Rude embarassing comment by midlevel

[amzyRN]

There was a midlevel provider that made a very rude comment to me in public and I'm wondering if I should report it or say something to the person. This is what happened. I was coming on to my shift and taking care of a chest pain patient. This person had been given nitrox3 with no effect. The resident taking care of the patient was also in and said the patient isn't responding to nitro, but hadn't told the cardiologist yet. They were going to take the patient for an angiogram that morning anyway to investigate. Anyway, the patient also had bradycardia so the last shift nurse said she was reluctant to give morphine or more nitro because she didn't want to decrease heart rate. The midlevel calls me in to the nursing station at the start of my shift and I've never worked with this person before. They ask why I haven't given nitro (I said because the patient hasn't had relief from nitro and I didn't want to decrease HR). I also said the patient was going for a cath today. I didn't know the midlevel was on the cardiology team. The midlevel looked at me and asked in front of everyone if it was my first day with a snide look on their face. I said does it seem that way and they said yes. They told me nitro doesn't affect HR (I should have know that and not taken the last nurses word for it, mistake) I probably should have known this person was on the team. The resident could have also called cardiology and said the patient wasn't responding to nitro. Anyway, the midlevel scolded me and ordered a nitro drip. Before this I had called the attending and asked about giving morphine regardless, and I gave the patient morphine with some relief. I start the nitro and they take the patient for the angio, they turn off the drip because the patient is not responding to nitro and it turns out the patient has no blockage. The chest pain isn't cardiac. Ever since then, I get nasty looks from this midlevel. Also, I've noticed I haven't been assigned many chest pain patients and that I've had very few of this midlevels patients. Do you think this midlevel told charge nurses they didn't want me on their cases? Also, should I talk to this person about the comment? I don't think I was that wrong in what I did, except not knowing nitro doesn't affect HR.

[SaoirseRN]

A better answer would have been, "I didn't give the nitro because the patient was not responding to it. Dr. Attending is aware, and I've given Xmg of morphine with some effect."

I don't agree with how the physician spoke to you, but you also need to explain what you have done, not just what you haven't.

As far as the other, I would speak about it to your charge nurse first before going higher. Ask if there is even an issue and go from there.

And next time you see that physician, say, "Good morning, Dr. So-n-So," smile, and pretend you didn't see the condescending look.

Edit: re-read, and should have said 'next time you see that midlevel'

[llg, PhD, RN]

Don't make a big deal of it. Yes, the mid-level did not behave nicely ... but then you did not communicate well at the start of the interaction. You both made mistakes. A good rule of thumb is: "Don't unnecessarily escalate an unpleasant situation -- especially when you are not blameless."

As the previous poster suggested, discretely find out whether the incident is hurting your career, assignments, etc. If so, then you may have to work on re-establishing your credibility. But if not, you would be picking at a wound that is best left alone.

[amzyRN]

I would like to ask my charge nurse about it but am afraid of being embarrassed all over again and if this mid-level didn't say anything then my charge nurse will know about it. I asked two other nurses about it, one of them heard the comment. She said I was doing fine and that I should just ignore it. I don't want to feel so weird every time I see this midlevel though because it really screwed with my confidence, so it is probably best to talk to one of the charge nurses. So should I for sure talk to the charge nurse? Would it be bad if they now know about the issue if they didn't before?

[SaoirseRN]

Ask the charge nurse. If there is an issue then she can hopefully help. If not, perhaps she'll even have good advice for you.

[PMFB-RN, RN]

By "midlevel" I assume you mean a PA and are not incorrectly calling an NP a "midlevel". Whatever they were they were a jerk to you and you shouldn't have tolerated it. You are just encouraging them to mistreat other nurses.

[HouTx, BSN, MSN, EdD]

Agree with PP. I have encountered quite a few PAs with a chip on their shoulder.. and tendency to insult nurses in public forums... maybe trying to prove themselves?

