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RANT - Nurses and techs "correcting" me and "knowing it all"


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Guest ERCat

I just have to RANT! I work in ER as a new grad and have been disgusted and annoyed by some of the nurses and medics overstepping their professional boundaries. It makes me feel disrespected and super annoyed. It also makes me look less credible in front of patients. Some examples... These have all happened in the last WEEK.

 

1) Tonight. Suturing a horrid lac on an elderly man's forehead. The medic comes in and watches. That was annoying in itself but then she says "Make sure you line up the muscle so he doesn't look like Spock." I appreciated the tips but then she kept watching and making comments. "You should start over there because it's easier to line up." Then when the patient would ask questions SHE would answer. If I got a chance to answer first she would say "Mmm hmm" as if I needed her assertion that I was right. Then as I'm concentrating on the laceration she starts doing an examination of the patient's me and tells me, "You ordered a knee immobilizer. I think this man's knee is intact, I suggest this brace over here..." Anyway - I was super annoyed and this is not the first time she has done this (and much of the time her clinical judgment is way off).

 

2) I had a patient who came in and explained that while she was donating blood yesterday a nurse told her that her heart rate was irregular, and ever since then she started noticing palpitations. On the monitor she actually was having frequent PACs. She was incredibly anxious. The doctor and I went in there and talked to her for a good 20 minutes, offered her reassurance that what she was experiencing was likely benign but that we would like her to follow up with the cardiologist, and all was well. Except five minutes later I get a call from the nurse saying "She's in bigeminy! I think you guys are wrong and you need to admit this patient." I rushed in and in front of the patient he is pointing to the EKG monitor and freaking out. I calmly told him that she was not in bigeminy, and then he kept arguing with me. He kept pointing at the PACs and saying "Look there is another one, look there is another one, and look she catches her breath every time! She's symptomatic!" I tried to reassure the patient again who was already nervous, and who knows what the nurse was saying to her when I wasn't there. When I left the room I could hear him say "I am sorry, if it was my family member I would expect better care."

 

3) Last Friday. I have a six-month-old with a 102.2° fever. No cough or URI symptoms so we are trying to find the source. She looked sick as heck. I ordered a urinalysis and the patient needed to be straight cathed. The nurse came in and asked "You really want me to straight cath the kid?" I said "Yes, she's a six month old female and UTIs are common and we need that urine." So I walked back in the room a few minutes later and the parents were refusing the straight cath. I asked the nurse what happened and he said - " well, they refused after I explained both sides to them." I said "Huh?" The nurse said "I explained how painful it would be and how I wouldn't my kid cathed." I said " well, we really need the urine because she looks sick and is febrile." He said "I was just being a patient advocate and I wouldn't want my kid cathed." I was PISSED. The parents left and that was that.

 

4) Same nurse as above. Multiple times, when I have ordered labs on a patient and he thinks they are stupid, I have literally seen him walking to the room and asked the patient "do you want me to poke you with a needle?" Obviously the patient says no, and then he'll come back and say "the patient refused an IV."

 

5) Lab results. So many times I have gone into the patient's room to tell them the results of their labs and imaging studies and they will literally say something like "oh yeah, that lady already told me." I will be like "what lady?" And they'll point to the nurse.

 

Don't get me wrong. I love nurses and medics. Many of them have way more ER experience than I do. Actually most of them do, because I am a new grad. I respect them and I need them. I learned a lot from them. I ask them a lot of questions. But maybe that has hurt me by making me look less credible. I feel like there's a way for them to share their wisdom with me without being disrespectful. At the end of the day, I am the provider. I don't know how to broach this with them. Any thoughts?

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Wow, the culture you're describing is atrocious.  ALL of these issues need to be addressed by the nurse manager, and you should also talk to your medical director about what's going on.  That stuff would NEVER fly with me, but I'm also not a new grad so I don't get the same treatment that you unfortunately seem to.  It's beyond frustrating, and all you can do is make sure that when an incident happens it gets addressed appropriately- three of those situations are directly intefering with patient care.

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No one on the medical "team" should ever undermine another member - ever - and NEVER in front of the patient.

 

I implore you to go to the Medical Director and the Nursing Director and cite your cases as above and ask for immediate intervention.

 

My temper - I would have escorted each individual out of the room and closed the door in their face - not entirely productive but rewarding at the moment.

 

Stand up for yourself and, if needed, learn the procedures that the nurse refused - YES, I know it isn't your job, but in the name of patient care and safety - it gets the job done and shows the patient you mean business.

