TheCat'sMeow Posted August 6, 2011 Report Share Posted August 6, 2011 I got yelled at by a nurse today (like a full 2 minutes of reaming out) for making an investigation suggestion (that my fellow and I both thought was appropriate). I guess I've been pretty luck b/c this the first time this has happened to me. He had a valid point and I talked to him after and things were fine however I don't think it's ever appropriate to yell at anyone at work. I know as a resident (or medical student) you should just bite your tongue but I can't help feeling like I'm building up a reservoir of bad feelings. A few more experiences like this and I'm afraid that I may start becoming a doctor that starts dishing it out. Any similar experiences and how do I keep it from making me gradually more bitter towards nurses/ (or other staff ppl who act this way)? Link to comment Share on other sites More sharing options...
Renin Posted August 6, 2011 Report Share Posted August 6, 2011 Last time a nurse reamed me out, I tried to blink innocently at her, "Oh, I'm so sorry you feel this way. Maybe I can fix the situation?" She told me that I clearly had no knowledge and stormed off. I was bitter about it afterwards, but you chalk it up to individuals, instead of "all nurses" - remember all the nurses that have been nice to you, right? It's like having a mean attending. It's part of the territory, but try to take a positive spin to it as well: maybe you learned a lot from that attending. Usually, the nurse was just having a bad day. Or just hates medical students. Or doctors. Or is jealous. Or whatever her reason is, she's probably consistently this way to everyone, so don't worry! It's not you *hugs* Link to comment Share on other sites More sharing options...
Satsuma Posted August 6, 2011 Report Share Posted August 6, 2011 A few more experiences like this and I'm afraid that I may start becoming a doctor that starts dishing it out. Any similar experiences and how do I keep it from making me gradually more bitter towards nurses/ (or other staff ppl who act this way)? Firstly you can't generalize - it isn't "all nurses" that you have an issue with, just that one. As students and residents who rotate through many services, we may not have the opportunity to know whether that nurse is consistently like that or was just having a bad day. For your own sanity you could just give that person the benefit of the doubt and let it slide. And no matter how people treat you remain professional toward them. As long as you remain professional, you've done your part. We interact with a huge amount of different people throughout our training. You are bound to come across a few you aren't going to get along with, or that are just going to be difficult people. It's just what happens when you don't work by yourself in a isolated room locked away from all other people! I once had a nurse (who I never even met before) come into a pt room where I was charting and just start yelling at me. It even took me awhile to figure out why she was yelling at me and so at first I was a bit stunned. I stayed calm. I pointed out that I thought she was acting rather unprofessionally in a calm factual way, I simply stated "I think you are behaving in a unprofessional manner right now". I was hoping that pointing it out calmly would just have her reflect, maybe step out of the room, or at least calm down. It didn't have this effect. Her eyes bulged out of her head even more and she yelled "Yes I am, and I don't care, that is my choice right now". lol I come across her now and then. And when I do, I admit I remember that incident and it makes me a bit angry still. I am sure she probably feels even worse given her behaviour. But at least I don't have to feel embarrassed about mine! So stay professional. And don't treat others in ways you wouldn't want to be treated - that way you aren't part of the problem! (and people won't post stories about you on this board!) Link to comment Share on other sites More sharing options...
HopeToBeGreen Posted August 6, 2011 Report Share Posted August 6, 2011 When people treat you badly, often there is a reason although it may have nothing to do with you. Nurses have a lot of reasons to be nasty. I think its amazing that most really are pleasant and professional most of the time. Nurses work long hours doing physically and emotionally challenging work. They get very little glory or thanks. No one ever got rich being a nurse. They have little control over their work. They have to take the patients they are given and work within rigid guidelines created by hospital administrators. They have to take orders from doctors who sometimes give them little respect. Patients and their families often treat nurses very poorly. In addition, nurses have personal lives like the rest of us. You never know what stress they have going on there. Maybe they have a sick parent, a teenager they can't control or a marriage that is falling apart. In addition to all this, nurses have very few outlets for their frustrations. They can't yell at the patients, the doctors or the administrators. In fact, a major problem for nurses is horizontal violence. That occurs when nurses get crap from all around them (patients, doctors, administrators etc). They can't give it back to the people they get it from so they take it out on each other. Now, I'm not saying that any of this gives a nurse the right to ream you out unreasonably. But I do think that if you take a moment to consider where the frustration the nurse took out on you came from it might help you to understand that it wasn't personal and that can make it easier for you to let it go. Link to comment Share on other sites More sharing options...
