PACU Nurses: How do you handle them?

[greenbean]

Hi all
I am a CA-1. amongst many issues that confront me during ca-1 year, i feel like i have issues with the pacu nurses .i rotate at 4 hospitals. at one , they are great, they put on all the monitors and get report within minutes. at the other hospitals, things are quite different, in the sense that im expected to put on all the monitors and end up waiting for 5-10 min b4 a pacu nurse even shows up to get report.

ive been told by my pd that there have been various complaints about me by the pacu nurses, who feel that im not approaching sign out in a team approach method. and not only that they also make up completely boogus stuff . for example, they said that i was giving incorrect amounts of fluid and urine output, which is something that im very detailed and exact about. and because so many of them complained to the pd, he basically thinks I am the problem

do any of you have this issue? and do u guys(the senior residents in particular) have any ways to deal with these nurses? they drive me up the wall

thanks
green

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[aredoubleyou]

Hi all
I am a CA-1. amongst many issues that confront me during ca-1 year, i feel like i have issues with the pacu nurses .i rotate at 4 hospitals. at one , they are great, they put on all the monitors and get report within minutes. at the other hospitals, things are quite different, in the sense that im expected to put on all the monitors and end up waiting for 5-10 min b4 a pacu nurse even shows up to get report.

ive been told by my pd that there have been various complaints about me by the pacu nurses, who feel that im not approaching sign out in a team approach method. and not only that they also make up completely boogus stuff . for example, they said that i was giving incorrect amounts of fluid and urine output, which is something that im very detailed and exact about. and because so many of them complained to the pd, he basically thinks I am the problem

do any of you have this issue? and do u guys(the senior residents in particular) have any ways to deal with these nurses? they drive me up the wall

thanks
green

Sounds like you are surrounded by a culture of laziness and ineptitude, not uncommon in stae/county/ academic hospitals - and your job is to cater to the nurses. If you are having problems with a bunch of nurses, you are way off line and in for a long and hard world of hurt because you are not falling in line with the culture there. If it is just a couple battle-axes, then you can fight the good fight if you really want, but you'll probably loose regardless.

Basically, your job as a resident is to fly under the radar as much as possible - and if that isn't happening, your life will be exceedingly easier for the next 2.5 years if you adopt this philosophy. Right now they are making stuff up about you that doesnt matter (fluids, urine, and such) - but if you remain a problem, you run the risk of them not witnessing your narcotics waste, writing you up for small infractions (leaving syringes, swearing, etc) - not a good position to be in...and constantly in a deffensive mode.

Just suck up an little bit of pride left, do your job, the circulators job, and the pacu nurses job - and keep your mouth shut. Do that and you'll have the last laugh, all the way to the bank. I am fortunate that I went to a program that has relatively good Pacu nurses and circulators, ect, which makes day to day life much nicer - but I remember as a med student at my school the case was more like what youre describing.

 

[jennyboo]

1. The moment you roll into your patient's assigned slot, make eye contact with whichever RN shows up first, smile and say "Hello" or "Good morning." I'll be the first to admit that in our 60-bed PACU there's no way I remember the nurses' names, but the one or two whose names I remember, I say their name. A greeting helps a lot.

2. Hook up the monitors. Even if 3-4 people are already there to do it. It helps if they SEE you participating rather than just standing there. Put the a-line in the tree, level and zero it. Start the BP cuff so it cycles while the EKGs are being applied. (By the way, I'm usually too lazy to put on EKGs, but the nurses are happy enough with BP and pulse ox from me.)

3. Bring your leftover narcotic syringe for that patient with you and in your pocket. If the patient complains of pain in the OR while waking up, hold the narcs, roll the patient into the PACU and let the nurses SEE you giving that 0.2mg of Dilaudid.

4. Ask if they need anything else before you step away.

 

[Dimoak]

One of the best ways to deal with PACU nurses is to just be pleasant. Some of them may be having a bad day and actually be looking to pick a fight with you. If that's a case, just don't give them any grounds to.

• As others in the thread have mentioned, be as polite as possible, and talk with them instead of down to them. Respectfulness is often reciprocated, and even if someone is having a bad day, it will significantly diminish the likelihood of them taking it out on you you.
• If you have a direct problem with the way a nurse is behaving, unless it's immediately harming the patient, don't call them out on it in front of everyone. Instead, make a mental note of what's going on, speak to a chief or attending about it, and they will address it appropriately at their own discretion.
• Keep excellent documentation. If a nurse calls you out on doing something, or not doing something, documentation is your best defense. If you keep good, detailed, and honest notes, it's unlikely anyone will get very far making unfounded accusations against you.

 

[loveumms]

I know this is sexist but, are you a female? I have found that most of the nurses that I ever have a problem with are the young females - and I think it's because I'm a female who is likely younger then them.


Rule #1: Give them whatever they ask for - within reason. Most of the time they are pretty straight on with requests.


And .2mg of dilaudid??? I guess I am more liberal with my narcotics. I don't give anything less than 10mg of morphine or 2mg of dilaudid before I leave the OR (except for peds, elderly or very short, non stimulating surgeries). I have not had any respiratory depression and the PACU nurses love a patient coming out of the OR comfy. Oh, and everyone gets anti-emetics. They are cheap and the PACU nurses hate, hate, hate a patient that is vomiting.

It's a give, take relationship. You give them a patient who isn't going to be a pain in their rear and they will go the distance when you need help.

 

[bne_12mne]

I agree with the advice you have been given so far.

My PACU experience is much like jennyboo's. Usually when I drop off a patient I hook up the pulse ox and BP cuff because I want to maximize my break time between cases to get a drink or use the bathroom and such. I don't do EKG's though...

Bringing some narcotic with you and giving a small, possibly even homeopathic dose when needed is easy to do, takes little time, and shows them that you care about the patient's post-op course and will win you easy points without endangering the patient significantly.

I think that most people in anesthesia residency have some problem with some nurse or nurses at some point in their training. PACU nurses, like most tend, to stick together and more than likely you have simply developed a bad reputation at one of your centers. That probably explains the "multiple complaints" at least in part.

I found that doing a PACU rotation early at my place really helped get to know the nurses so that they trust you and see your work ethic and style, and vice versa. They are always suspicious of new people and think that CA-1s are stupid, and maybe it will just take more time for you to get in their good graces. I bet your not the only CA-1 at your place having this problem.

In general, I've found that trying to fight battles with nurses is a no-win situation, so I don't try to do it. It's usually easier to try to side with them in some way...like we're all fighting against the man or something, because I think that's how most of them (and residents) feel a lot of the time. So if they want you to sign out to them in a certain way, then do it. If your apparent turnover time suffers for it, you can always tell your attending that it took the nurses 10 minutes to take report and you can sign your D time accordingly.

Anyway, good luck.

 

[greenbean]

yes im a girl, and i tend to look 'younger' than i am, if that makes any since

and pacu nurses in general give me a hard time , usually the middle aged ones, i havent come across too many young ones. its just really bothersome when there are 2 of them hooking up monitors, when im filling out my charting and they get annoyed b'c im not helping them and not being ' a team player', even though theyre already putting the monitors on and its their job to do that anyway

what is more irritating is that they would speak to my attendings about it and not to me directly. that kind of shysterness really ticks me off, especially when they are all clearly ganging up on me and making up crap thats just an outright lie and the attendings still are on their side.

but thanks again for your advice. pass me the ball and ill start dribbling now.😎

 

[huktonfonix]

I know this is sexist but, are you a female? I have found that most of the nurses that I ever have a problem with are the young females - and I think it's because I'm a female who is likely younger then them.


Rule #1: Give them whatever they ask for - within reason. Most of the time they are pretty straight on with requests.