 

Take care of yourself and your patients!

 

Keep us posted on your progress.

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#1. I would have said that I could sew a lot faster and straighter if I didn't have all the distraction. If she didn't take the hint, I would have asked her politely to leave. After that, I would have been impolite. I am remarkably skilled at being impolite. I might even have called security to make her leave so they would have had to fill out an incident report.

 

#2. Guy was probably referring to atrial bigeminy, although if someone says bigeminy the default assumption is ventricular bigeminy. If the patient was that nervous I might have spoken to cardio. I would have also explained to the nurse that they were exacerbating the situation by making the patient more nervous.

 

#3. Nurse sounds like a lazy slob. I would have said if you don't feel skilled enough to to a straight cath without hurting someone badly, I wil find another nurse and recommend you for remedial training.

 

#4. Same as above.

 

#5. Sounds like someone just wants to look like a know it all. Usually because they have a poor self-image.

 

What a remarkably toxic place to work. I'm with LTJGoneal - I would be in jail after a couple of shifts at your place. Do they treat everyone like this?

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Im currently working at a Peds office as an LVN waiting to start my program. Its common to cath kids of that age when we need a urine sample. The bag technique is unreliable and can take multiple hours to get a source. I would definitely talk to the nursing manager. Another example of nurses thinking that they are smarter than the provider. 

 

As far as the medic I would just ask if they need anything else from you and ask them to leave the room if not. 

 

I dont mean to use the term pull rank, but sometimes its needed to remind everyone on the team where there place is. 

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No one on the medical "team" should ever undermine another member - ever - and NEVER in front of the patient.

 

I implore you to go to the Medical Director and the Nursing Director and cite your cases as above and ask for immediate intervention.

 

My temper - I would have escorted each individual out of the room and closed the door in their face - not entirely productive but rewarding at the moment.

 

Stand up for yourself and, if needed, learn the procedures that the nurse refused - YES, I know it isn't your job, but in the name of patient care and safety - it gets the job done and shows the patient you mean business.

 

Take care of yourself and your patients!

 

Keep us posted on your progress.

 

I agree except I would not advise doing the nurses procedure for them. That's a slippery slope with a lazy nurse. Get the nursing managers phone number on hand. There's an old saying that nurses eat their young, all you need to do is give them a reason.  

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Our night nurse manager was actually our ER problem. He was putting in digital blocks on unexamined hand lacs AT THE TRIAGE DESK - citing patient pain.

Never mind the neuro or vascular exam or that it was soooo far out of his privileges as a nurse.

 

He was friends with the other male nurse who made my life hell. They had issues with professional women - whether MD or PA. They questioned my female attending to her face in the work bay.

 

We got little support from the admin because absolutely no one wanted to come in at night to witness this and they both would have Eddie Haskell'ed their way out of it.

 

I called a Plastic Hand doc one night for some badness in a hand and told him that the nurse put in the block at the triage desk. He fixed that problem at about 80 decibels standing in the work bay and called the DON at home at 2 am to expand on his disgust. Problem solved.

 

The other male nurse ended up getting fired for pure stupidity and ego. He questioned the absolute wrong female and she damn near pulled a wrestling move on him and made it clear he was way out of his league. The interaction was witnessed by an admin coming in to work at 7 am and nurse went bye-bye.

 

Karma is there - just never on our schedule.

 

Stay strong and stick to your medical ethics - patient first - always.

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Im currently working at a Peds office as an LVN waiting to start my program. Its common to cath kids of that age when we need a urine sample. The bag technique is unreliable and can take multiple hours to get a source. I would definitely talk to the nursing manager. Another example of nurses thinking that they are smarter than the provider. 

 

As far as the medic I would just ask if they need anything else from you and ask them to leave the room if not. 

 

I dont mean to use the term pull rank, but sometimes its needed to remind everyone on the team where there place is. 

 

This. I am all for being polite, until there is a time not to be polite. You are way past that point.

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I called a Plastic Hand doc one night for some badness in a hand and told him that the nurse put in the block at the triage desk. He fixed that problem at about 80 decibels standing in the work bay and called the DON at home at 2 am to expand on his disgust. Problem solved.

 

 

 

You don't have to be an MD to do this.  Congrats to this doc for solving a problem for the next patient.  Learn from this example. You're a provider now.  And the next time someone stands over your shoulder offering advice while you suture, I suggest you order them out of the room.  We're all on the same team, but you're a captain.