apache Posted August 6, 2011 Report Share Posted August 6, 2011 perfect psychiatry answer , all you needed to add was why do you feel this way, how can i work to avoid a similar situation in the future... this pisses people off way more than actually getting in a shouting match, and some of them will actually talk to you reasonably, haha Last time a nurse reamed me out, I tried to blink innocently at her, "Oh, I'm so sorry you feel this way. Maybe I can fix the situation?" Link to comment Share on other sites More sharing options...
cheech10 Posted August 6, 2011 Report Share Posted August 6, 2011 First, keep your cool, don't be antagonistic, and potentially even apologize to defuse the situation (even if you were not at fault). Then, file an incident report. That's what they would do to you. Or bring it up with the nurse manager/supervisor. There is no excuse for this behaviour from anyone, nurse, attending, or anyone else. We are all trying our best, and trying to do the right thing for the patients. I used to see a lot of attitude from fellow residents during my residency. Asking for consults was often like pulling teeth. That's a rational response from another resident: every consult brings additional uncompensated work. And it's easy to be a jerk when you aren't going to see someone again for a while. Thankfully, this kind of behaviour is extremely rare in community practice (at least from MD to MD, and between MD and RN in the same unit), because of the constant contact and long-term relationships we start to build. Link to comment Share on other sites More sharing options...
Sebriz Posted August 7, 2011 Report Share Posted August 7, 2011 This is what you needed to let her know.. R.N. = Reads Notes M.D. = Makes Decisions Link to comment Share on other sites More sharing options...
thehumanmacbook Posted August 7, 2011 Report Share Posted August 7, 2011 First, keep your cool, don't be antagonistic, and potentially even apologize to defuse the situation (even if you were not at fault). Then, file an incident report. That's what they would do to you. Or bring it up with the nurse manager/supervisor. There is no excuse for this behaviour from anyone, nurse, attending, or anyone else. We are all trying our best, and trying to do the right thing for the patients. I used to see a lot of attitude from fellow residents during my residency. Asking for consults was often like pulling teeth. That's a rational response from another resident: every consult brings additional uncompensated work. And it's easy to be a jerk when you aren't going to see someone again for a while. Thankfully, this kind of behaviour is extremely rare in community practice (at least from MD to MD, and between MD and RN in the same unit), because of the constant contact and long-term relationships we start to build. A bit of the side question - is there any additional benefit to accepting this work? I know it's uncompensated and adds to the growing pile of responsibilities on the resident's shoulders; but is anyone actually willing to accept it and be relatively nice about it? Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 7, 2011 Report Share Posted August 7, 2011 A bit of the side question - is there any additional benefit to accepting this work? I know it's uncompensated and adds to the growing pile of responsibilities on the resident's shoulders; but is anyone actually willing to accept it and be relatively nice about it? One service 'consults' another when their patient has issues that require the input of another specialty. For example, ER has a patient with multiple medical problems whom they believe needs to be admitted to hospital; therefore, they consult internal medicine and ask them to see the patient. My patient on general surgery develops chest pain and has an abnormal ECG; I page cardiology, who assesses my patient and takes him to the cath lab. The benefit is that the more you see and do, the more you learn, and it's infinitely better to have faced a clinical problem in training when you have readily available backup, than to see it for the first time as a consultant. Moreover, refusing a legitimate consult would leave you open to charges of unprofessionalism and poor patient care - it is part of your responsibility to respond to requests for assistance for the sake of your patients' welfare. Most of the unhappiness relates to hospital politics and questions about legitimacies of consults, which stem from systemic issues e.g. bed shortages which lead to conflicts over whether a patient is better suited for admission to a particular service versus another. However, just as in any other job (like retail), you can choose to make the effort to remain professional and pleasant, or let out your frustrations on those who ask you for help. Being in a service-oriented field, I enjoy the chance to help the referring physicians and patients, and am happy to receive all consults made in good faith. Link to comment Share on other sites More sharing options...
