You can only take so much screaming, impatience, and disdain

[shiccy]

Little story b/c I'm surprised at myself that the words came out of my mouth and also proud that I had the ability to tell the doc to stuff it...

Also is a nice learning experience for those that are just going into the nursing field ... PLEASE don't let people walk all over you, you MUST defend yourself. Do NOT allow physicians to talk to you in demeaning ways. YOU are what keeps patients safe. YOU are the one that is giving life saving medications. YOU are the ones that are there all night / day with the patients. You deserve respect and to not be yelled at.

Background information

I had a patient that had very little compensatory capacity due to heart disease, ESCOPD, afib w/ short bursts of SVT that remedied on its own typically, pulmonary HTN, etc.

I work on an intermediate floor and the patient is one of the nicest people I've ever met. She had been on our floor in the past, though I've not taken care of her directly, I assisted when she wasn't doing the greatest and we were getting Rapid Response up to transfer her to ICU. She was going b/c we couldn't get her controlled SVT HR-wise. She had been to and from our ICU's at least 3 or 4 different occasions this admit alone, and had spent way to much time in her mind (poor thing) in the hospital. She was ready to be discharged, but started having blood tinged sputum. The docs kept her overnight JUST in case.

When I did my assessment, she said that she had a bit of pain in her chest. She has had this pain in the past, so I gave her a bit of PRN pain med to see what would happen. I saw some irregular heart beats (few PAC's and what-not, nothing major), so I told her I'd check up on her in a little bit.

Upon my next check, she was definitely uncomfortable, moreso than usual. I was also checking on her b/c I could her our red tele alarm, and could see she was having SVT that was not controlled. I called cardio (SVT/CP) and pulmonary (was increased in SOB, as well, but also a CO2 retainer, so I was trying to see if he wanted a CXR/ABG). Cardio called back, ordered STAT 12-lead and a consult to the hospitalist to take a look at the patient.

(END OF THE BACKGROUND INFORMATION)

The hospitalist called back and refused to read the EKG (don't blame her, that's cardio's job, but I thought I'd pass it along anyways). She then started giving me the third degree on the patient. I was trying to give her all the information I have on her as far as pt history but also current status and problems. She then started to get angry and condescending to me and was getting me worked up by having a rapid firing question/answer session. Some of the answers I knew, others that I did not. For every question I was able to get right I got another rapid fired question. For every question I couldn't answer, I got a large sigh and her tone got more angry. It was like I was in school again and she was the worst teacher / I was having a test from my nightmare! -- you know -- the one where you're in your underwear giving a speech to the school and you forgot your flashcards??!

She finally screamed at me, "WELL WHAT ARE HER VITALS!?" At this point I'm completely out of breath from hyperventilating over her rapid fire question/answer session, and I could only remember the SBP (not DBP). I said, "It's 8x/?? hold on let me get the diastolic." In the time it took me to high step run 20 feet she repeated, in a near screaming tone, "WHAT ARE HER VITALS??!" I told her what they were, and she asked, "What time was that at?"

For this particular patient I had placed her on con't. SPO2. I've also been on the phone with the other two docs for 15 or so min. Since I had her on con't. SpO2 the BP time was no longer on the screen so I had to click into the patient specific window. Literally 2 seconds later (and I'm hitting the screen as fast as I can with my finger ... and I'm quick at it, too, one of the fastest on our floor) she screams again, "WHAT TIME WAS THAT TAKEN???!" I told her and she continued rapid firing at me.

I had to walk to the other side of the unit, and by this time I can't breath from anxiety and hyperventilation. She was continuing to scream at me and waiting for me to answer, but I had finally had enough....

The conversation is a little hazy after this. I'm attributing it to "the hulk" inside of me ... as well as having some anoxia r/t the SOB from the hyperventilation / running. All I know is that word vomit started pouring out... Here's the gist of how I responded.

Me: "Listen. You need to lose your attitude because it's not helping this situation."

Her: "Well I'm not giving you attitude, I'm trying to ....."

Me: "Honey YES YOU ARE. You have got me so flustered right now I can't think and I'm hardly able to breathe. I'm trying to help this patient and I can only do so much." I had to cut her off... it was bigger than me.

She finally apologized "if she came over as having an attitude" and said, "She was just trying to get a full picture of the patient that has obviously had a very extensive past medical history". She continued her apology, but at this point I had taken the phone away from my ear and was trying to catch my breath and stop hyperventilating.

She came to the floor, assessed the patient, and called the cardiologist and told him what was up, and that turfing a patient onto their services wasn't really what they were here for (which is 100% true). The patient ended up getting a dose of amiodarone IVPB and was totally resolved but was still sent to ICU for obs.

