Rude nurses affecting my job satisfaction...

[Guest ERCat]

I feel stupid even posting such a title because I do realize how I feel is up to me and it is my responsibility to learn to filter out the negativity and not let it affect me.

But... it does.

I have been practicing for two and a half years in the ER. I love the patient population, I love the crazy aspects of the job like clearing a full waiting room and gory procedures, and I adore the docs I work with. But continually I notice feeling bad at the end of the day because of a few nurses.

When I first started I had some awful nursing encounters I posted about. While things aren’t quite so bad as they were at that time, I still have at least a few nurse encounters a week that leave me feeling upset. Just this week. I had a nurse argue with me about why she felt a preformed splint was appropriate to put on my pediatric distal radius fracture after I had asked her to splint the little girl. When I explained I wasn’t comfortable and I wanted her to make an OrthoGlass splint she rolled her eyes and walked away in a huff. Yesterday I asked another nurse to ambulate my three time syncopal patient (she had a history of POTS and recurrent syncope, and was a huge pain in the rear for me and the nurse, very demanding and wirh a different compliant each time we walked in the room but nonetheless I wanted to ensure she was safe to discharge) and the nurse was so annoyed with the amount of time she had spent on this patient that she said “Nope, not doing that.” I have had other nurses express extreme annoyance with eye rolling and verbal protests for things like wanting to wait to discharge a back pain patient till their pain was sufficiently under control that they can walk (I don’t care if the nurses think they are drug seekers-  I won’t send someone home who can’t walk). I feel like I try to do right by my patients but it annoys some of the nurses who just want the DISPO (and write DISPO next to my patients on the board as if I am sitting around on my butt which irks me to no end).

And then I wonder if it’s just me because the nurses seem to have better relationships with some other providers. And I start to get down on myself wishing I was one of the providers they respected and loved working with. However I really do feel it is the nurses at this hospital. Because when I work at another hospital that is not quite as busy they are all FABULOUS and we have a mutually supportive relationship.  I know I should toughen up but the negativity takes a toll and makes me feel ostracized.

Don’t know exactly what I am looking for when posting this..: maybe I just want to complain! Or maybe learn ways I can conquer this so it doesn’t hurt my job satisfaction...

[EMEDPA]

that is not uncommon in large depts. I had those experiences at level 1 and 2 trauma ctrs. I worked at 1 for 15 years and another for 5  and still didn't know all the nurses' names. working at smaller rural facilities I know all the staff on a first name basis and socialize with many of them outside of work. some of them are my best friends. ditto hospitalists. at big places it is easy for them to be an assclown on the phone to folks they don't know. my current facility has 2 hospitalists. we get together after shifts and go to breakfast. one is in a band and my wife and I will go seem him play next time they have a gig. it is part of the culture of places that are always busy and never have the same staff 2 days in a row, that is one reason(of many) I don't work at that type of place anymore. 

[LT_Oneal_PAC]

My god I can’t wait to go rural. I’ve gotten mouthed off by family medicine and GI because I asked them to do their jobs. I went up to a nurse and said her name pleasantly, her response was “what.”  I just don’t get rude people. The 2 ! times I lost my cool, which for me is the development of a perturbed tone, I profusely apologized 2 minutes later.

[OldEDRN]

There is no excuse for a nurse to refuse to follow a provider's orders. They may be jealous that you were able to make the transition from RN to PA-C and this is their way of asserting themselves or  that "I know just as much as you do".  I was an ED nurse at level 1 and 2 trauma centers and worked with a lot of skilled and experienced, but bitter, nurses. Just brush it off and do what you know is right for your patients. 

 

[EMEDPA]

7 hours ago, OldEDRN said:

There is no excuse for a nurse to refuse to follow a provider's orders. They may be jealous that you were able to make the transition from RN to PA-C and this is their way of asserting themselves or  that "I know just as much as you do".  I was an ED nurse at level 1 and 2 trauma centers and worked with a lot of skilled and experienced, but bitter, nurses. Just brush it off and do what you know is right for your patients. 

 

yup, burnout is a terrible thing. you can't expect people to see 32 pts/8 hrs 5 days/week for years and not get bitter and jaded. so much nicer seeing 10-15 pts/24 hrs. 

[SedRate]

In my experience, once we get to know each other, they usually back off the attitude. Maybe it's a respect thing. Until we get to that mutual level of respect, I will oftentimes assist with dressing changes, patient turns, etc, and I think that helps a lot. The nurses are often running around, taking care of a ton of things, so I've found that setting some time aside to help goes a long way. Sometimes I even go so far as to ask, "Hey Jane, would you mind X task please? I know you're super busy, so if you can't, no worries, I can do it. Just let me know and I'll come by and do it later." More bees with honey vs vinegar thing. I always be sure to thank them for doing said tasks. Yes, it's their job, but a recurrent theme with job dissatisfaction is not being appreciated, so I try to tell them thank you and that I appreciate them taking the time to do it. 