thehumanmacbook Posted August 7, 2011 Report Share Posted August 7, 2011 Thank you LF!!! Makes a lot of sense now. I hope that if/when I get to this stage, i'll meet residents just like you! Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 7, 2011 Report Share Posted August 7, 2011 I got yelled at by a nurse today (like a full 2 minutes of reaming out) for making an investigation suggestion (that my fellow and I both thought was appropriate). I guess I've been pretty luck b/c this the first time this has happened to me. He had a valid point and I talked to him after and things were fine however I don't think it's ever appropriate to yell at anyone at work. I know as a resident (or medical student) you should just bite your tongue but I can't help feeling like I'm building up a reservoir of bad feelings. A few more experiences like this and I'm afraid that I may start becoming a doctor that starts dishing it out. Any similar experiences and how do I keep it from making me gradually more bitter towards nurses/ (or other staff ppl who act this way)? Sorry this happened to you. I'm sure most people have had a similar experience at some point in their training. As you stated, it's never appropriate to yell at others as a way to approach conflict, so the first point I want to make is that the person yelling has the problem. Not you. So don't make it your problem. While it feels right to gripe about what happened, I applaud you for your awareness that becoming bitter is not going to do you (or others around you) any good, and for seeking advice. If you like, ponder further on all the negative consequences of becoming a doctor who "dishes it out." I can't really think of any positives here. Second point: don't feel the need to respond right away. If you lose your cool, you lose. Take the higher ground. I would document the incident in my personal notes and then sleep on it - for me, that melts away most of the negative emotion, and I am able to approach the next step in a non-emotionally-charged, nondefensive manner, which is very important. As for that next step, from your description, I'm not sure if you just resolved the patient care issue with the nurse, or if you discussed their yelling as well. Who knows, bringing it to their attention could help them by making them realize the potential negative consequences of their behaviour. I have done just that with a peer - spoken to them about their behaviour, in a manner which gave them the benefit of the doubt. It was a middle ground (between doing nothing and writing them up) which seems to have worked well. When it was a superior who was yelling (but could not provide any specifics for their negative feedback when asked), again I slept on it. Then I wrote my response, thanking them for their viewpoint and trying to understand it, but also offering some of my experiences (using facts and quotations) to create a fuller picture and support my viewpoint how I was well on my way to improving those areas. If you're at all into self help reading, you might try The Four Agreements for more on how to maintain your happiness and equanimity when faced with these situations. Link to comment Share on other sites More sharing options...
chrail Posted August 7, 2011 Report Share Posted August 7, 2011 Interesting. I was chewed out by a resident last week. For nothing. Nothing to do with me, the nursing staff, or patient issues. The resident was pissed at the attending who was going above his head. So, agreed that it's not appropriate to yell at people at work. But, there will be idiots who scream and yell in all walks of life. Just make sure that you're NEVER, EVER the one to do the screaming and you'll be fine. In my limited experience there is way more MD-to-MD and RN-to-RN hate than anything inbetween. I got yelled at by a nurse today (like a full 2 minutes of reaming out) for making an investigation suggestion (that my fellow and I both thought was appropriate). I guess I've been pretty luck b/c this the first time this has happened to me. He had a valid point and I talked to him after and things were fine however I don't think it's ever appropriate to yell at anyone at work. I know as a resident (or medical student) you should just bite your tongue but I can't help feeling like I'm building up a reservoir of bad feelings. A few more experiences like this and I'm afraid that I may start becoming a doctor that starts dishing it out. Any similar experiences and how do I keep it from making me gradually more bitter towards nurses/ (or other staff ppl who act this way)? Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 7, 2011 Report Share Posted August 7, 2011 So, agreed that it's not appropriate to yell at people at work. But, there will be idiots who scream and yell in all walks of life. Just make sure that you're NEVER, EVER the one to do the screaming and you'll be fine. Interestingly, while I was obviously not happy at being screamed at initially, it did make me feel better about myself and my emotional/psychological health in comparison Link to comment Share on other sites More sharing options...
