OMG. I'm beside myself. I don't even know where to begin.
So, moral has been low at my facility........critically low. People fearing layoffs, hospitals near us closing down, census drastically low, a company being brought in to analyze the place for places to "make cuts", supplies not stocked anymore. Its gotten to the point where you just go to work, duck your head.......watch your patients and get out. Its all you can do.
I was THIS CLOSE to accomplishing that today. Actually, had a great shift........got all my work done, got to spend QT with the patients rather than just run in and hand them pills then leave. Made it all the way up to quit time........and a new nurse from down the hall tell me her pt. is desaturating. So, seeing day shift is taking their time getting on the floor........I go to help (this is like 5 min. before I want to leave).
I tell the nurse to call the attending while RT is in the room putting O2 on the pt. She tells me she doesn't know who to call.............a surgeon is the attending but someone else has been handling medical management. I tell her to call both and let them decide who is going to handle it.
A surgeon (not even on the case) sitting there starts giving me heck about my call to call both. Goes on and on about inappropriate calls he recieves and this and that. I humor him, tell the new nurse to call whoever is listed as attending and even ask "Who would you suggest be called." He has no answer (:smokin:of course) but proceeds to rant on and on about how bad calling everyone is. So, I go on helping the new nurse, waiting to get orders to put into action for the pt. (which is now delayed because the surgeon is slowing us down badly) and he decides he is going to "see the pt".
He goes in the pt. room, talks to her for like........half a minute.........and comes out of the room and proceeds to go on and on about inappropriate calls. I finally tell him I've heard his point, I got it, I need to move on to the pt's care now. I'm done with the conversation. He doesn't like this of course. Starts asking me to get the Charge Nurse/supervisor for him........wants to argue with me. I keep telling him "I'm done with this conversation, please......move on". He doesnt want to hear it. I wanted to knock the guy out at this point.
So, he storms off the unit, makes it clear I am being reported. Nice. And a friend/colleague sitting near at the time tells me I'm disrespectful. Doh:eek:.
OMG, never thought I'd be in a position where I'd have to swing through physicians to get focused on a pt. who is near needing Rapid Response. Now..........I have seen EVERYTHING.
Best part is, this facility is looking for reasons to get rid of people. So yes, on my way home I realize I just gave them reason to. Not very smart on my part.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Good for you for walking away.
However, he had a point too.
For the rapid response, you should notify the IM and let him defer to the closest IM resident. The surgeon does only surgical stuff and he should be notified later.
The doctor insisting his point, next time, just nod and smile and keep going he can't report you if you don't respond to him.
Knowing me, I would've just put up the "hand stop sign." my way of telling to stuff it.
Actually, I get this doc's perspective. Our ED docs have no ability to write orders or perform care on a admitted patient unless they are in a code situation. They have no privileges to do this, no right to order any type of intervention, and no right to perform anything. He'd be way out of bounds doing so, and would be reprimanded by the Chief of Staff. If he kept doing it, he'd get the boot. It's not about the money; it's about honoring his contract and working within his terms of hire. You can't ask a doc who has no privileges (and most ED docs do not have hospital privileges) to come in, assess, and write orders on any patient.
Do you not have a rapid response team? Our hospitalists and ED docs do have the right to order anything on any patient for whom we've called a code or a rapid response, regardless of who the attending physician is.
This was an RRT, and he was supposed to come. At a big hospital with multiple hospitalists, I could see it. At our place, ER's the only in house docs (1 doc after midnight) we've got during nightshift unless the hospitalist decides to overnight. It was all about the code differential. We called the pts PCP and he drove in (he doesn't live far from the hospital) but if we hadn't been able to get that trach back in, the guy would have coded before the pt's doc made the scene. Of course, then the ER doc would have got his code differential. We only had 4 folks in the ER right then, and they were flu pts, nobody really bad off or trying to die for him to be able to tell admin he had a good reason for not coming...
Our admin rep wrote the monster up for patient endangerment.
For the rapid response, you should notify the IM and let him defer to the closest IM resident. The surgeon does only surgical stuff and he should be notified later.
The doctor insisting his point, next time, just nod and smile and keep going he can't report you if you don't respond to him.
Knowing me, I would've just put up the "hand stop sign." my way of telling to stuff it.
Eh.......whats an IM? lol. We arent a teaching hospital so that may be why I dont know the term.
I didnt want to tell him my real rational for telling the nurse to call both. He probably would have liked me less but.....tuff.
