Harassment from nursing staff... new fellow... what to do?

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CodeBlu

CodeBlu

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Was just discussing this with a friend of mine... She's a cardiology fellow at a big ivory tower. I'm doing critical care at another ivory tower in another city...

Nurses calling you to tell you the K+ is 3.4... or just harassing and calling you for stupid things. Pages at shift change for absolutely nothing. Meanwhile, you just rounded. They're "asserting dominance" or so she described it. As a male physician, I have experienced this.... but, albeit to a much less degree.

Was wondering how you guys deal with this stuff?

I know that when I would get pain calls as an anesthesia resident, I would ALWAYS go see the patient. Cuz, even if I was drowning, the nurse would write my name in the chart and say... Dr. CodeBlu was notified that patient in 10/10 pain... did not assess. Ordered 10 mg oxycodone. Patient very uncomfortable. Doctor notified again.

Ugh. I hate passive aggressive BS... can we just not?
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Confront her directly. If she did describe her actions as "asserting dominance" then it is borderline bullying.
 
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CodeBlu said:
Was just discussing this with a friend of mine... She's a cardiology fellow at a big ivory tower. I'm doing critical care at another ivory tower in another city...

Nurses calling you to tell you the K+ is 3.4... or just harassing and calling you for stupid things. Pages at shift change for absolutely nothing. Meanwhile, you just rounded. They're "asserting dominance" or so she described it. As a male physician, I have experienced this.... but, albeit to a much less degree.

Was wondering how you guys deal with this stuff?

I know that when I would get pain calls as an anesthesia resident, I would ALWAYS go see the patient. Cuz, even if I was drowning, the nurse would write my name in the chart and say... Dr. CodeBlu was notified that patient in 10/10 pain... did not assess. Ordered 10 mg oxycodone. Patient very uncomfortable. Doctor notified again.

Ugh. I hate passive aggressive BS... can we just not?
Click to expand...

I think it's pretty common over here for nurses to page you for all sorts of things. B/c one, some dont have the knowledge to assess if its stupid or not, some might feel the need to tell doctor everything for whatever reason, and others want to avoid liability for anything. Ive gotten plenty of calls about normal vitals b/c the nurse felt that i need to be informed.

The nurse can always write your name in for anything. Thats the problem. as doctors we are responsible. Ive seen my name in so many stupid notes its insane, some are even complete BS. At some point i think it's just not worth teh energy to deal with the BS. When i did my intern year, ive seen many nurses just put paged doctor xyz about blah, did not respond. when in fact i called back within a few minutes but no one picked up. Was i going to start a note war on Epic? Nah...

But agreed, all this stuff is really dumb. Though i feel like it happens mroe to interns than fellows
 
Go to the gift shop occasionally and buy a handful of Hershey's kisses in a bag. Bring it to the offending nurse, and give it to her, telling her this is for her and the staff in appreciation for all that they do. You will most likely be treated very differently.
 
Buy them treats and kindly inform them that as the fellow there is a resident they can page for all bull**** orders. Then follow IlDestriero's advice.
 
Look, by definition all of the nurses there have been working in that unit longer than you have. Many if not most have been working there longer than you’ve been in training, including medical school for some. My point is you aren’t going to change obnoxious culture like this overnight - an alternative idea is to buy a pizza lunch/dinner after a rough shift, you’ll instantly be a super star. And don’t be a douche and ask for money from the other residents, attendings or such: you can afford it.

Typically “female on female” crime tends to be fairly nasty and more nuanced according to my coworkers but this isn’t always the rule. On our L&D ward in residency, the RN staff was so nasty to male residents (OB, anesthesia, EM/FM rotators) that a Title IX complaint was filed (University-based hospital). I wouldn’t be going down that avenue after your first few shifts, but there is recourse if the treatment is unreasonable
 
Also if you are getting a zillion replacement orders for mildly low labs maybe you could quickly throw together a protocol so the RNs can do it themselves in certain standard situations. Or, even better, partner with a resident and that can be his or her quality improvement project required for graduation at most programs.
 
Two words: banana bread ...or cup cakes

Have you been to the nurse’s lounge yet? Most nurses these days are fairly insulin resistant from all the sweets and refined carbohydrates they snack on all shift. There is fairly good research that the spike in insulin levels associated with that type of diet causes irritability and mood swings. Keep them quiet by keeping them well fed with cr@p. Bake a loaf of banana bread once a month, plop it in the nurse’s lounge with a note saying who it’s from and watch your pages magically disappear. They’ll be too busy slicing off a piece of your delicious banana bread to page you about nonsense.
 
July-isms

New residents/fellows therefore new territory to mark. I personally am not a "buy/bake nurses stuff" type of person but that's just me. My opinion is that if you buy them cupcakes from Billy's they'll complain that they're not from Magnolia (NYC reference) and if you bring pizza one week they'll complain that you don't buy them Chinese takeout the next week.