And .2mg of dilaudid??? I guess I am more liberal with my narcotics. I don't give anything less than 10mg of morphine or 2mg of dilaudid before I leave the OR (except for peds, elderly or very short, non stimulating surgeries). I have not had any respiratory depression and the PACU nurses love a patient coming out of the OR comfy. Oh, and everyone gets anti-emetics. They are cheap and the PACU nurses hate, hate, hate a patient that is vomiting.

It's a give, take relationship. You give them a patient who isn't going to be a pain in their rear and they will go the distance when you need help.

I suggest you modify your approach regarding narcotics to a more case specific basis. There are problems with too much narcotics too including PONV.

 

[jennyboo]

its just really bothersome when there are 2 of them hooking up monitors, when im filling out my charting and they get annoyed b'c im not helping them and not being ' a team player', even though theyre already putting the monitors on and its their job to do that anyway

Well, herein lies the problem -- "its their job to do that anyway." That's not a team player attitude. It's the big things that matter but it's the little things that make nurses b1tch. So making a show (yes, sometimes it is just a show) of "helping" a little by hooking up the pulse ox will go a long way. Look busy "helping" them even if it's not much.

Dropping patients off in the ICU is a similar situation to dropping them off in the PACU. In the PACU hook up the pulse ox. In the ICU I plug in the bed and put the a-line transducer in the tree and re-zero it. I do nothing else but the a-line is easy and makes them happy.

Ever notice that when they're pissed off they "stall" and take a long time before they are finally "ready" to get report from you? Slapping on their monitors hurries them up and gets you out of the PACU faster.

 

[greenbean]

well, when i bring my pt into the OR, i dont expect anyONE to put monitors on except ME. b'c thats my job. However, if the circulator is nice and decides to help me, i ALWAYS say thanks.

and making a show is not usually my way of doing business. i am a very direct person, for the most part. and at one of the hospitals i end up hooking up everything: pulse ox, ekg leads, bp cuff and i cycle that too . and i still have to wait for the nurse to give report. they are so lazy but if i dont do it, they complain! its totally frustrating 😱

is it going to be like this when i start going out into the workforce? b'c if its like this everywhere, im gonna be mucho pissed. like i said, ill take the ball and start dribbling, its seems like the only way to go, since I am "the problem".

Well, herein lies the problem -- "its their job to do that anyway." That's not a team player attitude. It's the big things that matter but it's the little things that make nurses b1tch. So making a show (yes, sometimes it is just a show) of "helping" a little by hooking up the pulse ox will go a long way. Look busy "helping" them even if it's not much.

Dropping patients off in the ICU is a similar situation to dropping them off in the PACU. In the PACU hook up the pulse ox. In the ICU I plug in the bed and put the a-line transducer in the tree and re-zero it. I do nothing else but the a-line is easy and makes them happy.

Ever notice that when they're pissed off they "stall" and take a long time before they are finally "ready" to get report from you? Slapping on their monitors hurries them up and gets you out of the PACU faster.

 

[ProRealDoc]

yes im a girl, and i tend to look 'younger' than i am, if that makes any since

and pacu nurses in general give me a hard time , usually the middle aged ones, i havent come across too many young ones. its just really bothersome when there are 2 of them hooking up monitors, when im filling out my charting and they get annoyed b'c im not helping them and not being ' a team player', even though theyre already putting the monitors on and its their job to do that anyway

what is more irritating is that they would speak to my attendings about it and not to me directly. that kind of shysterness really ticks me off, especially when they are all clearly ganging up on me and making up crap thats just an outright lie and the attendings still are on their side.

but thanks again for your advice. pass me the ball and ill start dribbling now.😎

I am a guy and I've had the same problem many times and not only in the PACU. Nurses for some reason, the middle aged ones in my experience, seem to have a chip on their shoulder. Could it be menopause? Is it jealousy? Who knows? They somehow seem to like to torture junior residents, either because they think you are stupid or otherwise.

Don't do what I did, but I'd often become angry and at times challenged them directly when I'd notice a hint of antagonism directed towards me. They would threaten me with calling my attending and my answer was always "go ahead" and I would proceed to give them a piece of my mind. However, you must be ready to deal with the potential reprimand from your attending.

Eventually, we learned to get along and even though it was not smooth sailing at times, they knew I would not tolerate their BS. Again, this was most likely the wrong approach but it worked for me.

 

[bne_12mne]

However, if the circulator is nice and decides to help me, i ALWAYS say thanks.

i end up hooking up everything: pulse ox, ekg leads, bp cuff and i cycle that too . and i still have to wait for the nurse to give report. they are so lazy but if i dont do it, they complain! its totally frustrating 😱

We have some nice circulators at my place, but not once has one helped me put on monitors.

As to your second point above, was there a time when you didn't wait to give report or something? If you left without giving report, even once, that would probably be enough to hose yourself with them for quite some time. Where I work, that would result in an incident report for sure.

If after all the advice you're getting here, you still feel like you are being persecuted in some way, start inviting your attendings to come with you to watch you give report. Of course they'll say no and think it's a strange request, but if then the nurses later complain about you to them, and you have to answer for it, you could tell your PD that you made the attempt to have a witness, get coaching and teaching, and were denied.

 

[InductionAgent]

Usually when I drop off a patient I hook up the pulse ox and BP cuff

Sometimes, you just can't win. Like most of us, my two biggest concerns when I bring a patient to the PACU are usually (a) getting the oxygen mask on the patient and (b) connecting the pulse ox. A lot of times our PACU nurses seem obsessed with getting the EKGs on as their first priority while a recovering patient is hypoventilating on room air without pulse oximetry.

If I ask them to attend to either the oxygen or the pulse ox, they will often retort "I know what I'm doing," or "just let me do my job," or "just fill out your paperwork." If I attend to the matters myself and start reaching for the oxygen mask, I get a similar response.

The one thing I've learned to do differently is to ask in a more calm manner that they attend to the top priorities first. As a beginning CA-1, I would be so worried about a bad outcome that I would make more of a demand, and then launch into a spiel about the prioritization of tasks upon a patient's arrival to the PACU with the intentions of modifying their behavior. I realized the futility of this approach.

I also have a lower threshold for taking a patient to the PACU with supplemental oxygen. Even though it's a short trip, by the time the O2 is hooked up in PACU it could be a few minutes.

 

[Bertelman]

Sometimes, you just can't win. Like most of us, my two biggest concerns when I bring a patient to the PACU are usually (a) getting the oxygen mask on the patient and (b) connecting the pulse ox. A lot of times our PACU nurses seem obsessed with getting the EKGs on as their first priority while a recovering patient is hypoventilating on room air without pulse oximetry.

If I ask them to attend to either the oxygen or the pulse ox, they will often retort "I know what I'm doing," or "just let me do my job," or "just fill out your paperwork." If I attend to the matters myself and start reaching for the oxygen mask, I get a similar response.

I also have a lower threshold for taking a patient to the PACU with supplemental oxygen. Even though it's a short trip, by the time the O2 is hooked up in PACU it could be a few minutes.

😕

We transport with O2 on every case.

 

[drccw]

It's ain't ever going to end with the PACU I tell ya...
Once you become an attending, it's still your responsibility to make sure the patient is stable and report has been given.

When I roll into PACU- my goal is to get vitals and give report as soon as possible....

Pulse Ox is my last priority- if you need pulse OX to tell you a patient is hypoxic then you aren't doing your job in transit...

First priority monitor- BP.. why? not because I am worried about hypotension (the patient should be stable leaving the OR)-> but because it's the monitor that takes the longest to return a vital. Pop it on and hit cycle.

