Hospitalist - problems with nurses

[Osteoth]

Some background, I went to med school at an academic center, then residency at a large (>400 bed) community hospital, and now am a hospitalist at a rural (<100) bed hospital.

I have only been here a little while, but so far I have gotten a few nursing complaints. In these complaints, the nurses lie, exaggerate and spin little things to make them sound terrible.

So far my medical director has not made a big deal out of them, but at the same time I know it cannot be good for me from a job perspective to keep getting complained about, and from a mental health standpoint I feel like I have to watch my back at work, which is unpleasant.

One example of this is a nurse reported me to her nurse manager due to "lack of clinical knowledge" because I accidentally placed a D50 order as an oral glucose in an EMR I have only been using for a little while.

Anyone with tips? In residency I received 1 complaint from a nurse once in 3 years, and pride myself on both my clinical acumen and my bedside manner with both nurses and patients...

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[NewYorkDoctors]

be nice to the nurse manager (mother/father hen mentality ) and the flock. Try to involve nurses on rounds if feasible . Try to learn their mass on a first name basis . Get discharge notes and orders done reasonably on time . Prep PRN orders ahead of time and anticipate Tylenol for fever or colace senna for constipation etc . They have to foley and clean ish off the bedsheets every day . Make sifting thru a billion old orders easier for them .

But if you’re already doing this then it’s politics and you’ll have to make friends and sweet talk the nurse manager…

 

[Splenda88]

Wow. That nurse is really petty.

One advice I can give you is that not to appear arrogant when you are talking to nurses.

Go out of your way sometimes and ask nurses what they think. They like that for some reason.

Most of them will go out of their way to help if they like you. However, they will put you under a microscope if they don't

Also, try to be in tune with the hospital culture.

 

[NotAProgDirector]

I was going to say many of the same things:

See if this is the culture. If it is, then the nurses will complain about everyone and your reports will be no different than everyone else. You need your director to be 1000% honest about this -- if you're not careful they will tell you that everyone gets complaints like this when they don't (to make you feel better). If the nurses complain like this about everyone, then you either need to learn to live with it, or get a new job. 'Cause culture eats strategy for lunch.

Learn all the nurses names, if you can. Use their first name (again, assuming culture is OK with this).

Ask every nurse for their opinion. Every day. Ask them if there is anything you can do for them, or if you've missed anything important.

Bring in doughnuts / muffins / treats of any kind. Best if they are season specific.

 

[anonperson]

Some background, I went to med school at an academic center, then residency at a large (>400 bed) community hospital, and now am a hospitalist at a rural (<100) bed hospital.

I have only been here a little while, but so far I have gotten a few nursing complaints. In these complaints, the nurses lie, exaggerate and spin little things to make them sound terrible.

So far my medical director has not made a big deal out of them, but at the same time I know it cannot be good for me from a job perspective to keep getting complained about, and from a mental health standpoint I feel like I have to watch my back at work, which is unpleasant.

One example of this is a nurse reported me to her nurse manager due to "lack of clinical knowledge" because I accidentally placed a D50 order as an oral glucose in an EMR I have only been using for a little while.

Anyone with tips? In residency I received 1 complaint from a nurse once in 3 years, and pride myself on both my clinical acumen and my bedside manner with both nurses and patients...

Feed the nurses once in awhile - something high in carbs and sugar preferably. Doesn't have to be expensive.

Keep them involved. They are a valuable resource. Be reasonably available.

Doesn't hurt to ask how they're doing either. People are less likely to report you for stuff if they like you, even a little bit.

 

[rokshana]

Just feed them on a regular basis… takes care of everything.

 

[Osteoth]

be nice to the nurse manager (mother/father hen mentality ) and the flock. Try to involve nurses on rounds if feasible . Try to learn their mass on a first name basis . Get discharge notes and orders done reasonably on time . Prep PRN orders ahead of time and anticipate Tylenol for fever or colace senna for constipation etc . They have to foley and clean ish off the bedsheets every day . Make sifting thru a billion old orders easier for them .

But if you’re already doing this then it’s politics and you’ll have to make friends and sweet talk the nurse manager…

That's one of the things that annoys me, I think I am a pretty good doctor to my nurses, I always put in PRNs, I always update them, I think it's the politics/culture of the place.

Wow. That nurse is really petty.

One advice I can give you is that not to appear arrogant when you are talking to nurses.

Go out of your way sometimes and ask nurses what they think. They like that for some reason.

