for the first time yesterday i was yelled at by a doc. i have been "waiting" for this day because i was really worried about how i would end up responding, but i am so proud of myself for not losing it. i am, however, so upset about the situation...
i had a pt being d/c'd to home, 88y/o, confused at times, difficult to communicate with. she was on bedrest for 1 wk, could not even turn on her own. when her daughter got to the unit i asked if pt had been ambulatory prior to hospitalization. yes, with a cane. i asked about her home/care...(stairs, does daughter have help, etc...). anyway, myself and pct get pt oob w/ walker to a chair. obviously very difficult for pt to even walk 2 feet. daughter looks nervous. :uhoh21: i ask if she thinks she would be able to care for her mom at home. no. tell daughter i can call md and ask for mom to transfered to snf for pt/ot. daughter wants that. well, md happens to be on the unit d/c'ing another of my pts. i go to md and barely start to explain situation...and she flips out!!
"why are you telling me this last minute when pt is supposed to be d/c'd?"
"you don't think the pt is appropriate for d/c...then hold d/c!"
"i came here in-between pts at my clinic to only see this other pt and you harass me...you have been harassing me all day...you called my office 4 times."
(me) "no, i did not, i called once." (her) "you called 4 times." (me) "no, i didn't, i called once." that went back and forth about 4 times. i had called her office once b/c the other pt was going to go ama and she called me 4 times to ask if pt was still there and to update me on when she would get to the unit.
anyway, she grabs my id and says she is going to write me up and blah, blah, blah. she leaves the unit, charge rn comes to ask me what happened and as i am telling her md starts coming down hallway again...yells at me to hold d/c, walks up to charge and yells at her to hold d/c and leaves again. now, case manager is telling me pt has to be d/c'd and i need to call and get order for transfer to snf as a rep is on the unit saying they can take pt today. also, for other pt, md wrote no rx after writing to continue new meds. charge rn pages md x2 with no return call. i call her office and receptionist says she is with pts, is it ok if other md calls me back...yes...please!!
so, other md calls back, i explain about the pt and how deconditioned she is and that daughter (although for the last wk has been saying she wants mom home) states she cannot care for mom at home and she would like for her to go to rehab first. md (who is obviously not aware of what had happened) is happy daughter decided that and says, "of course, that is perfect."
fast forward 2 hrs..... "mean md" calls me to yell at me some more. :angryfire she is saying that she should have been aware long before d/c that pt is deconditioned (duh...you are the md) and that it is my responsibility as a nurse to make her aware...which i respond that i had only had this pt this 1 day and until i talked to daughter did not know her pre-hospital condition. she then says that pt has been ordered the first day pt arrived, and why had i not done my job and followed though on the orders. i flip through chart and tell her there is no order for pt for pt and again, if there had been i only had this pt this 1 day! she keeps telling me how wrong i was and keeps asking, "do you see why i am so upset?" to which i respond, "no, i do not. i am sorry you perceive this situation the way you do, however, i feel like i was a great advocate for my pt, was being proactive and i do not understand how you do not see that." she tells me what a nice doc she is and how i am the only nurse she has ever yelled at (this is where i realize not only is she a *itch, but a delusional one at that)and she is so upset at me for causing her to get so upset and how unprofessional i am..... i tell her i am done speaking about it, i know i did nothing wrong, if she has anything else, call my manager as she is already aware of the situation. to which she replies she absolutely will.
:angryfire:angryfire:angryfire i am just sooo annoyed/mad/disappointed. there are things i wish i would've said, but am so proud of myself for remaining calm and professional, as i have a tendancy to say what i think w/out thinking about what i'm saying!! i know i did nothing wrong and only made sure my pt was safe. i feel really good about the outcome for the pt/family. i just do not understand why something so simple had to be such so stressful and upsetting.
that's what kills me about (some) doctors. yes, i know you have a bajillion more years of school than i. yes, i know you ultimately are in charge of the pt's care. however, there is a certain level of respect and courtesy that is due all human beings, regardless of their job title, junior league membership status, bank account balance, etc. it's when they get in better-than-you status that gets me. (i don't think it's right saying they think they are God because God isn't like that...He's SOOOOO much better than they!).
