"Don't piss off the nurses."

[AmoryBlaine]

So there is a thread going in the EM forums about the Top 20 things not to do in the department and along with good medical info alot of people have posted "don't piss off the nurses -- they can make your life miserable."

It got me thinking, this is certainly conventional wisdom in medicine but it seems that it has one of two implications, one of which is pretty awful ....

1. The statement "DPOTN" means that we as physicians should treat all ancillary/hospital staff with courtesy and respect at all times.

2. The statement "DPOTN" means that many RNs can behave in a vindictive and extremely unprofessional manner towards their physician counterparts with little if any fear of reprisal.

I mean, imagine if I as a physician got angry with a nurse and modified my order sets so as to give her more busy work to do throughout the day. I could imagine ordering more frequent neuro checks, making QD meds BID, giving the nurse lower thresholds to call the MD, ordering more frequent ambulation etc etc. What an unprofessional thing to do!

It would be interesting if it could be well studied from a sociological point of view, "do nurses attempt to create more work for physicians they don't like?" Who knows what the eventual answer might be, but if it were positive that would seem to me to be a stinging slap in the face of the nursing profession.

Thoughts?

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[Tired]

It would be interesting if it could be well studied from a sociological point of view, "do nurses attempt to create more work for physicians they don't like?"

You don't need to study it. Just ask them.

The majority I have asked have answered, "I don't, but I know people who have/do."

 

[lucky_deadman]

"do nurses attempt to create more work for physicians they don't like?"

ABSOLUTELY

And many of them will admit to it (if they like you).

 

[dpmd]

I mean, imagine if I as a physician got angry with a nurse and modified my order sets so as to give her more busy work to do throughout the day. I could imagine ordering more frequent neuro checks, making QD meds BID, giving the nurse lower thresholds to call the MD, ordering more frequent ambulation etc etc. What an unprofessional thing to do!
Thoughts?

I knew a surgeon who told me about ordering frequent neuro checks if he got stupid nurse calls at night. I don't know how often he did it (or if he really did it), but it seems like that would suck for the patient to get awakened that much. Timing your medications at intervals during the day (ie. pepcid at 10 and 2200, colace at 8 and 2000, etc) could accomplish the desired extra work without punishing the patient as much. Not that I advocate such things.

 

[OldPsychDoc]

Could the admonition be rephrased in the positive--i.e. "Treat the nurses as your valued colleagues and they may make your life easier" ?

Just wondering...

 

[Faebinder]

I have to admit that the nurse vs physician phenomena is alive but fortunately I have yet to have a nurse problem. I agree with OldPsychDoc. You get a lot more dragons with meat than with a punch to their snout.

 

[ekydrd]

I have seen that phenomena in action... I rarely get 4am calls regarding labs/vitals/meds/diet, but a collegue of mine tends to get them frequently. He is known as a real A__ hole by all of us, and treats the nurses even worse. He tends to get the "are you taking care of Mr. Soandso...?" calls throughout the day as well. Drives him nuts, and he complains, but he hasn't changed his own attitudes despite multiple people providing him that advice.

 

[AwesomO]

I have seen that phenomena in action... I rarely get 4am calls regarding labs/vitals/meds/diet, but a collegue of mine tends to get them frequently. He is known as a real A__ hole by all of us, and treats the nurses even worse. He tends to get the "are you taking care of Mr. Soandso...?" calls throughout the day as well. Drives him nuts, and he complains, but he hasn't changed his own attitudes despite multiple people providing him that advice.

He shouldn't be such an ass but this kind of behavior is appalling and I'm stunned that higher ups still put up with this sort of thing at work especially in an place as inefficient as the hospital.

Can you imagine any business functioning like this? Well Todd in accounting is a real jerk so Susy from marketing decided to bombard him with asinine phone calls so he couldn't get any work done.

I swear that the hospital is full of overgrown children. "Wahh he was an ass so I'm gonna act like a ten year old!" People who do this should be ashamed of themselves.

 

[OldPsychDoc]

Hey, where would Thursday nights be without this behavior?

He shouldn't be such an ass but this kind of behavior is appalling and I'm stunned that higher ups still put up with this sort of thing at work especially in an place as inefficient as the hospital.

Can you imagine any business functioning like this? Well Todd in accounting is a real jerk so Susy from marketing decided to bombard him with asinine phone calls so he couldn't get any work done. .

Which is exactly why "The Office" is so funny.

I swear that the hospital is full of overgrown children. "Wahh he was an ass so I'm gonna act like a ten year old!" People who do this should be ashamed of themselves.

"Scrubs"

 

[fab4fan]

You don't need to study it. Just ask them.

The majority I have asked have answered, "I don't, but I know people who have/do."

No. Because that would mean I would have to interact more with the person who is pissing me off. Why would I do that? That would be like cutting off my nose to spite my face. Dumb, dumb, dumb. When someone is annoying you, you want to do whatever it takes to make them go away and not come back--ever. Creating more work would be flat out stupid, not to mention juvenile and not in the best interest of patient care.

 

[Doowai]

When someone is annoying you, you want to do whatever it takes to make them go away and not come back--ever. .