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Guest ERCat

Thanks for the replies, guys. Nice to know I am not alone in my SHEER ANGER. I am in that phase where I want everyone to like me and I am realizing I am too "nice" and "open to learning" and I think because of that I get walked on. I guess I have to somehow learn to command respect... And that nurse doing digital blocks thing is HORRIFYING! But I suppose my stories are pretty horrifying too. LOL.

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You don't have to be an MD to do this.  Congrats to this doc for solving a problem for the next patient.  Learn from this example. You're a provider now.  And the next time someone stands over your shoulder offering advice while you suture, I suggest you order them out of the room.  We're all on the same team, but you're a captain.

 

 

This was over 15 years ago in Texas and the doc became a means to an end - The head nurse was the problem and we had nowhere to go for help. 

The need to call the plastics guy for a surgical issue brought an opportunity to have a situation remedied - and loudly.  It put the head nurse in a position where EVERYONE was aware of his transgressions and the big bad mean surgeon called him on the carpet. I still had to work with the jerk. So, yeah, I let someone else fight the battle but I got the spoils.....

 

Now, I am older and grayer and way less tolerant of anything like this. I call my own BS now and fight my battles regardless of who I am up against.

If it matters enough to patient care and doing the right thing - I am right there and they know I am coming.

 

I want young PAs to build their chutzpah and learn to present themselves professionally and with facts, practices and everything to support themselves and our profession.

The only way our profession is going to advance is through our intelligence, perseverance and doing the right thing.

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Not uncommon for new grads to face this at some point

 

My solution

 

Find a case that is you are CLEARLY right, no if's and's or but's about it....

Then, immediatly pull them aside, quietly and professional correct them (might not be a bad idea to have a witness to the conversation so they can't say you were inappropriate) and 100% demand that they not contradict you, or undermine you in front of the patient! Hold your ground, demand respect, but try to handle it yourself the first time (with a neutral witness)

 

Do not do this on one that has possibility of you not being right, cause that will be the one time you are wrong, and bam you just undermined yourself......

 

Durning this conversation show them your knowledge, as being superior to theirs, big words, lots of medical talk. Then I like ending it with the borderline insulting but honest phrase (Which is the the truth) if they want to practice medicine they need to return to PA, NP or MD school, get through it, pass boards, get licensed, then find a job..... Otherwise you will be managing your patients......

 

 

It is exceptionally important that this be done in a professional way, not in front of patients, non-threatening, and with "goodness" in your heart. If it is a personal attack, or raised voice they are VERY likely to report you to admin for b ring unprofessional or attacking, or even better yet "not being a member of the team".

 

 

Back to the initial idea - most if not all new grads go through this. As your medical knowledge and it's application expand, so does your confidence, the trick is to go from being the student to the teacher, and still have their respect, as the nurses will likely "save your A**" a few times in the ER and if you exclude them from the team, you are standing all alone, and that is not a good place to be.

 

 

In the above examples I would think the Urine on the 6m old with 102+ fever would have been a good one to push on, but honestly as a new grad you should NOT be doing <6-8m old PEDS fevers with out strong oversight from an attending..... These are the cases that can (and do) go bad quickly. The doc doesn't need to see the kid, but you should be talking with them. The febrile <6m kid gets almost every provider nervous, and the crappy looking febrile kid (<6m) is really a scary case......

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In the 5 hospitals I've worked, ranging from tiny rural to gigantic urban, there is always going to be a pissing contest between some nurses/techs and certain providers (although I HATE being called a tech haha). Usually it results in the mid-level or doc having to be an absolute ass to the offender in front of several people. But it actually works. I've seen nurses, lab, respiratory and paramedics told to either be quiet or leave the room numerous times.

 

One time a DO was getting grief from an EMT about a similar story to yours. The doc said please leave the room while I speak to my patient if you have no further business in here, and id also like to talk to you after I'm through. I listened and the DO told the patient that he apologized for the eager EMT and that sometimes that in interest of the patient they overstep their bounds. Later I heard him tell the EMT in a very professional way that after he gives report to the nurse he has no business in the room and that there is a time for suggestions regarding a patients care but that is not during his assessment. He also said fairly sternly that it doesn't need to happen again in his room.

