How do you deal with smart ass remarks?

[whournameiz]

Yes we all know it is appropriate to brush it off. But at what point can you remark back?!

And I mean smart ass comments in the hospital by nonMDs. You ask someone a simple question and they give u a rude smart ass comment back. Do you just let them walk on you?

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[lord_jeebus]

Yes we all know it is appropriate to brush it off. But at what point can you remark back?!

You can respond back at any time, but I can't imagine many scenarios where the benefits would outweigh the costs...

 

[babyruth]

I assume you mean by ancillary staff and nurses? That's a tough sitution because when they don't like you, they make your life hell. You can always respond with a serious remark back, such as:
"Is there something I did to make you angry at me?"
"I'm sorry. I'm just trying to learn because I'm new to the hospital, I would appreciate your help with this because I need to know how things are done around here."
"Can you explain that to me in more detail?"
"I'm sorry, Id din't realize it was that simple. Would you show me how to do that then?"
etc.

What I hate is the evil looks you get, even when you are not the culprit. Like when some staff hate residents/medical students in general. Just remember that you can always take it to the attending or GME and they can bring it up to the director of nursing, etc. to find a amicable solution.

 

[Hard24Get]

"I'm sorry. I'm just trying to learn because I'm new to the hospital, I would appreciate your help with this because I need to know how things are done around here."

"I'm sorry, I didn't realize it was that simple. Would you show me how to do that then?"
etc.

These are my most common replies, usually appended with "so I won't have to bother you quite so much in the future". I also throw in helpfulness, like staying after a procedure to help the nurse tidy up, etc. Kill'em with kindness. In 90% of sour-faced individuals, these techniques soften them up because they realize you plan on treating them with respect. We can then enjoy a great relationship. As it turns out, the other 10% don't get along with ANYONE, anyway.You have to realize that many don't like med students/residents exist because they have been $hit on before.

You may feel like the syrupy responses above are butt kissing, but if you get your intonation right, it will basically come out like, "look, I'm a great person and you have no right to talk to me that way. Check yo' attitude at the door. Kill'em with kindness.

Similar techniques work for all mean (or just temporarily mean) people.

 

[deleted87716]

Kill'em with kindness...Similar techniques work for all mean (or just temporarily mean) people.

Words to live by.

 

[nala]

I definitely agree with the above...kindness is always the way to go.
I stopped being surprised by how rude some people can be to med students the day I overheard this statement:
Med student walks up to L&D nurse's station and says the following:
"I know all of you are ignorant and stupid, but my question is pretty simple so maybe you can actually answer it."

I think my jaw actually dropped onto the floor. Most of those nurses had probably been nurses for longer than this kid had been alive. I guess if I had to deal with an arrogant med student saying something like that to me I wouldn't always have patience for med students. I might too adopt a "show me you're not a jerk and I won't treat you like one" attitude.

Remembering what that awful med student said to those nurses has made it more bearable when someone is nasty to me. You never know how they've been treated in the past.

 

[surrender903]

self deprecation is a valuable tool indeed.

"i realize that the question i asked may be simple, can you help me though?"

 

[Tired]

Yes we all know it is appropriate to brush it off. But at what point can you remark back?!

And I mean smart ass comments in the hospital by nonMDs. You ask someone a simple question and they give u a rude smart ass comment back. Do you just let them walk on you?

You can mouth off back to them whenever you want, and there is nothing that you can do to you other than continue to grumble and moan about the stupid med students.

Only in med school do people suggest that you take insults from complete strangers and say "thank you".

 

[dilated]

You can mouth off back to them whenever you want, and there is nothing that you can do to you other than continue to grumble and moan about the stupid med students.

Only in med school do people suggest that you take insults from complete strangers and say "thank you".

This always amazes me. Med students are conditioned to do whatever they're told and never, ever fight maltreatment. Sometimes you need to grin and bear it because you need to take care of business, but sometimes you should recognize it for what it is - bullying. They're bullying you because they think you won't fight back (and for every 1 med student who's an outright dick there are 10 who wouldn't say boo to a goose) and the best way to deal with bullies hasn't really changed since the playground days. I'm obviously not advocating punching them in the face or anything, but if you push back hard enough to make it clear that hassling you isn't going to be a cakewalk they'll almost always back off in favor of weaker prey. It's not just medicine, it's the same at any job where people think they can mess with you with impunity.

It's easy to tell based on who they do it to. One 4th year I was with, who's a tiny woman and is super nice to everyone, gets the worst of it. I've seen nurses straight up give her orders on an AI. Another one is a 6'5 DI football player going into ortho (naturally) and I've never, ever seen anyone start with him - in fact, they usually kind of run away when he approaches.