Most of them will go out of their way to help if they like you. However, they will put you under a microscope if they don't

Also, try to be in tune with the hospital culture.

I was going to say many of the same things:

See if this is the culture. If it is, then the nurses will complain about everyone and your reports will be no different than everyone else. You need your director to be 1000% honest about this -- if you're not careful they will tell you that everyone gets complaints like this when they don't (to make you feel better). If the nurses complain like this about everyone, then you either need to learn to live with it, or get a new job. 'Cause culture eats strategy for lunch.

Learn all the nurses names, if you can. Use their first name (again, assuming culture is OK with this).

Ask every nurse for their opinion. Every day. Ask them if there is anything you can do for them, or if you've missed anything important.

Bring in doughnuts / muffins / treats of any kind. Best if they are season specific.

I think that's what I'm learning, is that the hospital/organization both have a very poor culture, and that compounds with the fact that this is a rural hospital to the fact that it is difficult to fire someone. I know that at least two other nurses have left because they were bullied by the same nurse that has a problem with me.

It probably is the hospital culture, most other docs here are long term locums, and several have said that nurses complain about them on trivial things, but maybe my arrogance is showing when they would say that in my mind I would think, "not me", but maybe it is just everyone all day long.

You're probably right. I have a 2 year buy back for my sign in, and honestly I would probably stay after even if the culture was bad if they didn't fire me as its >75% MGMA and an easy job, I can leave at 530 every other day. Just need to keep my 3rd eye open at all times I suppose.

 

[gutonc]

That's one of the things that annoys me, I think I am a pretty good doctor to my nurses, I always put in PRNs, I always update them, I think it's the politics/culture of the place.



I think that's what I'm learning, is that the hospital/organization both have a very poor culture, and that compounds with the fact that this is a rural hospital to the fact that it is difficult to fire someone. I know that at least two other nurses have left because they were bullied by the same nurse that has a problem with me.

It probably is the hospital culture, most other docs here are long term locums, and several have said that nurses complain about them on trivial things, but maybe my arrogance is showing when they would say that in my mind I would think, "not me", but maybe it is just everyone all day long.

You're probably right. I have a 2 year buy back for my sign in, and honestly I would probably stay after even if the culture was bad if they didn't fire me as its >75% MGMA and an easy job, I can leave at 530 every other day. Just need to keep my 3rd eye open at all times I suppose.

I have no doubt that it's the culture. I also have no doubt that you can positively impact it enough to make this a good medium/long term option for you.

I'm not a hospitalist, so there are going to be some differences here, but I recently went from a large urban setting to a rural CAH. The nursing culture in the new clinic wasn't exactly toxic, but they had been dealing with locums (usually for 3-6 months at a time) for over 3 years before I came on as the new medical director. They had been dealing with rapidly changing physician attitudes and practice patterns for that time, so never knew what exactly to expect. So, understandably, they circled the wagons and focused on each other and the patients. One of the first things I did when I came in was sit down with all of the nurses (individually and as a group) and ask what they felt had been good and bad over the past few years and what they thought might improve it. Some of it was good information, some was petty, all of it was useful for me. It's only been 6 months and it's a phenomenal place to work, for me and for the nurses.

The other thing to keep in mind about rural areas and small towns is that a lot of the people who work there have lived there their whole lives and know everybody (and everything about everybody). This can be a blessing and a curse. The blessing is you're likely to get useful information about your patients that isn't in their chart because their nurse for the day is their parent's neighbor. The curse is that you're an outsider and will need to earn the nurses (and the patients') trust.

Your strategy here should be to understand and slowly modify the culture, at least as it relates to you and your work. Step 1 is to engage that nurse and get her on your side, or at least to stop actively fighting you. The rest will be easier from there.

 

[DrMetal]

One example of this is a nurse reported me to her nurse manager due to "lack of clinical knowledge"

You sure you didn't do something else to piss them off? This complaint of "lack of clinical knowledge" is a rare and ridiculous one (far more common are complaints about professionalism, timely communication, etc).

This smells of a nurse really trying to get under your skin, maybe retaliation for something else.

We've all placed incorrect orders. It's usually resolved quickly when the nurse or pharmacists points it out.

 

[Osteoth]

I have no doubt that it's the culture. I also have no doubt that you can positively impact it enough to make this a good medium/long term option for you.

