......

Over the past few years, I have had the opportunity to spend a lot of time with resident physicians during their practice and training. And the difference between their professional training and development and ours is as wide as the Pacific Ocean. I am not referring to the amount and depth of their training, I am referring to the very method in which this knowledge is provided. I often sit in the attending room when we have clinic and observe our attendings interact with the residents. Their opinions are encouraged and carefully considered.....they are coached and coaxed....congratulated when they go in the right direction and gently redirected when they are wrong.

They have weekly grand rounds which are catered with fresh fruit and salads and roast beef and fresh seafood in large halls and conference rooms. They are encouraged to supplement their education with research, teaching each other and publishing. I have observed this in several different teaching hospitals. By contrast, I struggled to get a quality, revelant clinical when I was completing grad school and I know that other advanced practice nurses do also; and let's not even talk about undergraduate clinicals.

They are told over and over again that they are leaders and young scientists and thinkers. That does not mean that they don't face abuse or criticism within their own rank. I posted earlier that they do and that sexual harassment seems to be a real problem.

My point is, that they don't need my nurturing; they get plenty of it! Does that mean it's okay to sneer at them when they order a medication that is not on formulary or scream at them if they ask for a blank physician's order? NO. I never said it was and I certainly never said that it never happened. It does. But I always stated from the outset that I don't believe that it is a huge problem for them and I still don't. No matter what you throw at them, at the end of the day they tell themselves that you are just a nurse or a unit clerk or an aide and they are still the doctor. I've heard them say it. Trust me, no physician is considering leaving the profession because of nursing attitudes or afraid to call and leave a telephone order because the nurse might be mean to them. Yet lectures are posted about attitudes resembling homicidal maniacs and bullying and abuse and the suffering of rape victims and I am urged to "rethink my position" because I don't agree that they need our nurturing so much? Yes, I was quite irritated by that.

You've been bullied terribly,but you must know that most nurses face the same thing, myself included. I could tell you stories of bullying from physicians and nurses that would have your hair standing on end but I don't feel like going there tonight. Since I left bedside nursing, it is much less of a problem for me but I will never forget what it was like out there.

[CRNI-ICU20]

So, I hope I am getting this right...

You resent that doctors are catered to, literally and figuratively, and nurses are not. You resent that they get LOTS of pampering, and therefore, you don't feel you should have to go beyond the professional expectation of courtesy to accommodate them? I hope I am encapsulating your statements correctly....and that you were quite irritated because you felt ?attacked because you don't feel the need to go beyond just the expectation and that you might have felt? that the references to bullying and rape victims was somehow not on the same plane in your thinking .....and to compare the two was "over the top?"

What I take from this is:

By your own words, I have been bullied, but "I must know that most nurses face the same thing....myself included"....That statement is EXACTLY what I was trying to point out!! That while we recognize it, and even acknowledge it....it is DISMISSED.. Somehow I am supposed to feel better that I am in good company with a whole bunch of OTHER nurses who have also been bullied??? as if to say, "well, you aren't the ONLY one who has been mistreated, slapped, raped, or kicked..." You are maybe right that the new doctors don't "need my nurturing". But I wonder, if it would make a difference in your life to once in a while, do the extra mile thing....on behalf of another....whether it is a doctor, nurse, or even your Self....

I think we were talking about two different things....I was talking about the issues of belligerence as applied to how nurses sometimes treat each other and some doctors....and how that sets a precedent for how things are going in medicine today....and how the same attitudes could be found in other human experiences that augemented, can and does lead to very bad things....again, I don't think diminishing the effects of bullying or gossip or backstabbing on another via re-labeling is honest....

One of the things I have learned about human nature is that it is common to try to gloss over bad behaviour as being something that it ISN"T....this is an artful skill with some....esp. abusers who have done this their whole lives without being confronted....but the way to combat abuse is to call it what it is....and to show those around them the far reaching effects of their decisions to abuse....(yes, I believe people choose to behave this way). Some will learn from this and turn from their ways, and other will scoff and minimize the situation, and tell the confronter that THEY ARE AT FAULT....

I am sorry you were irritated by my comparisons...but, I think they are very spot on....because I have studied this for a long time now....the origin, as it were, to a person's need to harm another....it originates mostly from someone who has deep seated insecurities and poor self esteem....generally speaking. On nearly every level, a rapist, or a genocidal/homicidal maniac is no different, they just exert their reaction in a different way....

You can kill a person with words just as easily as you can with a fist....

just ask a verbally abused woman/man if that is not a true statement...