 

[chimichanga]

This always amazes me. Med students are conditioned to do whatever they're told and never, ever fight maltreatment. Sometimes you need to grin and bear it because you need to take care of business, but sometimes you should recognize it for what it is - bullying. They're bullying you because they think you won't fight back (and for every 1 med student who's an outright dick there are 10 who wouldn't say boo to a goose) and the best way to deal with bullies hasn't really changed since the playground days. I'm obviously not advocating punching them in the face or anything, but if you push back hard enough to make it clear that hassling you isn't going to be a cakewalk they'll almost always back off in favor of weaker prey. It's not just medicine, it's the same at any job where people think they can mess with you with impunity.

It's easy to tell based on who they do it to. One 4th year I was with, who's a tiny woman and is super nice to everyone, gets the worst of it. I've seen nurses straight up give her orders on an AI. Another one is a 6'5 DI football player going into ortho (naturally) and I've never, ever seen anyone start with him - in fact, they usually kind of run away when he approaches.

interesting perspective from the med students...

from a nursing perspective, it seems that the shoe is on the other foot once the MS IV is now an attending...Not that all docs are rude to the ancillary staff, but there are those that do it daily...I always wonder where they lost their humanity...

Certainly there are nurses that hate MS and residents, but I think they are in the minority...Just as I think that docs that are rude to nursing are also in the minority...

just always remember what it was like to be on the receiving end of the humiliation game, and treat everyone (housekeeping, nursing, respiratory, CEO, volunteers, etc) respectfully...

i agree w/ the bully analogy...Give it back to them (privately)...bullies usually back down...though I can't speak as a MS...If a MS gives it back to a senior resident, his life may become an instant hell...but if a doc yells at me, it comes right back at him...he doesn't sign my paycheck, and we both work for the pt...

 

[SLUser11]

I stopped being surprised by how rude some people can be to med students the day I overheard this statement:
Med student walks up to L&D nurse's station and says the following:
"I know all of you are ignorant and stupid, but my question is pretty simple so maybe you can actually answer it."

Whatever.

Even if that's a true story, I highly doubt the cut at the nurses was completely out of the blue. Most likely it was a response to something they said or did, especially since they were OB nurses. Of course, it doesn't make it right, but I don't like your selective storytelling.

You can mouth off back to them whenever you want, and there is nothing that you can do to you other than continue to grumble and moan about the stupid med students.

This is almost 100% true. The old "be good to your nurses, or they'll make your life hell" bullcrap really only applies to residents and upwards. What can they do to med students to make their lives hell? They have no authority over them, they don't know your pager numbers, etc.

Still, it's bad form, and horrible practice for when you actually need to be nice as a resident.

Not that all docs are rude to the ancillary staff, but there are those that do it daily...I always wonder where they lost their humanity...

Ummmmm......think harder......why do they treat nurses bad? Because they were treated bad by nurses when they were lower on the totem pole. It's a vicious circle of self-propagated antagonism.




Please don't take from my post that I think it's OK to be mean to nurses. If you search some of my old posts, you'll see how much I hate the antagonism that's deeply engrained into the structure of medical education.

Honestly, if it's going to change, it has to change with the nurses first. For every jerk med student who's condescending or mean to a nurse, there's 10 nurses doing it to undeserving med students.

 

[chimichanga]

...Honestly, if it's going to change, it has to change with the nurses first. For every jerk med student who's condescending or mean to a nurse, there's 10 nurses doing it to undeserving med students.

That's funny...I guess it depends on your perspective...I don't think that the docs who are mean to everyone as an attending, were summarily shat on as students (by the nurses, or whomever)...They were just dinguses from birth...The same goes for nurses as well. The bitchy ones were bitches before nursing...
I was a staff nurse in a big city for years, and 99% of the time, there was collaboration, and symbiosis between the nursing staff and the physicians...Now in a rural community with one hospital, the nurses are like the Stepford wives, and it's still "yes doctor, I am a doormat, whatever you say goes"

I don't know, as I have never been a med syudent, but having just left a big teaching hospital, I loved med students and residents, and felt that they were always nicer than the attendings...And my philosophy has always been that if we treat EVERYONE with respect, it will return tenfold...

you sound really angry towards nursing, and it sucks that you had so many mean spirited nurses...We're not all bad, just as if I get yelled at by 2 cardiothoracic guys, I can't paint them all with the same brush either...

wow

 

[Tired]

I don't know, as I have never been a med syudent, but having just left a big teaching hospital, I loved med students and residents, and felt that they were always nicer than the attendings...And my philosophy has always been that if we treat EVERYONE with respect, it will return tenfold...

you sound really angry towards nursing, and it sucks that you had so many mean spirited nurses...

Like all nurses, you're very good at talking about mutual respect in one breath, then trashing the docs in the next ("I wonder when they lost their humanity").

I've got news for you: We all get trashed by nurses, and it's not a small minority nurses doing it, it's a culture in your profession.

 

[fang]

I've got news for you: We all get trashed by nurses, and it's not a small minority nurses doing it, it's a culture in your profession.