Also, for the ones who question your decisions, I've found that if you briefly explain why you want something done a certain, they really appreciate it and respect you as a provider because they usually just don't know. I usually get a better response to that than just telling them what to do and to just do it and not ask me questions. 

[dermnerd]

Agree with Sed's approach.

 

I experienced a similar situation. I was hired out of rotation into my current job. I work in an outpatient setting so slightly different experience. I am the youngest at my clinic among all staff and providers and caught a lot of push back and criticism from my nursing staff my first 6 months. It was frustrating, I took it personally and I can absolutely relate to how you're feeling. 

They certainly questioned by treatment plans, etc, but with time they began to trust me and my reasoning with positive patient feedback and success (easier to see outpatient of course).

I also will say this-- I worked as an MA prior to PA school to obtain patient contact hours and I remember what it felt like to feel unappreciated, underpaid and overworked...Still to this day I always take time to help clean up supplies, set up for biopsies, etc. I make a point to involve them and take their suggestions (even if I don't use that advice but more so do it to include them and let them know I value their opinions). I check in with them and ask them if I can help with anything. I always thank them for helping me with paperwork, procedures and patient communication. If they make suggestions and I know it's not the best option I have an open conversation with them and explain my thought process. I would suggest taking this approach and see if this helps. Don't get me wrong, I have had to put my foot down a number of times, but always in a professional manner. I let the little things go but am assertive when needed. Try to look on the positive side and bring that energy. Kill it with kindness. I have a great relationship with my staff now and they would do anything for me. Good luck!

[mgriffiths]

15 hours ago, ERCat said:

Yesterday I asked another nurse to ambulate my three time syncopal patient (she had a history of POTS and recurrent syncope, and was a huge pain in the rear for me and the nurse, very demanding and wirh a different compliant each time we walked in the room but nonetheless I wanted to ensure she was safe to discharge) and the nurse was so annoyed with the amount of time she had spent on this patient that she said “Nope, not doing that.”

My immediate response would be, "Ok, I'll just chart that I ordered you to ambulate the patient and you refused."  Then I would send the chart for review by administration.

It's one thing to ask for an easier solution or even complain, it's another thing entirely to simply refuse.

[thinkertdm]

I haven't really encountered any particular level of disrespect, but a PA is not an assistant, we are highly trained and educated to be a leader in a health care team.  We all have a role to play and if that patient dies, or falls, or has a sentinel event, it's on us.  I don't have time to make buddy buddy with people who are putting my patients at risk for the above, or disregarding my clinical decisions.

I sound like a hard ass, and I'm actually fairly easy going, but if it's your job and you don't do it, I'll discuss with my chain of command who will go down their chain of command.

I also know the capabilities of each member of my team, and don't interfere with nursing doing their job.

 

[sas5814]

kind of what mgriffiths said. We have an ortho doc who is a total horse's ass and gives any APP that calls a hard time. I just started cutting him off and I say "I'm either going to chart you refused to consult on this patient and send it for med staff review or I'm going to document your guidance. That is the sum total of what our conversation will be." 

It isn't up to me to fix crappy attitudes or burn out. I have my own patients and things to worry about.

[BruceBanner]

The thing about nurses is that they are an easily affronted bunch who want you to establish a relationship with them. Once you have that baseline rapport, you are usually good. You can be more casual with them and they will take orders from you. Without that, you are just another provider barking out orders without explanation, and nurses with their unions and layers of powerful nursing management have, over the years, become very recalcitrant to that.

It is SO easy to get on nurses bad sides, but also fairly easy to become one of their favorites.

Here are my tips, as a male who has run horribly afoul of a nursing cohort and also been really liked by them:

• Say hi to them every day, by name. Painful, yes, but they love it.
• Periodically ask them about some personal detail. How are their kids, how was camping, what did you do for the 4th, did you watch that game, etc.
• Make jokes with them after the ice is broken.
• Let them see a little humility; like telling them an embarrassing story, or even ask them to show you how to do something. They LOVE this. Just time it well. I'll say "can you show me your technique for this type of IV? I haven't done one in years."
• If you really want to pull out the stops you can bring in donuts/bagels/coffee or whatever and leave it in their break room.
• Try to just coexist on their level. By that I mean, you are both everyday people with families and pets and hobbies who just want to go home on time. If you commiserate with them as a peer, not a superior, they will respect you more. Again, appropriate timing and all. There is a time to be the boss and a time to be a friend.

[mgriffiths]

7 minutes ago, BruceBanner said:

The thing about nurses is that they are an easily affronted bunch who want you to establish a relationship with them. Once you have that baseline rapport, you are usually good. You can be more casual with them and they will take orders from you. Without that, you are just another provider barking out orders without explanation, and nurses with their unions and layers of powerful nursing management have, over the years, become very recalcitrant to that.

It is SO easy to get on nurses bad sides, but also fairly easy to become one of their favorites.