FWIW, nitro CAN indirectly affect heart rate ... drop in BP --> increase in HR --> increase in myocardial oxygen debt --> increased anginal pain (and so on). You were on the right track.

If the nasty PA is avoiding you, that's a positive outcome. FWIW, If the nasty behavior continues, I would address it in a one-on-one discussion. Be factual and ask why the PA feels it is necessary to insult you and impugn your ability in front of an audience. Bullies are attracted to soft, juicy targets. If you don't fit that picture they move on to someone else.

As PPs have advised, improving your communication skills in order to provide accurate & concise info to physicians will be a real asset, particularly in teaching hospital with so many medical students, interns, residents, etc.. floating around.

[amzyRN]

I've tried to talk to my charge nurse but every time I want to I feel like I might break down in tears and I don't want to be embarrassed at work, especial before I go onto my shift. I don't know why the comment bothered me so much but I want to talk to someone about it but don't want to get emotional. I guess I am really sensitive and it is so hard being a new nurse anyway to have someone say that to me was just crushing. I need to get over it I know. I don't want my coworkers to think I'm an idiot. Do you think a phone call would be okay instead.

[PMFB-RN, RN]

I've tried to talk to my charge nurse but every time I want to I feel like I might break down in tears and I don't want to be embarrassed at work, especial before I go onto my shift.

*** Well that is a real and legitimate concern.

I don't know why the comment bothered me so much but I want to talk to someone about it but don't want to get emotional. I guess I am really sensitive and it is so hard being a new nurse anyway to have someone say that to me was just crushing. I need to get over it I know.

*** Take this quote to heart.[h=1]“No one can make you feel inferior without your consent.”[/h]

― Eleanor Roosevelt

I don't want my coworkers to think I'm an idiot. Do you think a phone call would be okay instead.

*** Yes I can understand that feeling and you are right to be concerned. IMO the time to deal with inappropiate behavior is at the moment it occures.

[amzyRN]

I know it's better to do things in the moment but I was so stunned that I didn't know how to respond. I will call my charge tomorrow and hopefully this doesn't make things worse.

[nurseprnRN, BSN, RN]

Going back to the beginning, you really ought to have known that MS and sublingual NTG don't have much, if any, effect on heart rate and that the nurse that gave you report was wrong. You don't say when you came on shift, but "having a cath today" might have changed to "Get this guy down to the lab right now for an emergency procedure" if they had known he wasn't responding to NTG. Does your protocol call for stat EKG? Did he have one? Whether or not he was found to have had clean coronaries after The cath lab trip makes no difference in the decision to get him there in the first place, other data not included.

You might not have liked the comment, but you know what, it really wasn't about you. Get past that part and get on to the meat of the discussion, the patient assessment and treatment protocols and how well you know them.

Never assume that anyone else has done his/her job correctly if you know there's something wrong.

OK, so rookie mistakes. It happens. No harm done this time. Perhaps you're not seeing so many chest pain cases right now because they want to make sure you have a better grasp on how to assess them. Perhaps they're not assigning you so many patients from that team to spare you the hassles of dealing c that "midlevel*" for awhile until you are more confident. If you're really worried about it, ask your team leader or manager.

(* whatever the heck that is-- could you please specify next time? That term isn't universally used...)

[PMFB-RN, RN]

Going back to the beginning, you really ought to have known that MS and sublingual NTG don't have much, if any, effect on heart rate and that the nurse that gave you report was wrong. You don't say when you came on shift, but "having a cath today" might have changed to "Get this guy down to the lab right now for an emergency procedure" if they had known he wasn't responding to NTG. Does your protocol call for stat EKG? Did he have one? Whether or not he was found to have had clean coronaries after The cath lab trip makes no difference in the decision to get him there in the first place, other data not included.

)

*** Uh, no. It doesn't make the slightest difference what the nurse did, didn't, or should have known. There is no excuse for any provider to treat a nurse like that. The provider should be severely disciplined and, if they make a habit of creating a hostile work environment by bullying nurses, fired.