Why this job sucks ...

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Doctor Bagel

Doctor Bagel

so cheap and juicy
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Feeling miserable about being a resident right now and thought I'd share. I had a very bad call last week. Things happened, maybe not ideally, and in retrospect, maybe there were things that could have been handled more perfectly. However, I tried to be respectful to staff the whole night and tried to listen to them . However, we had one bad incident. Some antisocial dude got admitted and caused a scene when he couldn't get enough benzos. I went over immediately and thought I acted appropriately. However, I guess the staff wanted me to kick him out of the unit (btw, he was suicidal before he freaked out, which was the reason for his admission), so I really couldn't. Come to find out, the night nurses, who are people I don't work with often, sent a series of emails to their boss basically talking about how I did a bad job. Jeez, thanks -- you could have told me some of those thoughts in the moment, and, hey, I would have listened to you. Instead, they sent this anonymous email behind my back.

Yay. Can I quit? Sorry for the stream of consciousness email. Just feeling a little blindsided and wondering what I should do. Just blow it off?
 
As long as you handled it professionally, that is key. Another key is that "if you don't tell me, I can't fix it." That is affirmatively a failure of professionalism on their part. Your PD needs to stand up for you. Then, your PD needs to take it up with nursing supervisor. If your PD doesn't, you got a dud for a boss. The questions to ask are 1. What was the problem 2. What did you do incorrectly 3. What did staff do at the time there was the problem? The third question is the money, as the ex post facto maligning of your character is unhelpful at best, and destructive much more likely. You need to take the high road.
 
How did you find out they wrote that complaint letter? Did someone from your program bring it up with you? If your program has gotten involved then I wouldn't blow it off. At the very least, if I were you I'd probably write a response letter explaining your side of things (in a calm and civil way of course, as I know you already know to do!).
If nothing else, it might be a good idea to ask your chief or program director to clarify what the expectations are for residents when faced with this kind of situation.
Sorry that this happened to you. It does sound like the atmosphere at your program is pretty brutal. 🙁
 
To clarify, they sent it to the nursing supervisor on their unit, who sent it to me. We're doing a lot of changes with our call structure, we had this one bad outcome (the one I mentioned above), and she sent an email to them asking about it. They then decided to pretty much slam me, including making comments like I "hemmed and hawed" when called about what to do at 4 am. Well, yeah, because I was thinking about it. Note to self, answer like I don't even need to think. They then decided to throw in additional slams about this other pt, again, an issue they didn't bring up with me.

Unfortunately, people in my program seem fairly supportive now, but there are a lot of other power issues going on, so I don't know how this will play out. I'm just feeling really bummed about it because I feel like I work so much and then get kicked. And no, I'm not saying I did a perfect job that night. In retrospect, there are things I learned and things I'd do differently. However, I feel like I did an adequate job to address the situations and deal with the things happening.
 
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You can't please all the people all the time. Your PD knows this. If this is a rare event, it shouldn't affect you. He will get concerned if it becomes a pattern.

Still, be humble and learn to detect when irritation starts to rise, and learn to be a politician. Very good skill to have to climb ranks later in life.
 
And now thinking about it more, if the nurses were really as concerned about their safety and pt safety as they expressed in this email, why didn't they say anything to me? Instead, they let me do things they totally disagree with (from what they say 2 days later after a non-ideal outcome) and say nothing. How's that being an advocate for pt safety? These are nurses who've been there 20+ years, and I'm a resident. There's no power differential here that should stop them from saying something in the name of pt safety.

And in this nurse's email, he says stuff like I told her this would happen, which was total freaking bs. Didn't happen. BTW, I sent what I thought was a fairly professional email to the nursing supervisor, although I could have been a little more slick in retrospect. I did mention that I didn't get clear communication about what they were thinking and explained my rationale for treatments I did on this one pt and on the other pt. Luckily, I also did a decent amount of documenting in the charts that night.
 
Impromptu said:
Still, be humble and learn to detect when irritation starts to rise, and learn to be a politician. Very good skill to have to climb ranks later in life.
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So true. The nurse who did this throwing me under the bus business was making some subtle comments about stuff that maybe I should have picked up on. If I had worked with him more and if I wasn't already stressed out dealing with multiple nightmares at 4 am, maybe I would have. Lesson learned.
 
Can you request a debriefing session in which all parties can share their concerns and work out some ways to approach the problem(s) for the future? Not everyone may agree, but as long as it isn't a finger pointing session and everyone is bringing a listening, problem resolving attitude, I think it should help. Definitely better than letting bad feelings fester. Sorry for having such a bad experience- best of luck!
 
