Relationships with Docs

[shirleyTX]

I was reading about how nasty some docs can be, I myself cant say much because I'm only a second semester nursing student and haven't seen much of anything yet. But the question is for the ICU nurses. Does it differ -is it about the same worse or better. I feel since ICU nurses have probley a closer relationship with docs it might be different.

[Friesw/that]

i find pediatric docs have the most patience, and willing to answer "stupid" questions--

they'd rather you ask, than pretend to know

i find cardiac surgeons, ok ANY surgeon ARROGANT, and difficult to approach(i guess they are so tired by the time i see them)

i work in a medical center, so no worries about calling someone at home to wake them--they are usually in the next room...

you must be confident in your abilities/knowledge---predators try to get the wounded animal first...

[Meressa]

I used to work in a 15-bed SICU where we also took all the CABG/valve/AAA surgeries. This was my very first job right out of nursing school, so I remember all too well how the CV surgeons in particular could make you feel. But, I caught on real quick after that first surgeon made me cry. Eventually, I promoted to a Preceptor and then Case Manager. I always taught my new grads, in particular, one big thing. NEVER let them see you cry, no matter how they might upset you. Once you do this, you are seen as weak and it takes a lot longer time to get them to realize that you DO know what you are doing and can be trusted with their patients. However, if you stand up for yourself & keep your patient's needs as top priority (and yes, it can be done tactfully in most cases), they tend to learn to respect you and your skills.

Despite that horrible first few months with those CV surgeons, a year later I would actually even have them call from the OR and ask who the nurse assigned was for a patient they were sending me who was unstable, etc. (when they had seen new faces on the Unit). In cases like this, I always at least made sure a seasoned RN was there to help out a newer nurse. While I do NOT think this is appropriate at all for them to be allowed to choose their nurse & I often resented my Manager allowing it, even if at times it was eventually me they wanted with their patient, I do think it ties into how you approach them. From our end, that is all we can control. We cannot control how they behave in response.

Now, I am a seasoned RN myself, but the newcomer at my new position on a 20-bed ICU. Most of my first few weeks here were just standing back & listening to how the other nurses approached the pulmonologists we deal with every day. Now, I know exactly how I can approach each one & only 6 months later, I have a pretty good relationship with each of them.

One you can easily say, "Dr. X, his urine output has only been 40 ccs in the past 3 hours and his lungs sound really wet this morning. His K+ is 3.6. Would you like me to diuresis him & give a few runs of K+?" You quickly get dose orders for both generally.

Another you have to say, "Dr. G, his urine output was 40 ccs for the past 3 hours. His lungs are coorifice throughout. I am suctioning out large amts of white foamy secretions, and his K+ level at 6AM was 3.6." and then STOP & wait for his response. This is the doc that you can get along quite well with IF you remember that he does NOT like to have treatments suggested to him. And, if you do suggest treatment, he will likely do something very different than what you had asked for .

It is all about learning your doctors I guess is what I am trying to say. Listen and learn what they want/need to hear from you. Some will very much appreciate your knowledge and skills. Some will appreciate what you tell them, but insist on letting you know THEY call the shots. But, every single one of them, regardless of specialty, will have to be SHOWN in time that you can be trusted. So, new grads, hang in there. It does get better, I promise.

[LT Dave]

You will love my Theory! I am a male nurse and noticed I do get along better with male docs. My bet is that they will not raise thier voice at other men because there is the "violence" factor at work. When two male at together and arguing there is always to potential for violence, some guy may pop the other in the mouth. This is why men are on guard when dealing with threats. I know as a man if I had a real heat argument the worst thing that will happen with a woman is she will call me an a$$ and that is the end. Its very different with another male; the potential always exists.

[zambezi, BSN, RN]

I really enjoy the docs that I work with--they definately have their bad days (and nights) but who doesn't? If they are outright rude though, they usually hear about it and say their sorry--our NM brought one of our docs into her office and asked him what he though the nursing staff thought of him...well, his answer was wrong (he though everyone liked him....) and she make him write a letter to the staff...it worked, he still has a temper in stressul situations but has gotten much better and apoligizes later if he crosses the line...I am pretty friendly with most of the docs...as with my other coworkers, I make a point to be nice and usually ask how their families/vacations, etc are...It is just normal chitchat...If I have to call them, I make sure that I have all of my ducks in a row before I call, I know what I want, and I have learned out to ask for it depending on the doc. Most of the docs that I work with don't tolerate not being ready when you have to call them...In return, they usually trust our opinions and respect what we do...Incidentally, as a student, I felt that ICU nurses got more respect than floor nurses (right or wrong, it was an observation that I made) and I will admit that it did play a small part in my decision to persue critical care after school.