Would you seriously consider quitting nursing

[UM Review RN]

if you were treated badly--yelled at, disrespected, verbally abused--by the doctors you work with?

How does this treatment affect you? Does it affect patient care?

[MandyInMS]

I am seriously quitting bedside nursing for many reasons but it boils down to one simple point:

I can't be the nurse I entered the profession to be.

Too many many constraints on my time at the bedside due to increasing paperwork (despite computerization of charting and med administration)----and too much verbal and passive-aggressive abuse from some physicians and certain coworkers----well, ya know what, it adds up to quite a bit of frustration and a block to my being the nurse I intended to. I am seriously considering my options nowadays. And very sad about this, as I truly love nursing..................

the way it should be, anyhow.

Totally agree..I was saying just last night how I HATE working my orifice off and still feeling like I should have done more..feeling like I did my best but it was still half-rate..due to understaffing,paperwork,demanding pts/families...I USED to feel like I was top-notch..these days it seems like I only have time for the very basics...not the kind of nurse I WANT to be :/

[VickyRN, MSN, DNP, RN]

When I was working on the cardiac floor there was this little Italian doc who was a terror. He would throw fits on the floor (not always, but enough to give him a reputation), curse when you had to call him at night, and generally just treat the nurses with disdain and contempt. The hospital would do nothing to him, because he was a big money maker. :stone Yes, it is very demeaning and each time it happens it takes a piece out of your soul. All it takes is one bad apple to totally overshadow all of the wonderful, kind, good-hearted physicians out there.

[mitchsmom]

I can't be the nurse I entered the profession to be.

I know what you are saying, but I also think that people in a lot of professions say the same kind of thing... I used to say the same exact things about teaching. At least there are a lot of different areas and options in nursing. BTW, you can definitely tell me to shut up now since I'm still a student

[CritterLover, BSN, RN]

what could doctors do to retaliate as i'm thinking aloud.[/quote

though i have not experienced it myself, there are several stories on this bb from nurses who are finding their job/license in jeopardy because an md has retaliated against him/her because the nurse stood up for himself/herself or the patient. i'm hoping that it is not commen, but there are pompas jerks out there that believe they are god and are going to fight anyone who challanges that.

so if the md chooses not to act upon the data presented to him by a nurse, the md will be held liable- not the nurse.

i would be careful about this, too. the "buck" does not necessarliy stop with the doctor. an example that happened to a co-worker. pulmonologist trachs a patient at bedside. later that evening, patient begins to bleed. significantly. md is contacted. he is aware of the situation. he does nothing. during the course of the night, the patient continues to bleed. situation continues to deteriorate. md is contacted several more times. continues to do nothing. becomes verbally abusive to the nurse, telling her not to call again. patient continues to bleed. nurse is able to contact a surgeon, who though he was initially reluctant to intervene, did end up operating on the patient and fixing the problem. (i should mention that this surgeon had no prior relationship with the patient).

my point being that doctors have a chain of command, too. and if you are not getting an appropriate response from the patient's docotor, or the doctor on call, and if the situation is serious enough, you are obligated to go on to the next physician in line per your hospital policy, all the way up to the cheif of staff should the case warrent it. especially if the doctor is being abusive to you, the nurse, on top of ignoring the patient's situation.

i wouldn't activate the chain of command, though, without talking it over with the charge nurse and probably the nursing supervisor, to make sure the situation warrents it.

[UM Review RN, ASN, RN]

are you considering leaving angie?

No, but I've seen enough nurses worn to a frazzle trying to deal with this stuff. So I would want to change it.

I should add that if I had to go through this for a number of years without seeing any appreciable changes, I would definitely consider a different career.

I think it might be helpful to record incoming phone calls to the desk, for instance, as our calls to answering services are recorded. I believe it would certainly prove our point, don't you think?

Also, if docs and family members were aware of possibly being recorded (for Quality Assurance purposes, naturally) they might rethink what they say and how they say it, which might nip the problem in the bud.

Too many of us go through this sort of problem in the course of doing our jobs. It's time for a change.

[mattsmom81]

but 2 barriers mentioned in the article, which i do not understand are 1. fear of retaliation and 2. that nothing would be done about it anyway.

what could doctors do to retaliate as i'm thinking aloud.

and secondly, even if nothing is done about it, nurses need to cover their a$$es and document all of their interventions, including but not limited to conversations with the md that was contacted.

Fear of retaliation is real because too many facilities dote on their doctors...and if the doctor complains about a nurse for ANY reason there will be trouble. I have watched many doctors launch a smear campaign against a nurse and she ended up quitting, unable to find any support.

Nothing would be done about it anyway is a real possibility to in many facilities. The docs bring $$$ into the hospital thus are more important. if a nurse complains about a doctor, or 'talks back' the nurse may be the one who is blamed...the nurse is a 'troublemaker'. If she speaks to her peers or supervisor she will likely hear "Oh that's just the way Dr ____ is, don't take him seriously." Or.."Management knows he acts this way and doesn't care...take my advice and don't stir the pot."