Next monitor is SPO2 and finally ECG. And yes I hook all the monitors up when I hit PACU- not because I think the nurses are lazy or whatever but I get it done because while I am hooking up the monitors I am giving report to the nurse- so her or his only job is to listen to what I am saying.

finally- rapport with the PACU is as important as rapport with the OR staff- because our job, our team extends to the PACU. When a patient crashes in the PACU- they call for the anesthesiologist... so you gotta be a team player..

monitors and report should take 90 secs, 2 mins max. any longer and you're wasting time- and guess whose time your wasting? your own...

this brings me to another point... yes we went to med school. we are awesome, we are doctors and we need the ground that we walk on to be worshipped. But, bear in mind that we are all part of the same team. treat each and everyone you encounter with respect- from the nurse to enviromental services to the anesthesia techs to the cafeteria people... if you treat them well, then you will be well treated... and thus the reason I always get a double cheeseburger when all I order is a regular one... or why my ice cream alway seems to weigh a lot less than the 10 ozs it should... or why when I do ortho, I have all the block equipment waiting for me in the morning... it just makes your life easier to be nice and respectful

 

[Hockeyguy]

It's ain't ever going to end with the PACU I tell ya...

As I move along I'm starting to realize that. How about the battle-axes on labor and delivery. God they crack me up.

 

[CanGas]

I'm afraid I am going to disagree a bit here. 1st priority for me is pulse ox. Simple to install and immediately gives you HR and sat. Take a look back through the literature around the time pulse ox came out and look at the studies comparing peoples description of cyanosis vs actual sat reading. We are not good at detecting hypoxia.

Then the BP cuff. Then the ECG.

During installation of all 3 give handover.

As for the PACU. Suck it up and don't rock the boat. This has been addressed before so I'll just quote myself.

Take a look the collection of posts at:
http://forums.studentdoctor.net/showthread.php?t=558201

That’s life man. Pretend you’re in the military and just suck it up. They tell you to jump and you say how high. Lose the idea of personal autonomy at least for the first while during residency and it gets easier. The autonomy will come with time and your staff’s exposure to you.

Anyone can have a bad day and flub IV’s. Just ignore everyone and stick them again, or a 3rd time. I had a personal 3-strikes rule and in general as a junior if it took me more than 3 attempts for an epidural, or a line, or a block or whatever, just swallow your pride and ask the staff to do it or give some tips. They will respect you more for having some judgment on when to ask for help and the patient is better off as well.

My main trick was to keep a note on the particularities of each of my staff. Eg. so and so likes sufent not fent, Sevo not Des, tape the fricken epidural this way and place an a-line that way. Each start of the day you check your cheat sheet and do things the way that staff likes it done and they think you’re a superstar and back off a bit because you are doing the thing the “right way” eg their way. When you are alone you can do it the way you want to but for now just see how different people do different things, and pick and choose what you like for when you are out in practice.

CanGas

PS. There really should be no need to “fight” with nurses in the PACU. They like certain narcotics, give it. As long as it does not impact patient care or safety what’s the big deal. The have been doing this for 20 years longer than me, or this is the way that particular department does things, who am I to try and change things (as a peon anyways). As a resident just try to make things go smoothly for everyone. Slick for the OR staff, slick for the surgeons, slick for the PACU nurses. I want everyone to finish a day with me and think how smooth everything went. Now is not the time to rock the boat. When you are staff and a member of the department you can work on it. That said, if you have a strong reason, and feel that something is truly in the best interest of the patient I find that clearly explaining your rational goes a long way to smoothing things over.

Just my 2 cents

 

[Mista Suprane]

intentions of modifying their behavior. I realized the futility of this approach.

this is so true. very difficult to modify the behavior of nurses who have been doing their job for a long time, OR the younger ones who have been indoctrinated in the "this is the way we do things here" mentality by more experienced nurses around them, coupled with the "i am Young Nurse, RN, BSN, MSN, LMAO, just finished nursing school and i am smarter than these dumb residents." my experience with the some of the nurses in the SICU this past month has reinforced this.

if it is a matter of life and death i will argue, but it usually isn't (in fact, most things rarely are), so i bite my tongue, smile and say as geninuely as possible "oh, i didn't know that. i'll try not to be such a ******* next time." do this a few times around the unit or PACU, and you will be surprised as to how much cooperation it gains you around the floor, even from nurses you haven't interacted with. start things off on the wrong foot however, and you will be blackballed.

i know it shouldn't be like this, but IT JUST IS. at EVERY hospital. pick your battles, and use the serenity prayer when dealing with nurses. you will have a much easier time.

"god grant me the serenity to accept the nurses i cannot change, the strength to change the nurses i cannot accept, and the wisdom to know the difference."

 

[Arch Guillotti]

😕

We transport with O2 on every case.

i think o2 during transport is overrated. If ya got it, sure use it. It kills me when someone calls for o2, sits around waiting for it to show up, then pushes the pt. 10 yards over to the pacu. I don't really care about putting o2 on the pts. unless they look bad or the trip to pacu is a long way

 

[greenbean]

well thanks to you all for the advice, im glad to know that im not the only one who doesnt face this problem, as it seems pacu nurses are uniformly ****ttty to deal with, i just dont understand why putting monitors on *which is their job*, gets them so flustered when i dont do and im trying to finish my paperwork, but anyways i wont argue b'c like youre saying its futile and whats worse is the attendings never back me up and insist that I am the 'problem'

as for what i do first, i usually cycle the cuff b'c it takes the longest to return(ie the rate limiting step)


as far as why it takes so long to get a nurse for report, it doesnt happen all the time. yesterday when i was at l and d at a new hospital and i just finished a c/sxn. i brought pt back to room and helped with monitors and the nurse stood there for the most part(b'c its my job to do all this of course) and then when i was done walked out of room ahead of me and all the way down the hall to a chair and sat down, she started writing down stuff and after maybe 2 minutes looked up at me and said 'im ready'. since i have never been to l and d before *therefore no way i could have done anything to them to piss them off* and since i put on the monitors, i am still amazed by this behavior, this is almost worse than the pacu nurses i deal with. and when i was done giving report, there was no acknowledgment whatsoever, she just starting chitchatting with one of her other nurse buddies. fun times👎

this is so true. very difficult to modify the behavior of nurses who have been doing their job for a long time, OR the younger ones who have been indoctrinated in the "this is the way we do things here" mentality by more experienced nurses around them, coupled with the "i am Young Nurse, RN, BSN, MSN, LMAO, just finished nursing school and i am smarter than these dumb residents." my experience with the some of the nurses in the SICU this past month has reinforced this.

if it is a matter of life and death i will argue, but it usually isn't (in fact, most things rarely are), so i bite my tongue, smile and say as geninuely as possible "oh, i didn't know that. i'll try not to be such a ******* next time." do this a few times around the unit or PACU, and you will be surprised as to how much cooperation it gains you around the floor, even from nurses you haven't interacted with. start things off on the wrong foot however, and you will be blackballed.

i know it shouldn't be like this, but IT JUST IS. at EVERY hospital. pick your battles, and use the serenity prayer when dealing with nurses. you will have a much easier time.

"god grant me the serenity to accept the nurses i cannot change, the strength to change the nurses i cannot accept, and the wisdom to know the difference."

 

[proman]

I'd heard of stories about crappy PACU nurses before but let me tell you, they aren't uniformly ****ty. Most of the ones I deal with are nice, know my name, want to get their work done so they can go home just like me. I normally just do the pulse ox and almost always have the patient on oxygen during transport. Most of ours are Filipino, so maybe that makes a difference. And, we pay their salaries (through the anesthesiology dept)-that probably counts for something. Of all the nurses I've dealt with, our PACU nurses are my favorites and orders of magnitude nicer than the ICU nurses.

 

[Gern Blansten]

I am going to let you in on a little secret since you seem like a nice person.

-Bring them donuts once or twice. They love to eat.