They don't wear their bruises on the outside....but they hurt and wound just the same...

The root word of sarcasm comes from a French derivative: "the cutting of the flesh".....

So, I apologize for urging you to rethink your position...I am sorry you feel such resentment...

[SharonH, RN]

So, I hope I am getting this right...

You resent that doctors are catered to, literally and figuratively, and nurses are not. You resent that they get LOTS of pampering, and therefore, you don't feel you should have to go beyond the professional expectation of courtesy to accommodate them? I hope I am encapsulating your statements correctly....and that you were quite irritated because you felt ?attacked because you don't feel the need to go beyond just the expectation and that you might have felt? that the references to bullying and rape victims was somehow not on the same plane in your thinking .....and to compare the two was "over the top?"

No, you are getting it very wrong. You are not "encapsulating my statements" correctly. I do not resent that doctors are catered to. I don't have a problem with physicians, I've told you that. My resentment is towards you and a lecture about bullying and treatment of Jews in the 1940s because I feel that "fulfilling a professional expectation of courtesy" as you put it is just fine. That is what irritated me, not physicians. I was just trying to point out to you why I don't feel they need my extra attention. And as far as diminishing the effects of bullying or backstabbing or gossip.......I don't even know where all of that is coming from.

[CRNI-ICU20]

The diminishing statement is: " I must know that most nurses face the same thing." THAT sounds like to the recipient, ie me, that I shouldn't feel so bad about being bullied because it happens to most everyone.....this kind of communication/statement diminishes my expereience of being bullied....it would be like saying to a rape victim, "well, lots of women get raped you know...you're not the only one." Do you see how that might make a person feel not empathetically supported? This kind of thinking dismisses the injury as if it was almost a normal occurence, and therefore no big deal. So that is where it is coming from, Sharon. For some here, both doctors and nurses, IT IS A BIG DEAL whether you think so or not, or whether you believe that since so many of us have experienced belliegerence and bullying in our daily practice, and apparently doctors don't appear to be too concerned about it, "I don't know why we are."

WE ARE CONCERNED ABOUT IT BECAUSE:

In your own words: {All I am required to do is maintain a polite and professional demeanor and make sure that patients receive quality care.}

Now, do ya think patients will want to come to a hospital where the nurses and doctors are yelling and snarling at one another? Would you want to be laying there in pain or fear, and have your nurse growling about some $#@* blankety blank doctor? How about putting your words up there as a vision statement: Belligerence is a matter of perception.

How far do you think that would fly?

So, I am wondering why you resent me? Because I don't agree with you? Because I don't subscribe to your view of the world as you see it? Isn't that exactly what we are talking about here? Holding bad feelings against another person simply because they see something differently....and by your own words it's all about perception,EXCEPT if their perception is DIFFERENT THAN YOURS....then it's worthy of resentment? Wow!

When you say that you don't have a problem with physicians, but then you list the perks they get as opposed to the ones you couldn't get while doing your graduate work, it certainly sounds like you DO have a problem with them....

I can accept that you don't believe you need to give the newbies any of your "extra attention", as you put it. That is just you....I don't resent you for that.....so why do you resent me? Why are you choosing that emotion and sending it my way simply because I wanted to make points of my own?

You see, this is a VERY good example of how this sort of stuff festers and goes on in hospitals everywhere....one person dislikes another because........(fill in the blank).....and therefore deserves my ......(fill in the blank negative response)....

Now, can you see "where all of that is coming from?"

crni

[bigsyis]

I've never seen the disrespect that the OP referred to. However, I have seen some nurses barely tolerant of inept or ETOH-impaired MDs a few times.

[caroladybelle, BSN, RN]

Over the past few years, I have had the opportunity to spend a lot of time with resident physicians during their practice and training. And the difference between their professional training and development and ours is as wide as the Pacific Ocean. I am not referring to the amount and depth of their training, I am referring to the very method in which this knowledge is provided. I often sit in the attending room when we have clinic and observe our attendings interact with the residents. Their opinions are encouraged and carefully considered.....they are coached and coaxed....congratulated when they go in the right direction and gently redirected when they are wrong.

They have weekly grand rounds which are catered with fresh fruit and salads and roast beef and fresh seafood in large halls and conference rooms. They are encouraged to supplement their education with research, teaching each other and publishing. I have observed this in several different teaching hospitals. By contrast, I struggled to get a quality, revelant clinical when I was completing grad school and I know that other advanced practice nurses do also; and let's not even talk about undergraduate clinicals.