HopeToBeGreen Posted August 7, 2011 Report Share Posted August 7, 2011 This is what you needed to let her know.. R.N. = Reads Notes M.D. = Makes Decisions Ouch! That sounds like a formula for not getting any sleep when you are on call. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 7, 2011 Report Share Posted August 7, 2011 Thank you LF!!! Makes a lot of sense now. I hope that if/when I get to this stage, i'll meet residents just like you! No problem The vast majority of residents and physicians I've met work hard to ensure excellent patient care. Most issues stem from miscommunication. For example, tone is paramount. Even if you say yes to a request, if your tone is snippy or harsh, it will be perceived that you were unhappy about it and the other person will come away with a negative impression. Saying no in a nice way will actually come across better (sorry, we don't do --, but why don't you try --?). The other advice I have is to remain transparent, open-minded, and patient-centred. Someone who is expecting resistance to a request may interpret questions as a lead-up to a reason for refusal. Therefore, I find it worth the extra time to explain why I am requesting more information, e.g. I need to determine the safest protocol for a study. From the other side, someone may be making a request which sounds inappropriate, but it's possible that they are junior and not able to convey the reasoning very well, in which case I make sure I am understanding the situation correctly, and leave the door open for them to call back if needed. As mentioned above, apologies help defuse a situation when appropriate. I don't know if things are different in a larger, more anonymous centre, but here it's pretty easy to figure out who you're talking to, with online on-call schedules and all, and reputations spread quickly. Griping is part of human nature and bonding over shared experiences, but I don't think actual incidents will be that frequent if you make the effort to be pleasant and communicate clearly. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 7, 2011 Report Share Posted August 7, 2011 Ouch! That sounds like a formula for not getting any sleep when you are on call. Or worse. Nurses and techs have saved me many times. Link to comment Share on other sites More sharing options...
Darla Posted August 7, 2011 Report Share Posted August 7, 2011 Or worse. Nurses and techs have saved me many times. Agreed. And that sort of "us and them" attitude being used by so many med students and residents before us may be the reason that some nurses etc. have a short fuse with learners. Link to comment Share on other sites More sharing options...
A-Stark Posted August 7, 2011 Report Share Posted August 7, 2011 I don't really understand that attitude. Most of the time I really enjoy working with nurses, RTs, etc, and I'm not sure how it would contribute either to patient care or to a pleasant working environment to see other professionals as anything other than colleagues. It'll just be nice not to have to get all my orders co-signed in a year's time. Link to comment Share on other sites More sharing options...
Renin Posted August 8, 2011 Report Share Posted August 8, 2011 perfect psychiatry answer , all you needed to add was why do you feel this way, how can i work to avoid a similar situation in the future... this pisses people off way more than actually getting in a shouting match, and some of them will actually talk to you reasonably, haha LOL; that was totally what I followed it up with. It takes people off guard, and it gets things done, and I'm pretty scrawny - I don't do well in physical fights! Link to comment Share on other sites More sharing options...
Struggles Posted August 8, 2011 Report Share Posted August 8, 2011 This happens in all areas of life - any industry or relationship even (ex-gf anyone?). So its important to realize that it's not inherent to MDs and RNs and anyone else working in the medical setting. People can be pricks sometimes....so try not to be so surprised that this may happen to you. If I screwed up, I take the heat, that's a simple one. As long as someone doesn't go overboard (talk about your gender, race, etc etc) I just use it as motivation. If I didn't deserve to get yelled out at all, I do speak up. That's just my personal approach, everyone has their own. I'll stand up and very calmly ask "do you feel better? Are you done?" or ask them why they are yelling straight up. Mind you, I've been a told I'm an intimidating figure so if someone treats me this way, I can't let em push me around - I'm just not built like that, and I'll make sure they know. As long as I have some ground to stand on, it has worked well for me. This is possible especially if you already are well respected and you can keep your cool in high pressure situations and think on the fly. I've tried the "walk away" approach, or other passive methods, but if someone really reams me out for no reason (like mistaking me for someone else who did something wrong.....its happened!) I just can't let it sit. At least I sleep well. Either way, this will likely happen to everyone at some point, competent or not. Just be at peace with how you deal with it and you won't keep stewing over it - or that little angry bubble inside you will eventually find its way to the surface! Link to comment Share on other sites More sharing options...