-when you have a little down time, drop in and have a conversation with them. Ask about their kids, hobbies etc.

-Learn their names and address them by name.

-As you are coming in the PACU and the nurse is there, talk to your patients in a voice where the nurses can hear you and say something like this:
"You don't have to worry about pain, because we have wonderful PACU nurses that are the best nurses in the hospital at getting patients comfortable. They are going to take great care of you. I wish the other nurses in the hospital were as good as they are." It will be a self fulfilling prophecy and the nurses will love you because you have help set them up for a positive patient encounter.

-Look for the positive and when you find it, send a note to the nurses supervisor stating how much you appreciated that nurse's help in a certain situation and how she handled a difficult patient with such professionalism. The supervisor and the nurse will love it. It will be very difficult for them to file a negative report on you if you have filed a positive comment on them.

These things are all playing to natural human nature. We like people who treat us well and respect us as a member of the team. Nurses are no different.

Do the above things and get back to me in 3 months to let me know how the nurses fall all over themselves to help you out. If your relationship is already pretty bad, it won't happen overnight, but be persistent in your kindness and watch them come around. No matter what they do or say to annoy you, never let them see that it gets to you and kill them with kindness.

Once you have established a positive relationship with them, then you will be able to offer constructive criticism that will be listened to and respected. One last caveat. I have met people who are incapable of doing the above because they feel it is beneath them and their personality is just naturally abrasive. If that is the case, these techniques cannot be guaranteed.

 

[InductionAgent]

Pulse Ox is my last priority- if you need pulse OX to tell you a patient is hypoxic then you aren't doing your job in transit...

First priority monitor- BP.. why? not because I am worried about hypotension (the patient should be stable leaving the OR)-> but because it's the monitor that takes the longest to return a vital. Pop it on and hit cycle.

Next monitor is SPO2 and finally ECG.

So you just contradicted yourself in that pulse ox is not your last priority, apparently EKG is more of a last priority to you. At least we can agree that when a PACU nurse is putting on EKGs before attending to other things, the priority is out of line.

I obviously spoke out of turn in saying that SpO2 is as high up on other's priorities as mine, but I stand by my personal valuation of it. It is sensitive to early signs of hypoxemia, before cyanosis would become apparent. A patient can be moving air but still have oxygenation issues, so just watching a non-cyanotic patient breathing O2 does not mean all is well. Furthermore, SpO2 simultaneously monitors heart rate and rhythm, and by providing auditory as well as visual information allows continuous observation. Because it's so quick to hook up, I prefer to get this information cooking before the more time-consuming step of getting the NIBP.

One can use your same argument used with regard to pulse oximetry that clinical assessment of pulses should tell you if there's a BP issue. But having numerical data certainly helps to provide a more accurate and objective assessment.

 

[Med4ever]

This is exactly why we have this problem, no one tells nurses, that if they want to call the shots show some dedication to education and lengthy schooling and get your MD. Nurses are so quick to criticize residents and label them as stupid because most residents develop a passive attitude about these confrontations and don't show nurses how dumb they are. The end result, they never learn never grow and continue to think they are right.

Another reason medicine sucks

 

[Bertelman]

This is exactly why we have this problem, no one tells nurses, that if they want to call the shots show some dedication to education and lengthy schooling and get your MD. Nurses are so quick to criticize residents and label them as stupid because most residents develop a passive attitude about these confrontations and don't show nurses how dumb they are. The end result, they never learn never grow and continue to think they are right.

Another reason medicine sucks

Nurses are quick to cop the attitude because they are dissatisfied in their job, and they know they have just enough power to screw us over if they wish.

I promise they don't all want to be doctors. Most doctors don't even want to be doctors.

 

[CanGas]

Not where I work. Most places they are the most fun to work with as we see them so much we have a chance to develop a good rapport. I'm always joking with this one nurse (the one who is always slinging the sexual innuendo around) that if ever I have to give her an anesthetic she's getting regional + just enough of a propofol infusion to get her talking so I can get all the good stories out of her. She always says, nope, nothing but a GA for her

CanGas

well thanks to you all for the advice, im glad to know that im not the only one who doesnt face this problem, as it seems pacu nurses are uniformly ****ttty to deal with

 

[coprolalia]

and because so many of them complained to the pd, he basically thinks I am the problem

If your PD thinks that "you" are the problem without further investigation, then he is a lazy, naive idiot. Every "management" person who works in a residency program understands that certain gaggles of nurses usually single out one (or two) residents and then, often for minor or no reason, go on a mission to destroy them. It's a game and form of entertainment to some of them as a distraction to their petty, meaningless and miserable lives. This is how they exorcise their jealousy and lash out at what they perceive to be a surrogate for the "powers that be" that tell them what to do on a daily basis. You are emblematic of that attending who barks at them for being lazy that they can't do anything about, and if you are weak it's only going to get worse. Furthermore, if your PD doesn't "get" this, he shouldn't be a PD.

The best defense is a strong offense. Just start writing them up when they are surly or make even the smallest mistake. You're not going to spend a lifetime at this place or build your career there, are you? Then march through there like Sherman going through Atlanta. Pretty soon they'll either get out of your way or leave you alone, or both. At the same time, find one or two senior and respected nurses and be super sweet to them and bend over backwards to meet their every request. You can always call on them when someone complains.

Dealing with many nurses is a game. Just remember that. If they are clear that they are out on a mission to destroy you, have no qualms about returning the favor.

-copro

 

[Bertelman]

If your PD thinks that "you" are the problem without further investigation, then he is a lazy, naive idiot. Every "management" person who works in a residency program understands that certain gaggles of nurses usually single out one (or two) residents and then, often for minor or no reason, go on a mission to destroy them. It's a game and form of entertainment to some of them as a distraction to their petty, meaningless and miserable lives. This is how they exorcise their jealousy and lash out at what they perceive to be a surrogate for the "powers that be" that tell them what to do on a daily basis. You are emblematic of that attending who barks at them for being lazy that they can't do anything about, and if you are weak it's only going to get worse. Furthermore, if your PD doesn't "get" this, he shouldn't be a PD.

The best defense is a strong offense. Just start writing them up when they are surly or make even the smallest mistake. You're not going to spend a lifetime at this place or build your career there, are you? Then march through there like Sherman going through Atlanta. Pretty soon they'll either get out of your way or leave you alone, or both. At the same time, find one or two senior and respected nurses and be super sweet to them and bend over backwards to meet their every request. You can always call on them when someone complains.

Dealing with many nurses is a game. Just remember that. If they are clear that they are out on a mission to destroy you, have no qualms about returning the favor.

-copro

I don't think it's the PDs job to investigate a dozen complaints. It's simple. If this is the only resident the nurses complain about, then it's likely the resident's fault. That's how most managers would view this problem. It's not the PDs job to make sure the PACU nurses perform at a level satisfactory to one resident. (I rarely believe stories like this on SDN that "I'm an angel, I do my job, but all the nurses hate me!!!)

The PD isn't in the business of teaching PACU nurses efficient handoffs. He's in the business of educating residents and keeping the hospital happy.

If you want a sure-fire trip to the PDs office, march through PACU as a resident and start calling the shots. This falls under the category of when you need to fly under the radar. Copro's right in that you aren't going to build a career there. Unfortunately, the nurses have, and be aware they will use every trick in the book to keep that career afloat.

 

[coprolalia]

There are two sides to every story. A good PD knows that. I'm fortunate that I have a PD who understands "the game", and doesn't just take complaints at face value.

And, are programs training decision-makers or are they training doormats? I'm getting sick and tired, personally, of everyone expecting me and my colleagues to be doormats. Look where that's gotten us with the CRNAs.