The right Path said:
Can you request a debriefing session in which all parties can share their concerns and work out some ways to approach the problem(s) for the future? Not everyone may agree, but as long as it isn't a finger pointing session and everyone is bringing a listening, problem resolving attitude, I think it should help. Definitely better than letting bad feelings fester. Sorry for having such a bad experience- best of luck!
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It honestly might come to that. The reply I sent to the nursing supervisor will be forwarded to all of them. We'll see. I have a meeting with one of our PDs tomorrow about something else, and I'm wondering if I should bring this up.
 
Another thing that's bugging me about this situation is that in the slamoemail thing, the passive aggressive nurse in question kept on referring to me either by my first name or by my last name with no "dr" in front of it. However, he referred glowingly to his co-resident of mine who's a traditional macho type of guy (a pretty awesome guy, too) as "dr." so and so. I'm a female who seems younger than I am. Was there some disrespect for my competency because of that?

Or maybe not. It's not something I'd bring up with anybody, and I'm not trying to use that as an excuse. Just wondering if that's part of what's going on. I'm honestly having trouble understanding this one nurse's animosity directed right at me.
 
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Doctor Bagel said:
Another thing that's bugging me about this situation is that in the slamoemail thing, the passive aggressive nurse in question kept on referring to me either by my first name or by my last name with no "dr" in front of it. However, he referred glowingly to his co-resident of mine who's a traditional macho type of guy (a pretty awesome guy, too) as "dr." so and so. I'm a female who seems younger than I am. Was there some disrespect for my competency because of that?
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Yes, there was disrespect based on sexism. And, sadly, you are probably right about not bringing it up officially. You could perhaps bring it up with the individual, out of hearing of anyone else ("Do you know that you call dr x "dr x" and me "y"? I wasn't sure you were aware, and wouldn't want others to think you were being unprofessional.").

If you have a hostile colleague and are not going to get management support in dealing with them, pretty much your only option is to be punctiliously well mannered to them on every possibly occasion (any lapses will be held against you), keep excellent records of your interactions with them, and wait till either you or they moves on.
 
The right Path said:
Can you request a debriefing session in which all parties can share their concerns and work out some ways to approach the problem(s) for the future? Not everyone may agree, but as long as it isn't a finger pointing session and everyone is bringing a listening, problem resolving attitude, I think it should help. Definitely better than letting bad feelings fester. Sorry for having such a bad experience- best of luck!
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I completely agree with this approach. It shows that you care about your job, your patients, and maintaining a strong working relationship with team members/support staff. It shows a willingness to turn a negative into a positive by looking at the incident as a learning opportunity. I'd recommend being proactive in bringing this up to your PD when you meet.
 
Doctor Bagel said:
Another thing that's bugging me about this situation is that in the slamoemail thing, the passive aggressive nurse in question kept on referring to me either by my first name or by my last name with no "dr" in front of it. However, he referred glowingly to his co-resident of mine who's a traditional macho type of guy (a pretty awesome guy, too) as "dr." so and so. I'm a female who seems younger than I am. Was there some disrespect for my competency because of that?

Or maybe not. It's not something I'd bring up with anybody, and I'm not trying to use that as an excuse. Just wondering if that's part of what's going on. I'm honestly having trouble understanding this one nurse's animosity directed right at me.
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That definitely sounds fishy for pettiness. Maybe sexism, too, but that's harder to say. Don't bring that up. To anyone. You can't fight petty, and any attempt to do so will make you look petty. The only thing you can do is be the pro stand up gal, be calm, reasonable, and bend over just a little bit backwards to address this person's grievances (but don't compromise yourself). You can win the support of most people with kindness, but not everyone and if that's the case, just let it go. A person who is habitually nasty eventually acquires enough rope to hang himself.
 
The right Path said:
That definitely sounds fishy for pettiness. Maybe sexism, too, but that's harder to say. Don't bring that up. To anyone. You can't fight petty, and any attempt to do so will make you look petty. The only thing you can do is be the pro stand up gal, be calm, reasonable, and bend over just a little bit backwards to address this person's grievances (but don't compromise yourself). You can win the support of most people with kindness, but not everyone and if that's the case, just let it go. A person who is habitually nasty eventually acquires enough rope to hang himself.
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Yeah, I won't bring it up anywhere but here. Why I love SDN.

Update, I met with one of the PDs today and shared the email stream with her. She was fairly supportive and gave good feedback on the situation. I'm going to discuss it with the PD who handles who's more in charge of the unit where this stuff happened later.
 