I agree. I'm amazed by how much the medical culture tolerates childish and maladaptive behavior. The only thing I have to compare it with is a job as an engineer for a few years. In industry, the same power structure existed: operators, technicians, engineers, managers, directors, VP's, CEO. Rudeness to ANYONE up or down the chain was considered unprofessional. Unlike in medicine, rude techs or engineers would get "talked to" by a superior if they violated this culture. Technicians often made suggestions about designs, came to review meetings, etc, but they never badmouthed engineers (though I think they made fun of our general nerdiness.) Engineers and techs all reported to the same manager.

Contrast this with medicine, where it seems 75% of all people have ego issues (doctors, nurses, respitory therapists, everyone). Examples: the supersurgeon who has to "save" the pts from the IM docs, the IM doc who has to "save" the pt from the EM doc, the nurse who has to "save" the pt from the critical care doc, the RT who has to "save" the pt from the nurse. You say we're all working for the pt, but we're not-- hospital politics is all about figuring out what might threaten someone's tenuous self esteem, and then pandering to their ego in order to accomplish your goal. That means telling the RT tech "I'm sorry, I know it's simple but can you show me", and putting up with pushy nurses who are trying to prove to you and the world that they are needed by micromanaging how the resident puts in a foley. Personally, I think these kinds of attitudes reflect a weak personality and are bad for patients, but they are consistently tolerated.

 

[The_Sensei]

Yes we all know it is appropriate to brush it off. But at what point can you remark back?!

And I mean smart ass comments in the hospital by nonMDs. You ask someone a simple question and they give u a rude smart ass comment back. Do you just let them walk on you?

Just ignore the dopes.

 

[chimichanga]

Like all nurses, you're very good at talking about mutual respect in one breath, then trashing the docs in the next ("I wonder when they lost their humanity").

I've got news for you: We all get trashed by nurses, and it's not a small minority nurses doing it, it's a culture in your profession.

Just ignore the dopes.

Yea, I went to school, started working, and counted down the minutes to the "Let's trash the doc game"

Please...

Trashing co-workers is, as you all know, the sole property of the nursing staff...

Agreed, trashing other humans (not including docs) is part of the nursing culture...But to lay a whole rap on the whole profession, when only a few have trashed you, is no better than for what you condemn us

yea, it's our fault that docs yell at us...

signed,

the collective Stepford wives, you seem to wish we all were...

Come to our small town, you'll fit right in...

At least Fang kept it real about the whole culture (Remember, in your world, you rule that culture)

Look, I don't doubt that you have experienced the most bitter nurses that have embarrassed you, or whatever...Many exist...We've probably run into some of the same bitches...I am embarrassed for my profession as a whole when these behaviors happen...But, you know, there are bad mechanics, lawyers, janitors, whatever...

You are way off base painting us all with the same brush, inasmuch as I would be out of line judging all your peers by your comments...

99% of us wholeheartedly respect what you do...You incur liability that far exceeds ours...We get that...I don't want your liability...Were just asking for collaboration...Fang is off base here...There are plenty of docs and nurses that have the pts' best interest in mind...

Those bad apples though...

 

[theraball]

Yea, I went to school, started working, and counted down the minutes to the "Let's trash the doc game"

Please...

Trashing co-workers is, as you all know, the sole property of the nursing staff...

Agreed, trashing other humans (not including docs) is part of the nursing culture...But to lay a whole rap on the whole profession, when only a few have trashed you, is no better than for what you condemn us

yea, it's our fault that docs yell at us...

signed,

the collective Stepford wives, you seem to wish we all were...

Come to our small town, you'll fit right in...

At least Fang kept it real about the whole culture (Remember, in your world, you rule that culture)

Look, I don't doubt that you have experienced the most bitter nurses that have embarrassed you, or whatever...Many exist...We've probably run into some of the same bitches...I am embarrassed for my profession as a whole when these behaviors happen...But, you know, there are bad mechanics, lawyers, janitors, whatever...

You are way off base painting us all with the same brush, inasmuch as I would be out of line judging all your peers by your comments...

99% of us wholeheartedly respect what you do...You incur liability that far exceeds ours...We get that...I don't want your liability...Were just asking for collaboration...Fang is off base here...There are plenty of docs and nurses that have the pts' best interest in mind...

Those bad apples though...

The bottom line is, there are good and bad people in every profession. People around here tend to think medicine is particularly bad, because they've never worked anywhere else, but believe me, people are people no matter where you go.

The best strategy is to maintain good boundaries, always smile, be assertive but polite, and never let them get to you. It will be the same when we are practicing physicians dealing with the general public.

 

[yankeedoodle1]

The old "be good to your nurses, or they'll make your life hell" bullcrap really only applies to residents and upwards..

What I don't understand is why do Residents always feel that they have to be the ones to be polite and kind to nurses, so that nurses don't give them 'hell'. Why can't a resident make a nurses life 'hell' if he/she is being rude to them?
Why isn't this a two-way street. Where do nurses get all this 'power to treat residents like hell'? Don't they have superiors, someone a resident can go to, to complain to them about their rude and bullying behavior towards us?
It's ridiculous to have to put up with this kind of nonsense in a professional world. All we want is mutual respect, not 'butt kissing, so that we don't get treated like crap by nurses.'
Is that too much to ask?

