Verbal abuse by physicians in ICU

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:angryfire I have been in ICU for 4 years now, in 3 different hospitals. Never, have i EVER experienced or witnessed as much verbal abuse as I have since coming to this last hospital. I am a recent transplant from a much larger ICU where physicians truly respected the nurses' opinions....maybe 1 percent who didn't. now what i seem to be dealing with are dr's who don't respect me and who i don't respect in return. i hear other nurses getting screamed at over the phone and THEY TAKE IT!!! today was my first horrible experience, where the dr actually told me to "never bother him again". (the order was for him to place a CVC in a septic patient, he placed an 18gauge IV and wrote in his note "this will be sufficient". never attempted a CVP. I questioned him)

the nurses around me just said "oh, that's HIM." and i had the incident report in my hand ready to write him up.

i'm just venting. but any advice for how to deal with these docs would be appreciated. just please understand that it truly is the majority in this place. not just writing this because i had one bad experience. many of you would fall over if you saw this stuff these nurses take. i'm upset because you know how closely physicians and nurses have to work in the ICU setting.

thanks,

erinnRN

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Specializes in Utilization Management.

You have several choices.

You can ignore it.

You can write him up.

You can write him up via an Incident Report to Risk Management. After all, the patient is the one who could suffer (and later sue) from his refusal to either do the requested procedure or make a referral to another colleague.

You can c/o "workplace hostility."

You can make it a crusade by trying to talk to him--and all the docs--about the effects of poor caregiver communication on patient care. Ask for Risk Management, Management, and Nursing Management to be there, to name a few.

Or (my favorite)

You could move to a more nurse-friendly workplace, making sure you are explicit in your reason for leaving at your Exit Interview.

Above all, please understand that the nurse is far from powerless in these situations. It just comes down to which type of battle suits you, if at all.

Best wishes for a speedy & sane resolution to the problem.

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Specializes in ICU, step down, dialysis.

Hi ErinnRN, I just left a facility that I worked at for quite a few years, and was always amazed the entire time how badly the docs treated the nurses alot of the times. I had been a nurse for around seven years when I started there, and although I've had smart-*ss comments and such made to me, I had never been truly yelled at until I went there. Calling the house physician you were pretty much almost 100% of the time guaranteed to get an angry, snotty, condescending remark and demands on why you were calling them and not the attending. It was awful. Looking back, I really felt that every time I called I had a darn good reason and that it was never inappropriate at all, (I could see if I had called in the middle of the night about something dumb like a laxative, but all of the time it was something quite critical, like new AF with RVR, chest pain, desatting, hypotension, etc)but I still got this attitude. I also got it alot calling attendings anyways. Another bad tempered doc I had called about a patients BP in the 70's, got angry with me and his direct order was to "d/c the aline". He was furious with me....FOR WHAT??? It was just unbelieveable at times. Anywhere you go you will have some jerks, but this place was phenomenally bad in terms of how nasty they were when you called alot of them (not all of them were like that, of course). Many nurses there never worked anywhere else and thought this was the "norm". Whenever I would mention how bad the docs treated the nurses, I would always get weird looks from them.

I left and now work at a place where I don't hardly see this behavior at all, and it's wonderful. Not saying you need to leave, but I felt where I was, because everyone thought it was normal, there wasn't much chance of it ever changing it.

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This is absolutely excellent advice. :)

You have several choices.

You can ignore it.

You can write him up.

You can write him up via an Incident Report to Risk Management. After all, the patient is the one who could suffer (and later sue) from his refusal to either do the requested procedure or make a referral to another colleague.

You can c/o "workplace hostility."

You can make it a crusade by trying to talk to him--and all the docs--about the effects of poor caregiver communication on patient care. Ask for Risk Management, Management, and Nursing Management to be there, to name a few.

Or (my favorite)

You could move to a more nurse-friendly workplace, making sure you are explicit in your reason for leaving at your Exit Interview.

Above all, please understand that the nurse is far from powerless in these situations. It just comes down to which type of battle suits you, if at all.

Best wishes for a speedy & sane resolution to the problem.

Up Vote Up Vote ×
You have several choices.

You can ignore it.

You can write him up.

You can write him up via an Incident Report to Risk Management. After all, the patient is the one who could suffer (and later sue) from his refusal to either do the requested procedure or make a referral to another colleague.