Doctor Bagel said:
Yay. Can I quit? Sorry for the stream of consciousness email. Just feeling a little blindsided and wondering what I should do. Just blow it off?
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Gotta get thicker skin, but it happens to us all. At the start of the year if the nurse who's been there 20 years tells you the sky is red you deep down aren't 100% comfortable saying they're wrong. By the end of the year you'll tell your friends about scenarios like this with a laugh, recognizing it's BS nursing politics. They don't push women around more, they push people who don't push back around more which is disproportionately women. Timid-seeming guy interns get it too. It's hard to change your personality, but you'll probably seem more confident as a resident later on and that confidence will make them respect you so fear not.
 
dilated said:
Gotta get thicker skin, but it happens to us all. At the start of the year if the nurse who's been there 20 years tells you the sky is red you deep down aren't 100% comfortable saying they're wrong. By the end of the year you'll tell your friends about scenarios like this with a laugh, recognizing it's BS nursing politics. They don't push women around more, they push people who don't push back around more which is disproportionately women. Timid-seeming guy interns get it too. It's hard to change your personality, but you'll probably seem more confident as a resident later on and that confidence will make them respect you so fear not.
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The sad thing is that I'm a 2nd year, so I should be past this crap right and already have my thicker skin. Unfortunately, this is a unit where I'm pretty familiar with the day shift and swing nurses and feel like I have a decent working relationship with them. However, last year, I had very minimal contact with these night nurses, so I'm feeling their wrath. Also, there have been lots of stresses in the unit in general recently, so I think maybe I'm getting scapegoated just a little.

I'm hoping I'll laugh about it. Bummer factor is that I'm doing night float in two months and will have to work with these people a lot.
 
In these higher stress situations it is often helpful to do the following:

1. Get the information from the nurse.
2. Tell the nurse you will come to see the patient right away.
3. En route to see the patient, call your attending and brief them on what is going on. Hopefully they will have poignant advice.
4. Now you have talked over the problem and will be on more stable ground to make a decision.
5. Arrive at the unit, ready to assess the situation and intervene appropriately.
6. Call your attending to go over the plan, then implement the plan.
7. Write a note documenting the event, your discussion with the attending, and that the attending agreed with the plan. Now if the nurses are angry it is shared between you and the attending, which is better for you.

NB
-don't let anyone tell you what to do with your medical license (eg kicking out a suicidal anti-social patient because he is a behavioral disturbance...an inpatient psych unit should be able to handle this patient via talking him down, seclusion/restraints, or meds, though it is not fun and becomes work for the nursing staff.) The last thing you want is to d/c this patient at night, with no dispo, and then have him hurt himself or someone else. Don't do anything stupid.
 
Wow...I know I haven't posted frequently in years...and I'm a little late to this thread. But I am a nurse who has been choked, punched, kicked, thrown into a wall, seen a coworker stabbed, seen a female resident knocked to the ground, seen a visibly pregnant aide hit in the belly, dodged many an item being thrown, etc.

The first thing that should have happened was that if the nurses felt unsafe is a strong presence from security. Next, nursing management/nursing supervisor should let the patient know in strong terms that intimidating the nurses will not be accepted. Limit setting is completely appropriate with pts, even suicidal ones. It is perfectly okay to "code Armstrong" a pt, without calling for MD permission first...and in some facilities that gets help from the pysch ward who can de-escalate, all of this could have been happening while someone else was calling for the resident. This was totally handled wrong.

Taking frustration with having to deal with a pt that is acting out on a resident is covering call is ridiculous and childish behaviour...but unfortunately, it seems all the good nurses are burning out, and leaving in droves due to the conditions of hospital nursing and ridiculous and childish people are being let into nursing to take their place. Sometimes when units are staffed with nurses who all have less than 3 years experience, no one has a clue how to appropriately manage any circumstance out of the ordinary and situations like this all get sent to nursing management like little kids tattling on each other, instead of handling it like professionals. Then nurses wonder why no one takes them seriously.
 
I second that. Night nurses are very strange, wierd and kind of unhumane. I have seen night nurses especially in ICU increasing versed and fentanyl doses of intubated patients so that they dont bother them all night and in the morning when you come to do a breathing trial patient is sleeping like a baby....
 
Sadly, this kind of behavior is becoming more common from nurses. The kick these days within nursing is for nurses to be "empowered" to speak up against "abusive" doctors. This was originally intended for the few doctors who do stupid things like throwing charts. But it is now being abused by nurses to seek revenge against doctors they don't like. You may have inadvertently done something that made one or more of the nurses involved dislike you. This thing can be as stupid as the way you carry yourself.

Nurses know that a few key phrases, such as "I don't feel comfortable with Dr X's patient care" or, in this case, "I'm concerned about pt/my safety" are buzz words which can lend a degree of validity to any complaint.

As telenurse points out, good nurses are being replaced these days by whiny, petty, children who are still attached to their helicopter mom's umbilical cord, and are hypersensitive. If they decide they don't like you, they will use incidents like this to extract revenge on you. (I once learned from a nurse I had good rapport with that another nurse didn't like me and wanted to try to cause trouble for me because she decided that I didn't care enough about the patients)

And you are correct, female residents are treated differently by female nurses than male residents are. You cannot, under any circimstances, play the sexist card. I am female too, and during my residency, I had a periodic incidents with a handful of nurses over the years. It was most typically like what you describe- nurses that i didn't know well, over some patient incident that was I handled adequately but with room for some improvement. Or, in one instance, a when i answered my pager to learn "patient is bleeding from his trach" and I said "Oh, f&^k, I'll be right up"- despite this being a surgical floor, and me being a surgery resident, and all my male counterparts swearing continuously, I got written up for that statement.

