Melanin

That's what I was thinking - wait for a year (or maybe two) and then look elsewhere. It would be nice to leave this behind me because even if the new place was short-staffed and crazy, if the MDs behaved as though we were on the same team it'd make a huge difference.

Whoah whoah whoah- I very much appreciate the strong, kind wisdom and concern, but I am NOT suicidal! I was talking about how stress shortens our lives. Thank you very much for supporting me, you awesome nurses. I may well try family practice next. ?

I don't think reporting people is a good first step, either. At my practice, the surgeons have made a practice of reporting the RNs directly to our manager who then passes their complaints along to the RNs every week at our meeting. Some complaints are fully or partially legit, and we work on those. But it's hard not to get discouraged because a good portion of those complaints are, upon further investigation, unjustified (the RN did not call my patient, the RN did not respond in a timely manner, etc) and based on assumptions about our work rather than what the documentation shows and/or what actually took place. Our manager has asked the surgeons if they would please complain directly to the individual RNs when they have a concern, but the surgeons responded that this would be too time-consuming for them. Part of the problem is that everyone is so pressed for time that there is no room for anyone to evaluate and tend to the nature of our work or improving systems. I work at a great place with brilliant people, in a unique and fascinating subspecialty. Unfortunately the culture, as it stands, has resulted in a high RN turnover rate, which only adds to the ongoing tension because it is extremely difficult to find an ambulatory RN with prior experience in this particular subspecialty who is looking for a job in the weeks that we have an opening. So they wind up having to hire someone like myself, an RN-MSN with a great track record and lots of inpatient experience in tangentially related fields who still has a lot to learn about the specialty AND about the various preferences of a rather large number of surgeons.

Ha ha, that explains a lot. It looks like you have some experience. I'm pretty new (5 years now, second career). Thank you!

Ok, I should probably explain myself better in regards to the "I don't care" thing, since I don't want people to assume that I fit neatly into the (apparent) stereotype of the RN who asks a million irrelevant & stupid questions - at least, not in this case. In THIS case, the pharmacy that compounded a medication - the precise formulation of which was created and approved by a venerated surgeon who retired from our department - informed us that in two weeks they would no longer make it for us. The doctors who regularly prescribe this treatment were quite upset to hear this and even called the pharmacy to try to talk them out of discontinuing, to no avail. So I took on the task of finding a new source for that medication. I found 2 new compounding pharmacies willing to make the exact formulation for us, but at a much higher price (not covered by insurance, so out-of-pocket for patient). I did, however, find a third pharmacy who had their own version of this medication at a very reasonable price. It was a similar formulation but with one different ingredient and with a somewhat different ratio of ingredients. Since I am an RN, I didn't feel comfortable making the call on whether it would be okay to substitute a different formulation. That is why I approached an MD to ask for an opinion on the affordable option - I was preparing a written proposal for the MDs to review and discuss so that I could have the medication available prior to the two-week deadline I had been given. The MD I approached is an expert in the subspecialty that uses the medication. I did not ask him to explain how the medication works, or chat about my interest in the medication, or propose my own ideas for how to use it; I simply asked - or tried to - if the MD could weigh in on whether the affordable version was a viable substitute. Thanks!

I sometimes do that if the patient has an upcoming appointment within the next few days, that's for sure! It's a bit of a Catch-22, because the surgeons don't want us to pester them with questions they think we should be able to answer, but they can also be very territorial or particular about what we should or should not advise. I'm hoping that with time I'll figure out what the various providers want, but each one is different and there's so much friction.

Maybe I don't understand it either. . . basically, we field all phone calls and messages from patients and if it seems like the patient's complaints warrant a visit or trip to the ED we send them on. But we also provide a lot of advice and anxiety management to patients who don't need to be seen right away, so if for instance a post-op patient writes to ask what, in addition to taking pain medications, they can do for their post-op pain, instead of bothering the doctor with this we might advise the patient to elevate, or limit certain activity levels, or try certain techniques that can help. Basically, we try to take care of as many patient needs that we can in between office visits or else get them in sooner if warranted to help minimize the provider workload whenever possible. But we also room patients, clean rooms, provide instruments, assist with procedures, secure appointments for diagnostic tests, and a lot of other things. So for instance: increasing fluid intake, ambulating, eating more fiber, and trying an OTC medication recommended by their pharmacist for post-op constipation might not be written down in the surgeon's AVS, but a surgeon would be pretty irritated if I asked them to advise the patient on how to manage their constipation - am I influencing the plan of care when I do that? I'm not sure. . .