Needless to say when I got off the phone I smiled, took a nice deep, cleansing breath, and went on my way. My supervisor was helping me put the stat orders in the computer right in front of where I was standing most of the time, so she got a first hand account of the conversation we had. When I got off the phone all she could say is, "Wow... I never expected that to come out of your mouth."

I guess I'm one of those nurses/people that refuses to take anybody's guff! LOL

[Crux1024]

LOL!! I love that you tagged this as "growing a pair".!!

Good for you.

Being able to stay clear headed and organized is soo important in a situation like this.

[Flare, ASN, BSN]

:hlk: So glad you stood up for yourself. I think more docs like this need to be put in their place.

[RaeRae1997]

That Md was so wrong. I bet they won't mess with you anymore though cause they now know you won't put up with that kind of behavior.

[netglow, ASN, RN]

If she was worth her own salt she would've called said card and told him where he could go. Sheesh. It's not like you can fix her physican communication/passing the buck problems for her. All she's done is forever burned a spot in your brain as being far from a professional.

[leslie :-D]

the op reminded me of something i was taught in nsg school:

in emergent situations, members of the team are going to sound abrupt and not to take it personally.

this instructor also gave examples of abuse vs caustic, and while we should not tolerate the former, we should ignore the latter.

while it's not cool for anyone to scream at you (which i would have addressed with her at a better time), did you tell her you needed to open another window to get the vs?

or did you not answer her, until she yelled again?

either way, i'm not sure if this was one of those situations, but if you're happy, i'm happy.:)

leslie

[AE78]

:bowingpur:bowingpur

[brillohead, ADN, RN]

When I saw the thread's title, the first thing I thought of wasn't "pain in the butt patient" but rather, "another doctor got out of line, I'll bet!"

The really sad part? I'm not even a nurse yet, but I already know how many (not all) docs like to think they walk on water.

[PostOpPrincess, BSN, RN]

The hospitalist was hostile because she felt "dumped on".

And unfairly took it out on you.

Before this happens again and it escalates to the point of stopping her. If she/he or anyone else has a dismissive or disrespectful tone, say over the phone with a strong imperative. "STOP." and then redirect the person appropriately.

If she/he is in front of you, put your palm up and say "STOP." and redirect.

People have to be reminded, situation or not, about appropriate behavior.

It's a lot easier than having to apologize later.

During incredibly tense situations, I will be very, very direct in my tone. Anyone who doesn't understand that, I will tell to stop, especially if they are causing an increase in the stress level, example: Patient has sudden onset of bradycardia, and I am focused on giving Atropine. MD comes in and starts demanding an answer. Because I am focused, I do not answer right away. I can't multitask in that situation, because it is UNSAFE. I will say in a very direct (can be abrupt), "ONE MOMENT PLEASE." When patient's bradycardia has resolved, I give the entire story in "man speak." I.E. to the point, facts only, NO SUBJECTIVES. i.e. "Patient bradyed to 30's, Atropine 0.5 mg given IV, bradycardia resolved with Atropine."

MD has information, and understands that HE/SHE has to professionally behave.

Now..here's the hard part.

This comes with experience, and good interpersonal skills.

If you are not good at communicating, learn.

If you have thin skin and cry at a drop of a hat, too bad for you--get tougher. That's reality.

If you are not comfortable with your skills, PRACTICE.

Unfortunately, a lot of it comes with having a good self-esteem, and confidence.

If you come into nursing lacking both, you have HUGE milestones to overcome.

If you come into nursing intact with BOTH, you just have to learn the communication skills and how to deal with tense situations.

Good luck to all.

OP, ya did good.

[PostOpPrincess, BSN, RN]

the op reminded me of something i was taught in nsg school:

in emergent situations, members of the team are going to sound abrupt and not to take it personally.

this instructor also gave examples of abuse vs caustic, and while we should not tolerate the former, we should ignore the latter.

while it's not cool for anyone to scream at you (which i would have addressed with her at a better time), did you tell her you needed to open another window to get the vs?

or did you not answer her, until she yelled again?

either way, i'm not sure if this was one of those situations, but if you're happy, i'm happy.:)

leslie

You're probably right, Leslie...but if OP felt she was stepping over the boundaries, OP was correct in her response. I used to be on the Code Team and had to deal with many personalities--did it for years. Sometimes it's the situation--many times, it's just that they (superpeople) can get away with it.

[greenfiremajick]

"man speak..........."

[Batman25]

"man speak..........."

I like that phrase too and it is so true.