My recommendation: start to pay attention to your body language and how you work with these nurses. I suggest you try to tread more carefully than your male counterparts. It sucks, you'll probably have to ask them to take care of your patients, pretty please with sugar on top if it's not too much trouble and you're not to busy. When they say "jump" you say "how high"

And start keeping a log of any incidents that you think may have even the slightest potential to cause trouble. Make sure your radar is tuned in to these things. Document who did what and who said what in a factual way. Don't tell anybody you are keeping a log. Consider it insurance if you ever need to defend yourself.

That said, if you otherwise have good evaluations and a good reputation in your program, and your PD is reasonable, I don't think this will do you long term harm. It's just another painful part of residency.
 
It sounds like you did the best you could in a crappy situation... remember immediate documentation is your friend, err on the side of too much rather than too little including an explanation of all decisions. Is there a resident in your program ahead of you that you could talk with about this, at least in the sense of "what would you have done?" Also, if on night float you will be working with an attending regularly it might be worth your while to talk to them about this and their opinion on low threshold to contact them vs handling stuff on your own. Finally you -are- an intern after all, if you were as competent as a seasoned attending at this point in your training there would be no residency programs. I think as long as you're basing your decisions on coming from a place of patient safety and staff safety and you're documenting as such and not blatantly incompetent you'll be fine, even if a nurse wants to pitch a bitch about how you got from point A to point B. Sometimes you have to be comfortable knowing you did the best you could in a certain situation with what you were given, and after 3 days ruminating on it with additional info you didn't have at the time you think you would make a different decision... that's medicine. You have to learn from it and let it go, just don't make the same mistakes twice.

One other thing I'm curious about...is this nurse new to psych? Based on what you said and the psych wards I've worked on, that patient WOULD be getting more benzos... in addition to some haldol, as an IM shot for agitation.
 
Doctor Bagel said:
Yay. Can I quit? Sorry for the stream of consciousness email. Just feeling a little blindsided and wondering what I should do. Just blow it off?
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**** similar to this (nursing politics) has happened to me in the past and it's tragically funny how similar things can be.

Main thing you have to remember is that nurses can act like ******ed petulant little children. Once you realize this and treat them accordingly, your life will be much better.

Make sure your PD has your back in general by showing that you are a hard worker etc. This goes a long way.

Second thing is that you can monday morning quarterback any on call situation to death. Nurses will never understand the stress of being a physician and being that final stop gap before all hell breaks loose. Couple this with the fatigue of being on for 20+ hours and all the random bulls#hit associated with being on call, and you have a perfect recipe for managing situations in a less than ideal manner when rethinking things.

Residents, especially lower level residents, and especially female residents (I'm a male resident and have directly observed these things) you will always run into power issues with nursing. This will always be a struggle and you have to realize what is and isn't important in order to take care of YOUR patients and learn to compromise a bit.

As far as your situation is concerned, as long as no permanent harm or death occurred to anyone involved, I consider that a victory.

Just keep your cool when involved with nursing as they will be the first ones cackling to each other and writing cowardly emails. Just an example of the ridiculousness, our hospital recently implemented computer based orders which was a challenging transition for all hospital personnel. Some nurse calls requesting something and I tell her that I will order it and to look for it. I order it correctly and never hear from her the rest of the night

Two days later an email gets circulated how I never put in this order and how I ignored the request and if I was going to sleep at night I should do a verbal order. I'm livid at this and check to make sure the order was put in correctly, and it was. Dumb ass nurse just never checked in the correct part of the program and never repaged me to clarify and instead went straight to her email.
 
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It makes you wonder how many of these emails circulate around that don't get brought to our attention. I'm sure the nurses who sent this mean email didn't expect me to see it. Notably, they haven't made any response after I responded. Lesson for this future -- I'm going to specifically ask things like "what do you think" and "does this sound like a good plan?" in the future.

As for the safety situation, this was honestly the best place to deal with it, and nobody got hurt. Had the guy freaked out in the ED, things might have been uglier. And discharging this guy was just never an option. It's kind of amazing that they wanted me to do that, but I guess they really don't understand that we bear the liability if something happens.

As for errors on their part, I've looked over the cases and found a few specific examples where they violated policy by not paging me on things that they have orders to page me on. I'm not going to bring it up now, but if this plays out in a bigger way, I will. I've sent my email response, I've notified the program director, and I'm out for now.

I appreciate all the responses so far.
 
