As an Intern,Resident,how did you learn to be assertive with hospital staff?

[coldweatherblue]

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You learn to be assertive as an intern by learning to be assertive as a medical student.

As medical students, we're pretty useless in the hospital, and everyone knows it. Getting nursing staff to tell me about my patients or help me get material to do something for the patient is often like asking strangers if you can pull their teeth. I started third-year trying to be really enthusiastic/nice to all staff, trying to not interrupt them when their busy, trying to stay out of the way on computers, ETC. Then I realized that people were just taking advantage of my trying to treat everyone with the same basic respect that I want to give everyone. Basic considerateness is seen as weakness in the hospital, and nurses can smell it from a mile away. Unless you throw away what your mom said about, "playing nice with others" you'll never get all the things done that need to be done.

Often as a med student the most basic function of your existence is to make others feel good about themselves because of the awkward things you do and because you haven't worked in that unit for 20 years. Unfortunately medical students actually HAVE to learn medicine, whether or not it inconveniences staff who *work in a teaching hospital*, so students have to figure out how to respond correctly.

Basically if you know your patients well and understand your team's treatment plan, you can speak confidently with staff and they will respect you. The key is to be knowledgeable, concise, respectful and *confident* in your conversations with nursing staff. If you make the mistake of thinking that they will take pity on you and be nice to you because you're talkative/pleasant/respectful you will be eaten alive.

 

[Streicher]

As someone else pointed out, this can be boiled down to basic human interactions.

If someone is mistreating you, tell them to stop! Don't beat around the bush, be direct.

If this person is in a position with some power over you where they can afford to do so all they want and get away with it (which I suggest is your case) then you might have to be more firm.

Make an effort to run into him while he is out shopping for groceries. Wait until he has gone through checkout and is putting the groceries in his car. Make it so that you, coincidentally, have checked out at the same time and you run into him in the parking lot. Physically grab his shopping cart and stop it. Tell him to stop being a prick. If he doesn't, you throw over the shopping cart and push him. Reiterate.

After all, these are just some ****ing nurses or doctors

 

[HBSlim]

As someone else pointed out, this can be boiled down to basic human interactions.

If someone is mistreating you, tell them to stop! Don't beat around the bush, be direct.

If this person is in a position with some power over you where they can afford to do so all they want and get away with it (which I suggest is your case) then you might have to be more firm.

Make an effort to run into him while he is out shopping for groceries. Wait until he has gone through checkout and is putting the groceries in his car. Make it so that you, coincidentally, have checked out at the same time and you run into him in the parking lot. Physically grab his shopping cart and stop it. Tell him to stop being a prick. If he doesn't, you throw over the shopping cart and push him. Reiterate.

After all, these are just some ****ing nurses or doctors

troll much?

 

[Streicher]

OK, that was pretty trollish and not very serious. Sorry.

BUT, the idea is right. A lot of times when people in authority over you abuse you, they ignore your demands to stop.

SO, you have to be direct and demanding. In worst case scenerios (and I've done this before) you may have to kind of force them to acknowledge you. Follow them into a room while stating your request. Get close to them and block them from escaping, force them to be close to you. And let them know you DEMAND they stop what they are doing.

Then they HAVE to answer you in some way, and you will have a much better chance of success! Stick up for yourselves people!

If there is one thing I ABSOLUTELY HATE, it is people taking advantage of other people they are in power over. That is weak and disgusting.

 

[n3xa]

In fact, the profession is squarely anchored in human drama. You will do far more counseling, advising, breaking bad news, getting people to open up and confide in you, and teamwork issues than science in most clinical specialties.

YOU MEAN YOU HAVE TO... TALK TO PEOPLE?! NO WAAAAAAIIII 😱

 

[SitraAchra]

Wow, I would have loved to get in on this thread in its earlier stages.

Needless to say, I can only reinforce what the other residents have said. Cross-cover is not identical to the primary team and we do not know the entire nuanced plan.

TheProwler says it best: "That is something I will defer to the primary team."

I do love the sanctimonious, self-righteous nurses in the thread though, high comedy.

 

[da8s0859q]

I know medicine is a very very soft science. BUT, maybe the way you view medicine is different from how others do.

Well, softer perhaps. The whole "combination of art and science" thing that makes so many personal statements and secondary applications is rooted in at least some fact.

Seeing a long-time patient for MDD or some sort of anxiety is all kinds of soft -- counseling, lending a professional ear, all that -- but there's nothing soft about 5-HT reuptake inhibition or GABA agonism, even if the neuro types can't quite place their finger on the whole mechanism for why it helps.

Agree with people having different perspectives of just what the hell they're doing in medicine, but L2D has a point.

Um, you will learn that medicine is not about science (at least not 95% of it).

L2D, remind me what specialty you chose? I feel like it was surgery for some reason.

 

[45408]

L2D, remind me what specialty you chose? I feel like it was surgery for some reason.