 

[yankeedoodle1]

The old "be good to your nurses, or they'll make your life hell" bullcrap really only applies to residents and upwards.

What I don't understand is why do Residents always feel that they have to be the ones to be polite and kind to nurses, so that nurses don't give them 'hell'. Why can't a resident make a nurses life 'hell' if he/she is being rude to them?
Why isn't this a two-way street. Where do nurses get all this 'power to treat residents like hell'? Don't they have superiors, someone a resident can go to, to complain to them about their rude and bullying behavior towards us?
It's ridiculous to have to put up with this kind of nonsense in a professional world. All we want is mutual respect, not 'butt kissing, so that we don't get treated like crap by nurses.'
Is that too much to ask?

 

[amojan99]

Answer: UNIONS!

The nursing union is extremely strong, especially up here in NY and the northeast. Nurses could strike at a moment's opportunity and like many other unions often take advantage of the rules to work as little as possible and pull other shenanegans. Not that I'm saying all nurses do this. We have to understand that nurses have increasing workloads with the shortage of nurses, but is it too much to ask that they work somewhat as hard as we do, or at least support us?

 

[Tired]

Answer: UNIONS!

The nursing union is extremely strong, especially up here in NY and the northeast. Nurses could strike at a moment's opportunity and like many other unions often take advantage of the rules to work as little as possible and pull other shenanegans. Not that I'm saying all nurses do this. We have to understand that nurses have increasing workloads with the shortage of nurses, but is it too much to ask that they work somewhat as hard as we do, or at least support us?

It's more than a strike issue. The practice of nursing these days essentially prevents any kind of disciplinary or corrective action except in cases of extreme neglect. A physician who fails to follow his/her patients opens themselves up to malpractice torts. A nurse who ignores orders or fails to conduct assessments accurately will not even get talked to by superiors. Nurses are rarely terminated for poor job performance. Worst of all, multiple "quality improvement" initiatives have taken responsibility off of RNs for medication errors.

Nursing has zero consequences for poor job performance.

 

[chimichanga]

tired, your statements are laughable...

I have fired nurses for poor performance, there are corrective actions in place for med errors, and nurses are definitely held accountable for failure to assess, failure to intervene, practicing outside of their scope, etc...

I'm not sure on what you are basing your info, but please share your vast nursing experiences firsthand...

I ask one thing here: follow the link and read from pgs 22 on, and see the many nurses held accountable for things other than neglect. (this is AZ only)

http://www.azbn.gov/documents/newsletters/Journal%201st Quarter March 2007.pdf

 

[SLUser11]

tired, your statements are laughable...

I have fired nurses for poor performance, there are corrective actions in place for med errors, and nurses are definitely held accountable for failure to assess, failure to intervene, practicing outside of their scope, etc...

I'm not sure on what you are basing your info, but please share your vast nursing experiences firsthand...

I ask one thing here: follow the link and read from pgs 22 on, and see the many nurses held accountable for things other than neglect. (this is AZ only)

http://www.azbn.gov/documents/newsletters/Journal%201st Quarter March 2007.pdf

I agree with you, and believe that there are many excellent nurses working in academic environments. Unfortunately, they become less memorable than the ones that suck, especially in a profession (like medicine) where we tend to be very critical. Also, I believe that New York has unique nursing problems that people from the midwest don't encounter (me in MO, NE, and KS, you in AZ).

As far as Tired's comment, he/she is most likely stating a doctrine that he first heard as a med student from his residents, "Nurses suck, they're untouchable, they don't want to work hard, they're mean, etc." He will go on to believe this and resent the nursing staff as a resident and attending.

On the flipside, nursing students are hearing from their nurses and teachers, "Med students suck. They get in the way, they screw things up, they think they're so smart but they don't know anything, etc." They will go on to believe this and resent students and residents when they're practicing nurses.

And so the cycle of antagonism continues.

 

[SLUser11]

What I don't understand is why do Residents always feel that they have to be the ones to be polite and kind to nurses, so that nurses don't give them 'hell'. Why can't a resident make a nurses life 'hell' if he/she is being rude to them?
Why isn't this a two-way street. Where do nurses get all this 'power to treat residents like hell'? Don't they have superiors, someone a resident can go to, to complain to them about their rude and bullying behavior towards us?
It's ridiculous to have to put up with this kind of nonsense in a professional world. All we want is mutual respect, not 'butt kissing, so that we don't get treated like crap by nurses.'
Is that too much to ask?

It is a two way street, and often residents do respond in passive aggressive ways to make the nurses life hell. If a nurse calls them in the middle of the night with some BS report or request, the resident will respond by creating more work for the nurse (eg "ambulate the patient q1hr," or increase frequency of vital signs, or decrease time intervals between prn doses). This is their way of preventing the nurse from wanting to call the resident.