Doctor Bagel said:
Lesson for this future -- I'm going to specifically ask things like "what do you think" and "does this sound like a good plan?" in the future.
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I'd phrase it differently. You are the doctor and you shouldn't make it seem as though you need a nurses permission to carry out your plan of care.

I just let nurses know that if they have any concerns, they can feel free to let me know and I can address them. Sometimes it's based on lack of knowledge from a nursing perspective so this can be a helpful teaching moment.
 
SoCuteMD said:
I have learned, however, that if the nurse calls me with a situation and I sense that they are not going to be placated unless I DO SOMETHING NOW even if the situation is not one in which I'm going to do anything, I find work for them to do. For example, patient with pacer/AICD has 5 beats of non-sustained, asyptomatic v-tach and nurse is freaking out. I ask for a current set of vitals, an EKG, and for the morning labs to be drawn early. This takes a good 10 minutes at a minimum, earning me 10 minutes to wrap up whatever I'm doing and get to the bedside.
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Totally agree with this. Another way to look at it is that an inexperienced nurse may be really worried and feeling rather helpless (which won't be improved by waiting for us to arrive). Filling the 10mins it may take to get there will mean that the nurse won't just wait anxiously, will feel empowered with something they can get on with and will feel reassured before we even arrive.
 
Doctor Bagel said:
It makes you wonder how many of these emails circulate around that don't get brought to our attention. I'm sure the nurses who sent this mean email didn't expect me to see it. Notably, they haven't made any response after I responded. Lesson for this future -- I'm going to specifically ask things like "what do you think" and "does this sound like a good plan?" in the future.

As for the safety situation, this was honestly the best place to deal with it, and nobody got hurt. Had the guy freaked out in the ED, things might have been uglier. And discharging this guy was just never an option. It's kind of amazing that they wanted me to do that, but I guess they really don't understand that we bear the liability if something happens.

As for errors on their part, I've looked over the cases and found a few specific examples where they violated policy by not paging me on things that they have orders to page me on. I'm not going to bring it up now, but if this plays out in a bigger way, I will. I've sent my email response, I've notified the program director, and I'm out for now.

I appreciate all the responses so far.
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And it's your birthday today! Happy birthday!
 
dilated said:
Nurses don't push women around more, they push people who don't push back around more which is disproportionately women. Timid-seeming guy interns get it too. It's hard to change your personality, but you'll probably seem more confident as a resident later on and that confidence will make them respect you so fear not.
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Night nurses tend to think they are being patient advocates by sending the interns worthless pages in the middle of the night and it seems pick on people they know won't push back. If you don't push back you will keep getting these pages. A 3am diet or bowel regimen order request should get pushback. That said, I have found that when a nurse is worried about a patient they are often on the money. It is a difficult balance to push back without being too aggressive.

Some nurses are vindictive. I think the OP couldn't really have done much else. Getting defensive after the fact isn't going to help anyone. The facts of the story seem to be in her favor. Perhaps the nurses didn't realize the pt was suicidal. In the end, it sounds to me like the nurse just needed to vocalize her concerns. If nothing else, maybe from now on the nurse will be less passive-aggressive.
 
I guess the new med school admission requirements should include how good is your ability to kiss everyone else's ***** and how good are you at bending over and taking it. Having a backbone should probably disqualify you from medicine these days.
 
Bump because I just found this thread and think it's a good read for all the new residents who are dealing with these issues. I get along very well with almost all of the nurses, but all it takes is one float nurse (on her first day on your floor) who thinks you were being a jerk, and there's a paper trail. Even more hilarious, she wrote up the attending in the same e-mail ("Two men in white coats were suddenly in my patient's room, playing with the ventilator, having never introduced themselves to me!").

Anyway, I agree with the comments to "do something" for the nurse as you're coming up. A fresh set of vitals, a blood sugar, a current telemetry strip, drawing the morning labs early - it's an inexpensive way to get a fresh glimpse of the situation without ordering a whole bunch of unnecessary tests, and it makes everyone look like we're doing something. And you might catch a problem.
 
TheProwler said:
Anyway, I agree with the comments to "do something" for the nurse as you're coming up. A fresh set of vitals, a blood sugar, a current telemetry strip, drawing the morning labs early - it's an inexpensive way to get a fresh glimpse of the situation without ordering a whole bunch of unnecessary tests, and it makes everyone look like we're doing something. And you might catch a problem.
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The only issue with this is that nothing ever comes back normal.
 
Perrotfish said:
The only issue with this is that nothing ever comes back normal.
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Out of those things, if something is abnormal, it needs to be addressed anyway. Notice I didn't say "an EKG, Q8 hour troponins, and a chest x-ray," because those can start muddying the waters if they weren't indicated. If they didn't have labs ordered for the morning, you might not need to get them anyway. If they're not on telemetry, I wouldn't start them on it without a good reason.