Way I see it: The pt. had not had surgery yet. So, the surgeon was listed as the Attending, but he consult MD was doing medical management and at that point in time probably knew the pt. better. I actually preferred to get the consult MD on the phone at that point. But.........legalities come into play here. I could foresee the pt. being sent to the ICU and/or Rapid Response being initiated. In cases like that, I think you should always inform the attending of a change in condition. So, in truth.........I was anticipating the surgeon deferring to the consult MD. I figured may as well have the call out to them right away. Then, we could document "Attending physician nitified of change in condition" and not by lying.
If the surgeon who had the beef with me answered my question..........."Who would you prefer us to call?", a lot would have been cleared up for me and I could have..........errrr........humored him better.
If he says "Call the surgeon first", I would have agreed (just for show) and called him first, since they are the attending anyway. Chances are, they defer and we call the consult MD (or not and he gives us orders on what to do, even better). Only bad thing here is, it takes a bit longer waiting to call the consult MD if the surgeon does defer.
If he says "Call the consult MD first", I have mentioned by fear of not at least updating the "attending physician" first, but probably would have gone along with him since, as he said, he knew the other surgeon so I figure he'd know when he wants called and not.
Truth is, I was willing to talk to any physician who was actually on the case (the ********/moaning one was not) and get things moving before the pt. got worse. We had an opportunity to seize a problem before there was any pt. harm, and this guy was more interested in taking a few frustrations out on us that helping to see that through.
Either way, pt. focus was completely out the window no matter what I did. Humoring, ignoring, confronting........none of it got rid of him so we could focus on the pt. He just wanted to have his shinning moment to "put a few nurses in their place." His timing could not have been any worse.
Still, after talking to some fellow nurse friends (from other hospitals), they said I dealt with it right and couldnt understand why I was afraid for my job. Then the fog started lifting. Like I said..........I was very close to decking this guy. I did at one point say "I'm going to tell you nicely one more time." I think that could be reported as a threat. Probably will be. Its that little loss of temper snip it that has me worried.
Ah well, if I am canned, I am going back to WA like I've been wanting to. It'll be a very rough going, but in the end, if I am living in WA with a new job..........I'll have turned a negative into a positive.
My place is sort of like your place. I had a doctor YELL at me for the very first time in my career and hang up on me last week. I saw him in person before my shift ended and he was acting quite nice. I told him, "Don't you ever hang up on me again!".
At that point, he wanted to talk to my supervisor. I told him I welcomed him to talk to my supervisor! Job be damned, I will not be disrespected like that.
Luckily, my management supported my views.
And this is what needs to happen...our supervisors need to back us. At least my boss does that. Our docs know better than to get nasty with us, because they'll catch heck from her if they do. Actually, most of our doctors are very nice-I think having teams helps, because they have our back at times(if one of us gets hurt for example or needs to be looked at) and we try to help them out.
That said, I have gone head to head with a doc here and there and as long as we don't swear at or threaten them, we are able to defend ourselves.
You had no obligation to listen to this turkey when you were in the middle of an emergent situation. Grab the chart, and the phone numbers, and move it out. Call from the patient's room, or the staff room. Walking away fromhim while he was still ranting would probably feel pretty good too.
Specializes in psychiatric nursing, med/surg adult care.
Eh.......whats an IM? lol. We arent a teaching hospital so that may be why I dont know the term.
Internal medicine.
In our hosp we have IM, Pedia, Surgery, OB/Gyne residency training for doctors before they become fellows on their respective choice of specialization. After residency they will take an examination quite similar to board exam then another 2 years of fellowship (specialty) training. After that another long exam, then they can be called consultants or certified cardiologists, or gastroenterologists, oncologists, urologist, pediatric/adult pulmunologist, etc.
As with the original thread, if the presenting problem needing immediate intervention is outside the scope of surgery, and the patient has been referred to the services of IM beforehand, we call for the IM resident doctor.
When crap has happened to me on the job -- being outsourced, etc. -- usually I look back and think, "Man, that was the best thing that happened to me." Sometimes it takes a while, somethings I'm still ticked about the way it went down, and obviously I got so sick of it in computers I left the field, but good can come of this, whatever happens.
I typed a long responses and at the last second I accidentally clicked the refresh button. Doh!
Basically it said two things
1) You did the right thing, and don't sweat it and,
2) The surgeon should not have been paged for the desats. The surgeon ONLY is to be called for items related to the surgery directly (UNLESS your facility or doctor specifies otherwise), and the medical doctor is to manage the patient's other medical problems and/or complications. I learned (aka yelled at) which doctor to call early on in my career as a nurse. I also find that surgeons are clueless with medical management anyways. They really are limited to the surgery part only. I called the surgeon once to report a critically low blood sugar and he ripped me a new @$$hole. Nowadays the surgeons at my work literally write "Do NOT call me for medical management, please call the hospitalist" (they write it exactly like that, word for word!)