Good luck getting an answer. 😉 I'm pretty sure it's not a surgical field though.

 

[Gastrapathy]

Its always fascinating to me that the threshold for phone calls is so different at a private practice hospital than at a teaching hospital. No PP hospital nurse clarifies orders at 3 am.

I tell my housestaff that if they ever get told that a nurse is going to call the attending to make that nurse put her money where her mouth is. They don't really want to call me.

 

[Hoody]

LOL, this is for Prowler and Co....


medicine resident vs. floor nurse:

http://www.youtube.com/watch?v=PZctYYfwd8w&feature=related

 

[NYRN]

We all know there are bad/rude nurses and bad/rude doctors. For the most part in real life, everyone gets along well and the patient gets what they need without any issues.

I enjoy working in a teaching hospital. Its amazing to see the progress of the residents from the day they walk into the door in July, till graduation and then even beyond if they stay as attendings. I love when med students are around, if they are working in my area, I offer them procedures like IV starts, blood draws, NG tubes, foleys, EKG's, etc. If they want to do it, I will walk them through it.

There is no reason for anyone to be forceful or rude to anyone else. This has been shown to be harmful to patients, because then the teams don't communicate well. Treat the nurses with respect and they will treat you the same way.

 

[NYRN]

Its always fascinating to me that the threshold for phone calls is so different at a private practice hospital than at a teaching hospital. No PP hospital nurse clarifies orders at 3 am.

I tell my housestaff that if they ever get told that a nurse is going to call the attending to make that nurse put her money where her mouth is. They don't really want to call me.

So you really don't want to know if there is something seriously going on with your patient?

I know a surgeon who was be sued (successfully) by the patient because of this exact thing. He was called, threw a hissy fit over the phone because he was "disturbed" in the middle of the night refused to come in and the patient had a bad outcome. If a problem is serious enough for me to call you in the middle of the night and the housestaff cannot resolve the problem, then I'm calling you. I'll gladly put my money where my mouth is. I'll also be telling the patient and the family that you were pissed that you were angry for being called.

 

[SouthernSurgeon]

So you really don't want to know if there is something seriously going on with your patient?

I know a surgeon who was be sued (successfully) by the patient because of this exact thing. He was called, threw a hissy fit over the phone because he was "disturbed" in the middle of the night refused to come in and the patient had a bad outcome. If a problem is serious enough for me to call you in the middle of the night and the housestaff cannot resolve the problem, then I'm calling you. I'll gladly put my money where my mouth is. I'll also be telling the patient and the family that you were pissed that you were angry for being called.

You continue to (deliberately?) miss the point. No one on here is saying they don't want to know what is going on with their patient or that they don't want to be informed about a serious problem. Gastrapathy's post was talking about the "threshold" for paging and the fact that only at a teaching hospital, where residents are looked at as little more than cannon fodder, would a nurse page someone at 3am to "clarify orders"

 

[NYRN]

You continue to (deliberately?) miss the point. No one on here is saying they don't want to know what is going on with their patient or that they don't want to be informed about a serious problem. Gastrapathy's post was talking about the "threshold" for paging and the fact that only at a teaching hospital, where residents are looked at as little more than cannon fodder, would a nurse page someone at 3am to "clarify orders"

I agree with you if this is what everyone on this thread was getting at, but some people on here were referring to being paged late for any reason. I would be pissed too if I was getting paged at 3 am for BS. I don't get why anyone would need to clarify orders at 3 am anyway unless it was a stat order, all the routine orders are for the day shift or early in the night shift like 9 pm 😕

 

[SouthernSurgeon]

I agree with you if this is what everyone on this thread was getting at, but some people on here were referring to being paged late for any reason. I would be pissed too if I was getting paged at 3 am for BS.

I think you would be hard pressed to find a single resident here who is complaining about getting paged for a legitimate patient issue, at any hour of the day or night. That's our job. I have RUN to patients rooms at 3am if there was a true emergency, and I would never fault a nurse for paging me in that situation (I would fault them for NOT paging me).

I don't get why anyone would need to clarify orders at 3 am anyway unless it was a stat order, all the routine orders are for the day shift or early in the night shift like 9 pm 😕

I don't get it either, and yet it happens with ridiculous frequency. Thus all the angst from interns like me throughout this thread.

 

[NYRN]

I think you would be hard pressed to find a single resident here who is complaining about getting paged for a legitimate patient issue, at any hour of the day or night. That's our job. I have RUN to patients rooms at 3am if there was a true emergency, and I would never fault a nurse for paging me in that situation (I would fault them for NOT paging me).



I don't get it either, and yet it happens with ridiculous frequency. Thus all the angst from interns like me throughout this thread.

