When nurses go behind your back

[monkeybutt]

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What do you do when nurses go behind your back to your attending because they don't like the orders you gave them? Does this happen to you often (daily?)? Do you confront them if you find out? Does your staff stick up for you?

 

[xaelia]

Conflict between providers only harms patients.

Work harder to earn the trust of your staff. Make sure they feel comfortable coming to you with questions about your orders; encourage a safe environment for them to address their concerns and allow you to hear their concerns and educate them regarding your plan of action.

 

[SoCuteMD]

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[Arcan57]

If nurses are routinely going behind your back, it means they don't want to talk with you about their concerns. If this only happens with 1 or 2 nurses then it may be their issue. If the majority of nurses are doing this, then the general consensus is that you are: 1) dangerous and 2) a jerk. In non-emergent situations, a couple of minutes explaining why you want to give drug x or don't want to use drug y can build trust and grease the wheels for non-standard orders in the future. In emergent situations, go back afterwards and discuss the reasoning. An angry nurse is a nurse that can destroy your ability to care for your patients, and there are relatively few things that end up being worth the trade-off.

 

[tegs15]

My second month in the ED I butted heads with two different nurses. Due to timing, I was able to take one to the side and explain my rational and asked her opinion. We had a good discussion and now she is a great asset. She looks for me if we have a critical pt or off-service residents are concerning her.

The other nurse I was not able to speak with as I would have hoped. Now if we are both on, there is some passive-aggressive tension when she is caring for my patients, or should I say when I'm seeing her patients. It has made some shifts very tedious to say the least.

Take the time to educate and listen to your nurses, A good ED nurse knows how things should be done and will help you go along ways. Additionally include them in your treatment plan and when time permits teach them something. Just last week had one of the charge nurses, who just started his NP courses, ask me about a belly pain. We went over to the PACS machine and discussed CTs in general and the pt's positive CT for appendicitis! I think he really appreciated it. Communication is the Key!

 

[bulgethetwine]

What do you do when nurses go behind your back to your attending because they don't like the orders you gave them? Does this happen to you often (daily?)? Do you confront them if you find out? Does your staff stick up for you?

I have a two-strike policy. Strike one, I go and seek them out. Try my best to resolve it.... it's one thing to have a little conflict (this happens even with the best providers) but the onus is on me to seek out, educate, explain, and move forward.

The first time anyway.

The second time? F Truck That. Modern nursing organizations/management encourage them (nurses) to be as vocal as possible, and sometimes individual nurses just don't get it. If you can look yourself in the mirror and honestly say that you did your best to explain things, solicit questions, etc. the first time (assuming this isn't happening to you with a large proportion of nurses to suggest you're really the problem) don't lose any sleep over it.

Having insight into your behavior and being able to check yourself when interpersonal work relationship are strained is an important skill to acquire during residency. Be humble, patient, and be an educator. But don't kiss their ass. Knowing when to cut your loses, to confidently and professionally understand when the pathology *isn't* you, is equally important.


Good luck.