Also, those are things to do to mollify a concerned nurse. If it's a non-issue ("I'm just calling because there's no Tylenol ordered, and in case he needed some Tylenol tonight, I just wanted some available"), then do nothing. I get calls for asymptomatic blood pressures in the 160s, and I'll probably say, "Okay, thanks, bye." If it's something where you're going to come evaluate the patient, then having some new info on hand is good.
 
That's is such a ridiculous situation, and totally unfair for you to be in. Sadly it does not seem uncommon, as a friend of mine witnessed this on emerg to another resident. Basically the nurses ganged up on one of the R1's and wrote her up, without mentioning a thing to her during the shift. Completely unprofessional.

What I have found really frustrating is that really BS situations come up like this the more inexperienced/inept the nurse is, like it is some disturbing compensation mechanism. For example, the other day I brought a patient into recovery post c-section and the nurse basically chewed me out over the patient having an art-line in, and her defense was "we don't do art-lines here [on the obs floor]". Yes, we put that line in for sh*ts and giggles, that must be it, not because she needed one or anything.

Worked with tons of great nurses who have helped me and taught me stuff in residency, and totally love them for it. It just takes that one in the middle of night for me to want to bang my head against a wall.
 
This happens all to frequently in myriad situations. If I notice an interaction such as the ones described above I make a point to talk to the charge nurse or the supervisor regarding the nurse(s) in question and if need be document the encounter. If they're waiting 2-days to flame you and there is already groundwork in place to the contrary it creates a more realistic picture of what actually happened.

Likewise, if a nurse is being a hero and, as mentioned, "protecting the patient" from the doctor (e.g. being obstructive and not part of the team) it is within reason to speak to his/her direct supervisor and ask for a reassignment.
 
pressor said:
For example, the other day I brought a patient into recovery post c-section and the nurse basically chewed me out over the patient having an art-line in, and her defense was "we don't do art-lines here [on the obs floor]". Yes, we put that line in for sh*ts and giggles, that must be it, not because she needed one or anything.
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Maybe I'm wrong, but thats not the way I would interpret that comment. My interpretation is not that the pt didnt need an art line, but that the nurse is a lazy **** who doesnt want to mess with monitoring and maintenance of the art line in the "obs" unit because she's a lazy ****.

And to that I would say "I'm still putting in the art line set orders, you can choose to follow them or not, that is your prerogative but I'm not taking out the art line and I'm not giving you permission to ignore it"
 
Doctor Bagel said:
Feeling miserable about being a resident right now and thought I'd share. I had a very bad call last week. Things happened, maybe not ideally, and in retrospect, maybe there were things that could have been handled more perfectly. However, I tried to be respectful to staff the whole night and tried to listen to them . However, we had one bad incident. Some antisocial dude got admitted and caused a scene when he couldn't get enough benzos. I went over immediately and thought I acted appropriately. However, I guess the staff wanted me to kick him out of the unit (btw, he was suicidal before he freaked out, which was the reason for his admission), so I really couldn't. Come to find out, the night nurses, who are people I don't work with often, sent a series of emails to their boss basically talking about how I did a bad job. Jeez, thanks -- you could have told me some of those thoughts in the moment, and, hey, I would have listened to you. Instead, they sent this anonymous email behind my back.

Yay. Can I quit? Sorry for the stream of consciousness email. Just feeling a little blindsided and wondering what I should do. Just blow it off?
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I think this story shows some gender differences in medicine, and yes I'm stereotyping here, because it's true most of the time (although not universal).

Male residents (in general) tend to be self confident to a fault; female residents (in general) tend to be self doubting to a fault.

In that situation I'd be tempted to fight fire with fire and play some dirty tricks. Such as making a complaint to the hospital that I saw that ******* nurse steal a vial of benzos or narcs from the patient's bedside. It wont be substantiated of course and at teh end of the day nothing would happen to the nurse. However it would certainly make him sweat a little and that by itself would be worth it. :laugh:
 
Socrates25 said:
I think this story shows some gender differences in medicine, and yes I'm stereotyping here, because it's true most of the time (although not universal).

Male residents (in general) tend to be self confident to a fault; female residents (in general) tend to be self doubting to a fault.

In that situation I'd be tempted to fight fire with fire and play some dirty tricks. Such as making a complaint to the hospital that I saw that ******* nurse steal a vial of benzos or narcs from the patient's bedside. It wont be substantiated of course and at teh end of the day nothing would happen to the nurse. However it would certainly make him sweat a little and that by itself would be worth it. :laugh:
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I've worked at plenty of hospitals where that would result in the nurse getting fired at the very least, although the firing would happen in a few months after they started noting every single little detail the nurse did wrong (such as subtle charting mistakes or not entering times appropriately) so they 'd have evidence to do the firing.
 