But does this help? No, it just increases tension between the two professions. If somebody is an a-hole, and then you're an a-hole in return, you're still an a-hole.

 

[chimichanga]

SLU,

nice posts...

I never heard the crap comments about med students sucking, when I was in school...I'm sure it happens...We are a catty profession...

As a nursing instructor now, I hammer home to my students that the entire team (lab, resp, nursing, students of all kinds, residents, attendings, housekeeping, etc) are ALL important to the delivery of good, safe care; and the more we hate on each other, the worse it is for the patients, because it becomes less about the patient, and more about one's ego (thank you Fang!)

On the flipside, I would hope that in med school and residency, that the hate of nurses isn't being perpetuated as well, though I'm sure it exists...

Living in a small town now, with one hospital, I am discouraged at both the nurses (for being doormats, and continuing to allow themselves to be treated with widespread disrespect) and the "old school" docs that march to the beat of their own drum (as if it were 1965, and expecting to keep the nurses in their collective "place")

Communication is key...an quick example: I was a supervisor in a large, urban teaching hospital ER. Teach teams came down to admit the pt...I'm fine with that, and respect their need to learn. But with a 6 hour wait in my ED, and the admitted pt has a bed assignment, I need that pt to go upstairs. I could be an dingus, and just move the pt, without alerting the teach team (many nurses did this). I chose to call the chief resident, and explain the ED's situation. She was fine with moving the pt now, then the neuro resident could do her exam, do the LP, etc. upstairs, and the ED has a bed freed up. Simple communication between the two entities helped the outcome for the pt, and improved our working relationship. 'Cause when we're slow, please do your ventric in the ED bed, I'm more than happy to accomodate...Bring the whole teach team down to do their H&Ps, etc. You can use the bed for as long as you want.

Patients aren't best served by this stupid animosity...We both bear responsibility, and should both strive to learn from historical mistakes made by all parties...

Being a house sup now, I can see how the floor nurse calling you 6 times during the night for stupid crap, annoys the hell out of you...I'm working on that one, as I see it as a BIG problem in our hospitals now...

 

[babyruth]

Lets get back to the topic at hand and not do the poopoo nurses/poopoo doctors act. My main point was that, as Chimi, said, it pays to get along and here are some statements to do it.

Let's face it, as a med student, nurses and other ancillary staff know a lot more than you and you can learn from them, even though you have more schooling then them right now. You might know more organic chem than they do, but they have usually been in the field and know a lot more about hospital procedure and certain medical procedures than you do right now. This knowledge ratio switches as you move on, but it is a benefit to learn from them; esp. the old timers who can show you a few tricks or two.

 

[Tired]

As far as Tired's comment, he/she is most likely stating a doctrine that he first heard as a med student from his residents, "Nurses suck, they're untouchable, they don't want to work hard, they're mean, etc." He will go on to believe this and resent the nursing staff as a resident and attending.

No, I'm stating my own experiences first hand, both as a med student for 4 years, a CNA for 6 years, and anecdotal info from my wife, who has been an RN for 7 years.

In that time I have seen and heard of countless eggregious errors, from orders ignored, splints put on backwards, medications given twice or not at all, delay in administering antibiotics for hours to critically ill patients, delays in getting CTs done on stroke patients, delays in getting EKGs done on MI patients, medications given without orders, vital signs not taken, assessments not done, and on and on and on.

The current model in nursing is to assign all mistakes to the category of "system failure", relieving them from individual responsibility. This is especially true for medication errors where, at least in my state, a strict non-retaliation policy is intended to encourage med error reporting.

If this isn't your experience, good for you. But given the constant critiques that physicians are subject to (peer review, attending oversight, M&M's, case presentations), I don't understand why any discussion on problems in nursing is immediately taken personally. If there were a process of performance evaluation and practice critique in place for nursing, many of these problems would not go on unchecked. Of course, given the immediate visceral response to my comments, I can see how far off we are from that ever happening. Too bad.

 

[chimichanga]

tired...

we all have countless stories of nurses gone bad, docs missing things leading to death, PAs sucking, NPs not knowing enough...

blah blah blah

you are painting nurses with a wide brush...I personally know of docs covering each others' mistakes up, violating EMTALA, getting a slap on the wrist from BOMEX for gross malpractice...SO WHAT...I don't think the profession of medicine is in shambles because of those few...

My "visceral" response comes from your ignorance on this topic...You have no firsthand knowledge as a nurse, and frankly can't speak objectively on the topic...