I'm not a hospitalist, so there are going to be some differences here, but I recently went from a large urban setting to a rural CAH. The nursing culture in the new clinic wasn't exactly toxic, but they had been dealing with locums (usually for 3-6 months at a time) for over 3 years before I came on as the new medical director. They had been dealing with rapidly changing physician attitudes and practice patterns for that time, so never knew what exactly to expect. So, understandably, they circled the wagons and focused on each other and the patients. One of the first things I did when I came in was sit down with all of the nurses (individually and as a group) and ask what they felt had been good and bad over the past few years and what they thought might improve it. Some of it was good information, some was petty, all of it was useful for me. It's only been 6 months and it's a phenomenal place to work, for me and for the nurses.

The other thing to keep in mind about rural areas and small towns is that a lot of the people who work there have lived there their whole lives and know everybody (and everything about everybody). This can be a blessing and a curse. The blessing is you're likely to get useful information about your patients that isn't in their chart because their nurse for the day is their parent's neighbor. The curse is that you're an outsider and will need to earn the nurses (and the patients') trust.

Your strategy here should be to understand and slowly modify the culture, at least as it relates to you and your work. Step 1 is to engage that nurse and get her on your side, or at least to stop actively fighting you. The rest will be easier from there.

I think you're right, I probably just need to give it some time and space and try to re-engage at a later time with a more positive attitude and try and build a more collaborative relationship.

You sure you didn't do something else to piss them off? This complaint of "lack of clinical knowledge" is a rare and ridiculous one (far more common are complaints about professionalism, timely communication, etc).

This smells of a nurse really trying to get under your skin, maybe retaliation for something else.

We've all placed incorrect orders. It's usually resolved quickly when the nurse or pharmacists points it out.

I think it was that a patient had an extremely high K (6.5) come back, and I wanted to repeat to rule out hemolysed sample but the nurse wanted to treat. She basically refused to put in a verbal recheck until I put my foot down as I was out of the building at that time. This nurse tends to think that she knows better than the doctors and I have heard her call other doctors "idiots" and "dumbdumbs" to the entire unit and to me. Very unprofessional, and frankly just wrong behavior.

 

[Splenda88]

I think you're right, I probably just need to give it some time and space and try to re-engage at a later time with a more positive attitude and try and build a more collaborative relationship.

I think it was that a patient had an extremely high K (6.5) come back, and I wanted to repeat to rule out hemolysed sample but the nurse wanted to treat. She basically refused to put in a verbal recheck until I put my foot down as I was out of the building at that time. This nurse tends to think that she knows better than the doctors and I have heard her call other doctors "idiots" and "dumbdumbs" to the entire unit and to me. Very unprofessional, and frankly just wrong behavior.

Well, a lot (or probably most) nurses with a few years of experience think they know more than IM/FM hospitalists. This is coming from a former nurse. There is a subtle indoctrination in nursing school.

"You are the patient advocate." "You are the ones protecting patients from incompetent/greedy doctors." I can't tell you how many times I heard these phrases when I was in nursing school.

The experienced ICU nurses at my hospital are pain in the [insert].

 

[chessknt]

I think you're right, I probably just need to give it some time and space and try to re-engage at a later time with a more positive attitude and try and build a more collaborative relationship.

I think it was that a patient had an extremely high K (6.5) come back, and I wanted to repeat to rule out hemolysed sample but the nurse wanted to treat. She basically refused to put in a verbal recheck until I put my foot down as I was out of the building at that time. This nurse tends to think that she knows better than the doctors and I have heard her call other doctors "idiots" and "dumbdumbs" to the entire unit and to me. Very unprofessional, and frankly just wrong behavior.

Was it hemolyzed? I would think if it was that report would kind of be rendered moot no?

To be fair being out of the hospital is a huge hit to credibility. As someone who stays in the hospital because I have stuff to do when I get a phone call from a hospitalist about their patient decompensating while I hear their kids in the background at 3pm I roll my eyes and sometimes find that this has been an ongoing issue for hours getting worse because they weren't in the hospital and didn't understand this wasn't something that was going to get better. The RRT nurse will sometimes call when there is gross mismanagement occuring because they know I am around and will come fix the dumb****ery. Maybe a local culture thing but I dealt with the same problem in fellowship and when I worked at a VA.

 

[Osteoth]

Well, a lot (or probably most) nurses with a few years of experience think they know more than IM/FM hospitalists. This is coming from a former nurse. There is a subtle indoctrination in nursing school.