Despite the delusional state this doc was in, you have every right to repeat the information until this thick skulled fool got the message. One would think that a candidate for medical school education would require at least average intelligence. It is in no way acceptable to allow someone to pin their own obvious shortcomings on anyone else. One must own their behaviors and shortcomings. As you may have guessed, making someone a scapegoat is a MAJOR pet peeve of mine.
I'm not trying to argue with you on the point, but just wanted to clarify my thoughts on that. My thinking is that when they are acting like a child, as she was, then they are not listening to what you are saying. They have their mind made up. So it is pointless, and a waste of breath. They don't hear you anyway.
And I can imagine what a patient or visitor walking by seeing this would think. And also, even if she did call 4 times, that's okay. If her patient needs the doctor, and the nurse should call as often as needed. To me, arguing about how many times she called just seems pointless and a not as important as the rest of the converstation. Kinda of a pick your battle kinda thing.
Specializes in Education, Acute, Med/Surg, Tele, etc.
Oh yes, and btw...hopefully this thought will help you now or in the future. You did your fellow nurses an honor by being professional and sticking up for your patient, staff and yourself. Think about how many other people didn't...and where that put you?
From another nurse in this world THANK YOU! It may not seem like it now...but you may have just helped rid the healthcare industry of yet another persons bad work ethics and practice...
I'm not trying to argue with you on the point, but just wanted to clarify my thoughts on that. My thinking is that when they are acting like a child, as she was, then they are not listening to what you are saying. They have their mind made up. So it is pointless, and a waste of breath. They don't hear you anyway.
And I can imagine what a patient or visitor walking by seeing this would think. And also, even if she did call 4 times, that's okay. If her patient needs the doctor, and the nurse should call as often as needed. To me, arguing about how many times she called just seems pointless and a not as important as the rest of the converstation. Kinda of a pick your battle kinda thing.
I agree...it is childish. This was at the start, when I was still in "shock" that I was getting reamed for something I shouldn't be. Admittedly I am (at times) stubborn and prefer to have the last word WHEN I KNOW I AM RIGHT. I will also admit my mistakes/faults. So, it kinda evens out !! I know in my head at the time I was thinking "I am not going to be told I did something I did not do."
I agree...it is childish. This was at the start, when I was still in "shock" that I was getting reamed for something I shouldn't be. Admittedly I am (at times) stubborn and prefer to have the last word WHEN I KNOW I AM RIGHT. I will also admit my mistakes/faults. So, it kinda evens out !! I know in my head at the time I was thinking "I am not going to be told I did something I did not do."
I still think you handled it great. I hope your DON does something about it!
Having your manager verbally aware is fine. You did a good job handling the situation as it was occurring. Now you need to put it all in writing. A copy to your nurse manager, a copy to the medical director of the hospital and a copy to the physician. If you are part of a union, contact your shop steward and find out who you need to copy in the union on this letter. Make sure they all know about it.
Sounds like this doctor was freaking out because she didn't know about the patient's deconditioned state and was taking her miss out on you - the available staff member. That is inexcusable. *You* are the employee of the facility - the doc is a contracted private practioner. The facility *should* be standing behind you - your manager should have nipped this in the bud as it was happening. Now you need to ensure that this doesn't happen again.
So did the patient go to a SNF?
While there is NO EXCUSE for that doctor pitching a fit like a three year old, I agree that the MD should have been made aware of this patient's condition while discharge planning, but has this physician been sending residents to see the patient? Did the patient put on the "everything's wonderful Dr. Sunshine, I feel great!" when she popped her head in for the three minutes per day the docs get when they round on patients, as she has her hand on her call light the instant the doc leaves for you to help her move her leg three inches? I have a feeling that there is a lot at play here. More than likely this is a huge hospital based, medicare funded practice where the docs take on way too many patients to possibly be safe.
i know i did nothing wrong and only made sure my pt was safe. i feel really good about the outcome for the pt/family. i just do not understand why something so simple had to be such so stressful and upsetting. 
hbgwan, LPN, LVN
236 Posts
that's what kills me about (some) doctors. yes, i know you have a bajillion more years of school than i. yes, i know you ultimately are in charge of the pt's care. however, there is a certain level of respect and courtesy that is due all human beings, regardless of their job title, junior league membership status, bank account balance, etc. it's when they get in better-than-you status that gets me. (i don't think it's right saying they think they are God because God isn't like that...He's SOOOOO much better than they!).