Nurses do whatever they can to establish dominance in July because they know everyone is new. While true as Admiral says that most have been working in these units longer that some of us have been alive that still doesn't grant them an MD. The ICU is a special place because for the most part they actually do know what to do for a patient they just dont have the authority to do just "do stuff" so they have to ask someone. If there's no resident on rotation, than you're it and in July they trust a resident's input much less than they trust yours as a fellow.

July sucks and it's just a month you have to get through. I do think there is a place to kindly ask, "What did the resident suggest?" If they say the didn't call the resident then kindly explain the hierarchy and give them their solution in the process. It's a song and dance that's played out every year. (Although harder if June 30 they knew you as a resident and July 1st you're the fellow. They may still see you as a resident) Again, if there's no residents on rotation, just deal.
 
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My experience is that nurses are not absurdly demanding, and a little consideration (modest amounts of occasional treats, etc) goes a long way towards producing comity and harmony. Complementing them on well done jobs, pick ups of clinical tidbits that can benefit a patient, or even clarifying an ambiguous order can enhance working relationships, and in fact nurses enjoy being around fellows and residents that are positive, complementary, and allow them to enjoy their careers. You are just one of many pass through physicians they will encounter over their long career path. Most physicians in training are quite easy to forget by these nurses. You have the opportunity to not only to distinguish yourself as an outstanding human being as a resident/fellow to these nurses, but also can use this as a springboard on how to treat others throughout your own career. The little things that seem so trivial to us may matter a great deal to others, so step back from the books, the long rounds, the excruciatingly detailed H&Ps, the exhaustion of the seemingly endless nights on call, and the cumulative pressure that develops being sandwiched between attendings, patients, residents, medical students, and staff. Make your medical life something extraordinary by being kind, humorous, and giving to the nursing staff, the chief of staff, and the janitorial staff alike.
 
Welcome to “nursey nurse” BS. I wasted so much time refereeing the drama between the CRNAs and nurses on the OB floor....I still can’t believe grown adults can be as ridiculous as those folks were.
 
As a resident I found the OR nurses a pain. Instead of showing up and setting up my room in silence I started showing up, saying good morning, and setting up my room. Made all the difference. If you know their names so much the better.
 
nolagas said:
As a resident I found the OR nurses a pain. Instead of showing up and setting up my room in silence I started showing up, saying good morning, and setting up my room. Made all the difference. If you know their names so much the better.
Click to expand...
It could be residency thing because in private practice I find OR nurses infinitely nicer but we've also worked together for almost 10 years now. They're also good about schooling the new OR nurses so the OR in general is a pleasurable environment. OB is a separate hell. That nursing culture is so dysfunctional that nothing can save it at this point. ICU nurse like us because we basically save their patients when there is drama in the unit and they're a blessing for us when their is drama on the floor/OB unit. They speak our language, again, unlike the OB robots.
 
CodeBlu said:
Was just discussing this with a friend of mine... She's a cardiology fellow at a big ivory tower. I'm doing critical care at another ivory tower in another city...

Nurses calling you to tell you the K+ is 3.4... or just harassing and calling you for stupid things. Pages at shift change for absolutely nothing. Meanwhile, you just rounded. They're "asserting dominance" or so she described it. As a male physician, I have experienced this.... but, albeit to a much less degree.

Was wondering how you guys deal with this stuff?

I know that when I would get pain calls as an anesthesia resident, I would ALWAYS go see the patient. Cuz, even if I was drowning, the nurse would write my name in the chart and say... Dr. CodeBlu was notified that patient in 10/10 pain... did not assess. Ordered 10 mg oxycodone. Patient very uncomfortable. Doctor notified again.

Ugh. I hate passive aggressive BS... can we just not?
Click to expand...

sounds kind of standard for an ICU trainee at an level
Twiggidy said:
It could be residency thing because in private practice I find OR nurses infinitely nicer but we've also worked together for almost 10 years now. They're also good about schooling the new OR nurses so the OR in general is a pleasurable environment. OB is a separate hell. That nursing culture is so dysfunctional that nothing can save it at this point. ICU nurse like us because we basically save their patients when there is drama in the unit and they're a blessing for us when their is drama on the floor/OB unit. They speak our language, again, unlike the OB robots.
Click to expand...

Be nice, kill with kindness, but if you are being super nice and professional and the harassment continues you tell your attendings honestly and truthfully what is happening and why its not appropriate. I can see this being super annoying and a problematic person who may need to be dealt with by a non-trainee (her boss)
 
MoMoGesiologist said:
Personally I’ve found male nurses in the ICU a lot less likely to give you passive aggressive attitude. They just wanna get their work done and keep it moving. No need to kiss their asses with baked goods.
Click to expand...
Thank you. I don't understand this whole idea of kissing people's assess with baked goods and s hit. I am not going to contribute to their damn pre-diabetes and mood swings AND encourage bad behavior. The only times I have ever bought nurses food was in sincere appreciation of their good work and kindness. In PRIVATE PRACTICE.