"You are the patient advocate." "You are the ones protecting patients from incompetent/greedy doctors." I can't tell you how many times I heard these phrases when I was in nursing school.

The experienced ICU nurses in my hospital are pain in the [insert].

They really can be. Any tips for winning them over, especially in situations where they are completely, absolutely wrong?

Was it hemolyzed? I would think if it was that report would kind of be rendered moot no?

To be fair being out of the hospital is a huge hit to credibility. As someone who stays in the hospital because I have stuff to do when I get a phone call from a hospitalist about their patient decompensating while I hear their kids in the background at 3pm I roll my eyes and sometimes find that this has been an ongoing issue for hours getting worse because they weren't in the hospital and didn't understand this wasn't something that was going to get better. The RRT nurse will sometimes call when there is gross mismanagement occuring because they know I am around and will come fix the dumb****ery. Maybe a local culture thing but I dealt with the same problem in fellowship and when I worked at a VA.

It was hemolyzed. I don't think my medical director really cares about this petty stuff, it just makes me feel uncomfortable and makes me feel like I just want to minimize any interaction with the nurses and hide in my office as much as possible. I'm just starting a 2 year contract too.

I get that, but I was just walking in. I was in the unit within 5 minutes of getting the call.

 

[chessknt]

They really can be. Any tips for winning them over, especially in situations where they are completely, absolutely wrong?

It was hemolyzed. I don't think my medical director really cares about this petty stuff, it just makes me feel uncomfortable and makes me feel like I just want to minimize any interaction with the nurses and hide in my office as much as possible. I'm just starting a 2 year contract too.

I get that, but I was just walking in. I was in the unit within 5 minutes of getting the call.

I had the exact same feeling at a job I was at except it came from petty internal politics and financial struggles and from other doctors (like refusing to admit status epilepticus from the ER with no neurologist in the hospital, er reports me to hospital who gets mad at medical director who gets mad at me). The only solution is to leave IMO--so much happier when I did. I had forgotten how not ****ty working could be.

 

[timpview]

Your medical director might not care.. until when he/she does.

He/she is also keeping every report in your file. Nearly all of these complaints regardless of how trivial and petty you think they are is saved to use against you if and when they (hospital admin/med director) see fit.

So don’t think for a second this stuff is ignored.

The main thing you can do is minimize your walking in the mine field. Limit your interaction. Respond quickly. Don’t talk to anyone unless you have to. Never try and change the system. Never criticize. Never report a nurse. If they want something just do it unless it’s something egregious.

If things really start adding up then get a new job before you get in formal trouble.

 

[Splenda88]

Your medical director might not care.. until when he/she does.
He/she is also keeping every report in your file. Nearly all of these complaints regardless of how trivial and petty you think they are is saved to use against you if and when they (hospital admin/med director) see fit.
So don’t think for a second this stuff is ignored.
The main thing you can do is minimize your walking in the mine field. Limit your interaction. Respond quickly. Don’t talk to anyone unless you have to. Never try and change the system. Never criticize. Never report a nurse. If they want something just do it unless it’s something egregious.

If things really start adding up then get a new job before you get in formal trouble.

Lol.

Like the aggressive message I got from a nurse a few days ago.

"Patient BUN went from 20 yesterday to 30 today, what are you going to do about it?"

Creatinine was 0.7 and BUN was 20 the day before; creatine 0.9 and BUN 30 when she messaged me..

I went and talked to patient and ask her a few questions, then started her on IVF at 75cc/hr for 6 hrs. RN is happy. Win-win... Lol

 

[Osteoth]

I had the exact same feeling at a job I was at except it came from petty internal politics and financial struggles and from other doctors (like refusing to admit status epilepticus from the ER with no neurologist in the hospital, er reports me to hospital who gets mad at medical director who gets mad at me). The only solution is to leave IMO--so much happier when I did. I had forgotten how not ****ty working could be.

Yeah, problem for me is I have a 5 figure signing bonus I would have to pay back if I left... this job also pays really well, and is easy. It's just the people that are miserable.

It's actually crazy, we just had a patient with a WBC count of 30 tbili of 6, dbili of 5 they wanted me to admit for IV abx sepsis w/u. I'm like this is crazy they need ERCP...

Your medical director might not care.. until when he/she does.

He/she is also keeping every report in your file. Nearly all of these complaints regardless of how trivial and petty you think they are is saved to use against you if and when they (hospital admin/med director) see fit.

So don’t think for a second this stuff is ignored.