 

I've also seen the old "when you have MD, DO, FNP, or PA on your badge THEN they can make the call...until then just do your damn job." Which also actually works. Haha

 

I just hate it when I see people think they have to be total assholes to everyone to get respect. Unfortunately I've had a few of hose everywhere I work. I have honestly found that ER is the most hardcore with personalities. And you seriously have to make it known you aren't going to take crap off of people.

 

 

Sent from my iPhone using Tapatalk

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I have a low threshold for that sort of thing...we had a nurse fired for just this sort of thing awhile back.  I honestly think she had an underlying mental illness that wasn't being addressed, however, he/she/it are still responsible for their actions.  When I have problems like that, I'm politely impolite, tell them to stay in their lanes and if it continues, I will bypass the manager and go straight to the College of Nurses - threatening an RN with that here is a big deal because life essentially stops for them until the complaint is fully addressed...that usually gets their attention fast.

 

SK

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My buddy and i often joke that nurses know JUST enough to think they know it all, but not enough to know what they dont know.

 

I agree with the others, ventana especially, that you need to pull rank. Sternly and professionally. Do you think a physician would tolerate this?? Neither should you. There is a hierarchy in a medical environment, and you are near the top. This is how residency works---you know your place and get to be made very uncomfortable if you forget it. Just make sure you are correct before you pull rank, because if not then you just sunk your own ship!

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None of that would fly.  In the first instance, I would stop and stare at the medic.  I would wait for him/her to catch on and if it happened again I would hand them the tools and say, "Here.  You're an expert, you do it."  Wait for them to attempt to take the tools and then pull them away, "Actually you are not legally capable of doing that so how 'bout you shut up or leave?" 

 

The male nurse you referenced sounds like he's got a chip on his shoulders.  I'm guessing that you are a female?  I have never seen such disrespect except male-to-female offenses, that's why I say that.  But it doesn't matter - it's not acceptable.  I think pulling him aside and giving him a good lecture on what is expected, what is required, and that he's not cutting it would be a good idea.  Have witnesses.  I think in the setting of the PACs pulling him aside and saying, "For your information, I am taking excellent care of this patient.  I have run this case by the doctor in the ED and we agree.  Unless you believe yourself to be superior to the MDs, of course.  If you ever undermine my relationship with one of my patients again...."  and finish it with what will happen in your institution. 

 

Nurse's giving lab results has always bothered me.  Do they do that to the MD's Pts?  If they do, then it's a culture problem, not necessarily you. 

 

Keep your chin up, stick to your guns. 

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I have never seen such disrespect except male-to-female offenses 

 

I've seen disrespect cross every gender combination, both in my personal experience and in reading about others' experiences. For instance, I was reading somewhere about a PA who was doing a suture and this female medic comes in and watches and says, "Make sure you line up the muscle so he doesn't look like Spock."

 

Oh wait...

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The worst disrespect I've seen is female to female - RN's vs MD/PA that are ex-RN.  They think of them as traitors...and the reverse, in that a few look down on their "peers" .  Only thing worse I find is RN vs NP - the NP's I've noticed often feel they're above doing certain things, like cleaning up after themselves.  Weird, since I manage to find the extra 30 secs needed to clean up after myself...since I'm used to working without an assistant, I just do it.

 

SK 

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I've seen disrespect cross every gender combination, both in my personal experience and in reading about others' experiences. For instance, I was reading somewhere about a PA who was doing a suture and this female medic comes in and watches and says, "Make sure you line up the muscle so he doesn't look like Spock."

 

Oh wait...

 

I have not seen disrespect in as many ways as you have, apparently; it sounds to me that the medic was actually not as disrespectful as the male nurse in the discussion.  But I appreciate the discussion.  And I'll note, I did not say that I have never seen disrespect from females towards males or other females.  I was trying to say that the male nurse loudly undermining the patient-provider relationship by saying, "If it were my family member..." was pretty much the most atrocious and blatant disrespect I've heard from anyone in medicine, period.  I have never had a male nurse disrespect another male provider in the same way.  So I was curious if this was a first for me, or if it fell into the same patterns that I have seen previously. 

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This conversation is pretty interesting but it really comes down to being a leader.  If you are leading and delegating properly you should be afforded the proper respect without 'pulling rank'.  If someone undermines you I would immediately pull them aside to have a very one sided conversation.  While you are a PA you are a new grad and regardless of rank experience counts.  Remember to always be...humble, credible, and approachable this should help build the trust between the old nurses/techs and yourself and hopefully many of your grievances will vanish.

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