Rendar5 said:
I've worked at plenty of hospitals where that would result in the nurse getting fired at the very least, although the firing would happen in a few months after they started noting every single little detail the nurse did wrong (such as subtle charting mistakes or not entering times appropriately) so they 'd have evidence to do the firing.
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That's how it is at most hospitals. About a 100% chance of losing your job for this claim, even if it is totally unsubstantiated. Carries a very good chance of being reported to the board of nursing with possible loss of license.

Never underestimate how easy it is for an RN to lose their job in the hospital, we are an expendable resource with an endless sea of new graduates to take our place.
 
Wow, necrobump of a pretty miserable time in my training.It's truly a scary and miserable experience for a resident, and I'm still a little angry at this one particular nurse, who btw I had to work with a lot in the following months. Neither of us mentioned anything and just pretended like it didn't happen. He's since retired.

As for other consequences, there really weren't any. There's nothing official in my file about this, and my program directors actually were supportive. And my life in general is better, so things improve. Being a resident is hard, but fortunately it's a limited time period in our careers.
 
Doctor Bagel said:
Wow, necrobump of a pretty miserable time in my training.It's truly a scary and miserable experience for a resident, and I'm still a little angry at this one particular nurse, who btw I had to work with a lot in the following months. Neither of us mentioned anything and just pretended like it didn't happen. He's since retired.

As for other consequences, there really weren't any. There's nothing official in my file about this, and my program directors actually were supportive. And my life in general is better, so things improve. Being a resident is hard, but fortunately it's a limited time period in our careers.
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Learning that residency is a team sport but not everyone is playing on the same team is a miserable and valuable lesson. Nurses who have been in the same position for a long time stay and are not clinically skilled are still there because they know how to play the game. If the hospital culture is punitive (which is still the rule rather than the exception), then if something goes bad you can expect the nurse to try and cover themselves to make someone else the obvious target. That's human nature. The key that some experienced nurses have learned is that you can't always predict when the pt is going to tank so you need to be sending up a constant stream of complaints and allegations so you don't have to resort to anything as obvious as back-dating charts, etc. The additional bonus to this approach is it makes it extremely difficult to be terminated since there's always the threat of claiming whistleblower status. As long as the nurse avoids smearing the truly powerful (department heads, CNOs, big-name/volume subspecialists) this constant cloud of chaff can keep a marginal nurse safely ensconced in their position indefinitely.
 
Doctor Bagel said:
To clarify, they sent it to the nursing supervisor on their unit, who sent it to me. We're doing a lot of changes with our call structure, we had this one bad outcome (the one I mentioned above), and she sent an email to them asking about it. They then decided to pretty much slam me, including making comments like I "hemmed and hawed" when called about what to do at 4 am. Well, yeah, because I was thinking about it. Note to self, answer like I don't even need to think. They then decided to throw in additional slams about this other pt, again, an issue they didn't bring up with me.

Unfortunately, people in my program seem fairly supportive now, but there are a lot of other power issues going on, so I don't know how this will play out. I'm just feeling really bummed about it because I feel like I work so much and then get kicked. And no, I'm not saying I did a perfect job that night. In retrospect, there are things I learned and things I'd do differently. However, I feel like I did an adequate job to address the situations and deal with the things happening.
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That's why it's important for our profession to really stop being so excessively PC about things and lines going back to where they should be-we are the drs, and we are the man/woman at the top, and nurses are the support staff and so forth.

I've had similar situations, and one of the keys is,sadly, being the first to make the complaint. I've had a situation for example where the nurse would take things said and write them as orders. When I said that it was unacceptable, she would tell me how it was my word against hers or crazy things like that. Or having adminstrative staff tell me "to do it myself". I put a stop to that really quickly, and personally spoke to the nursing supervisor and even said, I am the physician, this person is the support staff. I am not here to help her, she is here to help me and other physicians.

It's important for your PD to stand up for you, and for this situation to be addressed. It's incredibly unprofessional for a nurse to do something like this, and for it to not have any consequences. Also this whole idea of nurses writing residents up is absurd. We are not governed by nurses, and I think it's important for us as physicians to bind together and really make some legislation that supports us in our role.

You should really be making a complaint and also writing the nursing board about lack of professionalism. Also I would get your fellow residents to also see if they've had any issues with this person, and you should suggest if the situation was truly this serious, for this nurse to be fired. Sometimes examples need to be made of people.
 
DrAwsome said:
You should really be making a complaint and also writing the nursing board about lack of professionalism.
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The ironic part of this statement is that nursing is not a professional career, it's a trade that until only recently has required simply an associates degree. Unfortunately, as a power play lately they maneuvered themselves between the physician and the patient and attempted to create an ancillary arm of medicine in the name of nursing.
 
I think Arcan said it best in his above post. As for the past two comments, we as nurses are taught and frequently reminded to chart defensively for the same reason why we cannot take verbal orders at many institutions. There has to be a trail of charting that justifies everything we do or do not do. It sucks, and yes it does feel like we are taught to do what appears as throwing others under the bus at times... once again, it sucks.