Some residents do get pissed if they are called late at night, emergency or not. In the case with the attending who was sued, unfortunately, the ER doc is also named in the suit even though the problem with the patient could have only been taken care of in the OR, and that doc refused to come in. Bad attitudes do effect patient care, and we all need to learn how to work together. If there is an issue like the computer expiring the orders in the middle of the night, a policy should be put in place where the routine orders can be renewed automatically until 7 am the same day. In my hospital the computer doesn't do this, but I have heard of places that do.

I would LOVE to know what nurses have time in the middle of the night to go through daytime orders that they don't have to do and try to clarify them. Do they have nothing better to do? I've never worked on the floor, but when I worked at night, I was running around like crazy, looking at routine orders for the day shift was not on my list of things to do.

 

[45408]

Tonight's winning phone call:

Pt is a consult for a partial SBO. Admitted by medicine. Nurse pages me, then says she had called the hospitalist for an order to give meds down the pt's NG tube. Hospitalist said no, talk to surgery. She calls me, asking for an order to give meds down NG tube. I'm not inclined to do that, because then you clamp the NG tube for 30-60 minutes, and enteral absorption isn't exactly optimal when you're obstructed. Besides, most meds can be held for 3-4 days while we wait for bowel function. No films were obtained to verify placement of the NG tube (we usually only do that if we're going to put anything down it).

Nurse: "So can I have the order to give meds down his NG tube?"
Me: What does he have ordered for PO meds?
Nurse: lots of flipping through the chart and "ummmmm" before "Well, he doesn't have any ordered."
Me: *biting tongue* "Okay then, we'll just leave things as they are."

In other words: Can I have an order for something that I won't use?

 

[45408]

two classic threads btw:

http://forums.studentdoctor.net/showthread.php?t=412827

http://forums.studentdoctor.net/showthread.php?t=266673

 

[fahimaz7]

. Good one.

No, its not some random attending. And yes, they do notice.

Cool story, bra, but orders are generally not clarified very well. So yeah, by law, I'm supposed to call you and get such clairified (no matter the time). If Im doing a 24 hour chart check at 2am and I cannot read your chicken scratch writing about NG's to gravity or suction, you are most definitley getting a call. Give me attitide and I will probably turn you in to the supervisor. 🙂


Its your job. do it.

I love SDN. This thread is the primary reason that I wake up and read a few threads in the morning. Always fun to watch a few residents and attending's argue with someone about their job.

 

[drizzt3117]

I generally agree with some of the concepts in this post. I think you need to focus on what you need to get done, while not losing sight of what's good for the patient and how to make sure the nursing staff understands your instructions and even if they don't agree with them, at least understand that it's coming from the entire care team and not from you. Nothing makes your residents more annoyed then if they send you to get something done for a patient and they end up getting paged by nursing for the exact issue you were supposed to deal with.

A lot of the time, if you know what's going on, people will just go along with the treatment plan that makes sense regardless of who delivers the information. I don't know how many times during 3rd year I've looked back on notes the next morning and seen "per surgical resident, x" when I was the only person that had seen the patient or talked with the nursing staff. Of course you will always find some people who want a resident to sign off on things (or in yesterday's case, an attending. We had to drag a senior attending out of an OR to hand-write a note in front of a nurse to open up an OR at the VA 🙄 )

You learn to be assertive as an intern by learning to be assertive as a medical student.

As medical students, we're pretty useless in the hospital, and everyone knows it. Getting nursing staff to tell me about my patients or help me get material to do something for the patient is often like asking strangers if you can pull their teeth. I started third-year trying to be really enthusiastic/nice to all staff, trying to not interrupt them when their busy, trying to stay out of the way on computers, ETC. Then I realized that people were just taking advantage of my trying to treat everyone with the same basic respect that I want to give everyone. Basic considerateness is seen as weakness in the hospital, and nurses can smell it from a mile away. Unless you throw away what your mom said about, "playing nice with others" you'll never get all the things done that need to be done.

Often as a med student the most basic function of your existence is to make others feel good about themselves because of the awkward things you do and because you haven't worked in that unit for 20 years. Unfortunately medical students actually HAVE to learn medicine, whether or not it inconveniences staff who *work in a teaching hospital*, so students have to figure out how to respond correctly.

Basically if you know your patients well and understand your team's treatment plan, you can speak confidently with staff and they will respect you. The key is to be knowledgeable, concise, respectful and *confident* in your conversations with nursing staff. If you make the mistake of thinking that they will take pity on you and be nice to you because you're talkative/pleasant/respectful you will be eaten alive.

 

[45408]

Both of you talk like this is anything new. Residents have said the same thing for years and nurses have made the same arguments for years. its reality.

Uh, no.

Only proves the point I just made, i.e. that the arguments you and Hoody make with each other are arguments that have been made over and over and over again and are nothing new. Its the back and forth argument that will always exist and dilemma that will always exist between doctors and nurses.

Again, no. It's a small minority, and the slow nurses irritate the other nurses too. Nurses complain to me about some of their co-workers, just like there are residents who aren't very good.