I'm all for "flying under the radar", but if it involves compromising patient care or somehow diminishing my role as the one ultimately responsible for that patient's outcome, then I say cut a swath ten miles wide in each direction and raze everything in site. I know someone who's involved in a lawsuit right now because of something that happened in the PACU. Have any of the nurses involved in that patient's care been named? Hell no. But, guess what? Several residents have.

Some units need an enema from time to time, and the nurses know that they can usually bully their way over a bunch of meek and uncertain residents. If you show them you won't take their bullying, guess who usually backs down? And, that's usually what this is about: bullying. Know what I say? Mess with the bull, you're gonna get the horns.

-copro

 

[Arch Guillotti]

I don't think it's the PDs job to investigate a dozen complaints. It's simple. If this is the only resident the nurses complain about, then it's likely the resident's fault. That's how most managers would view this problem. It's not the PDs job to make sure the PACU nurses perform at a level satisfactory to one resident. (I rarely believe stories like this on SDN that "I'm an angel, I do my job, but all the nurses hate me!!!)

The PD isn't in the business of teaching PACU nurses efficient handoffs. He's in the business of educating residents and keeping the hospital happy.

If you want a sure-fire trip to the PDs office, march through PACU as a resident and start calling the shots. This falls under the category of when you need to fly under the radar. Copro's right in that you aren't going to build a career there. Unfortunately, the nurses have, and be aware they will use every trick in the book to keep that career afloat.

Agree.

Do not fight the power. Fly under the radar. If they are pissed at you and making complaints to the powers that be, then something is awry. Right or wrong, you either need to change or adapt.

I know NOTHING about the OP and what kind of resident s/he is. I am not pointing the following at the OP but there are PLENTY of crappy residents out there and/or folks with an attitude or chip on their shoulder.

 

[coprolalia]

Right or wrong, you either need to change or adapt.

Wait until you get named in a lawsuit because you were only trying to "play nice" or doing something simply to appease a PACU nurse bully. Your attitude will change. Up and until then, they will think of you as an idiot-in-training no matter what you do.

And, if you are doing something that is truly substandard of care and/or dangerous, then they owe it to you (or to whomever they are complaining) to provide objective facts so you can improve your performance. Rarely - rarely - is this the case, and even more rarely are the complaints objective. Most often, they are simply subjective reflections of whether or not they "like" you. Feh.

-copro

 

[ProRealDoc]

If your PD thinks that "you" are the problem without further investigation, then he is a lazy, naive idiot. Every "management" person who works in a residency program understands that certain gaggles of nurses usually single out one (or two) residents and then, often for minor or no reason, go on a mission to destroy them. It's a game and form of entertainment to some of them as a distraction to their petty, meaningless and miserable lives. This is how they exorcise their jealousy and lash out at what they perceive to be a surrogate for the "powers that be" that tell them what to do on a daily basis. You are emblematic of that attending who barks at them for being lazy that they can't do anything about, and if you are weak it's only going to get worse. Furthermore, if your PD doesn't "get" this, he shouldn't be a PD.

The best defense is a strong offense. Just start writing them up when they are surly or make even the smallest mistake. You're not going to spend a lifetime at this place or build your career there, are you? Then march through there like Sherman going through Atlanta. Pretty soon they'll either get out of your way or leave you alone, or both. At the same time, find one or two senior and respected nurses and be super sweet to them and bend over backwards to meet their every request. You can always call on them when someone complains.

Dealing with many nurses is a game. Just remember that. If they are clear that they are out on a mission to destroy you, have no qualms about returning the favor.

-copro

Agree with Copro.

 

[aredoubleyou]

Wait until you get named in a lawsuit because you were only trying to "play nice" or doing something simply to appease a PACU nurse bully. Your attitude will change. Up and until then, they will think of you as an idiot-in-training no matter what you do.

And, if you are doing something that is truly substandard of care and/or dangerous, then they owe it to you (or to whomever they are complaining) to provide objective facts so you can improve your performance. Rarely - rarely - is this the case, and even more rarely are the complaints objective. Most often, they are simply subjective reflections of whether or not they "like" you. Feh.

-copro

Your talking about extreme cases. This dude doesnt want to put monitors on the PACU patient, or whatever because thats the nurses job and theyre sitting around eating donuts and jellybeans and not being helpful - this is a case where you suck it up, do their job for them, sign out in the manner they like to hear the info, and move on with your life - because in the end it makes your life easier than constantly fighting. When they are pushing labetalol because the systolic number on the monitor is blinking but your written orders says to not push anything until the pressure is 30 points higher - thats when you start with the horns.

 

[Arch Guillotti]

😕

I don't get bullied because I have a good relationship with the PACU nurses as well as their nurse managers. If they don't agree/understand something that I want, I explain it to them. If that doesn't work (which is almost NEVER) then a line is drawn in the sand and the smack is layeth down. The reality is that this almost NEVER occurs.


I avoid the "us versus them" mentality. I do what is medically indicated for the patient, period.

When I am in the PACU now I am not "in-training". I am not a resident any more. I give orders, and the nurses (and residents) take them.

My point is that if a single individual is being complained on multiple times and no one else is having the same problem, one of two problems usually exist:

1.) a crappy resident is involved
2.) a resident is involved that doesn't get along well w/others and/or has a chip on their shoulder

I am not referring to the OP, my comments are more general in nature.

Wait until you get named in a lawsuit because you were only trying to "play nice" or doing something simply to appease a PACU nurse bully. Your attitude will change. Up and until then, they will think of you as an idiot-in-training no matter what you do.

And, if you are doing something that is truly substandard of care and/or dangerous, then they owe it to you (or to whomever they are complaining) to provide objective facts so you can improve your performance. Rarely - rarely - is this the case, and even more rarely are the complaints objective. Most often, they are simply subjective reflections of whether or not they "like" you. Feh.

-copro

 

[Bertelman]

I'm not suggesting we train doormats. What the OP described (in my mind) was one hospital where PACU nurses were great, and another with a poor culture. I'd guess one of those is a VA.

When the entire culture of an organization is against odds with what you believe is right, I don't think it is prudent for a newly-minted junior anesthesia resident to fight the battle.

If the junior resident is having problems with PACU nurses at a single facility, talk to your colleagues. Is it just you, or is everyone treated this poorly? If everyone sees what you see, as a group you should take it up with the PD. Say it is compromising patient care, etc.

I'm also not one to start writing up nurses unless it truly has compromised patient care, and even then I would likely choose to speak with the nurse in person first. These nurses have all day to file paperwork. They will drown you in incident reports for trivial ****.

I'm by no means a doormat, but I know what these nurses are looking for, and as long as giving it to them doesn't compromise my standards or patient care, I'll do it if it gets me out of PACU 3 minutes earlier with a smile on my face. It's easy. I stroll in, hook the O2 up to the wall, hook up whatever monitors belong on my side of the bed, scribble my paperwork, chat about something interesting, and I'm out the door. I've got the same attitude in the OR. If the surgeon asks for more bovie, and it's within my reach, I lift a finger and turn it up.

 

[coprolalia]

My point is that if a single individual is being complained on multiple times and no one else is having the same problem, one of two problems usually exist:

1.) a crappy resident is involved
2.) a resident is involved that doesn't get along well w/others and/or has a chip on their shoulder

I don't agree that this is "usually" and necessarily the case. And, you forgot another obvious choice in your false dilemma...

3.) Every other resident takes their **** and someone finally gets sick of it and speaks up.

This person is then put on the "black list" and the group of "bully" nurses goes on a mission to destroy that resident who dared to question them.

I've seen this happen multiple, multiple times on many different units. More often than not, the "bully nurse" (sometimes it's even a cohort of 3-4 nurses who've been their the longest and have outlasted everyone else) isn't even liked by his/her colleagues, but (for some reason) has gotten so powerful that everyone is afraid of them.