I'm not at all justifying what this particular nurse did- there's no reason to act like that in any professional work environment. But I do not agree with the whole Dr. vs RN theme the thread has taken on. Would it be acceptable for a PA to act like this just because they are a "professional career"? Individuals are going to handle certain situations differently, this particular RN just handled it terribly.

No animosity at all towards MD's, I've taken verbal harassment from a few MD's before without reporting them, and I have been reported by MD's for things that were out of my control or didn't even happen on my shift. RN's have a hard job to do, and MD's have an even harder job to do- healthcare is a difficult field to work in. But at the end of the day, I've gotta look out for me and my license.
 
Boogie Man said:
I think Arcan said it best in his above post. As for the past two comments, we as nurses are taught and frequently reminded to chart defensively for the same reason why we cannot take verbal orders at many institutions. There has to be a trail of charting that justifies everything we do or do not do. It sucks, and yes it does feel like we are taught to do what appears as throwing others under the bus at times... once again, it sucks.

I'm not at all justifying what this particular nurse did- there's no reason to act like that in any professional work environment. But I do not agree with the whole Dr. vs RN theme the thread has taken on. Would it be acceptable for a PA to act like this just because they are a "professional career"? Individuals are going to handle certain situations differently, this particular RN just handled it terribly.

No animosity at all towards MD's, I've taken verbal harassment from a few MD's before without reporting them, and I have been reported by MD's for things that were out of my control or didn't even happen on my shift. RN's have a hard job to do, and MD's have an even harder job to do- healthcare is a difficult field to work in. But at the end of the day, I've gotta look out for me and my license.
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The problem is that there is, like in every profession, a hierarchy. Nurses want to forget that. they want to get their 2 year degree and say oh yes, we are like doctors, we know the same, but we do all the work and they get the pay. Statements like that are not only ridiculous and almost delusional, but they lead to a lot of animosity. I once had a CNA, a CNA!! tell me how she preferred to work with nurses rather than first year residents. Needless to say, she was quickly replaced.

Further, as a nurse, you have to know where you fall in this hierarchy. You are not the dr, you should also not be defensive about your role. You need to "know your place" sort of speak. As residents, med students, etc. I think we all do. I would not talk to my residents the same way I talk to my attendings. And we are all physicians. I respect that the attending, PD etc is above me and I have no problem with that.

In the same manner, I personally cannot tolerate nurses who think they are doctors or are on the same level as doctors. No, you are not a doctor. Do your job well and you will be appreciated. Do not throw the doctor under the bus. It will come back to haunt you in 90% of the cases. Do not over step your role. Do not chew out a doctor-again it will come back to haunt you. As doctors we let a lot of things slide. Most of us do not pursue things aggressively I would say when it comes to us feeling respected or whatever when a nurse or other staff is inappropriate. But it is naive to think that we are not going to speak up when we are sufficiently annoyed. I have, and I have seen a good number of my peers do as well. And again, nurses and other staff are easily replaceable. Know your place, do a good job, and there will be no issues.

Lastly I don't think the issue here was charting. Chart all you want, but under no circumstance over step your role and chew out a physician. I think that's asking for trouble. What this nurse did was absurd, and she should have been fired.
 
i've been in ur predicament with really mean backstabbing nurses that reported me. i had already been kicked out though and given one more month and that was my last month. but don't lose hope. if they haven't said anything about it, don't worry about it too much. try to avoid too much confrontation in the future and lay low. good luck! hope u have better days.
 
I'm a medical student, and I've seen a nurse tell my residents which medications she prefers to give a patient. She'd say stuff like: "don't use this steroid, use this other one instead." She'd interrupt us when we were interviewing a patient to tell/ask us things that could have waited. When my residents would say: "I'll ask my attending if she'd rather switch to this other medication for the patient," the nurse would retort: "No, just give it now; there should be no need to ask or delay any further!" ...and my residents would let that slide. They'd talk about this nurse's nonsense to their own colleagues, but they wouldn't start arguing with her on the spot. They had more class then to start a battle right there on the floor during morning rounds.

Also, I've noticed nurses saying stuff like: "I'm going on break in 25 minutes, so I can't do this now," or "I'm getting off work soon, so I can't do this." The funny thing is, "soon" for some people seems to include something like 1 1/2 hours from the current time. I've also seen nurses say: "sorry, I can't answer your question because I'm off now, the next nurse will tell you," even though the next nurse hasn't been the one taking care of the patient for the past shift, so she knows not how to answer anything my team is asking her.

I have yet to hear doctors say: "sorry, don't page me, I'm on lunch break," or "I'm off in 30 minutes, so I'm not going to do this task." Also, residents work overtime all the time. There just needs to be a baseline of respect from all health care workers, as well as a dedication to the job.
 
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