Academics sucks ass and I am so glad my second go round is over and those biatches can die and rot in hell. Fu..ck them. I am over that sh..t. I don't deserve that just cuz you are insecure and want to be evil when all I do is come to work and try to do my damn job. I see how they kiss the male docs’ behinds.

In this post, I don't know if the nurses are just covering their assess or being intentional jerks. But I, as a female doc have experienced the wrath of nurses simply because I exist. And it's total bull****. I tell you what, this s... does NOT happen to me in PP. Only ever experienced it in academics cuz those damn biatches know they can get away with that ****.

F... academics. And academic nurses. There are a few good ones, but there are plenty that are biatches just for the hell of it. It's a power play.
 
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CodeBlu said:
Was just discussing this with a friend of mine... She's a cardiology fellow at a big ivory tower. I'm doing critical care at another ivory tower in another city...

Nurses calling you to tell you the K+ is 3.4... or just harassing and calling you for stupid things. Pages at shift change for absolutely nothing. Meanwhile, you just rounded. They're "asserting dominance" or so she described it. As a male physician, I have experienced this.... but, albeit to a much less degree.

Was wondering how you guys deal with this stuff?

I know that when I would get pain calls as an anesthesia resident, I would ALWAYS go see the patient. Cuz, even if I was drowning, the nurse would write my name in the chart and say... Dr. CodeBlu was notified that patient in 10/10 pain... did not assess. Ordered 10 mg oxycodone. Patient very uncomfortable. Doctor notified again.

Ugh. I hate passive aggressive BS... can we just not?
Click to expand...
Suck it up buttercup. Keep your mouth shut for a year and do your job. You will get thru this. They can't stop the clock. DON'T kiss their asses. It's total bull****. Lots of people get thru this.
I can't tell if this is just people being evil or trying to cover their asses. But just go to work and try to prevent yourself from getting into conflict. If you don't react, it will eventually stop. They will find someone else to bully. It's a f..ucking power game.
 
chocomorsel said:
Thank you. I don't understand this whole idea of kissing people's assess with baked goods and s hit. I am not going to contribute to their damn pre-diabetes and mood swings AND encourage bad behavior. The only times I have ever bought nurses food was in sincere appreciation of their good work and kindness. In PRIVATE PRACTICE.

Academics sucks ass and I am so glad my second go round is over and those biatches can die and rot in hell. Fu..ck them. I am over that sh..t. I don't deserve that just cuz you are insecure and want to be evil when all I do is come to work and try to do my damn job. I see how they kiss the male docs, behinds.

In this post, I don't know if the nurses are just covering their assess or being intentional jerks. But I, as a female doc have experienced the wrath of nurses simply because I exist. And it's total bull****. I tell you what, this s.. does NOT happen to me in PP. Only ever experienced it in academics cuz those damn biatches know they can get away with that ****.

F... academics. And academic nurses. There are a few good onees, but there are plenty that are biatches just for the hell of it. It's a power play.
Click to expand...

You are my spirit animal Dr C
 
chocomorsel said:
Get the hell out. Why are you doing this to yourself? For what? Prestige? F... That!!
Click to expand...
The point I was actually trying to make isn't that I'm treated particularly horribly now as an attending. I'd say it's pretty much the norm of any other group/hospital . We were just treated incredibly well as fellows. We were treated literally as senior attendings. Also, I like the $ I'm making lol
 
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SaltyDog said:
Just retaliate by writing labor intensive PITA orders. Q1H BP’s by manometry, etc.
Click to expand...
Doesn't mean those nurses will follow them. I'll never forget as a medicine intern in NYC, on my icu rotation with no intensivist in house, the night shift nurses got epi syringes, and w/o any orders or permission from anyone, were pushing iv epi to keep a patient from coding until the next shift at 7am so they wouldn't have to deal with it.
 
Ezekiel2517 said:
Doesn't mean those nurses will follow them. I'll never forget as a medicine intern in NYC, on my icu rotation with no intensivist in house, the night shift nurses got epi syringes, and w/o any orders or permission from anyone, were pushing iv epi to keep a patient from coding until the next shift at 7am so they wouldn't have to deal with it.
Click to expand...
So they were keeping the pt alive because it was the right thing to do or so that the next shift would have to deal with the end of life stuff? We need more deets on a story like that!
 
Ezekiel2517 said:
Doesn't mean those nurses will follow them. I'll never forget as a medicine intern in NYC, on my icu rotation with no intensivist in house, the night shift nurses got epi syringes, and w/o any orders or permission from anyone, were pushing iv epi to keep a patient from coding until the next shift at 7am so they wouldn't have to deal with it.
Click to expand...

