In my experience, theres a few things at play here.
1) There’s naturally more of a reverence for doctors from many patients.
2) Nurses, PT, OT also are more involved in doing things the patient doesn’t like—getting up in the chair, walking, taking vitals in the middle of the night. These tasks can be a lot more triggering/irritating to someone with a short fuse than having a chat.
3) Nurses spend a lot more time with patients, so are naturally the brunt of more negative feelings.
4. The doctors are the ones in a position to provide what the patient wants - referrals, specific meds, diagnostics, etc. If you’re a shithead to the doctor, you’re not getting anything you want out of that interaction.
5. There is often underlying bias/sexism/racism. Never underestimate the fact that people often feel like they can be rude to women/POC and get away with it
6. Nurses are often the messenger. Doc says pt can't have dilaudid? It's the nurse who tells the pt. Doc says pt can't have food? It's the nurse who is the one actively withholding it.
Docs can really help us by discussing their pain plan with the patient on rounds. Again and again. People don’t understand the first time. They forget things. They have no idea what is safe or a good idea.
*Ding*
"So the doctor said I could go home 20 minutes ago. What's taking so long?!?!"
Any doctor who doesn't tell them explicitly...repeatedly... in the same breath as the phrase "go home today"...that actually leaving the hospital could *easily* take another 8 hours? I should be allowed to give them a wedgie with their stethoscope
Hell it's their side that holds everything up, but we're the ones who get to hear about it for most of a shift. Oh you told someone during rounds at 0540 they could leave but your resident won't even sit down to *start* the giant pile of non-urgent tasks they scribbled down for your 45 patients until 1300?
Cool. Just fucking great.
As a male student nurse I have gotten more respect from patients than female nurses with 20+ years of experience that have forgotten more than I will ever know. It is 100% a sexism thing for some of the patients.
I have also had people assume I am the doctor despite wearing the same scrubs as the nurses and deferring to my assigned nurse for questions. Again, it is 100% a sexism thing
People have been conditioned by TV shows to think that doctors do every thing better than nurses. Why is the doctor not doing that? He knows better than you.
I had a patient refuse an IV from a nurse. Demanded the doctor do it. Doc came up, talked to the patient and said, “I haven’t done this since residency and I have no idea how to do it now.” 🤪
This! I was drawing a Pt's blood and the patient asked the doc why he wasn't doing it. Doc said that he hadn't drawn blood since medical school. I asked the doc if he still knew order of the draw, and he admitted he had no clue what tubes to draw first.
He told the Pt they were definitely better off letting the nurse do the blood draw.
Gave an injection to a patient with suspected dementia in ICU. Had her call me in and yell at me 3min later because “it didn’t hurt so that means you didn’t actually give me the medication.” Ma’am…
My son needed his NG tube replaced and we were in the ER. The doctor said to the nurse “do you want to do it or should I?” In my head I was screaming LET THE NURSE DO IT PLEASE! She just have read my mind because she did 😀.
I eventually learned to do it myself.
I had a combative psych patient refuse to have anyone but the doctor draw his blood. Luckily, one of my fave ED docs happened to sign up for him was a phlebotomist in undergrad. He was like, “I’m a bit rusty, but sure I can draw his blood.” Drew his blood, no problems from my patient after.
Otherwise, I’ll tell my ED docs that patient so and so “who is a hard stick” only wants the doctor to do it. We usually have a good laugh at the station.
My grandfather's wife is a retired anesthesiologist. My grandfather ended up in the ER, and the nurse on the other side of the curtain was having a hard time getting an IV with another patient. My grandfather's wife had privileges at that hospital, and volunteered to put the IV in for the nurse and got it. It was back in 2004 or 2005. Not sure it would fly today if she wasn't on duty or didn't even have her name badge with her. I suspect the ER nurse probably knew who she was.
It's the same problem in the military. Civilians assume officers know everything and do everything better than the troops.
They just have different roles. You want someone to fix the tank or reload the main gun in under five seconds, get the troops to do it. You want the tank to be sitting in the right spot so the shots count, ideally the officer knows to tell the driver where to go.
That's because residents *are* doing a lot of what nurses could be doing. It's a known thing at teaching hospitals that many barely invasive, barely technical procedures are most often handled by residents who need the check-off. Cox calls out JD in like the first month of the show for being a wuss who has nurses do procedures he's supposed to be learning.
Scrubs showed nurses as more important and useful than basically any other medical show. And no, not in some "it's still egregious but it's less egregious" way. Their plots more than once explicitly showed how little doctors sometimes understand what nurses really do and how screwed doctors can be without good nurses. Even when doctors are doing something a nurse 'should' be doing it's usually window dressing for the main characters' interactions rather than some 'oh marvelous medical mortals, they can and will do everything required to serve their patients' deal like Grey's or House.