The main thing you can do is minimize your walking in the mine field. Limit your interaction. Respond quickly. Don’t talk to anyone unless you have to. Never try and change the system. Never criticize. Never report a nurse. If they want something just do it unless it’s something egregious.

If things really start adding up then get a new job before you get in formal trouble.

Exactly my thinking. So far these things have been ignored, but they can't be good for me in the long run.
I agree. I have two years until my payback period is over, so the answer is probably just to "quiet-quit" as the kids like to say and help my patients but do not engage with anyone.
Funny you say that, you think reporting nurses is more trouble than its worth? I was thinking about going that route but my gut tells me not to, not quite sure why

Lol.

Like the aggressive message I got from a nurse a few days ago.

"Patient BUN went from 20 yesterday to 30 today, what are you going to do about it?"

Creatinine was 0.7 and BUN was 20 the day before; creatine 0.9 and BUN 30 when she messaged me..

I went and talked to patient and ask her a few questions, then started her on IVF at 75cc/hr for 6 hrs. RN is happy. Win-win... Lol

Problem is when something egregious is asked. If I had treated this patient with a normal K then they could have gone the other direction been too low.

 

[Splenda88]

Problem is when something egregious is asked. If I had treated this patient with a normal K then they could have gone the other direction been too low.

As a another poster said above, you don't do anything that can harm the patients.

I was a nurse for almost 8 yrs and I can say that I am familiar with the culture. Nurses for reasons I dont get want to feel appreciated by DOCTORS.

Know most of the nurses name and address them by using their name when you are interacting with them, come back in 3-6 months to tell me how much these nurses love you.

 

[Splenda88]

Yeah, problem for me is I have a 5 figure signing bonus I would have to pay back if I left... this job also pays really well, and is easy. It's just the people that are miserable.

Would you mind sharing salary and signing bonus?

 

[VA Hopeful Dr]

This entire thread seems like an amazing advertising campaign for outpatient medicine

 

[Splenda88]

This entire thread seems like an amazing advertising campaign for outpatient medicine

There are pros and cons in everything.

It appears that more FM docs want to do HM these days as opposed to IM who want to do outpatient.

It would nice to know the % of FM docs switching to HM FT vs IM docs switching outpatient medicine.

 

[Ubba]

Easiest thing to do here is to buy them off with bi-weekly Dunkin' Donuts. I'm sure this will offend some people, but nursing culture is practically saturated with gossip, pettiness, and a sort of sarcastic jadedness that splits people into the "in" or "out" group. Especially out in the sticks, where there's less variety of things to talk about and discussions often revolve around people rather than experiences like concerts/travel/museums. In fairness, the jadedness is pretty common among doctors, too.

If you want to play nice with them and hang out for 25 minutes at a time chatting about the weather and Post Malone, that'll work, but if you have other things to do and/or don't want to get dragged into inane conversations, it remains true that it's hard for the nurses to complain about you when they know they'll get sugary dough and coffee every other Friday. Probably the best way to keep your sanity as well as your social standing.

 

[VA Hopeful Dr]

There are pros and cons in everything.

It appears that more FM docs want to do HM these days as opposed to IM who want to do outpatient.

It would nice to know the % of FM docs switching to HM FT vs IM docs switching outpatient medicine.

I mainly meant it as a joke.

From the outpatient side, and having a wife who is an internist who went from inpatient to outpatient, biggest thing I've seen is the frustration people experience and the patience required to get an outpatient clinic running the way you want it to. You have to know how things want to run and tailor your practice fairly early on to accomplish that. It takes usually between 1 to 2 years and requires a fair number of not overly positive patient interactions as you weed out the folks that don't fit with how you want to do things.

 

[Osteoth]

Would you mind sharing salary and signing bonus?

They both start with a 4.

Easiest thing to do here is to buy them off with bi-weekly Dunkin' Donuts. I'm sure this will offend some people, but nursing culture is practically saturated with gossip, pettiness, and a sort of sarcastic jadedness that splits people into the "in" or "out" group. Especially out in the sticks, where there's less variety of things to talk about and discussions often revolve around people rather than experiences like concerts/travel/museums. In fairness, the jadedness is pretty common among doctors, too.

If you want to play nice with them and hang out for 25 minutes at a time chatting about the weather and Post Malone, that'll work, but if you have other things to do and/or don't want to get dragged into inane conversations, it remains true that it's hard for the nurses to complain about you when they know they'll get sugary dough and coffee every other Friday. Probably the best way to keep your sanity as well as your social standing.

