What to do? Need to vent!

[Jethro Tull]

This is my first post on the forum, guys, but I've got to vent a little. Please, bear with me.

I notice that most of the posts here are made from the reference point of the hospital or clinic nurse. I don't work in a formal venue as such. I'm a specialized sort of hospice nurse. I work an on-call gig from midnight to eight a.m. wherein I respond directly to the residences of patients who are experiencing sudden changes of condition. Given the nature of hospice work (end of life care) you can imagine that many of my calls entail critically ill patients in very dire situations. Ergo, it is essential that I have frequent one-on-one telephone contact with physicians, after hours.

Fortunately for me, our institution works with several physicians who are true gentlemen (and women). They seem to understand the nature of the job that they've taken on and realize that together, we form the only link to medical assistance and consultation available to entire households of people who have decided to accept the burden of caring for their loved-ones all the way up until the time of death.

The great majority of my calls relate to one of three major issues: Intractable pain, anxiety / panic, and Dyspnea. As you consider this, please keep in mind that this isn't occurring in the relatively controlled environment of a hospital, but rather in the back bedroom of someone's home, replete with screaming children, teary eyed wives, and the occasionally drunk and violent frustrated family member.

Again, bear with me. I relate all this not to pat myself on the back or regale you with the horrors of my job, but rather to illustrate exactly how important it is that the nurse-physician line of contact be maintained. Without it, there's nothing else to fall back on and everyone's looking right at you for solutions.

So...

It turns out that our Medical Director in Chief takes one week out of the month to field all of the after hours calls for our patients. This man is...unpredictable. At times, he's the consummate professional. At other times, however, he is as rude and demeaning an individual as it is possible to imagine (while still remaining on the clean side of profanity). Moreover, his proclivities are known among virtually all of the regular nursing staff as well as the management team and the Patient Care Administrator.

I honestly do not know how to deal with the man. I do not know what to do. As it is, standing in a room full of grieving family members anxiously waiting for relief for their loved one is hardly the place to conduct a verbal confrontation over the phone. The management are so inured to his mannerisms that they tout a "deal with it, that's just who he is" policy to the employees. It's frustrating.

Let me regale you with a tale from last night.

I answer a call for an individual who was experiencing acute dyspnea (orthopnea) with air-hunger related panic prior to my arrival. On arrival, I find a patient who is unresponsive with supra-clavicular retractions, diffuse ronchi, consolidated lung-bases, with circumoral and acrocyanosis. Of course, a panicking, tearful family is present.

So, I reposition the patient, start O2, suction the airway, get baseline vitals and call the Doc. The call goes like this:

Me: Sorry to disturb you Doc. I've got John Smith, a 75m with acute dyspnea, resp rate is 44 shallow...

Doc (interrupting): So what. What does his respiratory rate got to do with anything. What do you want to do, treat a respiratory rate. Is that what you wanna do? Do you wanna treat a respiratory rate. Is that it?

Me (interrupting): Doctor, the...

Doc (interrupting again): Is he conscious? Is he? Is this man conscious?

Me: No, doctor. He is unrespon...

Doc: Well how do you know he's having trouble breathing then? Huh? It's always like this. We do this all the time. It's always the same thing. How can he be experiencing air hunger if he's unconscious? Did he tell you he's having trouble breathing? You wanna treat his respiratory rate, huh? You think that'll help? How about that? Should we treat his respiratory rate?

etc...etc...etc...


This is a no B.S. recounting of the beginning of my conversation with this...man. Fortunately, in between his sarcastic outbursts, I was able to relate the fact that he was slowly turning blue from hypoxia. Fortunately, the doc mumbled a few appropriate orders and then terminated the call.

I tell you, being spoken to in that manner can really shake you. I might be more sensitive than most, but having someone I absolutely COUNT on in a time of crisis speak to me as though I'm somehow mentally deficient has a horribly demeaning and demoralizing effect on me. Moreover, it makes me very reticent to call the doctor back when I see the next patient.

I don't know. Anyway, thanks for letting me vent a little. Advice is appreciated.

-J

[Christof60]

First off, thank goodness that those Doctors are becoming rarer and rarer...
But that aside, may I ask if you are male or female? I ask, because in my view, it does make a difference. If you are female, I can only suggest filing a grievance with your supervisor, with specific times/places/people present, etc.. What you describe is classified as a hostile work environment and can be cause for a nasty lawsuit... That usually gets some attention...

Now, as a male, I have found it to be as simple as getting the Doctor alone, then letting them know that if they EVER talk to me or treat me that way again, they are in for the ass-kicking of their life.. Problem solved... One I did this too actually became a very good friend of mine and one day hunting quail together he relayed to me that I completely surprised him with my action but also gained his utmost respect because "no one has ever stood up to me like that"...

Sounds like you are one heck of a nurse, and even with hopeless DNR cases, dealing with the family is as hard as it gets.. DNR rarely means DNR anymore..

Best of luck to you, and keep us posted on how it goes..

Christof

PS.... Just noticed the "Jethro Tull" so you must be a male... Try option two..

[AmandaWIRN]

So threatening bodily harm is your suggestion for handling a dispute between two professionals??? It's behavior like this that causes some physicians to view nurses as less-than-professional. Regardless of your gender, the proper & professional thing to do is to file a grievance with either your manager or medical director.

PS- there ARE females who like Jethro Tull, too...