WTF
 
Most of the nurses I dealt with in residency were great to work with. A few were not. I personally wouldn’t order them do something that would prevent the patient from getting rest.

For the rare and difficult ones. No baked goods, candy or pastry. Just bring a brand new staff nurse who is 22 years old, attractive and fresh out of school. Apparently those are the ones that get eaten.
 
MoMoGesiologist said:
So they were keeping the pt alive because it was the right thing to do or so that the next shift would have to deal with the end of life stuff? We need more deets on a story like that!
Click to expand...
So they wouldn't have to run a code at 6am and "deal with the end of life stuff" that would likely have prolonged their shift
 
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Ezekiel2517 said:
Doesn't mean those nurses will follow them. I'll never forget as a medicine intern in NYC, on my icu rotation with no intensivist in house, the night shift nurses got epi syringes, and w/o any orders or permission from anyone, were pushing iv epi to keep a patient from coding until the next shift at 7am so they wouldn't have to deal with it.
Click to expand...


So where were the doctors?
 
D P356 said:
Most of the nurses I dealt with in residency were great to work with. A few were not. I personally wouldn’t order them do something that would prevent the patient from getting rest.

For the rare and difficult ones. No baked goods, candy or pastry. Just bring a brand new staff nurse who is 22 years old, attractive and fresh out of school. Apparently those are the ones that get eaten.
Click to expand...
And where are you going to find this 22 year old to bring in? Order one online?
 
Meh, I had phone calls like that when I started as an intern. Part of it is figuring out if the new people are good or not and if they are dependable or not. Those calls stopped pretty quickly, like a month or so after beginning intern year, once the nurses knew me better. What I find amazing is that it sounds like this is the first time you’ve had to deal with this type of behavior! Every year the new people go through the bs phone call stuff, I’ve had conversations with our SICU fellows because they’re not immune from it either. Just keep on doing you and they’ll stop. Also why aren’t they calling the residents first????
 
Don't underestimate the value of a smile and saying hello and thank you.

And don't forget why you're really there:
A - care for the patients
B - graduate, earn the certificate and opportunity to take board exams
There is no C - make bitter angry people happy

Remembering C is helpful to get through the days when nurses or attendings are ****ting on you.

I've never in my life bought a nurse a donut. It seems like such a transparently shallow stupid ploy that even the petty clowns you're aiming to seduce would see through it.
 
I don't know... It doesn't sound personal (though there is perhaps aspects that are that have not been mentioned). It sounds more like facility policies and a nurse's job responsibility to notify you of "x" value under a given threshold etc... Once they get to know your routine they will likely hold on to those more trivial things until you round (assuming you do so regularly). It adds more work for them to make those calls in the first place.
 
pgg said:
I've never in my life bought a nurse a donut. It seems like such a transparently shallow stupid ploy that even the petty clowns you're aiming to seduce would see through it.
Click to expand...

You'd be surprised. I bake a lot, and once made a huge batch of muffins for my wife. Unfortunately, she decided to go on a diet right at the same time. So as not to let them all go to waste, I brought them to work. First shift devoured them all within hours, and I kept hearing about how much they loved my muffins for the next six months. I also noticed that my BS pages went down for a while.
 
nimbus said:
So where were the doctors?
Click to expand...
Like I said, intensivist is not in house at night. So just got interns and residents. Everyone knew the patient was circling the drain. Sometimes it takes a while but it's just a matter of time. Stereotypical micu patient. The nurses just did whatever they wanted to do. They were actually joking about it. Couldn't care less about the residents or interns
 
LOL when i was an intern our chief on service would put in orders that read as such:
“Before calling housestaff with any abnormal vitals obtain X and Y, and draw these labs, send off, and get 12 lead ekg, etc”.

Basically the idea was to put out the message that if u call me with Nonsense, then I’ll find a way to throw some nonsense grenades back at you.
Haha that put the BS calls to a quick STOP.
Also, it seems the way to nursing staff’s heart IS through their stomachs. Bring cupcakes one day and see what ensues. DO NOT bring healthy, vegan, keto anything bc they dont want the healthy stuff. Which is good bc all that crap is expensive.
LOL @GravelRider who posted about insulin resistance levels above—had me in STITCHES! 😆
 
My wife loves to bake. Often makes FAR more than would be healthy for me or my family to eat. We take them to friends and neighbors, but sometimes I'll take a bunch of cookies or something to work. It is always greatly appreciated and as noted above, people remember it down the road and often have expressed how good they were, even weeks or months later. I don't go out of my way to bring these things, but just happen to have things available at times.

I think people are easily bought with baked goods, based on my personal experiences.
 
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