This makes sense, donuts on saturdays/sundays it is.

 

[dgdg]

I think you're right, I probably just need to give it some time and space and try to re-engage at a later time with a more positive attitude and try and build a more collaborative relationship.

I think it was that a patient had an extremely high K (6.5) come back, and I wanted to repeat to rule out hemolysed sample but the nurse wanted to treat. She basically refused to put in a verbal recheck until I put my foot down as I was out of the building at that time. This nurse tends to think that she knows better than the doctors and I have heard her call other doctors "idiots" and "dumbdumbs" to the entire unit and to me. Very unprofessional, and frankly just wrong behavior.

Regardless of the facility social culture, failing to follow a physician order to repeat an abnormal, and potentially life threatening, lab result is insubordination, a risk to the patient's health, and a liability risk to everyone involved.
Unless the nurse believes you have committed a dangerous medical error or something criminal, she/he cannot refuse the physician order regardless of how much she/he dislikes it.
You need to document in the chart (get on remotely to place the stat order and document your personal call with the nurse that you were placing the order). If you don't document everything, you put yourself in serious malpractice liability.

 

[Osteoth]

Regardless of the facility social culture, failing to follow a physician order to repeat an abnormal, and potentially life threatening, lab result is insubordination, a risk to the patient's health, and a liability risk to everyone involved.
Unless the nurse believes you have committed a dangerous medical error or something criminal, she/he cannot refuse the physician order regardless of how much she/he dislikes it.
You need to document in the chart (get on remotely to place the stat order and document your personal call with the nurse that you were placing the order). If you don't document everything, you put yourself in serious malpractice liability.

Yeah, something some of the other docs have made me realize is that as a hospitalist 1/2 my job is patient care, 1/4 is nurse relations and 1/4 is avoiding a lawsuit lmao.

 

[dozitgetchahi]

This entire thread seems like an amazing advertising campaign for outpatient medicine

Yes and no.

I’m an outpatient only rheumatologist. At my first job out of fellowship, I dealt with office staff (and an overall culture) not dissimilar to what OP is describing - extremely petty, staff often making ridiculous complaints/trying to make mountains out of molehills/trying to make the physician look bad, etc. The first moment I knew something was up was when we were about to have our first monthly staff meeting - mind you, I was just one month out of fellowship - and one of the office staff typed up a three page single spaced list of petty/bull**** complaints about me and my performance etc. (I have discussed this situation elsewhere on SDN - to make a long story short, this office staffer and my office manager were best buddies from high school, and the office staff had a nebulous “health issue” that was rumored to be MS, and she basically wanted a job where she could show up and do practically nothing while still getting paid [she was lazy and ineffective at the job]. My office manager was willing to help her have a do-nothing job, and the manager was good friends with higher ups at the hospital, and so one way for them to accomplish their shared goal of letting this office staff do nothing was to make the doctor look as bad as possible. And because the office manager was friends with the higher ups and had convinced them that the horrid office staffer was a “good employee”, I was apparently stuck with that person in my office. No matter how much I complained, no senior manager would allow this person to be switched out.)

Bottom line: the only thing that helped was changing jobs. And believe me, I tried everything discussed here - kissing their asses, buying them food and other stuff, etc etc. All of it was a waste of time and money. I stayed at that job far longer than I should have, thinking it would get better etc, but it never did. And every job I’ve had ever since has been a night and day difference in terms of how well the staff mesh with me etc - my current nurses are wonderful to work with, and work hard and are efficient. There was nothing actually wrong with me as a doc - the staff at that first job were just freaking horrible.

 

[Splenda88]

They really can be. Any tips for winning them over, especially in situations where they are completely, absolutely wrong?

Call them by their name. Ask them what they think even if you don't really care about what they think.

Others here say buy them donuts/pizza. I bought pizza for the ED nurses and lunch for a whole floor once, and it was only $80+ and $200 respectively. Maybe I should do that more often...like every 3 months for different floor.

 

[pastafan]

Amazon product ASIN 0671027034
This and food.

 

[end stage fibro]

To be fair being out of the hospital is a huge hit to credibility. As someone who stays in the hospital because I have stuff to do when I get a phone call from a hospitalist about their patient decompensating while I hear their kids in the background at 3pm I roll my eyes and sometimes find that this has been an ongoing issue for hours getting worse because they weren't in the hospital and didn't understand this wasn't something that was going to get better. The RRT nurse will sometimes call when there is gross mismanagement occuring because they know I am around and will come fix the dumb****ery. Maybe a local culture thing but I dealt with the same problem in fellowship and when I worked at a VA.