Now, you can "bow your head" and take it like a man, or you can (in my humble opinion) tuck your cowardice away and strive to change things. As I said already, the best defense is a strong offense.

I've been in this situation when certain nurses have tried to bully me. The first instant where this happens, I try to use humor to point out the stupidity of their behavior. If this is met with a laugh and a self-realization in that individual that they are being an a-hole, that's usually the end of it. But, if they keep coming with the "you better learn your place quick, lowly resident" that occassionally happens, that immediately prompts an email to their supervisor and my program director. You have put people on notice at that point, and any subsequent complaint from that individual is inherently watered-down in comparison to your pre-emptive strike.

The fact is, most residents simply buckle under the weight of bullies. I'm not new to residency. I've seen this happen a lot. The end result is that the nurse effectively manages the patient and gets whatever he/she wants, not always to the patient's benefit. And, if they perceive that they can get you to do whatever they want you to do, they will continuously take advantage of you. If you're okay with that prospect, then far be it from me to tell you to do anything differently.

Now, I'm not saying that you shouldn't listen to nurses and validate their opinion (and even explain to then when, why, and exactly how they are wrong when they are wrong), but too many times people simply take the path of least resistance because, frankly, it's easier for them. And, many nurses (come on, let's be honest here... we all know who the trouble makers on any given unit are) will continue to prey on you if you present yourself as weak.

The next problem is that if you actually show the balls to stand up to them, they will try as vociferously and tenaciously as possible to knock you down. Funny how that seems to be diffused if you've already put your PD and their supervisor on notice.

You gotta be smart, folks. Dealing with some nurses is a game. Most are wonderful and excellent at what they do. Most also are extremely helpful and want to do what's best for the patient. Others simply see you as the enemy, and many will band together in an attempt to destroy you if you don't play by their rules.

Bottom line: You don't have to take their ****.

-copro

 

[ProRealDoc]

I don't agree that this is "usually" and necessarily the case. And, you forgot another obvious choice in your false dilemma...

3.) Every other resident takes their **** and someone finally gets sick of it and speaks up.

This person is then put on the "black list" and the group of "bully" nurses goes on a mission to destroy that resident who dared to question them.

I've seen this happen multiple, multiple times on many different units. More often than not, the "bully nurse" (sometimes it's even a cohort of 3-4 nurses who've been their the longest and have outlasted everyone else) isn't even liked by his/her colleagues, but (for some reason) has gotten so powerful that everyone is afraid of them.

Now, you can "bow your head" and take it like a man, or you can (in my humble opinion) tuck your cowardice away and strive to change things. As I said already, the best defense is a strong offense.

I've been in this situation when certain nurses have tried to bully me. The first instant where this happens, I try to use humor to point out the stupidity of their behavior. If this is met with a laugh and a self-realization in that individual that they are being an a-hole, that's usually the end of it. But, if they keep coming with the "you better learn your place quick, lowly resident" that occassionally happens, that immediately prompts an email to their supervisor and my program director. You have put people on notice at that point, and any subsequent complaint from that individual is inherently watered-down in comparison to your pre-emptive strike.

The fact is, most residents simply buckle under the weight of bullies. I'm not new to residency. I've seen this happen a lot. The end result is that the nurse effectively manages the patient and gets whatever he/she wants, not always to the patient's benefit. And, if they perceive that they can get you to do whatever they want you to do, they will continuously take advantage of you. If you're okay with that prospect, then far be it from me to tell you to do anything differently.

Now, I'm not saying that you shouldn't listen to nurses and validate their opinion (and even explain to then when, why, and exactly how they are wrong when they are wrong), but too many times people simply take the path of least resistance because, frankly, it's easier for them. And, many nurses (come on, let's be honest here... we all know who the trouble makers on any given unit are) will continue to prey on you if you present yourself as weak.

The next problem is that if you actually show the balls to stand up to them, they will try as vociferously and tenaciously as possible to knock you down. Funny how that seems to be diffused if you've already put your PD and their supervisor on notice.

You gotta be smart, folks. Dealing with some nurses is a game. Most are wonderful and excellent at what they do. Most also are extremely helpful and want to do what's best for the patient. Others simply see you as the enemy, and many will band together in an attempt to destroy you if you don't play by their rules.

Bottom line: You don't have to take their ****.

-copro

You can tell which attendings got beaten down into submission during residency as they are the ones who are quick to blame the resident for anything the nurses complain about.

These are the spineless attendings who in order to 'keep the nurses happy' will tell you to always acquiesce to their request and "learn to get along with them in order to have an easy night and get plenty of sleep". I was actually told that twice in one rotation by different attendings.

My answer: "I am never plan on sleeping on call nights ".

 

[maceo]

I don't agree that this is "usually" and necessarily the case. And, you forgot another obvious choice in your false dilemma...

3.) Every other resident takes their **** and someone finally gets sick of it and speaks up.

This person is then put on the "black list" and the group of "bully" nurses goes on a mission to destroy that resident who dared to question them.

I've seen this happen multiple, multiple times on many different units. More often than not, the "bully nurse" (sometimes it's even a cohort of 3-4 nurses who've been their the longest and have outlasted everyone else) isn't even liked by his/her colleagues, but (for some reason) has gotten so powerful that everyone is afraid of them.

Now, you can "bow your head" and take it like a man, or you can (in my humble opinion) tuck your cowardice away and strive to change things. As I said already, the best defense is a strong offense.

I've been in this situation when certain nurses have tried to bully me. The first instant where this happens, I try to use humor to point out the stupidity of their behavior. If this is met with a laugh and a self-realization in that individual that they are being an a-hole, that's usually the end of it. But, if they keep coming with the "you better learn your place quick, lowly resident" that occassionally happens, that immediately prompts an email to their supervisor and my program director. You have put people on notice at that point, and any subsequent complaint from that individual is inherently watered-down in comparison to your pre-emptive strike.

The fact is, most residents simply buckle under the weight of bullies. I'm not new to residency. I've seen this happen a lot. The end result is that the nurse effectively manages the patient and gets whatever he/she wants, not always to the patient's benefit. And, if they perceive that they can get you to do whatever they want you to do, they will continuously take advantage of you. If you're okay with that prospect, then far be it from me to tell you to do anything differently.

Now, I'm not saying that you shouldn't listen to nurses and validate their opinion (and even explain to then when, why, and exactly how they are wrong when they are wrong), but too many times people simply take the path of least resistance because, frankly, it's easier for them. And, many nurses (come on, let's be honest here... we all know who the trouble makers on any given unit are) will continue to prey on you if you present yourself as weak.

The next problem is that if you actually show the balls to stand up to them, they will try as vociferously and tenaciously as possible to knock you down. Funny how that seems to be diffused if you've already put your PD and their supervisor on notice.

You gotta be smart, folks. Dealing with some nurses is a game. Most are wonderful and excellent at what they do. Most also are extremely helpful and want to do what's best for the patient. Others simply see you as the enemy, and many will band together in an attempt to destroy you if you don't play by their rules.

Bottom line: You don't have to take their ****.

-copro

the following is vital vital advice.. seriously. one i learned after residency,which was too late. but it serves me greatly to this day. Seriously, listen closely.


"DONT FIGHT BATTLES YOU CANNOT WIN"
period.
thanks for your time

 

[Gern Blansten]

It is rare that nurses don't respond to being treated in a civil and respectful manner. There is a middle ground between being a doormat and being an a-hole that no one likes. It is a fine art to get them to do what you want them to do and make them think it was their idea.
If you want to seal your fate at your program, treat everyone as your inferior. It doesn't fly as an attending and it doesn't fly as a resident. It is definitely possible to get the desired effect without being a jerk.
It is true that you may not be building your future career at this training program, but you will meet many potential future partners. If you are dysfunctional in dealing with others, that reputation will follow you. I have seen it happen. Your career options can be impacted.
It is okay to stand up when needed, but pick your battles. If you cause a scene about minor things, people will blow you off when it really matters.
If you are constantly meeting people who are idiots, maybe some introspection is necessary. It may be that the only consistent feature of all of your dissatisfying relationships is you.