Excellent. Remember the 3 rules of revenge : 1) never tell anyone what you are going to do 2) never tell anyone what you did 3) wait a year to get revenge so its not traced directly to you - if someone did something to you today and you get even tomorrow its obvious who did it. Revenge is a dish best served cold.


My sister in law is a nurse and she has told me of all sorts of crap they did to residents who annoyed them. Its worse the lower down the totem pole you are. 1st years - sometimes have to eat alot of doo doo. Just like hazing in fraternities etc - its a cake walk, just keep walking and stay in the game. Or like wrestling or football - if you expect to get sacked by the other guys, its not so surprising when it happens. Expect someone to try and lay you out, clean your clock. If you expect everyone to play nice it will really bother you when someone hits you hard enough to take the wind out of you. Eventually the tide turns. Take it as a game - expect to get sacked every now and then.

A good friend of mine played pro-football 6 years. In college, just prior to scout week (when scouts are looking at potential college recruits) he had a compound fracture of his forearm during a game. He had the trainer pull it back in, taped it up and kept playing. Try to be nice, but otherwise man up and take whatever crap they toss at you.

And if you are someone who thinks like fab4fan, just remember that nobody is made of Teflon. Everyone has a weakness that will allow you to take them down and out. Nurses who think they are made of Teflon and want to make your life miserable, can be shown they are as vulnerable as anyone else - if you are ruthless enough to show them.

 

[DrDre311]

No. Because that would mean I would have to interact more with the person who is pissing me off. Why would I do that? That would be like cutting off my nose to spite my face. Dumb, dumb, dumb. When someone is annoying you, you want to do whatever it takes to make them go away and not come back--ever. Creating more work would be flat out stupid, not to mention juvenile and not in the best interest of patient care.

Fab4fan, I respect your musical taste but I think you may be unique (or at least not represent the majority) among nurses. It isn't nearly as prevalent at my current institution, but at the county hospital & VA where I went to med school, the phenomena of nurses creating extra work for disliked residents was an inarguable reality. It went the other way, too, though; in general, if you're good at your job and nice to your colleagues, everything is easier for everybody--especially the patient (which is the point of the whole thing, right?).

As an aside, I think the quality of the hospital is inversely related to the intensity of the "vengeful nurses" theory; i.e., nearly absent on the pedi surg onc floor at St. Jude, and widespread on the general medicine floors at the old VA.

Revenge is a dish best served cold.

And if you are someone who thinks like fab4fan, just remember that nobody is made of Teflon. Everyone has a weakness that will allow you to take them down and out. Nurses who think they are made of Teflon and want to make your life miserable, can be shown they are as vulnerable as anyone else - if you are ruthless enough to show them.

Dude, who are you? I'm beginning to think you're actually Liam Neeson's character from Batman Begins, and you're telling all the new 'terns that they're going to fall prey to the evil nurses because they "lack the courage to do what is necessary."

 

[PeepshowJohnny]

Personally, I think it goes both ways.

I've seen the "unliked" resident get pestered with stupid stuff just because they know it pisses him off. I.E. It's no skin off the night nurses teeth to call him at 0300 when he's on night call to ask him to clarify an order. The nurse wakes him up and basically wins.

However, I've definitely seen the "opposite" as well. On one rotation the senior resident was a nice guy and universally beloved by the nurses, his junior was...well a douche. Eventually, nurses got so fed up dealing with the junior they just started skipping him and going write to the senior to ask for orders and such. It was not a good situation for anyone, since the "nice" senior was being pestered because nobody wanted to deal with his junior resident.

 

[Tired]

No. Because that would mean I would have to interact more with the person who is pissing me off. Why would I do that? That would be like cutting off my nose to spite my face. Dumb, dumb, dumb. When someone is annoying you, you want to do whatever it takes to make them go away and not come back--ever. Creating more work would be flat out stupid, not to mention juvenile and not in the best interest of patient care.

C'mon, be honest. You don't know anyone who pages the a$$hole on call for stupid reasons at 3am, just to wake them up? Hell, even my wife has done it (and that conversation sparked one of the 2 or 3 real blowout arguments of our marriage).

The problem is that nurses use passive-aggressive techniques to steal our sleep and frustrate us. But we're too stupid early in internship/residency to deal with it in the same passive aggressive format. Typically, the RN calls the intern at 3am for "temp trending up from 97F to 989F", and the intern blusters and yells.

What we should say is, "You're right, that's very worrisome. Please check vitals q10min for the next hour. Also please document the patients carotid/radial/femoral/DP/PT pulses q2hrs the rest of the night, because this could be an uncommon presentation of Takayasu's Arteritis."

And yes, Amory, I do this now.

 

[fab4fan]

Excellent. Remember the 3 rules of revenge : 1) never tell anyone what you are going to do 2) never tell anyone what you did 3) wait a year to get revenge so its not traced directly to you - if someone did something to you today and you get even tomorrow its obvious who did it. Revenge is a dish best served cold.