Here are my tips, as a male who has run horribly afoul of a nursing cohort and also been really liked by them:

• Say hi to them every day, by name. Painful, yes, but they love it.
• Periodically ask them about some personal detail. How are their kids, how was camping, what did you do for the 4th, did you watch that game, etc.
• Make jokes with them after the ice is broken.
• Let them see a little humility; like telling them an embarrassing story, or even ask them to show you how to do something. They LOVE this. Just time it well. I'll say "can you show m your technique for this type of IV? I haven't done one in years."
• If you really want to pull out the stops you can bring in donuts/bagels/coffee or whatever and leave it in their break room. Again, timing.
• Try to just coexist on their level. By that I mean, you are both everyday people with families and pets and hobbies who just want to go home on time. If you commiserate with them as a peer, not a superior, they will respect you more. Again, appropriate timing and all. There is a time to be the boss and a time to be a friend.

I abhor this stuff - but unfortunately it is VERY helpful.

[HmTwoPA]

1 hour ago, BruceBanner said:

The thing about nurses is that they are an easily affronted bunch who want you to establish a relationship with them. Once you have that baseline rapport, you are usually good. You can be more casual with them and they will take orders from you. Without that, you are just another provider barking out orders without explanation, and nurses with their unions and layers of powerful nursing management have, over the years, become very recalcitrant to that.

It is SO easy to get on nurses bad sides, but also fairly easy to become one of their favorites.

Here are my tips, as a male who has run horribly afoul of a nursing cohort and also been really liked by them:

• Say hi to them every day, by name. Painful, yes, but they love it.
• Periodically ask them about some personal detail. How are their kids, how was camping, what did you do for the 4th, did you watch that game, etc.
• Make jokes with them after the ice is broken.
• Let them see a little humility; like telling them an embarrassing story, or even ask them to show you how to do something. They LOVE this. Just time it well. I'll say "can you show me your technique for this type of IV? I haven't done one in years."
• If you really want to pull out the stops you can bring in donuts/bagels/coffee or whatever and leave it in their break room.
• Try to just coexist on their level. By that I mean, you are both everyday people with families and pets and hobbies who just want to go home on time. If you commiserate with them as a peer, not a superior, they will respect you more. Again, appropriate timing and all. There is a time to be the boss and a time to be a friend.

Well said, but its unfortunate that you have to. In other words be a decent human being and dont treat people like shit. If you walk into your job thinking that you are above nurses, or that you are their boss, you've already messed up and deserve to be treated poorly. Long standing poor treatment of nurses for decades by physicians has created the culture that is present now. My grandmother was a new nurse when they were just starting to be allowed to wear colored scrubs. She said one physician told her she looked like a slut, because she was not wearing all white. I strongly believe the us vs them culture was started by physicians feeling that they are on another "level" than nurses, and later when PAs and NPs were added to the mix, they were on another "level" as well. Many studies show that the best healthcare is served on a team basis. 

[EMEDPA]

21 hours ago, mgriffiths said:

My immediate response would be, "Ok, I'll just chart that I ordered you to ambulate the patient and you refused."  Then I would send the chart for review by administration.

It's one thing to ask for an easier solution or even complain, it's another thing entirely to simply refuse.

yup, I had a pt who needed IV hydration once and the nurse refused to start the line. I told her in front of the whole ER staff, "that's why it's called an order and not a suggestion". she got the idea I was pissed and went off and did it.

[Cideous]

Respect?  We are Assistants.  Don't believe me, just read our name?  <dripping with truthful sarcasm...>

[Reality Check 2]

I am not in an ER anymore but have experienced this ad nauseam. 

My team at the VA now is awesome. I tell my patients we are a team and that the nurses know what they are doing and they should A. Follow instructions at some point and B. Know that we function as a team.

In the past I found that once I broke the ice with a few nurses - it worked. Never got along with some - ever. Just how it is. I worked on remembering names. I helped with clean up. My rule of sharps always made nurses happy - I remove all my own sharps - PERIOD. No one touches the tray until I pull my own sharps. I draw my own med if I am injecting - that peeved a few but once explained - they came around. 

You might have to pull admin in on some of the flat out refusals - that has to stop. Medicine isn't really a choose what you want to do type of thing. 

I tried the loud verbal thing in the station as well. I would ask - loudly enough for others to hear but not in the hall - "Hey, Cindy, did you see that Mr. B needs to ambulate with a pulse ox? If his sat drops while walking - we have to change our plans." Out loud in front of others sends some peer pressure to do one's job. 

Good Luck to you - you sound compassionate and thorough - please don't change that.

[coloradopa]

I have a pretty simple way to address this problem. This is a nursing problem and nursing has to deal with it. I have variable relationship with the nurses but I have a very good relationship with the charge nurses who have a very dim view of nurses not doing their job. So if I have a problem with an order or timely work I simply point out the issue to the charge nurse who addresses it. Problem solved. 

[Guest ERCat]

Thank you all for your helpful feedback!