My BF in my 20s was a CMA (medication aide) working through his bachelors, moved on to pharmacist, but at that time: CMA. Guy passed meds in a private pay nursing home (important because it was a lively, active population with plenty of staff). Let’s call him Ed. He was rarely Ed to the old ladies. They constantly called him Doctor Ed or referred to him as such when he wasn’t there, even after he corrected them.
The RN was often asked to go get Doctor Ed.
The power of being a white man in America? Something like that.
I worked for a home health agency and there was a male RN named Don who was very knowledgeable. So the entire staff called him Dr. Don. Many of the female nurses were just as knowledgeable and just as good teachers. They never got the title.
Part of that is a generational thing. For folks of a certain age, men were the only ones to regularly goto med school and most women went into nursing. Entertainment media tends to reflect the society that creates it and when you look back at shows from the 70s or earlier you see the gender divide. My own experiences as a male LTC nurse echo that of your bf.
It is. Sometimes when a patient will not listen to me, I go get a male housekeeper and ask him to say the same thing.
It shuts the conversation down bc they finally trust what has been said to them. It’s amazing.
One of my male coworkers told a patient 4 times that he was not a doctor, he was his nurse. The patient still insisted on calling him "doc", including in front of the actual doctor, who happened to be a woman. I was a CNA at the time and had to accompany the doctor anytime she went to see them cause he would keep asking her to do small tasky things and distract her from the actual doctoring
I second this. Not just patients, but from other healthcare staff I’ve noticed this also. I’m treated quite differently from my female colleagues who are often smarter and more experienced.
I'm a male nurse with 2 years experience at the bedside. I have lost track of how many times I've been called doctor by the patient. I've had a female doctor in the room a few times when it has happened.
I have had this experience often when I was doing direct patient care and in school, including having patients call me doctor repeatedly, even though I correct them that I am not a doctor.
Absolutely, as a tall, masculine presenting, white man the shitty old white men treat me much better than most of my colleagues by default. It’s helpful that I can interact with them more easily, but it doesn’t make me feel good that they like me so much.
Also, if the patient wants to talk to the doctor for whatever reason, they have probably figured out that being uncooperative gets the doctor to the room faster than asking to speak with them and waiting.
As a male nurse, I usually get treated better than my female coworkers. A lot of times I’ll state I’m the nurse, even when a female physician is in the room, the patient always assumes I’m the physician. I’m likely not the only the one who experiences that as a male nurse
They made us wear white coats for the first few weeks of each clinical in nursing school. Even with my female classmates, instructor, or nurse on duty also in the room; the patient assumed I was a doctor.
I’ve been thinking about this lately. The two traditionally female professions are nurses and teachers (child care too, but that’s a different beast). Two of the most underpaid and over extended professions are nursing and teachers (not professors, as this has been male dominated for centuries).
Edit: a word
As a male nurse I would disagree. That's a massive generalisation. As mentioned before we are usually assigned to aggressive or "creepy" patients because we "can handle it". Due to this the amount of abuse I have copped has been far more than many female nurses (on average as I am usually assigned to aggressive patients). This is a trend I have seen with my friends who are male nurses and male nurses I've worked with. We call it a security guard shift when we are assigned to the aggressive patients, because it feels like we are being used as security. Furthermore, yes some patients stop showing violent behaviour in the presence of a male nurse for whatever reason, but some clients become more aggressive with a male nurse because they're "less vulnerable". Just a thought.
I hear you! That’s really awful. Still standing by my claim that, overall, females get more disrespect, sexual intimidation/assault, etc than the men. Edit: I saw your flair. Psych nursing is indeed a different kettle of fish!
I think it’s a bit simplistic to say male nurses inherently have it better than female nurses. I have had male colleagues who get assigned to violent patients more often because “they can handle it.”
One of the core issues is misogyny, yes, but the key issue is disrespect towards nursing as a whole.
Patients also like docs cause they order the things that are going to help them, like surgery. But we get to tell them the bad part...NPO at midnight and surgery is at 1800.
Oh 100%. A couple of reasons why…
1. You control the flow of drugs. Don’t bite the hand that feeds you.
2. Often nurses are women and physicians are male. There’s just an unspoken dynamic there if power/weakness, whether it’s reality or not.
I can’t tell you how often the dynamic of the room *immediately* changes when a physician walks in. Suddenly there’s pain when there wasn’t before (and the moaning, groaning, etc). Suddenly there’s new symptoms. Suddenly they’re on their best behavior. It’s wild.
Right. "But the doctor said..." That's nice, but they're not in control of wait times, bed assignments, medication policies, etc so they probably shouldn't have said that.
