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Thread: What to do? Need to vent!

  1. #1
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    What to do? Need to vent!

    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

  2. #2

    Re: What to do? Need to vent!

    I've reported a MD for a similar episode. AN infectious disease doc, i got positive blood cultures back on a patient in the middle of the night, called them in to him (he was on call for himself that night) because that is an alert value. he yelled at me for waking him up for something "trivial." he told me that he wouldn't be consulted if the patient didn't have an infection and that it shouldn't be a surprise for the patient to have positive blood cultures. then he told me i should never have called him, i should have called the attending! like I said, it was an alert value, i explained that to him and the policy for calling alert values to the appropriate physician, and since he was ID that was him. he then hung up on me without even stating "no orders." I reported him. Thats what i recommend you do. Nurses should never have to be treated with disrespect from another professional.

  3. #3
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    Re: What to do? Need to vent!

    Quote Originally Posted by amberdouglas View Post
    I've reported a MD for a similar episode. AN infectious disease doc, i got positive blood cultures back on a patient in the middle of the night, called them in to him (he was on call for himself that night) because that is an alert value. he yelled at me for waking him up for something "trivial." he told me that he wouldn't be consulted if the patient didn't have an infection and that it shouldn't be a surprise for the patient to have positive blood cultures. then he told me i should never have called him, i should have called the attending! like I said, it was an alert value, i explained that to him and the policy for calling alert values to the appropriate physician, and since he was ID that was him. he then hung up on me without even stating "no orders." I reported him. Thats what i recommend you do. Nurses should never have to be treated with disrespect from another professional.
    What happened to this Doc after you reported him?
    Cary James Barrett, RN, BSN


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