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

[meatheadPA]

As lame as it sounds, you need to show confidence and not let that happen. Someone will get hurt. You need to put them in their spot. Its part of your job as a PA. You and the doc are responsible and in charge. If you need a straight cath and it doesnt happen, that child may be hurt. If you have a problem, talk to the medical director. You fall under the medicine side, not the nursing. Let the directors duke it out. Nursing is protected by an extremely strong union and you dont need to get involved. If a nurse is doing things such as digital blocks, that criminal. Same thing as you performing an open bypass... 

 

In summary, dont be a soft target. Fix it on the spot. If you dont like confrontation, just remove yourself and go to the medical director. Dont let anything justify our patients care or your license. 

[JohnnyM2]

If you aren't the alpha, someone else will be. A professional would never challenge you in front of a patient and you should never allow it. Period. Of course, if you have doubts, you need to seek advice but not from every tech in the ER. Have you given them the impression you are unsure of yourself? The consequences of that can be severe. (See the movie U-571).

[moestown1016]

Some nurses have saved my ass and some nurses have pretended to accomplish something I couldn't ("yes I feel a faint pulse in this extremity") when it was found to have no circulation after studies. Some of stabbed me in the back or thrown me under the bus. Idk. I listen to the seasoned nurses and when someone expresses concern I stop and rethink my strategy and plan. Sometimes it stays the same. Sometimes I check on them a few more times. I respect experience and an experienced nurse/provider won't be unprofessional in front of the patient. As a female provider I've had my share of sexist RNs who think im an idiot. I've learned to not lose sleep over it as long as I know I'm doing the right thing. Idk. We all go through this to some extent. Open mind. Stick to guns. Yada yada yada. My license is the one ultimately on the line so sometimes I remind them of that. Especially when I overhear them telling charge nurse "well (sigh) she wants to do a big workup". No. The patient requires a big workup. Whatever. I try not to get angry. It spills over into my personal life if I get angry and my relationships suffer. Can't we all just do what's right for the patient?

 

Side note: I also like it when I can openly stick up for my staff and have called patients out for their rude and abusive behavior and can get really passive aggressive if they are disrespectful to my nurse that busts their ass off all day. One patient asked for cup of water in front of me. Nurse stops what she's doing gets her a cup and hands it to her. Patient looks at it and said "i want more ice". So the nurse went BACK to the machine and added more ice. She didn't know what to say so she just did it. I was appalled. I swiftly changed the prescriptions to something else. I had already felt a little to generous giving norco to a minor MVC so felt justified to change it to tramadol. It made me feel better at least. Plus I told the nurse so she knew I respected her.

 

Just some thoughts. Sometimes I want to punch people I work with so I just drink a glass of wine or if I'm really angry go for a run.

 

Y'all we could write a book

 

 

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[ColoradoIMCardsPA]

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?

 

I will just affirm that the situations described are extremely inappropriate on the parts of the nurses/medics mentioned.

[Guest ERCat]

I have to say that after just a few months of working with these people and gaining experience this no longer happens.

[KMD16]

First. Agreed w/ most poster. You must put an end to this. It must stop. Not acceptable.

 

You must realized that in medicine, there are different level of bullying. There's hierarchy in medicine and this hierarchy also correlate w/ years of experience. As you build confidence/experience in yourself and those around begins to trust your judgement, you'll be respected and left alone to fly solo.

 

It all about fighting for your spot so you've got to fight for your spot and do it without risking losing your job. A smell of fresh blood in the water so it feeding time.

 

Too much politics in medicine. Your supervising doc is probably enjoying what the medic and nurse are doing to you. I won't be surprised. So, I would careful who you report this to and how you go about reporting this. This isn't to say that you shouldn't report the behavior of the medic and nurse. Realize this folks were there before you.The medic for example probably golf w/ your supervising physician every weekend or secretly dating the nursing supervisor.

[Russell]

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?

Great advice from everyone here. I started to notice this in my surgical training and from that point on I decided that I would never work in a hospital setting! Too much of a pecking order. Now after several years practicing, I'm sure I could handle it better, but why would I? Outpatient is the way to go! ;) 

[billo]

I can understand what you're going through.  My advice is to stand up for yourself.  You need to start confronting these techs/RNs about what and why their actions are bothering you.  Be confident and stern.  I would complain to the nursing manager after you've tried handling the situation yourself and have failed.  Nurses can get very passive aggressive and make your life miserable.  They will become passive aggressive if you directly go to the nursing manager.   

[True Anomaly]

I think that now the OP has stated that the issues they highlighted in their post have resolved, I'm closing the thread