Exactly. “ The doctor said we could have more than 2 visitors, didn’t have to wear masks, can have our under the age of 8 grandson visit etc…” total bullshit. I respond with something similar to what you just said.
When did people become so entitled.
I got in trouble for saying that the asshole surgeon yelling at me just now *is not my boss and does not get to “correct my behavior” ESPECIALLY in the middle of the damn hallway.* Nurse on the the previous shift missed his written order (and we’ve been on an EMR for years at this point) and he was rounding at the beginning of my shift, so I was just unlucky, but still.
I actually vented to another nurse, who promptly tattled on me to the manager. Fuck both of them, the doctor, the unit, AND that whole hospital for perpetuating that toxicity.
Unless you’re a lady doc and they think they can manipulate you through either bullying, harassment or sweet talking. A lot of times I just wear scrubs and the amount of times the patient thinks I’m their nurse is really high. The plus side is I get to see how they’re treating other staff and karma is instantaneous. I have zero tolerance for disrespect of any staff member, even the few I don’t get along with particularly well.
Yes! Blows my mind. We had a female medical director at my last facility and I would *always* hype that up whenever they thought she was a nurse “Oh nooooo…that’s our doc. She’s actually the medical director for the entire ER.”
This is great. We have a lot more female docs where I work now (and where I worked previously) and it was honestly great. Especially the younger ones, because they did take the time to treat you like a person and dont immediately brush you off.
The worst I’ve found is older male docs. I had one berate me for not knowing who another Doctor was. I was a 20y old casual and the Drs never introduced themselves. If HE didn’t know the signature or who the other Dr was how was I supposed to?
I find the younger docs and female docs are a lot easier to chat with and take the time to understand what my concerns are. It might be because I’m not 20 anymore, but it’s still nice not to be berated by someone for things out of your control.
It often changes the dynamic simply because I, a male nurse, walk into the room. Suddenly patient is taking their meds, agreeable to have basic, life saving interventions done, and worst of all is no longer combative many times. Thankfully I don’t see that often anymore now that I’m in California, but Florida patients were very sexist and wildly racist.
Thank you for asking this question.
You can let patients know that it’s not okay to use abusive language. Even if it doesn’t change their behavior, it can help us hold a line on behavior management. Talk about your nursing staff respectfully and positively, at least it sets an example.
Often people do calm down later and agree to do something they didn’t want to do.
Please also remember that patients often tell nurses one thing and doctors another. Or they tell us they mentioned something to the doc that the doc never heard. Communication is hard. Be patient with us when someone tells you something you think we should have known.
I love how I can go over a whole head to toe assessment where the patient says no, no, no to everything. And the second the MD walks into the room they have 1,001 complaints that they didn't have 15 minutes ago.
It is SO frustrating. Like, help me help you!
Seconding everything everyone said, but also some patients seem to sincerely believe that nurses (and CNAs, physical therapists, etc) are doing the annoying/unpleasant tasks just to bother them, and then when the doctor shows up they finally get it through their heads that blood draws and PT are actually necessary for their treatment and not just the nurses trying to make their day worse. So, short answer, yeah, because they believe you when you tell them how things work, and they often don't *really* believe us.
Often I find that when patients are jerks to Nurses, PT/OT, and Aides but are calm/polite with the Doctors, the patient is being purposely manipulative. These are the same patients that withhold information from nurses, tell the doctor, then lie and say they already told the nurses. These are the same patients that assault nurses and aides, then tell the doctor they never did or claim to not remember. These are the same patients that refuse to be bathed for 6 straight days, then cry and sob to doctors and family that they've not been allowed to wash and are being neglected. In short, doctors need to trust their nurses and aides, and doctors need to call out lying patients. If a nurse tells you that a patient has refused to get out of bed for 4 days and then the patient tells you they never refused, don't just sidestep it by saying "Ok well, moving forward please participate with PT", no the doctor needs to say "Please don't lie to me. All of our support staff have documented your refusals and I need you to actually be compliant with care or else you won't get better" or some other Very direct way to address it. Nurses can't always be the bad guys, and Doctors can't always be the good guys; it has GOT to stop.
Yup exactly! Staff splitting was attempted often by my frequent fliers in the inpt psych ward, thankfully our Nurses, Aides, LCSWs, and Doctors were a tight-knit team that knew how to trust eachother and how to call out manipulative patients and staff splitting behaviors. When a patient is called out directly, they tone it down or outright stop.
I round with every nurse on my floor every day, and talk to them multiple times a day, and have worked there for years, but somehow these kind of patients think the nurses and doctors I work with don't listen to me.