You can c/o "workplace hostility."

You can make it a crusade by trying to talk to him--and all the docs--about the effects of poor caregiver communication on patient care. Ask for Risk Management, Management, and Nursing Management to be there, to name a few.

Or (my favorite)

You could move to a more nurse-friendly workplace, making sure you are explicit in your reason for leaving at your Exit Interview.

Above all, please understand that the nurse is far from powerless in these situations. It just comes down to which type of battle suits you, if at all.

Best wishes for a speedy & sane resolution to the problem.

Wow, what a great reply. I may print this one out & keep it with me for future help.

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Good options from Angie O'Plasty...it all depends on the amount of support in the environment and how much fight you have in ya.

Hasn't physician abuse been shown to be a key reason nurses leave the profession?

When nurses stick together and insist on management support, change can occur. One lone dissenter however may become a target so one must be cautious. ;)

When the time is ripe we CAN effect positive change in a unit with problems such as physician abuse. I've seen strong managers back their staff and succesfully discipline an abusive physician. I've also seen MD loving administrators (or the MD's themselves) totally ruin the nurse who dared speak up. And everything between.

I think many of the seasoned nurses here have worked somewhere where we've just had to move on, the toxic workplace is not worth it to us. If there is no support why beat your head against a wall.

What hurts most is the nurse focused blame:a new nurse is bawled out undeservedly, she talks to her peers and hear "Well he does this to other nurses but NOT ME." which insinuates the problem is with the NURSE. Sad when we don't back each other up with abuse in the workplace. :(

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We nurses MUST stick up for ourselves AND each other! I don't care who you are or what hospital you work in, if you are a nurse or a physician, you are an ADULT LICENSED PROFESSIONAL. period. Do whatever it takes to bring change to this behavior, do not tolerate it. Let management know FACTS, in writing, and keep a copy for yourself. Support your co-workers! If I witness a physician badgering a co-worker--I grab a few other nurses and physically stand behind her. It has worked every single time. I think Dr. Jerk got the hint that we outnumbered him, 4 to 1. :) He shut right up. I also had a doc tell me on the phone "I don't care what happens, don't call me again." Of course, I wrote that as an official verbal order on the bottom of a half-full order sheet. He came in, saw the orders, and went to tear the page out but couldn't because it had other orders on it. He's been a peach since.

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I usually just tell angry/snotty mds that if they want, I will be happy to take it outside. Usually shuts them up quite fast (weighing in at 220 pounds usually have that effect).

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It's really unfortunate that there are people out there whose lives are so miserable that they find it necessary to yell at others to make themselves feel better...although I think misery is one of the cornerstones of being an MD. Some of them just seem to deal with it better than others.

I second what others have said, but would add a few things.

First and probably most importantly, really watch your tone when you're interacting in this situation. Don't ever raise your voice or allow your anger or agitation to be apparent. Remain calm and plesant at all times. This can be really difficult, but is worth the effort since it keeps you from stooping to their level. It usually either helps to calm them down, or pisses them off even more, both of which I find enjoyable.

Second (and someone already said this), write their little snide comments as verbal orders where appropriate. Especally when they say NOT to do something, it needs to be doccumented and there is no better place than the orders. Good idea to do it on a page with orders already on it!

If an MD refuses to act in a certain situation and you believe that this is puting the pt at risk, it is imparitive that you call your medical director. The other day we had a MD admit a pt at 2am but refuse to come in and see the pt. who was in a bad way and needed an MD at the bedside. We got our med director (who is luckily very nice) out of bed, and I think that probably got the admitting MD in a bit of hot water...hehehe.

Finally, if you're on the phone with someone who is yelling at you, just hang up. Call them back in 5 minutes and ask if they're ready to be professional. I like to remind them that I don't particuarly like waking people up at 4am, but am just trying to do my job. Remember that MDs often get called a lot at night, different floors and hospitals. I imagine it would suck badly, but still that's no excuse to be unreasonable. If am MD is yelling at you in person, I'd try and break in and tell them that their behavior is unacceptable and will not be tolerated...or just walk away.

Of course, this is all assuming that you didn't mess up and deserve a good lashing!

It's also important to support your more timid co-workers when they're on the recieving end of things.

Good luck!