Well, I stayed out of this since my opinion was gravely misunderstood, but after initiating this ruckus by playing the devil's advocate, I guess that I will get back in.

First, having seen interns, residents and fellows (some from the NIH) royally chewed out in front of everyone at rounds (pharmacy, nursing, dietary, social work) at Johns Hopkins (and other facilities) by angry attendings, I can say that not all hospitals and attendings are that nuturing, uplifting, and encouraging.

And, let's see, how much money do interns make, and how many hours do they have to work and be oncall for to get it. In many facilities, they make less than nnurses, and when you calculate that the work 80 hours a week and may be on for 24 hours straight, and must do this for several years on end. Also, how much money do they have to pay for their classes as opposed to what we do? They leave school, often over $100,000 in debt.

They will also continue to work well over 40 hours a week, plus seeing patients after hours and being on call, to build a practice. Do most nurses want to do that?

Now if facilities could work nurses 24 hours straight, make nurses work 80 hours a week for the same wages, and be guaranteed of our hours for 1-3 years, or more, no matter how nasty our supervisor is to us......they might feel free to throw in a catered lunch or two. If our schools charged as much as med schools, do, we might have better options for clinicals.

If one wants to envy their privilege of an occasional good lunch and want it for yourself, I suggest one start paying the price that comes with it, and decide whether it is worth it.

But would nurses be willing to get out of schools, tens of thousands of dollars in debt, work 80 hours a week for 3 or more years, etc. Heck, we have posters that gripe when they cannot get loans for school, or getting someone to watch their kids for their school hours.

And I haven't seen a catered MD lunch, such that to me would be preferable to getting some sleep or attending to my personal life.

MDs aren't leaving the profession, because of nursing abuse. Well, in their case, that would mean throwing away 10 or more years of their life and the ability to pay of all those accumulated loans. Does this mean that anyone should be able to abuse them freely and it won't be taken seriously?

My comment about comparing denial of nurse's abuse of interns/residents, to that of denying date rape, sexual harassment, sorry but I stick by that. When we dismiss MDs complaints about nurses abusing them....it is very similar to when people dismiss women that complain of sexual harassment or domestic violence. We say, "If it was so bad, why didn't you leave?", or "Maybe, you are overwrought and making it out to be worse than it was?", or "Oh, it wasn't meant that way".....all of which dismisses the victim, excuses the bad behavior, permitting it to continue and giving legitimacy. We also ignore that maybe the victim can't just leave (domestic violence). The attitudes that permit ANY form of abuse need to be changed, even if we feel that abuse is not that bad. We shouldn't blowing off this complaints.

And while belligerence can be a matter of perception, there is some behavior that is just plain nasty . And some of the behaviors that I saw going on at the Philadelphia hospital could not by any REASONABLE person be considered anything but rude and mean.

------------------------------------------------------------------------------------------------

We keep trying to perpetuate health care as a team that works for the good of the patient. If we truly believe that, we have to act like a team. And that means nurturing everyone as a team, and not letting jealousy/envy over perceived advantages, divide us and interfere with the collaboration. It means not permitting abuse to get in the way.

Will all team members abide by this? Of course not, there will always be some member that thinks that they are "more equal" than others. But, I for one, choose to stick with working as the team, because that is best for the patient. And permitting any department to abuse a team member is wrong.

[caroladybelle, BSN, RN]

However, I have seen some nurses barely tolerant of inept or ETOH-impaired MDs a few times.

Actually if the MDs were ETOH impaired, the nurses should not have been at all tolerant.

[bigsyis]

Actually if the MDs were ETOH impaired, the nurses should not have been at all tolerant.

This was back in the early 80's. It wouldn't happen today, I don't think!

[CRNI-ICU20]

WELL SAID CAROLADYBELLE!!

You make me proud to be a nurse. It would be an honor to work on a "team" with you. Maybe we will "bump" into one another one day...wouldn't that be a hoot??

crni:nurse:

[UM Review RN, ASN, RN]

Well, I stayed out of this since my opinion was gravely misunderstood, but after initiating this ruckus by playing the devil's advocate, I guess that I will get back in.

First, having seen interns, residents and fellows (some from the NIH) royally chewed out in front of everyone at rounds (pharmacy, nursing, dietary, social work) at Johns Hopkins (and other facilities) by angry attendings, I can say that not all hospitals and attendings are that nuturing, uplifting, and encouraging.