I hope that made sense. I am a triage nurse who works in an outpatient clinic with providers who provide numerous interventions, including surgeries. I don't work in the operating room.

I work in an ambulatory setting in a specialty where patients come in for treatment. Sometimes the patient needs surgery. Sometimes over the course of the years they need repeat surgeries. Sometimes the patient needs to try medications for a while to see if the problem can be solved or at least managed without surgery. Sometimes over the course of months or years their disease progresses to a point where surgery is the only option. Sometimes the patient must decide whether they can live with their symptoms or whether they would choose to have surgery. All of our providers are surgeons. If the patient has surgery I triage them prior to and after surgery.

While I know that they are busy and I admit that reading the room isn’t my greatest talent, I do know that I am not chatty and I have been told that I need to be more forward and ask more questions. Although now that you mention it, maybe I could have kept my input to myself regarding the patient experience perspective because maybe a surgeon will never see the value of that perspective in the grander scheme of repairing people. But at the same time, I wish my contributions were at the very least tolerated. My coworker, who is on the opposite end of the spectrum (extravert) gets treated similarly. I can’t figure out how to bridge the gap. I hope my personality isn’t the problem, but I’d be willing to work on this if it would help. It’s so hard to figure this out when the surgeons don’t seem to want to interact. Plus there are occasions when I have no choice but to ask a question.

I work in ambulatory with surgeons, and I have been told that the RNs should not venture so far as to recommend conservative pain relief strategies such as icing or warm compresses because we are practicing "out of our scope." I have approached a surgeon to ask his opinion about a new formulation for a very specialized & frequently prescribed medication that the surgeons needed and in the middle of my first sentence he cut me off by yelling "I don't care." I've had a surgeon literally turn his back to me and begin speaking to another provider as soon as I started contributing to a discussion about the experiences of a certain population of patients who I triage all day and who provide their own perspective of what they experience in terms of a very specific and subjective condition. No matter what I do or say, they think I am a complete imbecile. They want me to shut up and fax stuff. I try not to care about this every single minute of every day. I tell myself that it doesn't matter what they think, since I am not doing anything terrible or dangerous. But every single day I also consider whether I can go on like this. I wonder if this is even healthy - maybe the stress of all this is shortening my life span. Why should I kill myself for a surgeon? Even if I love what I am learning with all my heart and brain, I wonder if I should just go back to being poor and yet treated with decency and respect. I don't know what to do. I have worked in this clinic for about 10 months now. Will it ever get better?

Understood. But like I mentioned, if I review charts before clocking in, as has been my habit, I have been warned by other RNs - some in a kind way, some in a sort of "if you don't get off my computer, you'll regret it" way - that I could get fired for a HIPPA violation, should one of them decide to report me for doing so. Sot it all comes down to time management during the shift. Time management is a catch phrase that comes up a lot when the staff is extra busy, such as when we're short-staffed. My own opinion is that little changes in processes and procedures could also go a long way towards helping RNs with this time management problem.

That sounds like a great system! It would help so much!

True! One barrier I run into is that we're expected to start the shift by taking report at 0700 so that the night shift can leave by 0730 - which seems like plenty of time, but there's a lot going on sometimes. . . From 0730-0800 we start passing the 0800 meds, and around that time the lab results from the night shift start rolling in & we check the vitals entered by the CNAs and fill out all of the sepsis reports and look at all the blood sugar results. So if anyone wants a PRN or has to go to the bathroom or has low blood sugar or has an am procedure & we have to help with the transfer, our time is pretty squeezed (though yes, when there's a high-alert medication we should MAKE time). I've made a habit of showing up prior to my shift to review the orders before I clock in (since, as I said, we're not allowed to punch in/out late or early). However, a few of the night RNs have expressed anger that I am taking up space at a computer at the nursing station ("you're sitting at MY computer," is what they say), and more than one has warned me that I could be reported for a HIPPA violation, so I'm wondering if this is an unsafe approach (for me personally, not for the patient).

That's a very good question. I wonder if we could have a certain allotted time in the am to examine all the contingency orders and get the straight, rather than being expected to pick them up on the fly. That is, I don't regularly have enough time during my shift to examine all the orders because as soon as I clock in, I have to RUN to keep up with the antibiotics and assists to the commode and pain med requests and bad IVs and CT consents, etc. Also, we have to hunt for contingency orders, which could be on the active orders page, or written in small print on the PRN mar, or else written in on the scheduled medication MAR. Hunting for parameters can be rough when you're dealing with an unfamiliar medication, or with an MD with their own preferences (some say transfuse for hemoglobin