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Specializes in Neonatal ICU.

If there is anything that I have learned about being on the receiving end of poor behavior, it is: if you DO NOT allow it happen...stand up for yourself... don't put up with it, and TALK BACK...they will (99% of the time), BACK OFF AND NEVER TREAT YOU LIKE THAT AGAIN. That person treats you poorly because they think they can get away with it. If you show them that won't happen with you, they will know better next time. Believe me, I have been in this situation. It took so much reaching deep down inside me to pull out some assertiveness the first time it happened but there was an MD being downright MEAN to me, in front of a patient's family-no less, and I got my guts together and told myself-WHO DOES HE THINK HE IS???!!! :angryfire I AM NOT GOING TO PUT UP WITH THIS...then WHAMMO! Out came my inner strength and I told him where to go. Now he did not back down right away, but neither did I...and guess what? That was 4 years ago and he has been sugary sweet nice to me ever since. Shortly after our "fight" he profusely apologized over and over again. Nowadays - even if he is in a rotten mood to everyone else - HE'S NOT TO ME!! And guess what, the next time I ran into a rude and obnoxious MD, it didn't take so much reaching deep down inside, the assertiveness was right there.

On a side note, when the first incident happened, another nurse said, "oh, I wouldn't have argued back. I just ignore that behavior". So that made me feel like maybe I shouldn't have fought back. I second guessed myself over and over. :uhoh21: Finally I came to the realization that NO! SHE is wrong! Why should I let someone treat me like that? It is NOT OK to go around treating people like scum, I don't care who you are...so my advice is, stand up for yourself - you do not deserve that and you will be grateful & proud that you did in the end. :yeah:

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It's really unfortunate that there are people out there whose lives are so miserable that they find it necessary to yell at others to make themselves feel better...although I think misery is one of the cornerstones of being an MD. Some of them just seem to deal with it better than others.

I second what others have said, but would add a few things.

First and probably most importantly, really watch your tone when you're interacting in this situation. Don't ever raise your voice or allow your anger or agitation to be apparent. Remain calm and plesant at all times. This can be really difficult, but is worth the effort since it keeps you from stooping to their level. It usually either helps to calm them down, or pisses them off even more, both of which I find enjoyable.

Second (and someone already said this), write their little snide comments as verbal orders where appropriate. Especally when they say NOT to do something, it needs to be doccumented and there is no better place than the orders. Good idea to do it on a page with orders already on it!

If an MD refuses to act in a certain situation and you believe that this is puting the pt at risk, it is imparitive that you call your medical director. The other day we had a MD admit a pt at 2am but refuse to come in and see the pt. who was in a bad way and needed an MD at the bedside. We got our med director (who is luckily very nice) out of bed, and I think that probably got the admitting MD in a bit of hot water...hehehe.

Finally, if you're on the phone with someone who is yelling at you, just hang up. Call them back in 5 minutes and ask if they're ready to be professional. I like to remind them that I don't particuarly like waking people up at 4am, but am just trying to do my job. Remember that MDs often get called a lot at night, different floors and hospitals. I imagine it would suck badly, but still that's no excuse to be unreasonable. If am MD is yelling at you in person, I'd try and break in and tell them that their behavior is unacceptable and will not be tolerated...or just walk away.

Of course, this is all assuming that you didn't mess up and deserve a good lashing!

It's also important to support your more timid co-workers when they're on the recieving end of things.

Good luck!

No...even when you "mess up" say, overlook a lab that needed to be drawn or forget to total out an I&O, they should still not give you a "lashing". We nurses are not perfect. If a lab wasn't drawn, they can ask where it is...you say "Oh, it's not in the computer, sorry...guess it was overlooked" and they could say.."Could you please draw it now?" Wasn't that easy? Problem solved. No need for the doc to act like a nurse is moron when she probably already feels like one for overlooking an order.

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I work in a very similar enviroment to what you described. A nurse who moved here recently says "the staff & physicians here have had a dysfunctional relationship for so long that is now accepted, normal behavior." I found a conflict resolution class very helpful, I did not know that the hospital has a policy of no tolerance for bevavior that violates their "Code of Conduct." Even when I have not been able to reslove the conflict in the moment, I have used the lines of communication estabilshed in the policy with success. Your institution may have a similar policy. Good luck to us all!

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