And your comment of no performance evaluation and practice critique for nursing is simply not true...In my 12 years as an RN, I have at least BI-ANNUALLY had a performance review (in any given clinical setting), am subject to peer review by the board if there's a complaint (face it, as a doc, your board of medical examiners doesn't review you unless there's a complaint lodged)

Hell, the (MD) president of our hospital's board of directors is the owner of the ONLY hospitalist group in town that admits 85% of our patients. Do THAT math...He can effect change and policy that financially benefits his group...Do I think all docs are this dishonest? NO

Your sweeping generalizations are simply false...I have been a staff nurse, charge, supervisor, educator, peer review, director, clinical specialist, and at every level, I was subject to REGULAR performance evaluations and peer reviews, just as I suspect you have been through as a CNA, and especially as a med student, and will face as a resident...

please stop the animosity, as you are in danger of becoming the very prick that SLU describes in the anecdotes (allegedly) passed along to nursing students about med students and residents...

 

[chimichanga]

I appreciate everyone's indulgence of me crossing over from the clinician's forum...I have always enjoyed med students and residents, because as a whole, they have been nice, professional, and eager to learn from everyone...I respect physicians for taking 95% of the liability (nurses do incur liability, not likely financially, as compared to docs, but can and do lose their livelihood for mistakes in patient care)...I don't want your job, you do it much better than I ever would...

just a thought from an enlightened med student (on this site):

... Without sounding too philosophical, I think it's interesting to see how people get their information. No one seems to take the time to research an issue, consider the ins & outs, pros & cons, and then independently develop an informed opinion. Opinions are based on one or two experiences and/or perceptions gleaned from conversations and then are passed on as dogma. These are the same people who probably swear by EBM.

 

[Playmakur42]

Treat people as you want to be treated.

If that doesn't work, try to "kill them with kindness".

If that doesn't work, try standing up to them.

If that doesn't work - http://hitman.us/main.html

 

[ChildNeuro]

Someone should come up with a short course about communication between healthcare personal in the hospital. Personally, the hospital where I am at now the nurses are overall fantastic. They volunteer information to me about patients that I am only consulting on, and have shown me various tricks about how to get labs done quick etc . . . I try to be extra-respectful of nurses, i.e. put the chart back in the right place, ask polite questions about patients without acussing them of providing poor care. A nurse yelled at me last week, but then apologized when they realized saying they were "just joking", after I was writing down a patient's meds from their med list (important to know what the pt. is actually getting.) I pay pretty close attention to my patients, and am there early alot in the hospital and don't need to sleep during the night like some of my colleges, I don't know what changed but nurses don't harass me like I occassionally got as a med student starting rotations, I think I went out of my way to be nice to nurses early, although I still try to be a nice as possible time permitting. It is important to stand your ground and show what knowledge you have and take charge of the care of your patients, attendings have told me that the residents really respect me. The nurses can tell when you have taken responsibility for a patient's care and will usually assist you, but may get annoyed if you just jabber with friends on rotations about how beer you will drink on the weekends instead of reading.

 

[hyperbaric]

If that doesn't work - http://hitman.us/main.html

How nice - they take credit cards!!

 

[hilseb]

That's funny...I guess it depends on your perspective...I don't think that the docs who are mean to everyone as an attending, were summarily shat on as students (by the nurses, or whomever)...They were just dinguses from birth...The same goes for nurses as well. The bitchy ones were bitches before nursing...
I was a staff nurse in a big city for years, and 99% of the time, there was collaboration, and symbiosis between the nursing staff and the physicians...Now in a rural community with one hospital, the nurses are like the Stepford wives, and it's still "yes doctor, I am a doormat, whatever you say goes"

I don't know, as I have never been a med syudent, but having just left a big teaching hospital, I loved med students and residents, and felt that they were always nicer than the attendings...And my philosophy has always been that if we treat EVERYONE with respect, it will return tenfold...

you sound really angry towards nursing, and it sucks that you had so many mean spirited nurses...We're not all bad, just as if I get yelled at by 2 cardiothoracic guys, I can't paint them all with the same brush either...

wow

I think it is useless to try to assign blame. Every dingus who bullies has a supposed justification. Many of the scenarios if not all of them listed on this thread are probably realities for some people in medical eduction and in hospitals. I definitely think some of it is there before these people entered the medical field. I really wonder why some people who are selfish and mean get into some disciplines, especially L & D, but it happens. I have also worked in a medical education setting at a clinic where there really was a tyrannical person in charge of the education and the clinic, and I could see how institutional nastiness could accustom some people who were being trained in that setting to be nasty.

 

[lumbering]

I'm an MS II, but I have various ideas.

1) Play it cool; take it in stride.

This means ignore it the first few times, especially if the smart ass comments are minor.

2) Legitimize their complaints.

"I understand that it might be annoying to deal with medical students."

3) These 13 words are >95% effective in getting someone to change his/her attitude instantly:

"If I was in your position, I would feel exactly the same way."

Source: Dale Carnegie

4) "Be hearty in your approbation and lavish in your praise" (again from Carnegie)

Reward people emotionally when they treat you well:

"I appreciate you taking the time to explain this to me."
"You have an amazing attention to detail."
"You are always on top of your game."

[all followed by a big smile]

5) Build rapport early.

Make comments about the nurse's clothing. Ask about how his/her weekend.