My sister in law is a nurse and she has told me of all sorts of crap they did to residents who annoyed them. Its worse the lower down the totem pole you are. 1st years - sometimes have to eat alot of doo doo. Just like hazing in fraternities etc - its a cake walk, just keep walking and stay in the game. Or like wrestling or football - if you expect to get sacked by the other guys, its not so surprising when it happens. Expect someone to try and lay you out, clean your clock. If you expect everyone to play nice it will really bother you when someone hits you hard enough to take the wind out of you. Eventually the tide turns. Take it as a game - expect to get sacked every now and then.

A good friend of mine played pro-football 6 years. In college, just prior to scout week (when scouts are looking at potential college recruits) he had a compound fracture of his forearm during a game. He had the trainer pull it back in, taped it up and kept playing. Try to be nice, but otherwise man up and take whatever crap they toss at you.

And if you are someone who thinks like fab4fan, just remember that nobody is made of Teflon. Everyone has a weakness that will allow you to take them down and out. Nurses who think they are made of Teflon and want to make your life miserable, can be shown they are as vulnerable as anyone else - if you are ruthless enough to show them.

I think you completely misunderstood me. I don't do revenge games. I just want whoever is bugging me to go away, so that is why I would never create extra work--why would I set that person up to come back into my world? I want them to go away.

Revenge just never works out in the end. It takes up too much time, it's juvenile, and as I have said many times it is not in the best interest of the patient. No matter how deeply I may despise a doc, I'm not going to get into game playing. I wasn't "brought up" that way.

 

[fab4fan]

Fab4fan, I respect your musical taste but I think you may be unique (or at least not represent the majority) among nurses. It isn't nearly as prevalent at my current institution, but at the county hospital & VA where I went to med school, the phenomena of nurses creating extra work for disliked residents was an inarguable reality. It went the other way, too, though; in general, if you're good at your job and nice to your colleagues, everything is easier for everybody--especially the patient (which is the point of the whole thing, right?).

Wow. I guess all the diploma grads from Catholic hospital nursing schools must be dying off. I'm a dinosaur.

 

[fab4fan]

C'mon, be honest. You don't know anyone who pages the a$$hole on call for stupid reasons at 3am, just to wake them up? Hell, even my wife has done it (and that conversation sparked one of the 2 or 3 real blowout arguments of our marriage).

The problem is that nurses use passive-aggressive techniques to steal our sleep and frustrate us. But we're too stupid early in internship/residency to deal with it in the same passive aggressive format. Typically, the RN calls the intern at 3am for "temp trending up from 97F to 989F", and the intern blusters and yells.

What we should say is, "You're right, that's very worrisome. Please check vitals q10min for the next hour. Also please document the patients carotid/radial/femoral/DP/PT pulses q2hrs the rest of the night, because this could be an uncommon presentation of Takayasu's Arteritis."

And yes, Amory, I do this now.

I know people who do. I'm just saying I don't. That's just a line I won't cross. I don't know, I can't explain it, it makes me want to cringe. You bomb-page the intern or resident out of some petty spite, then one day when you really need him/her, that's the time time that resident/intern will take a little longer to answer and you'll be having true emergency. So just don't go there. Be the professional you claim to be.

 

[fuzzyerin]

Personally, I think it goes both ways.

However, I've definitely seen the "opposite" as well. On one rotation the senior resident was a nice guy and universally beloved by the nurses, his junior was...well a douche. Eventually, nurses got so fed up dealing with the junior they just started skipping him and going write to the senior to ask for orders and such. It was not a good situation for anyone, since the "nice" senior was being pestered because nobody wanted to deal with his junior resident.

Yes, I have been subjected to this "opposite." I have always had a good relationship with most of the nurses since I was an intern, especially on the surgical floors. I'm now a third year, just a week away from my fourth. When my pager goes off, the first words out of my mouth are "why is my pager going off, I have two juniors underneath me who are supposed to be paged!" And when I call back, the conversation is usually "hey, fuzzyerin, I figured I'd page you directly because I know you'd know what to do..."

Aaarrggghh! I thought the benefit of being a senior was that you weren't dealing with the bull**** anymore!

 

[BSN2DOC]

I have actually never encountered nurses doing this, but I know of it happening. I work with pediatric residents and ped residents are perhaps the most easy going docs I have ever encountered. They treat the nurses with respect and they get respect in return.

However, I have encountered docs on adult units that are complete a**holes to the nurses and frankly if I were working on that floor, I probably wouldn't be the most pleasant with those residents. But on the flip side I have encountered nurses who are biatches to the docs for no apparent reason.

But I have a shocking idea -- how about healthcare professionals respect each other on a professional level?

 

[AwesomO]

I have actually never encountered nurses doing this, but I know of it happening. I work with pediatric residents and ped residents are perhaps the most easy going docs I have ever encountered. They treat the nurses with respect and they get respect in return.

However, I have encountered docs on adult units that are complete a**holes to the nurses and frankly if I were working on that floor, I probably wouldn't be the most pleasant with those residents. But on the flip side I have encountered nurses who are biatches to the docs for no apparent reason.

But I have a shocking idea -- how about healthcare professionals respect each other on a professional level?

Because everyone in the hospital reeks of self importance like a teenage girl running for prom queen.