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

[leslie :-D]

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.

after rereading the op, it sounds like the op was getting worked up re the way he was being questioned.

i'm still not convinced this dr was being purposely demeaning.

it 'sounds' like she was trying to get as much data as possible.

and i would not have responded as he did ("honey") and hang up, since the dr was trying to explain herself.

however, i do commend the op for asserting himself.

while i would have handled it differently, i'm glad he was vindicated.

leslie

[cb_rn]

Who knows if that doctor was just terse or trying to be a harda*s. But we all know there are a few that love to pull rank just like there are nurse managers and charge nurses and every other position of authority, semi authority, or perceived authority due to some abbreviation on a nametag that get off on their little powertrips.

I know I've had some attending physicians take great pains to ask questions of the new nurses on the floor until they find a question the nurse doesn't have an answer for.

These few MDs I'm thinking of like to wait until they have a pack of new residents circling around them and then sniff out the new kid to rapid-fire on all sorts of stuff they never ask a seasoned nurse about. They like to do it at the med cart in front of the other nurses, The more embarassing the better. Its awful to watch and you can't give anyone any real preparation for it because if you know the answers to all the typical stuff, they'll keep coming up with something new. (Something they probably don't know the answer to either.)

These doctors like to see how easily the newbies fluster.

I was dreading my own trial by fire since I had the misfortune of witnessing another new nurse get it hard and fast early in my orientation.

I'm not normally a rude person but after a brutal drilling by one of the surgeons that came to private practice from the military -- he finally got to a question (wish I could remember what the question was!) where I said, "Isn't that more of a medical issue than a nursing one?" It felt like time stood still and everyone at the nursing station stopped and stared. I think they were waiting for me to get my head snapped off and handed to me.

I almost apologized for my audacity but before I could open my mouth he blinked and sniffed, "I guess you're right." And since that day I have had no issues with that doctor. So I guess my accidental bravado helped me out.

Of course, that was just with one doctor. There were at least one or two that have made me feel like a fool at one point or another. But that's when I was young, beautiful, sweet & kind, skinny, and sensitive None of those things apply anymore!

[mustlovepoodles, RN]

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

You are now~!

[UM Review RN, ASN, RN]

Glad you addressed it immediatelly. Those situations are very short-lived in the minds of the perpetrators.

Only thing that made me wonder if the doc meant no harm was that she apologised. In my experience, that's pretty rare.

[wooh, BSN, RN]

(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)

First off, good for you! Second, this was the best part of your whole post. LOVE it! I'm picturing a bunch of you huddled around a monitor with timers going for a race. So funny!

[shiccy]

Sorry had to catch up a bit ... To Leslie yes I did say, "Hold on let me check" when asked what time the vitals were received on. Also I did *not* hang up on her, but took the phones mouthpiece away from my face and pointed it in the air so I could still hear what she was saying, but so she didn't have to hear my huge sigh after I told her she needed to tone it down.

There were a few things that bothered me during the entire situation. She knew her consult was BS, *I* knew her consult was BS, yet the caustic conversation was still taking place. She was also rapid firing questions so quickly that it was literally impossible for me to even respond. Since she was talking in the way she was, she was making a stressful situation worse when it didn't have to be, and in the long run making the 'information gathering' a TON more difficult for me AND for her.

This physician, in general (found this out after I kind of clued her in on the way she was speaking to me) is considered fairly obnoxious throughout the entire hospital. I was not the first and I'm sure not the last person to have poor communication with her...

I guess I should also put in that I'm actually very used to being screamed at or having physicians talking to me in a very short fashion. I'm a guy, I hate to be woke up as well, so when I call I present the facts as quickly and as accurately as possible, and we go from there. The huge difficulty with this patient is not only did she have a VERY extensive past medical history, but she also had a very (1+month) PRESENT medical history ... and all or most of this were absolutely vital information for her to hear. The 'information gathering' phase of our conversation was not going to be short, and that's not helped with being obnoxious on the phone.

She and I both knew she was going to have to physically view the patient. The patient physically was not doing well, which was something that I was definitely able to convey to the MD before she started in. She ended up keeping me on the phone for >10 minutes which obviously was getting nothing done for the patient and was NOT helping the situation at all. She was mentally going through options/scenarios on her own and muttering incoherently, while I could be giving a stat bolus dose of IVPB amio...

The stupid part of the whole ordeal is that I could have had the amio bolus completed and the patient would have been near 100% stable by the time she had even gotten on the floor.

[tewdles, RN]

Nurses must stand up for themselves.

By and large, doctors who vent their frustration and anger about situations upon the nurses discover where they may get away with it and where they may not...

Similarly, they discover which nurses will tolerate it and which will not.

I am not advocating "wars" here...I am advocating that nurses be professional enough to keep conversations and comments directly related to the patient and the care. If/when we encounter MDs who are unable to bridle their behavior and tongues, we must refuse to be party to the behavior in very clear language.

It is good that some nursing schools give their students some insight into this problem. Any nurse who works in a hospital WILL encounter a physician who will be rude and demeaning at some point. We are ahead of the game if we learn how to defuse these situations early.