I agree with the thrust of your post, but I have to say that staying in the hospital is worth pennies in street cred and I think is mostly theatrical. Some hospitalists go home and nothing gets followed up until the next morning- that is malpractice, especially when you can get results "paged" to your phone in Haiku and you can track sick pts. I think there there are maybe (and i mean maybe) 1 in 1000 cases where being at the bedside might help.

come at me, everyone

 

[gutonc]

I agree with the thrust of your post, but I have to say that staying in the hospital is worth pennies in street cred and I think is mostly theatrical. Some hospitalists go home and nothing gets followed up until the next morning- that is malpractice, especially when you can get results "paged" to your phone in Haiku and you can track sick pts. I think there there are maybe (and i mean maybe) 1 in 1000 cases where being at the bedside might help.

come at me, everyone

It mostly is performative. But sometimes you have to put on a show.

 

[chessknt]

I agree with the thrust of your post, but I have to say that staying in the hospital is worth pennies in street cred and I think is mostly theatrical. Some hospitalists go home and nothing gets followed up until the next morning- that is malpractice, especially when you can get results "paged" to your phone in Haiku and you can track sick pts. I think there there are maybe (and i mean maybe) 1 in 1000 cases where being at the bedside might help.

come at me, everyone

The problem is you are depending on someone else to put something in to a computer for you to track. Being in the hospital means you can look at someone and know if there is a problem in <5 seconds. My office has a tele monitor for the entire unit--I know there is a problem before the nurses sometimes because I can see when something is going awry.

I get that most of the time it is fine but if YOU were in the hospital and something started to go wrong would you want your doctor to be fielding phone calls about you waiting for some labs/imaging/etc to come back when you feel like something is seriously going wrong or would you want someone in there to take a look and see that something bad is going down so you would get triaged effectively?

Like if you get a call because troponin is going up and 'patient doesnt look good' etc. Now you can order EKG and some labs imaging etc all of which take over an hour or you can walk in the room and see is this A) someone who looks ok NSTEMI low risk path or B) Diaphoretic panicked look in the eyes high risk path. Option B for anyone who knows anything is going to trigger personal phone calls to speed things up because it looks bad. You cant make that decision at home.

 

[Osteoth]

The problem is you are depending on someone else to put something in to a computer for you to track. Being in the hospital means you can look at someone and know if there is a problem in
I get that most of the time it is fine but if YOU were in the hospital and something started to go wrong would you want your doctor to be fielding phone calls about you waiting for some labs/imaging/etc to come back when you feel like something is seriously going wrong or would you want someone in there to take a look and see that something bad is going down so you would get triaged effectively?

Like if you get a call because troponin is going up and 'patient doesnt look good' etc. Now you can order EKG and some labs imaging etc all of which take over an hour or you can walk in the room and see is this A) someone who looks ok NSTEMI low risk path or B) Diaphoretic panicked look in the eyes high risk path. Option B for anyone who knows anything is going to trigger personal phone calls to speed things up because it looks bad. You cant make that decision at home.

If video software were more widely accepted you could.

 

[DrMetal]

while I hear their kids in the background at 3pm I roll my eyes and sometimes find

Wow, I'm glad we don't work in the same hospital. One time I called in an order, and someone behind me yelled "Fore!" (around 2:00 pmish). The nurse on the other line asked me if I was on a golf course. To which I replied, "I'm not not on a golf course." We all had a good laugh.

 

[emergentmd]

I had an ER doc who for some odd reason was on the nurses bad side. Had complaints about thinks where other docs doing the same would get a pass. Talked to him, he asked what he should do. He went down the list of active steps that I knew wouldn't change one thing. If the nurses don't like you, they will find even the dumbest thing to complain about.

After listening to all of his reasoning and solutions, I told him to go grab donuts/breakfast next time he goes. Just be nice. Buy lunch periodically and things will be fine. Haven't heard much complaints since. Now they like him and he doesn't feel like working under a microscope. Prob cost him $50 every month.

Nurses can be like vultures circling a wounded deer. Once they circle, there is nothing you will do to "fix" things and will always feel them circling. Give them food and they will stop circling.

