Surgeons - ugh!

[Melanin]

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?

[JKL33]

18 hours ago, Elaken said:

Or the fact that nurses learn *so* much on the job and it is unfair to expect a 2 year nurse to know X and Z are pointless updates but by year 5 she will know it.

I don’t think doctors realize how much we have to just pick up as we go [...]

You're making my point. You have given a reason/excuse that, from any perspective other than a nurse's, is not really very acceptable, but you still think your perspective is important. My whole point was that other people have perspectives, too. And I am asking if nurses should be reported as a first step, rather than having their perspective taken into consideration. That is all.

8 hours ago, subee said:

It's a very stressful job and while all of the other interns and residents were growing up , they were busy brown nosing,

And not being allowed to make excuses.

14 hours ago, Melanin said:

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.

More information is good, even though the discussion about irrelevant questions was in response to the idea that we should report people regardless of our shortcomings or their perspectives.

But with regard to your umbrage about apparent stereotypes, the title of your post is "Surgeons - ugh!"

Either address the issue or don't. If the problem people are the owners/partners, decide whether that's the kind of boss you want and whether you think you can develop a working professional relationship. If you want to try then talk to him/her/them, then do it. If you don't want to, leave. If this practice is part of a large organization, talk to your upline. Or the office manager.

There are many ways to get a break with people like this, the specific approach is based on the specific situation and people. Working steadily on a professional rapport is usually successful and I've very rarely encountered anything like what you are describing. When I have, I say something like, "Do not speak to me that way. We have the same exact goal, which is to do this properly."

In your specific example, I would have wasted neither time nor breath in my initial approach: "X pharmacy can compound as follows [hand over scratch paper with showing their proposed ingredients and ratios] - is that acceptable or not?"

If they said "I don't care!!" I would have said, "Do you want me to stop pursuing it?" If they said, "Just make a &*(## decision!!!!" I would have said, "No, I will not. Either you want to interact about this or you don't. If you don't, I am dropping it. If you do, then interact appropriately."

I'll grant you it doesn't sound like a very pleasant environment.

You can either try a few things or you can move on.

[FolksBtrippin, BSN, RN]

15 hours ago, Melanin said:

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!

You are a good nurse with excellent problem solving. The doc is an ***. Of course we can all empathize with how busy he is and blah, blah, blah. But he's an ***. It's an occupational hazard of becoming a surgeon. You can get a big head with all the boot licking and become an ***, because you'll rarely be confronted.

Sorry you had to deal with that.

Keep on being a great nurse, even if you have to go somewhere else.

[JKL33]

16 minutes ago, FolksBtrippin said:

If you are not accusing the OP of stupidity or inappropriateness then why bring this up here?

Simple: Because it was in direct reply to your reporting suggestion, and I don't agree that reporting people is the only or the best solution as a usual first step, and the reason I don't think it is a best approach is because it doesn't represent the same kind of consideration that nurses expect and benefit from despite our own shortcomings.

[Melanin]

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.

[FolksBtrippin, BSN, RN]

Deleted.

[rn&run]

You sound like a very reasonable employee and advocate - both for your patients, and the surgeons whom you [are trying to] support.

I'm totally biased -- this kind of behavior from surgeons is exactly why I left the OR. I understand they are under extreme stress, but I prefer colleagues with more highly evolved 'people' skills. I've found that urgent-care/family practice is a much better fit for me. There are still plenty of opportunities for triage, patient-education, procedures, and professional development. And a lot less power-playing *********

[Melanin]

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. ?

[maryellen12]

Wow. And sour lemon got 8 thumbs up??

The surgeons attitude is a risk to the health of his patients. His behaviour reflects his ignorance. https://www.npr.org/sections/health-shots/2019/06/19/734044306/when-surgeons-are-abrasive-to-coworkers-patients-health-may-sufferhat a prat.

Teamwork is crucial and all members of the team need and deserve to be treated with complete respect.

He should have taken a moment to listen and explain.

[Sour Lemon]

1 hour ago, maryellen12 said:

Wow. And sour lemon got 8 thumbs up??

Right?? Should have been at least double that!! ??

[dlhrgah, ADN, BSN, MSN]

Melanin, though I read a lot of the comments, I didn't read through them all, so hopefully, I'm not repeating something you've already heard. As an RN myself, ADN, then BSN, & now in midwifery school, I've encountered that, "I think I'm better than you" attitude & it's absolutely ridiculous & you do not have to tolerate it. Before getting my BSN, I hadn't long started at a new hospital (I'm a L&D Nurse) when I encountered a CRNA (older gentleman) who totally degraded the nurse who was orienting me right in front of the patient, which for me, made us both look, well stupid to the patient we were going to be caring for. So, I asked her to speak to him about is unprofessional behavior & she advised me that it wasn't a good idea because he would make our lives miserable. I went to the floor supervisor to inform her that I was going to go talk to the CRNA & wanted her to know about it in advance. Notice, I didn't go to her for permission, as we are grown adults that don't need permission to speak to other colleagues. I went right up to him, introduced myself & politely told him that I was a registered nurse who worked hard to earn my degree & that if he wanted to be respected for the degree he worked hard for then he needed to show that same respect to others & kindly advised him to never speak to us like that again, especially in front of a patient. He huffed at me & I simply walked away & then for the next month I just killed him with kindness & he finally caved & we had such a great working relationship after that. He would even occasionally give me a hug. It was great! So, my advice. Have a respectful conversation with those providers who do need to realize that they are being unprofessional & rude & that no staff deserves to be treated with such disrespect & if they want things done a certain way, then they should contribute to updating or creating preference cards that staff can look at & follow. Good luck & God Bless.

[kp2016]

On 8/30/2019 at 5:22 AM, Melanin said:

I have worked in this clinic for about 10 months now. Will it ever get better?

It is very unlikely to get any better. If the Surgeons are the type that think nurses should be seen and not heard that won’t change. (I’ve worked ED, OR, PACU and Specialty Clinics)

Over the years I’ve worked with Doctors who absolutely would not listen to anything said by any RN. I’ve also worked with amazing doctors who would happily give orders for drugs / treatments i’d already initiated or try something because I suggested it as an option.

You’ve made it to 10 months. I’d hang on for 2 more then start applying for something else. There are plenty of doctors/ units out there that actually value nurses and understand that we can make value contributions when given an opportunity.

[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.