Does it get to a nurse over the years? It sure can...this career takes a lot out of a person IMO. The ones who last this long have developed strong coping and adjustment skills over the years, are coping with very difficult conditions and have learned to survive. They are to be congratulated. :)

[kmalloyrn]

Although I have not worked in acute care in years - I can tell you that life is not much different in public health other than the person yelling at you is the angry community member who thinks you should do something about the fact that he got sick after eating two double cheeseburgers and a twelve piece chicken McNugget meal. It had to be food poisoning and not over consumption! Or the community member that holds you personally responsible for the flu vaccination shortage (of course you have just denied him a flu shot because he is 48 and healthy). Or the health officer who expects you to submit to a smallpox vaccination and be a member of the smallpox emergency response team even though they do not plan to be vaccinated or compensate you for taking on added responsibilty. These are just a few of the reasons that I consider quitting nursing on almost a daily basis. And then I see what is happening with the tsunami in Asia and wish I could afford to take three months off work to volunteer with the International Medical Corps and realize I don't want to quit nursing - I want to quit nursing the spoiled American public who demands good health, in a pill, shot or bottle, and is not willing to assume any responsibility in their own health. Don't quit nursing - volunteer for a medical mission and you'll remember why you became a nurse.

[SmilingBluEyes]

actually, this discussion was fueled by this article and several threads on this bb about how docs treat nurses. here's the article. yes, i know it's old, but it's still very valid.

i get yelled at on the average of about once a month by different docs who have to be called in the middle of the night. management is very supportive of my complaints. however, each time it happens, it takes something out of me and i can see it affects my coworkers also. so i wondered how deeply we were affected and how it affected patients as well as decisions to leave nursing.

https://registration.philly.com/reg/login.do?url=http://www.philly.com%2fmld%2fphilly%2fliving%2fhealth%2f3413398.htm

doctors behaving badly may drive nurses away

by merritt mckinney

new york - (reuters health) - even though the us is in the middle of nursing crunch, with an estimated 126,000 unfilled nursing positions, many physicians do not realize that their own bad behavior may be driving some nurses from the field, according to the results of a new survey.

"one of the things we are concerned about is the nursing shortage," the report's author, dr. alan h. rosenstein, the medical director of vha west coast in pleasanton, california, told reuters health. as administrators struggle to deal with the ramifications of the nursing shortage, they must focus not only on recruiting new nurses to the field but also on retaining current nurses, he said in an interview.

the relationship that physicians have with nurses can have a "profound" effect on whether nurses choose to stay in the field, he said.

many doctors seem unaware of that, suggest the results of the survey of 1,200 nurses, physicians and hospital administrators. though nearly 93% of all respondents had witnessed disruptive behavior by a physician, doctors were significantly less likely than nurses and executives to believe that such incidents have an important influence on nurses' morale, according to a report in the june issue of the american journal of nursing.

about 31% of all respondents knew of a nurse who had left their hospital as a result of a physician's disruptive behavior.

nurses were also more likely than physicians to believe that doctors do not value their input and collaboration as much as they should. and nurses were more likely than doctors and executives to feel that nurses do not have enough administrative support to deal with conflicts with physicians.

nurses reported several barriers to reporting problems with physicians, including intimidation, concerns about retaliation and a belief that nothing would be done about the complaint, the report indicates.

solving the problem will require a "multifaceted approach," according to rosenstein. doctors and administrators "must make an effort to cultivate a more supportive environment, one in which nurses and nursing care are valued and respected."

however, other factors that contribute to low morale among nurses, such as cutbacks, scheduling issues and mandatory overtime, must be dealt with, the california physician added. educational programs aimed at fostering better relationships between nurses and physicians "can't be successful if the underlying factors aren't first addressed," he concludes.

but dr. diana j. mason, the editor of the journal, disagrees that troubles in the nurse-physician relationship cannot be worked out until other problems are tackled. there are several steps that can and should be taken right now, she notes in an editorial that accompanies the study.

among other things, mason suggests that hospitals study the state of nurse-physician relationships on their own wards and adopt a "zero-tolerance" policy towards all abusive employees. and nurses should be helped to develop the skills needed communicate effectively with physicians, mason suggests.

in addition, mason states, "nurses should stop referring to physicians as 'doctor so-and-so' while physicians address them by first names. whether we use last or first names, we must stop perpetuating such inequality."

and nurse-doctor relationships can also affect patient care, mason told reuters health in an interview. "we have research documenting that communication between nurses and physicians strongly shapes patient outcomes." she cited a 1986 study that found the nurse-physician communication was the leading predictor of patient mortality in intensive care units.