And, let's see, how much money do interns make, and how many hours do they have to work and be oncall for to get it. In many facilities, they make less than nnurses, and when you calculate that the work 80 hours a week and may be on for 24 hours straight, and must do this for several years on end. Also, how much money do they have to pay for their classes as opposed to what we do? They leave school, often over $100,000 in debt.

They will also continue to work well over 40 hours a week, plus seeing patients after hours and being on call, to build a practice. Do most nurses want to do that?

Now if facilities could work nurses 24 hours straight, make nurses work 80 hours a week for the same wages, and be guaranteed of our hours for 1-3 years, or more, no matter how nasty our supervisor is to us......they might feel free to throw in a catered lunch or two. If our schools charged as much as med schools, do, we might have better options for clinicals.

If one wants to envy their privilege of an occasional good lunch and want it for yourself, I suggest one start paying the price that comes with it, and decide whether it is worth it.

But would nurses be willing to get out of schools, tens of thousands of dollars in debt, work 80 hours a week for 3 or more years, etc. Heck, we have posters that gripe when they cannot get loans for school, or getting someone to watch their kids for their school hours.

And I haven't seen a catered MD lunch, such that to me would be preferable to getting some sleep or attending to my personal life.

MDs aren't leaving the profession, because of nursing abuse. Well, in their case, that would mean throwing away 10 or more years of their life and the ability to pay of all those accumulated loans. Does this mean that anyone should be able to abuse them freely and it won't be taken seriously?

My comment about comparing denial of nurse's abuse of interns/residents, to that of denying date rape, sexual harassment, sorry but I stick by that. When we dismiss MDs complaints about nurses abusing them....it is very similar to when people dismiss women that complain of sexual harassment or domestic violence. We say, "If it was so bad, why didn't you leave?", or "Maybe, you are overwrought and making it out to be worse than it was?", or "Oh, it wasn't meant that way".....all of which dismisses the victim, excuses the bad behavior, permitting it to continue and giving legitimacy. We also ignore that maybe the victim can't just leave (domestic violence). The attitudes that permit ANY form of abuse need to be changed, even if we feel that abuse is not that bad. We shouldn't blowing off this complaints.

And while belligerence can be a matter of perception, there is some behavior that is just plain nasty . And some of the behaviors that I saw going on at the Philadelphia hospital could not by any REASONABLE person be considered anything but rude and mean.

------------------------------------------------------------------------------------------------

We keep trying to perpetuate health care as a team that works for the good of the patient. If we truly believe that, we have to act like a team. And that means nurturing everyone as a team, and not letting jealousy/envy over perceived advantages, divide us and interfere with the collaboration. It means not permitting abuse to get in the way.

Will all team members abide by this? Of course not, there will always be some member that thinks that they are "more equal" than others. But, I for one, choose to stick with working as the team, because that is best for the patient. And permitting any department to abuse a team member is wrong.

Please allow me to apologise if anyone took my comments to mean that abuse toward any team member is OK.

Once again, let me spell out the reason for my sarcastic comment.

Often, when a report comes out that discusses perpetrator vs victim abuse, the perpetrator reacts with a counter-allegation that no, he is the real victim here.

I saw the OP's post with its allegation as that type of response to a claim that nurses are frequently abused by docs.

However, subsequent posts have enlightened me to the fact that MDs, interns, and residents also suffer from workplace violence, and as Caroladybelle stated so well, the fact that both groups can make a truthful claim to abuse, is no reason to dismiss the problem.

[GadgetRN71, ASN, RN]

I feel similar to how Sharon feels. I am an easy going type and I tend to have good relationships with the surgeons I work with(residents as well) but I don't feel the need to nurture them necessarily. They do look after their own and I have witnessed far more nasty behavior towards nurses by docs than vice versa. There are many that have had their fannies kissed through much of their life and lack social skills as a result.

The way I view it is I treat others how I like to be treated. I don't start off being "belligerent". But if advocating for the patient or myself when the doctor is being rude, nasty or abusive makes me a B&^%h than so be it. I am not a doormat or a whipping girl. I am simply a professional who expects to be treated as such. As far as the "rough" hours that interns and residents have to work, they get compensated for it later, believe me. My favorite is when you call a doctor at home for something important and they get angry! Um hello?! You did know what the hours were going to be like when you decided to become a doctor! If I'm expected to carry a pager for a paltry 1.50 an hour(or worse yet, play the little secretary in the OR room, and call their wives/girfriends/mistresses to tell them they'll be late for supper) then I don't want to hear any whining.