If the nurse is female:

MS: You have a C shaped smile.
nurse: Huh
MS: Some women have a smile shaped like the letter U...where their teeth go straight back...kind of like a horse [mime it with your hands]. Other women have a smile shaped like the letter C where their pearly whites are lined up in front. Supposedly, C-shaped smiles are associated with nice friendly faces and U shaped smiles are associated with mean faces.
Nurse: haha [big smile]

6) Speak in a calm confident voice. When you speak nervously/anxiously, you put people on edge, and they often subconsciously attempt to retaliate.

7) The bold challenge. When the smart ass comments continue and become too harsh, it's time to stand your ground.

"You know...I would appreciate it if you would be nicer to me."

Try to do this is such a way that the nurse has a chance to save face gracefully. You might want to preface such a comment with a legitimization (see #2).

8) Gaze

In acting, there is a concept known a gaze. When you gaze (stare) off into the distance while other people are looking at you, it is assumed that you are of higher status/power. If you are focused on attendings/patients/charts and treat nurses like scenery, they may grow to resent it. Look people in the eye from time to time to let them know that you recognize their existence.

9) Humor

MS: Can I take a look at that EKG again.
Nurse: [handing it to you] Right...because we know you're the hot shot doc.
MS: [sacastically] You know it. [do muscle flexing poses]

Nurse: [spoken to a fellow nurse with you in hearing range] Argh...I hate how we always have med students around.
MS: Aren't they the most annoying little bastards. Lets talk about them behind their backs.[big smile]

 

[fang]

I appreciate everyone's indulgence of me crossing over from the clinician's forum...I have always enjoyed med students and residents, because as a whole, they have been nice, professional, and eager to learn from everyone.

Chimichanga-- Thanks for reading this forum, because unlike a lot of people you're actually in a position to change the culture (since you teach nursing students). I like the idea of some kind of cross-disciplinary seminar to acknowledge the nastiness that goes on between nurses and residents and reinforce the point that it's not acceptable behavior. Most nurses and doctors are mature enough to avoid the petty games, but it's the minority who are not who can make life hell for everyone, and probably the pt as well.

If I had one thing I'd want to tell nurses in general, it's this: I value your opinions and like you want to do what's best for the pt. Please leave your ego at the door and try to work with us as a team as opposed to proving to us how much knowledge you posess. Share ideas, but don't accuse us of ignoring or mistreating the pt if we don't agree. Recognize limitations-- forgive the resident when he/she didn't forgets to order additional pain meds or the med student when he/she takes 10 minutes to copy down vitals, and we can forgive you if you don't chart a medication promptly or remember to elevate the head of the bed. In general things would be better if we could each behave like mature adults and treat each other with just a minimal amount of respect.

I'm sure some nurses would have plenty of ideas for doctors as well.

 

[chimichanga]

fang,
thanks for the support and advice...both are much appreciated...I strive to show the students how important it is to respect everyone involved in the health care delivery of our patients...

I feel your (collective) pain...I supervise many mouthy, opinionated, uncaring nurses...My apologies for them

 

[sponch]

In my four years of medical school, I've only encountered one nurse who was a real witch and would go out of her way to give medical students a hard time while at the same time kissing up to the residents and attendings. She is uniformly hated by the students. The remainder of the nurses were nice and generally interested in providing good care, though there was definitely a spectrum in terms of accountability and competence. Like anything else, you have people who are really good at their jobs and some who really ought to do something else. As far as the bully goes, she's just a miserable person and will remain so while we all go on to do bigger and better things. Though, I have to admit that I've thought about slashing her tires on more than one occasion.

 

[DebDynamite]

Well, it's the end (almost) of my 3rd year and I have run into 4 nurses who have treated me like crap. Usually, I deal with smart ass remarks by making one back (and laughing), but each and every time one of these comments was directed at me by a nurse, I was actually really involved in whatever was going on in the room, and decided to ignore it because I wanted to stay focused on what was happening around me, not the comment. Every one of the smart ass comments was made on an assumption of what I was about to do wrong, or might do wrong- but had yet to do incorrectly. Every time it was a female nurse. I have never received a smart ass comment from a male nurse (I am female).

Just yesterday I received a lengthy diatribe from a nurse about how we need more NP's in the world and that would prevent indigent women from dying of breast & cervical cancer. This was in response to the rural health research I did on cervical cancer- which I described to her as an epidemiology project (which it was, however my job was to sit and interview women and hold discussion groups) in order to be brief. She went on to tell me that the last thing we needed was number crunching and instead we need our patients to feel heard. I had been listening to her for about five minutes (I'm going into psych). What she said to me was of course insulting, and to top it all off- I used to be a nurse. None of the nurses around here know this, I look younger than I am and I worked as a nurse briefly before going to med school- but there was a lot of irony to all of this.