OMG. I'm beside myself. I don't even know where to begin.
So, moral has been low at my facility........critically low. People fearing layoffs, hospitals near us closing down, census drastically low, a company being brought in to analyze the place for places to "make cuts", supplies not stocked anymore. Its gotten to the point where you just go to work, duck your head.......watch your patients and get out. Its all you can do.
I was THIS CLOSE to accomplishing that today. Actually, had a great shift........got all my work done, got to spend QT with the patients rather than just run in and hand them pills then leave. Made it all the way up to quit time........and a new nurse from down the hall tell me her pt. is desaturating. So, seeing day shift is taking their time getting on the floor........I go to help (this is like 5 min. before I want to leave).
I tell the nurse to call the attending while RT is in the room putting O2 on the pt. She tells me she doesn't know who to call.............a surgeon is the attending but someone else has been handling medical management. I tell her to call both and let them decide who is going to handle it.
A surgeon (not even on the case) sitting there starts giving me heck about my call to call both. Goes on and on about inappropriate calls he recieves and this and that. I humor him, tell the new nurse to call whoever is listed as attending and even ask "Who would you suggest be called." He has no answer (:smokin:of course) but proceeds to rant on and on about how bad calling everyone is. So, I go on helping the new nurse, waiting to get orders to put into action for the pt. (which is now delayed because the surgeon is slowing us down badly) and he decides he is going to "see the pt".
He goes in the pt. room, talks to her for like........half a minute.........and comes out of the room and proceeds to go on and on about inappropriate calls. I finally tell him I've heard his point, I got it, I need to move on to the pt's care now. I'm done with the conversation. He doesn't like this of course. Starts asking me to get the Charge Nurse/supervisor for him........wants to argue with me. I keep telling him "I'm done with this conversation, please......move on". He doesnt want to hear it. I wanted to knock the guy out at this point.
So, he storms off the unit, makes it clear I am being reported. Nice. And a friend/colleague sitting near at the time tells me I'm disrespectful. Doh:eek:.
OMG, never thought I'd be in a position where I'd have to swing through physicians to get focused on a pt. who is near needing Rapid Response. Now..........I have seen EVERYTHING.
Best part is, this facility is looking for reasons to get rid of people. So yes, on my way home I realize I just gave them reason to. Not very smart on my part.
I just don't see how you were being disrespectful. From what you describe, you were trying to get the best care for the patient. I do understand the surgeon's frustration, but good grief, he didn't have a dog in the fight. What gave him the right to go off on you?
A lot of people might have just walked away at the end of the shift and let the new nurse deal with the situation. No good deed goes unpunished.
It sounds like your facility is a nightmare. And things do sound kind of iffy for your job security right now, especially if management is looking for excuses to get rid of staff. On the other hand, it's better to lose your job than to risk losing your license---which certainly could happen in an atmosphere like you describe.
I hope all turns out well for you in the end. I'm sorry this is happening to you.
Watched a general surgery attending have a hissy fit in front of a patient and family member just as I was coming on. She stormed out like the tasmanian devil, then there was silence as we 3 looked at each other, and the patient said she hoped "she wasn't acting like that doing my surgery, sheesh!" and rolled her eyes. Then they started to laugh, and so did I, couldn't help it. Later we pass in the hall, I do not say a word to her, just able to stop the wide grin. She acted so hormonal she lost the respect of the patient, and family too.
As I am told time and time again ...maybe it wasn't what you said, but the way you said it.
That was one thing I couldn't stand being on the floor, where I worked it was always what the doctor said. I remember there was one lady and her wound had gotten bigger. A lot bigger. I even measured it!(even though everyone that saw it, and said it looked even bigger) I had actual numbers to back me up! Docs' response: I can't be bothered with small things like that.
oh ok! Of course he was right and I was wrong.
Maybe its better this way. I have never been so relieved as when I left the floor, I lasted less than a year and went back to my old job with a nice raise and RN status and have never looked back. Maybe it'll be better to move on.
Our docs know better than to get nasty with us, because they'll catch heck from her if they do. Actually, most of our doctors are very nice-I think having teams helps, because they have our back at times(if one of us gets hurt for example or needs to be looked at) and we try to help them out.
PostOpPrincess, BSN, RN
2,211 Posts
Good for you for walking away.
However, he had a point too.
For the rapid response, you should notify the IM and let him defer to the closest IM resident. The surgeon does only surgical stuff and he should be notified later.
The doctor insisting his point, next time, just nod and smile and keep going he can't report you if you don't respond to him.
Knowing me, I would've just put up the "hand stop sign." my way of telling to stuff it.