The key is to treat others with respect.

 

[jetproppilot]

I don't agree that this is "usually" and necessarily the case. And, you forgot another obvious choice in your false dilemma...

3.) Every other resident takes their **** and someone finally gets sick of it and speaks up.

This person is then put on the "black list" and the group of "bully" nurses goes on a mission to destroy that resident who dared to question them.

I've seen this happen multiple, multiple times on many different units. More often than not, the "bully nurse" (sometimes it's even a cohort of 3-4 nurses who've been their the longest and have outlasted everyone else) isn't even liked by his/her colleagues, but (for some reason) has gotten so powerful that everyone is afraid of them.

Now, you can "bow your head" and take it like a man, or you can (in my humble opinion) tuck your cowardice away and strive to change things. As I said already, the best defense is a strong offense.

I've been in this situation when certain nurses have tried to bully me. The first instant where this happens, I try to use humor to point out the stupidity of their behavior. If this is met with a laugh and a self-realization in that individual that they are being an a-hole, that's usually the end of it. But, if they keep coming with the "you better learn your place quick, lowly resident" that occassionally happens, that immediately prompts an email to their supervisor and my program director. You have put people on notice at that point, and any subsequent complaint from that individual is inherently watered-down in comparison to your pre-emptive strike.

The fact is, most residents simply buckle under the weight of bullies. I'm not new to residency. I've seen this happen a lot. The end result is that the nurse effectively manages the patient and gets whatever he/she wants, not always to the patient's benefit. And, if they perceive that they can get you to do whatever they want you to do, they will continuously take advantage of you. If you're okay with that prospect, then far be it from me to tell you to do anything differently.

Now, I'm not saying that you shouldn't listen to nurses and validate their opinion (and even explain to then when, why, and exactly how they are wrong when they are wrong), but too many times people simply take the path of least resistance because, frankly, it's easier for them. And, many nurses (come on, let's be honest here... we all know who the trouble makers on any given unit are) will continue to prey on you if you present yourself as weak.

The next problem is that if you actually show the balls to stand up to them, they will try as vociferously and tenaciously as possible to knock you down. Funny how that seems to be diffused if you've already put your PD and their supervisor on notice.

You gotta be smart, folks. Dealing with some nurses is a game. Most are wonderful and excellent at what they do. Most also are extremely helpful and want to do what's best for the patient. Others simply see you as the enemy, and many will band together in an attempt to destroy you if you don't play by their rules.

Bottom line: You don't have to take their ****.

-copro

Don't ever, ever forget, Cop, that

residency is a conduit to the holy grail.

Yeah, ya gotta make a stand sometimes, but MOST TIMES

IT DOESNT REALLY MATTER.

He said this.

She did this.

Who cares?

Drop off your patient and move on to the next chapter.

You are there FINITELY.

The troll ancillary staff at your residency are there INFINITELY.

I've been where you are now. I know its hard to keep the BIG PICTURE alive in your head.

I think, at least concerning your emotional well being, you could leave alot more stuff alone then you do.

Walk away from conflict, friend.

Most of the time.

A few years from now even the attendings won't remember your name.

 

[Calilove]

NOTE TO RESIDENTS/Fellows: Know your role and play your position!

(For those of you that aren't clear on this, you are the only one on the team that is still TRAINING! If you still aren't sure, compare your Freakin' check stubs with those in question and count your lack of $$$ in comparison!!! You haven't earned the right to march through the PACU and give orders... Most of you (CA-1s) haven't completed Morgan & Mikhail or even Baby Miller for that matter...Don't argue with seasoned nurses, you'll never win! You'll be labelled as the complainer, the problem resident, and receive LUKEWARM recommendations when you're looking for a job in this SHT-T economy in about three years...)

Calilove's HOW TO guide to residency/fellowship survival: Bow your head, bend over, and say "thank you sir/maam, may I have another" until that certificate of residency completion is IN YOUR HAND!

 

[jetproppilot]

When I am in the PACU now I am not "in-training". I am not a resident any more. I give orders, and the nurses (and residents) take them.


NOTE TO RESIDENTS: Know your role and play your position!

Calilove's HOW TO guide to residency survival: Bow your head, bend over, and say "thank you sir/maam, may I have another" until that certificate of residency completion is IN YOUR HAND!

Hard pillow to swallow when you're LIVING IT

but wisdom nonetheless.

 

[coprolalia]

IT DOESNT REALLY MATTER.

He said this.

She did this.

Who the f uck cares?

It matters when it involves patient care, my friend. I care when someone flat-out refuses to do something that is needed, or does something that wasn't ordered then asks me to write the order ex post facto... especially when it is potentially dangerous. The program cares when that person then goes and complains trying to cover their own a** and create a smokescreen for their own poor performance and generalized bullying of everyone, including the attendings.

This happened to me once in residency. Guess who "won"? (Hint: I'm still here.) 😉

You don't have to take their ****. But, you gotta know how to play the game. I appreciate your sentiment, though.

-copro

 

[Bertelman]

It matters when it involves patient care, my friend. I care when someone flat-out refuses to do something that is needed, or does something that wasn't ordered then asks me to write the order ex post facto... especially when it is potentially dangerous. The program cares when that person then goes and complains trying to cover their own a** and create a smokescreen for their own poor performance and generalized bullying of everyone, including the attendings.

This happened to me once in residency. Guess who "won"? (Hint: I'm still here.) 😉

You don't have to take their ****. But, you gotta know how to play the game. I appreciate your sentiment, though.

-copro

Are we still talking about delayed signout in PACU?

One night on call a PACU nurse gave the "standard" morphine dose post-op. Didn't realize the order wasn't in. Also failed to realize the patient had CKD 4, and that the morphine would be hanging out for a long, long time. She sneaked around and casually asked us to write the order. Resident said no when they realized why the morphine wasn't ordered. Nurse went up the chain to the attending, who also said no. Then she jumped over to another chain, and asked the sucker PA to write the order, who also likely didn't understand the effects of impaired renal Fx on morphine. PA wrote the order.

I never once thought about compromising what I thought was right that evening. That nurse wasn't getting shit from us. I still lokk at her suspiciously to this day.

But I thought we were talking about delayed signouts. That's a completely different story. I'm not gonna raise hell because a nurse is too fukin lazy to hook up a bp cuff. It happens to me all the time in OB. Drop off a C/S, I've got the Pt. hooked up, BP done, my charting done by the time I see a nurse. Some of them don't even know what the pulse ox cable looks like on the new machine. My goal is to get out of there, period.

 

[Bertelman]

While I'm at it, Copro, I don't see why your attitude has changed all that much since the thread on OB nurses.

...That's why I make it a point to smile, coddle them, get to know them, and b.s. around with them when I get the chance. Even for the few minutes. It pays off. If they call me to start a tough IV, I'll do it (if I'm not in the middle of something else).

When's the last time you actually sat down and had a dialogue with an OB nurse that didn't consist of complaining about why a pump wasn't set-up, why they called you first before getting the patient to the bathroom, why they didn't call you when the patient first hit the unit and now they're at 9 cm... etc.

The one guy on that thread that seemed to adopt your position by taking a stand against a nurse not starting a proper IV was dismissed as a troll by you.


If the OP had behaved as you described above, he probably wouldn't be in this mess.