What I try to do is not make assumptions about anyone. Just like the jackass med student did abut the nurses he knew nothing about, I have been
insulted this year based on assumptions about me that were founded in ignorance. Since I don't want to turn out to be like these people, I try not to make assumptions about anyone. And when it suits me, I really do make smart ass comments back, but I do so in a joking way and move on. But so far I have only had to do this with the MD's.

 

[Jejton]

Answer: UNIONS!

The nursing union is extremely strong, especially up here in NY and the northeast. Nurses could strike at a moment's opportunity and like many other unions often take advantage of the rules to work as little as possible and pull other shenanegans...

I find it hard to believe that you have any experience working in the medical field, or at least with your eyes open. Yes everyone works hard in some ways, but I dont know nearly as many doctors who are emotionally and physically burned out as I do nurses. Doctors, especially in training, work hard - agreed - with long shifts and such. But to say that nurses are taking advantage of the rules to work as little as possible?! Maybe I am living in an alternate reality but the vast majority of RN's that I have met as an EMT, as a clinical volunteer and as a patient definately do not fit that mold.

 

[luminos]

Vitals Q1h, Accuchecks Q1h, Lactulose Q1h with no bardex, 24 hour urine collections for protein

 

[luminos]

Call me a cynic but I doubt any of the people talking tough on this board actually stand up to anything. Sure you can tell an attending about a "mean" nurse, does anything really happen or change? Not really. They only answer to the charge nurse, who usually sides with their staff (everyone serves their own best interest).


Take everything in stride, keep your mouth shut. You'll run into weird personalities everywhere. Just keep your cool and don't say anything you'll regret.

 

[Tired]

Vitals Q1h, Accuchecks Q1h, Lactulose Q1h with no bardex, 24 hour urine collections for protein

I hear this comment fairly often, and it's pretty disgusting. We shouldn't be settling staff conflicts by abusing our patients.

 

[goooooober]

I'm an MS II, but I have various ideas.

1) Play it cool; take it in stride.

This means ignore it the first few times, especially if the smart ass comments are minor.

2) Legitimize their complaints.

"I understand that it might be annoying to deal with medical students."

3) These 13 words are >95% effective in getting someone to change his/her attitude instantly:

"If I was in your position, I would feel exactly the same way."

Source: Dale Carnegie

4) "Be hearty in your approbation and lavish in your praise" (again from Carnegie)

Reward people emotionally when they treat you well:

"I appreciate you taking the time to explain this to me."
"You have an amazing attention to detail."
"You are always on top of your game."

[all followed by a big smile]

5) Build rapport early.

Make comments about the nurse's clothing. Ask about how his/her weekend.

If the nurse is female:

MS: You have a C shaped smile.
nurse: Huh
MS: Some women have a smile shaped like the letter U...where their teeth go straight back...kind of like a horse [mime it with your hands]. Other women have a smile shaped like the letter C where their pearly whites are lined up in front. Supposedly, C-shaped smiles are associated with nice friendly faces and U shaped smiles are associated with mean faces.
Nurse: haha [big smile]

6) Speak in a calm confident voice. When you speak nervously/anxiously, you put people on edge, and they often subconsciously attempt to retaliate.

7) The bold challenge. When the smart ass comments continue and become too harsh, it's time to stand your ground.

"You know...I would appreciate it if you would be nicer to me."

Try to do this is such a way that the nurse has a chance to save face gracefully. You might want to preface such a comment with a legitimization (see #2).

8) Gaze

In acting, there is a concept known a gaze. When you gaze (stare) off into the distance while other people are looking at you, it is assumed that you are of higher status/power. If you are focused on attendings/patients/charts and treat nurses like scenery, they may grow to resent it. Look people in the eye from time to time to let them know that you recognize their existence.

9) Humor

MS: Can I take a look at that EKG again.
Nurse: [handing it to you] Right...because we know you're the hot shot doc.
MS: [sacastically] You know it. [do muscle flexing poses]

Nurse: [spoken to a fellow nurse with you in hearing range] Argh...I hate how we always have med students around.
MS: Aren't they the most annoying little bastards. Lets talk about them behind their backs.[big smile]

Very smart MSII. It's great that you know this already. I am a MSIV. Needless to say, I completely agree. IT NEVER EVER PAYS OFF TO REACT EMOTIONALLY. You only give power to others over you. Keeping your cool and letting things roll off your back (to a reasonable limit of course) will always make you look good in the end. If the need arises to respond, keep it very professional and never emotional. Meet with ther person in private and let them know you don't appreciate their comments and it is counter-productive towards excellent patient care. If you need to gather yourself and cool off, just find a way to walk off for a few minutes and then come back to deal with the difficult person, professionally. As physicians we have to work with not only nurses, but pharmacists, patients, patients' families, police, social services, etc. As leaders in our patients' care, it will always be up to us to set the tone and keep things professional not only for the benefit of our patient (number one), but also for our own emotional and psychological benefit.

Personally, I love nurses and yes, even though there have been some tough ones to deal with, they are definitely the exception and not the rule. My props to Chimichanga.