 

[Osteoth]

I had an ER doc who for some odd reason was on the nurses bad side. Had complaints about thinks where other docs doing the same would get a pass. Talked to him, he asked what he should do. He went down the list of active steps that I knew wouldn't change one thing. If the nurses don't like you, they will find even the dumbest thing to complain about.

After listening to all of his reasoning and solutions, I told him to go grab donuts/breakfast next time he goes. Just be nice. Buy lunch periodically and things will be fine. Haven't heard much complaints since. Now they like him and he doesn't feel like working under a microscope. Prob cost him $50 every month.

Nurses can be like vultures circling a wounded deer. Once they circle, there is nothing you will do to "fix" things and will always feel them circling. Give them food and they will stop circling.

Not gonna lie this was never how I thought it would be as an attending.

 

[anonperson]

Not gonna lie this was never how I thought it would be as an attending.

Your experience isn't the norm. Most physician-nurse interactions are fine.

 

[Osteoth]

Your experience isn't the norm. Most physician-nurse interactions are fine.

It’s more just the level of attention that multiple people have told me they pay to this kind of stuff. Guess I shouldn’t expect too much deference as a Hospitalist.

 

[NITRAS]

Your experience isn't the norm. Most physician-nurse interactions are fine.

I think new nurses get brainwashed in RN school that they know more about the patient and care more, so they should be telling us what to do.

I also think that being extra thankful for them for doing the basics in their job goes a long way.

 

[emergentmd]

It’s more just the level of attention that multiple people have told me they pay to this kind of stuff. Guess I shouldn’t expect too much deference as a Hospitalist.

Your experience has nothing to do with doctor/nurse relationship. It is relationships in general. Happens in all fields esp when you have some authority. Being in management sucks and you sometimes can never be right.

 

[DrMetal]

, I told him to go grab donuts/breakfast next time he goes. Just be nice.

I've never bought them food, but I do talk to them, sometimes about their personal lives. I love it when they try to blame their BMI on a 'thyroid problem'. A little empathy/sympathy can go a long way (which I don't have, mind you, I have to fake it)

 

[Osteoth]

I've never bought them food, but I do talk to them, sometimes about their personal lives. I love it when they try to blame their BMI on a 'thyroid problem'. A little empathy/sympathy can go a long way (which I don't have, mind you, I have to fake it)

Lmao.

 

[timpview]

Your experience has nothing to do with doctor/nurse relationship. It is relationships in general. Happens in all fields esp when you have some authority. Being in management sucks and you sometimes can never be right.

You don’t have authority. And you’re not in management.

 

[mumixam]

You don’t have authority. And you’re not in management.

we do, kinda. We are leaders of the care team.

 

[NITRAS]

we do, kinda. We are leaders of the care team.

Do you hire, fire the nursing staff? Set nursing policy? I don’t.

You have liability. A moral responsibility, too. If a nurse does something bad, you can complain to nursing leadership and they can decide the appropriate action. I have very limited control, ultimately.

You own your own clinic, you can effect all that.

 

[Osteoth]

Do you hire, fire the nursing staff? Set nursing policy? I don’t.

You have liability. A moral responsibility, too. If a nurse does something bad, you can complain to nursing leadership and they can decide the appropriate action. I have very limited control, ultimately.

You own your own clinic, you can effect all that.

Did doctors use to have more control over nurses?

 

[The kitchen sink]

The lesson is that there is no one in the hospital that will protect you, except you.

A lesson learned now is better than never learned.

 

[Splenda88]

Did doctors use to have more control over nurses?

Talking to a few docs that are in their 60s, it seems like they had more control. One pulmonologist in my hospital has that line: 'It's no longer a doctor's order anymore, it's just a suggestion because the nurses will do whatever they want.'

 

[The kitchen sink]

Talking to a few docs that are in their 60s, it seems like they had more control. One pulmonologist in my hospital has that line: 'It's no longer a doctor's order anymore, it's just a suggestion because the nurses will do whatever they want.'

Until the liability is actually spread to someone other than the physician, then it is an order and has to be followed. Unfortunately, it’s on us to enforce this through multiple barriers.

 

[Splenda88]

Until the liability is actually spread to someone other than the physician, then it is an order and has to be followed. Unfortunately, it’s on us to enforce this through multiple barriers.

Nurses have gone rogue. I guess they are emboldened by admin. Amazingly, I noticed nurses in academic center where I did residency were more disciplined than nurses at these community hospitals.