ThomasRolland Posted August 8, 2011 Report Share Posted August 8, 2011 Lol I think it helps to be tall and intimidating, like someone else mentioned... Then you won't get yelled at even as a 1st year student. Link to comment Share on other sites More sharing options...
Jochi1543 Posted August 9, 2011 Report Share Posted August 9, 2011 I've never been yelled at, but on my medic practicum, I had a preceptor who simply ignored me - he just pretended I was not there. It's a bizarre experience and a much more clever way of abusing someone than yelling at them. I was extremely uncomfortable around him, to the point where I was having difficulty providing patient care with him in the room, and yet I could not really complain about this, because there were no outrageous incidents to speak of. If I explained that my preceptor NEVER spoke to me and would do things like close the door in my face when I was following him or walk between me and another person while we were having a conversation and start talking to the other person as if I was not there, I probably wouldn't get anywhere as there were no incidents where he lashed out at me verbally or physically. I had discussed this with other staff members, but they basically said he was a total tool and I was going to have to deal with it just like they did - except for things are totally different between colleagues vs. preceptor and student. I think this type of behaviour is even worse, personally, because there's no recourse. If anyone has dealt with similar things, please do share your approach. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 9, 2011 Report Share Posted August 9, 2011 Never speaking to you? You could make a case for failure to fulfill their educational obligations. Link to comment Share on other sites More sharing options...
ploughboy Posted August 9, 2011 Report Share Posted August 9, 2011 I don't know if things are different in a larger, more anonymous centre, but here it's pretty easy to figure out who you're talking to, with online on-call schedules and all, and reputations spread quickly. Oh, it's the same everywhere. I work at some pretty big places associated with a really large school, but you'd better believe that *everybody* has a city-wide reputation. That emerg staff? He refers too early and inappropriately, and doesn't work people up. That medicine senior? She's really nervous, and consults subspecialty services for things that a general internist should be able to handle. That orthopod junior? Better page the Medicine Consult service now, behind his back, because otherwise all of the patients on the ward are going to die horrible lingering deaths... I'm kind of glad I don't know what my own reputation is, but I'm pretty sure it likely involves the word "dumbass". It works both ways, though. When I'm on a consult service and get paged by certain ED docs I know that the patient has been worked up the ying-yang because that doc *hates* handing off undifferentiated patients. Likewise I know medicine seniors who will gladly deal with anything and everything on the floor, and if I'm getting paged to take over care it's not because the the patient is being dumped, but it's because the ward nurses are tired of dealing with a complex patient and want the patient off the floor. Then there's at least one orthopod resident in the Centre of the Universe who was an orthopaedic staff doc (and a good one) for over 10 years in his home country before coming to Canada. His consults are like "Ya, I think Mr. X has this clinical problem, I've ruled out these three other things, and labs and imaging are pending for the other two things it might be. He's doing fine, we've got things under control and are treating him on spec, but if your service could see him sometime I'd appreciate it". Best consults ever. So ya, long story short everybody has a reputation, even at the large centres. Link to comment Share on other sites More sharing options...
ploughboy Posted August 9, 2011 Report Share Posted August 9, 2011 Lol I think it helps to be tall and intimidating, like someone else mentioned... Then you won't get yelled at even as a 1st year student. That will only take you so far. I'm tall and inappropriately large, and the room light dims when I stand in the doorway, but I still got yelled at repeatedly as a clerk. Not so much as a resident, but that may be institution-specific. However, in my intern/R1 year I did hear the phrase "Are you _sure_ you want to do that, doctor?" a lot... Link to comment Share on other sites More sharing options...
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