 

[coprolalia]

In the OB post, people were trying to assassinate an entire group of nurses. In this thread (my posts, in particular), I'm primarily talking about dealing with individual trouble-makers. You know, those that go to your supervisor when they have a problem instead of speaking directly to you.

Trouble-makers and bullies are everywhere and in every unit. And, don't worry. I've had to deal with a couple of problem OB nurses in my time, as well. But, clearly I'm not now nor have I been saying all along that all PACU nurses (or other nurses) are bullies or trouble-makers (or anything else). If you re-read my posts again, I'm sure that this will be more clear. I get along famously with the vast majority of nurses in our hospital.

I've said this before multiple times on this forum (if you care to search that too) that you must remain clear, factual, and unemotional when you find yourself in conflict. And... document, document, document. Furthermore, if someone is accusing you of something (no matter what it is), you also have the right to ask for specifics (time, place, person, event, details) of the complaint, as well as what should have been, in their opinion, the better course of action in the incident. If they can't do that, I feel fully justified in telling the person, in so many words, to stop wasting my time.

Take that advice to the bank. It's pure money.

-copro

P.S. Let me be more clear. I put the pulse ox and the monitors on in the PACU to be helpful. I try to give a succinct report to the nurses that gives them the info they need to be helpful. I ask them if they need anything else for the patient before I leave the unit to be helpful. If they come to me because a patient is complaining for whatever reason, I ask them what they think the problem is and change or add orders to be helpful. Some nurses, no matter what you do, will go out of their way not to be helpful. They are not team players. They are instigators. They need to be dealt with accordingly. Sometimes, it is an entire unit, yes. In which case, it is out of your hands as a resident... but document the deficiencies in an email to your PD. Then, they can't later say, "You never told us there was a problem." Sadly, much of what we do - how we interact with each other - in the hospital is just another game to some people, and they have such pathetic lives outside the hospital that they bring all their drama with them to work. Don't play their game. But, don't take their **** either. That's the point.

 

[ProRealDoc]

It is rare that nurses don't respond to being treated in a civil and respectful manner. There is a middle ground between being a doormat and being an a-hole that no one likes. It is a fine art to get them to do what you want them to do and make them think it was their idea.
If you want to seal your fate at your program, treat everyone as your inferior. It doesn't fly as an attending and it doesn't fly as a resident. It is definitely possible to get the desired effect without being a jerk.
It is true that you may not be building your future career at this training program, but you will meet many potential future partners. If you are dysfunctional in dealing with others, that reputation will follow you. I have seen it happen. Your career options can be impacted.
It is okay to stand up when needed, but pick your battles. If you cause a scene about minor things, people will blow you off when it really matters.
If you are constantly meeting people who are idiots, maybe some introspection is necessary. It may be that the only consistent feature of all of your dissatisfying relationships is you.

The key is to treat others with respect.[/quote]


Very true

 

[Arch Guillotti]

OK.

Light a candle. Dude, relax!

I don't agree that this is "usually" and necessarily the case. And, you forgot another obvious choice in your false dilemma...

3.) Every other resident takes their **** and someone finally gets sick of it and speaks up.

This person is then put on the "black list" and the group of "bully" nurses goes on a mission to destroy that resident who dared to question them.

I've seen this happen multiple, multiple times on many different units. More often than not, the "bully nurse" (sometimes it's even a cohort of 3-4 nurses who've been their the longest and have outlasted everyone else) isn't even liked by his/her colleagues, but (for some reason) has gotten so powerful that everyone is afraid of them.

Now, you can "bow your head" and take it like a man, or you can (in my humble opinion) tuck your cowardice away and strive to change things. As I said already, the best defense is a strong offense.

I've been in this situation when certain nurses have tried to bully me. The first instant where this happens, I try to use humor to point out the stupidity of their behavior. If this is met with a laugh and a self-realization in that individual that they are being an a-hole, that's usually the end of it. But, if they keep coming with the "you better learn your place quick, lowly resident" that occassionally happens, that immediately prompts an email to their supervisor and my program director. You have put people on notice at that point, and any subsequent complaint from that individual is inherently watered-down in comparison to your pre-emptive strike.

The fact is, most residents simply buckle under the weight of bullies. I'm not new to residency. I've seen this happen a lot. The end result is that the nurse effectively manages the patient and gets whatever he/she wants, not always to the patient's benefit. And, if they perceive that they can get you to do whatever they want you to do, they will continuously take advantage of you. If you're okay with that prospect, then far be it from me to tell you to do anything differently.

Now, I'm not saying that you shouldn't listen to nurses and validate their opinion (and even explain to then when, why, and exactly how they are wrong when they are wrong), but too many times people simply take the path of least resistance because, frankly, it's easier for them. And, many nurses (come on, let's be honest here... we all know who the trouble makers on any given unit are) will continue to prey on you if you present yourself as weak.

The next problem is that if you actually show the balls to stand up to them, they will try as vociferously and tenaciously as possible to knock you down. Funny how that seems to be diffused if you've already put your PD and their supervisor on notice.

You gotta be smart, folks. Dealing with some nurses is a game. Most are wonderful and excellent at what they do. Most also are extremely helpful and want to do what's best for the patient. Others simply see you as the enemy, and many will band together in an attempt to destroy you if you don't play by their rules.

Bottom line: You don't have to take their ****.

-copro

 

[coprolalia]

Arch,

Did you read this...

In the OB post, people were trying to assassinate an entire group of nurses. In this thread (my posts, in particular), I'm primarily talking about dealing with individual trouble-makers. You know, those that go to your supervisor when they have a problem instead of speaking directly to you.

Trouble-makers and bullies are everywhere and in every unit. And, don't worry. I've had to deal with a couple of problem OB nurses in my time, as well. But, clearly I'm not now nor have I been saying all along that all PACU nurses (or other nurses) are bullies or trouble-makers (or anything else). If you re-read my posts again, I'm sure that this will be more clear. I get along famously with the vast majority of nurses in our hospital.

I've said this before multiple times on this forum (if you care to search that too) that you must remain clear, factual, and unemotional when you find yourself in conflict. And... document, document, document. Furthermore, if someone is accusing you of something (no matter what it is), you also have the right to ask for specifics (time, place, person, event, details) of the complaint, as well as what should have been, in their opinion, the better course of action in the incident. If they can't do that, I feel fully justified in telling the person, in so many words, to stop wasting my time.

Take that advice to the bank. It's pure money.

-copro

P.S. Let me be more clear. I put the pulse ox and the monitors on in the PACU to be helpful. I try to give a succinct report to the nurses that gives them the info they need to be helpful. I ask them if they need anything else for the patient before I leave the unit to be helpful. If they come to me because a patient is complaining for whatever reason, I ask them what they think the problem is and change or add orders to be helpful. Some nurses, no matter what you do, will go out of their way not to be helpful. They are not team players. They are instigators. They need to be dealt with accordingly. Sometimes, it is an entire unit, yes. In which case, it is out of your hands as a resident... but document the deficiencies in an email to your PD. Then, they can't later say, "You never told us there was a problem." Sadly, much of what we do - how we interact with each other - in the hospital is just another game to some people, and they have such pathetic lives outside the hospital that they bring all their drama with them to work. Don't play their game. But, don't take their **** either. That's the point.

This is ultimately about who's responsible for the patient. Again, I know someone who's being hauled into court because of an incident in the PACU. None of the PACU nurses have been named.

Figure it out. This is about more than just "getting along" and I hope many of you reading this realize that. I agree wholeheartedly with Gern Blansten about picking and choosing your battles. Too often, though, all I see is doormats. We're giving away our Profession... slowly... by bits and pieces...

-copro

 

[Arch Guillotti]

Figure it out.

-copro

I'm working on it🙄.

Here's what I said earlier:

"I do what is medically indicated for the patient, period."

What else do I need to work on?