"nurse-physician communication is not just a matter of 'let's be polite to each other,'" mason said. "it's a matter of true teamwork with mutual respect for each provider's expertise that he or she brings to a patient's care."

in the interview, rosenstein said that he did not mean that immediate steps should not be taken to improve relations between nurses and doctors. instead, he said it is important to realize that this issue is just one of several related to nurses' morale.

"this is one piece," according to rosenstein. "other pieces have to be dealt with" as well, he said.

source: american journal of nursing 2002;102:7,26-34

oh, yes, i consider myself a fairly assertive and strong person; and my coworkers tell me all the time they admire my skills and abilities. but i feel my soul is being chinked down by things like this.......i am tried of have to assert myself as a shield against overbearing physicians, certain coworkers, and of course intolerably rude patients and family members. it's gettin old, on top of the heaps of paperwork being piled on us year after year, jumping thru hoops to please lawyers and jcaho. i am gettin tired after only 7 years at the bedside and it saddens me. i want to heal, not harm, patients.....thank you for not saying i should just "stop it cold" by asserting myself. it does not mean a hill of beans when no support comes from higher up. one can only handle so much, i guess and maybe i have approached my limit.

[SmilingBluEyes]

Although I have not worked in acute care in years - I can tell you that life is not much different in public health other than the person yelling at you is the angry community member who thinks you should do something about the fact that he got sick after eating two double cheeseburgers and a twelve piece chicken McNugget meal. It had to be food poisoning and not over consumption! Or the community member that holds you personally responsible for the flu vaccination shortage (of course you have just denied him a flu shot because he is 48 and healthy). Or the health officer who expects you to submit to a smallpox vaccination and be a member of the smallpox emergency response team even though they do not plan to be vaccinated or compensate you for taking on added responsibilty. These are just a few of the reasons that I consider quitting nursing on almost a daily basis. And then I see what is happening with the tsunami in Asia and wish I could afford to take three months off work to volunteer with the International Medical Corps and realize I don't want to quit nursing - I want to quit nursing the spoiled American public who demands good health, in a pill, shot or bottle, and is not willing to assume any responsibility in their own health. Don't quit nursing - volunteer for a medical mission and you'll remember why you became a nurse.

If I had my way, I would study to be a midwife and practice in places like Mexico where the need is great and the works of midwives appreciated. But alas, with a family to raise it's not too likely. I would love to care for a more needy and deserving population, sometimes. Don't get me wrong; I have had WONDERFUL patients thru the years.....they keep me going this long. A thank you and hug go a llllllllllllooooooooooooong way for me. I just would like to see less of the paperwork, CYAing and physician-catering that goes on today in so many hospitals in the USA.

[leslie :-D]

well yes, i suppose i would consider quitting nursing if i had to utilize my assertiveness skills on an ongoing basis, day in and day out.

i guess i've been fortunate - except for the paperwork.....no escaping that.

[pickledpepperRN]

When a physician asks the time when I call at night I just say, "2"17 am."

Asked why I am calling at that time of night?

"Because your patient needs a doctor" or "Because I want your patient alive."

If told, "Don't call me again!" I ask, "Should I write that as an order? Let me read that back."

Once I called with low K+ and ^PVC's and was told, "Don't worry about it."

Answer, "I am reporting my assessment of your patient, NOT me psychological state."

Ofter we have another nurse listen in. If possible this is the shift supervisor. Then call the medical director. Check your hospitals policy.

Write an incident report.

Now staffing problems are taking longer, but it is MUCH better!

I would not work where the administration and medical director did not assist in patient advocacy. If my manager were abused for advocating for patients and nurses I would work to change it or leave.

[tntrn, ASN, RN]

Have I considered leaving nursing? Yes, each and every day, I consider it. I think computer charting is only the tip of the iceberg in actually giving us less time at the bedside. What little (computer charting) we do now certainly doesn't give us more time in actual patient care because now we are inputting patient charges as well as lots of other tasks that used to be done by a unit secretary. Our poor unit secretary is busy just answering the phone and working the door monitor system for our locked unit. We have to wash our patient beds now after a delivery (thank you so much LDRP ). Lots of new tasks have now become the norm for nurses that have little or no bearing on actual patient care. JCAHO is a sham: the new requirements they invent every year are disguised as being better for patient care but are really just means for them to keep their miserable jobs.

The thing is: finally, after 28 years of nursing, and lots of contract negotiations, nurses are finally, at long last, getting (more) properly paid for years of experience and at nearly $50/hr now, it would be hard to get that doing something else. I am considering a business totally unrelated to nursing that I could operate out of my home. I don't plan to work more than about 5 more years anyway. Maybe not even that long. My DH has a mandatory retirement age at 60 and we're under 3 years and counting. I'm quite sure I don't want to continue working once he will be around more. I might continue a shift a week for a while, but if I won the MegaMillions, I would not be one of those people who would keep their jobs. Not me!