[SoldierNurse]

So threatening bodily harm is your suggestion for handling a dispute between two professionals??? It's behavior like this that causes some physicians to view nurses as less-than-professional. Regardless of your gender, the proper & professional thing to do is to file a grievance with either your manager or medical director.

PS- there ARE females who like Jethro Tull, too...

I think I understand where Christof60 is coming from.

Male MD is rude [less-than-professional] to Male RN. Male RN approaches Male MD, face-to-face, with calm but stern command voice, [remains on a professional level] and conversation continues w/o fist flying. Nonetheless, all the while in conversation the Male RN's body language indicates he is not intimidated by this Male MD, which in previous phone conversation was very unprofessional. The key being the Male RN shows no fear of the Male MD.

Actually, my wife [an RN of 15 yrs] has told, a time, or two, a few rude, sarcastic, and unprofessional Male MD's to find another nurse to pick on because she will not accept such behavior.

However, it may be easier, maybe not, for a Male RN to let a Male MD know he should chill out with the personal, time wasting, sarcastic insults regards to patient care.

The point being, don't fear the MD, and in turn the MD may respect the RN.

[Dan-O]

First of all, kudos to the original poster for possessing a nice, broad vocabulary.

As an old, Army dog, I have nothing but the utmost respect for using a chain of command for this sort or situation. The MD's position, pay grade, education, social status, etc...is no excuse for lacking in professionalism or restraint. In fact, the opposite should apply. He needs to be held accountable for his poor behavior. No man/woman is an island and we all answer to someone.

There should be someone in your corner who carries the same weight, or more, as the offending MD. Let them clear it up. Maintain your dignity and professionalism. Keep doing a wonderful job and concentrate on your patients care.

[SoldierNurse]

First of all, kudos to the original poster for possessing a nice, broad vocabulary.

As an old, Army dog, I have nothing but the utmost respect for using a chain of command for this sort or situation. The MD's position, pay grade, education, social status, etc...is no excuse for lacking in professionalism or restraint. In fact, the opposite should apply. He needs to be held accountable for his poor behavior. No man/woman is an island and we all answer to someone.

There should be someone in your corner who carries the same weight, or more, as the offending MD. Let them clear it up. Maintain your dignity and professionalism. Keep doing a wonderful job and concentrate on your patients care.

One of the benefits of being an Army nurse officer is we are on a more level playing field, so to speak, with the MD Army officers. In fact, my present Orthopod [I am s/p L RTC repair] is a CPT. I realize we have a MD to patient relationship but he also treats me as a peer professionally.

I agree, the chain-of-command, whether military, or civilian is always the best path. However, I strongly believe an RN should not be intimidated by a rude, unprofessional MD.

[Christof60]

So threatening bodily harm is your suggestion for handling a dispute between two professionals??? It's behavior like this that causes some physicians to view nurses as less-than-professional. Regardless of your gender, the proper & professional thing to do is to file a grievance with either your manager or medical director.

PS- there ARE females who like Jethro Tull, too...

If you read into the thread a bit, "Diplomacy" has been attempted.. I was also speaking as a man, which as a woman, I dont expect you to understand completely. To me it becomes a very personal issue, and no man had better treat me in that manner after many attempts to "Professionally" handle it...
One of my current charge nurses in ER is lucky she is not a man at this point in time with the continued way she treats me. I bite my tongue on a nightly basis, but since she works any extra they ask her and IS a very smart, hardworking nurse, her behavior is tolerated. Maybe you have a better idea when diplomacy isnt working?

And yes there are female Jethro Tull fans, but if I used "Spice Girls" as my moniker, would you not assume I was a certain gender? ;-)

[Christof60]

However, it may be easier, maybe not, for a Male RN to let a Male MD know he should chill out with the personal, time wasting, sarcastic insults regards to patient care.

Spot on.... I simply think it comes down sometime to the "Alpha Male" thing deep inside us... Cross that line, and your many degree's and initials at the end of your name mean squat... Personal attacks are just that, even in a "Professional" work setting...
I would wonder what TraumaQueen would expect of her spouse (if married) to do if a Doctor pinched her bottom at work or pushed her to tears of quitting?
I know what I would do if that occurred to my wife, but fortunately for me, she handles the OB/GYN doc's as well if not better than I could.. She's very spunky to say the least..

[Christof60]

First of all, kudos to the original poster for possessing a nice, broad vocabulary.

As an old, Army dog, I have nothing but the utmost respect for using a chain of command for this sort or situation. The MD's position, pay grade, education, social status, etc...is no excuse for lacking in professionalism or restraint. In fact, the opposite should apply. He needs to be held accountable for his poor behavior. No man/woman is an island and we all answer to someone.

There should be someone in your corner who carries the same weight, or more, as the offending MD. Let them clear it up. Maintain your dignity and professionalism. Keep doing a wonderful job and concentrate on your patients care.

Yes, in that perfect little world we all want to live in, and I would never advocate my approach as the first resort.... But keep this in mind, I am currently working at an ER where a doctor who has been on "probation" for the last two years, cursed me and struck me while we were doing a conscience sedation procedure.. He was lucky that I remained professional, but he got the "message" later from me.. My DON took it all the way to HR and also the MD group for which he works and I didnt even get an apology from the man (thru professional channels, privately, he groveled)...

Might not be everywhere, but Doctors are still coddled and allowed a wide berth STILL in this field when it comes to being unprofessional and rude..