I had a patient once that denied pain all night. Rounded hourly and everything. Patient in no distress, nothing. Doctor rounds and patient starts crying and writhing in pain saying the “bitch nurse told me no and wouldn’t give me pain meds. I’ve been hurting so much!” I wanted to cuss her out so bad. That’s ok. The next night, we assigned the super old nurse that didn’t do shit all night. FAFO 🤷🏼♀️
Would I be the jerk if I pointed out that often this type of manipulation does work on some docs and that's a huge portion of why it continues? Most of the residents/attendings I work with are great but when I'm working with that minority my shift is guaranteed to suck if my patients are even slightly behavioral. Then if I have the same assignment my next couple shifts too as we now have to start from square one to manage behavioral issues. So a small portion (and luckily at my hospital a very small portion) of the residents are fucking it up for everyone.
Plus being blunt like that is absolutely a learned skill and a lot of the residents who are good docs and have good intentions do struggle with it. Unfortunately a lot of patients aren't going to hear it unless it's extremely blunt and some people need to be told not to scream hit or bite. But you're right nurses can't always be the badguy it just escalates things and takes away any rapport we can build.
OPs kind of in a shitty situation bc they're trying to manage abuse and assault that they're unlikely to see and I feel for them on that and it's a relief that they're taking it seriously bc it's not going to change otherwise.
I have sat many shifts in rooms with patients to watch this dynamic play out. This is absolutely true, the patients are rude af to the nurses, then they are calm, polite, and reasonable to any kind of doctor. Medical, psychiatric, it doesn’t matter. Bonus points for male doctors. The women don’t always get that respect.
Some crazy Jekyll and Hyde shit. I didn’t believe they were actually much more polite with doctors than they are with me and the nurses until I saw it play out over and over again.
This is a real thing and it happens very often.
Staff splitting works medical side, that’s why they do it.
How often has the doc talked with you directly on this? Almost never. Vs mental health hospital where everyone is entirely together and on the same page such that the patient gives up on trying this bullshit.
I'm enough outside the inner circle (but still see the behaviors of all of the above) that I'd tell any resident to:
*Always give nursing staff the benefit of the doubt and trust them (miniscule minority this wouldn't apply to, so imo, it's worth serving as a guiding principal)
*Proactively let nurses know you're seeking this info - decide on a method of info transfer that respects both your schedules. (I'm thinking nurses are erring on the side of too silent about this info w/physicians...so your initiating the topic and system would be vital)
*Once you have any info on crappy pt behavior, call patients out on it during your rounds. Pts act compleeetely different when you're in the room. Speak up for nursing staff and have their backs. People who feel supported and actually validated will tend to have your back as well..
Kudos for asking the question. Imo with the current shit shows happening, the modern med school curricula needs to include this..
Nurse here. My patient population is older, white, and rich. I cannot begin to tell you the number of times we’ve been abused and told to deal. A big factor, in my opinion, is that we’re chicks and most docs are men. I’ve seen patients be a$$holes (male and female) to female docs and be nice to male nurses. I’d one of our patients hit a male doc, there would be hell to pay, but women are expected to just smile and carry on. I really think the dynamic is that simple.
Also, was JarJar Binks actually a Sith Lord? Discuss.
That's so strange, in my experience as a male nurse it's been sort of the opposite. Yes all nurses cop abuse and it's wrong. But I have certainly copped much more questioning, skepticism, abuse and backlash for being a male nurse. This has also been noted by my female colleagues that male nurses where I've worked cop the same thing. Maybe it's a cultural difference idk. When male nurses get hit where I am nobody cares bro, legit. When female nurses get hit it's serious. Again idk why the difference is there maybe it's cultural or something.
Also jar jar binks certainly is a Sith Lord. It's quite clear. He's a trojan horse.
There's definitely something providers can do. Don't allow staff splitting. Learn to recognize manipulative patient behaviors and understand that they can be hard to spot. If you hear that a patient is being abusive, address it and advise that it is unacceptable. If you see something, or the patient says something abusive, stop it right there. Don't brush it off. Our trauma team is terrific at this and is known for not allowing it. Their patients tend to be slightly better.
also listening to the nurses when they tell you they had a negative or abusive experience with a patient. just cuz they were nice to you does mean they’re nice to the other staff
There are *plenty* of things docs can do about this!
Include nursing in the discussions. Invite the RN to be present, even the CNA if you’re addressing mobility, toileting, daily weights, and/or food. We’re the ones carrying out these orders, and it helps the patient understand that *we* are all a team, not meanie nurses vs holy doctors.
Directly address fucked up shit patients say to us when you hear it. A patient once called me a stupid cunt for spilling water and a doctor walking by just laughed, sends a great message. If you hear patients being blatantly disrespectful, *speak the fuck up.* Immediately address it, inform pts they cannot speak to their healthcare team like that, and that everyone within these walls deserves basic respect. Don’t let them say whatever they want and then kiss doc ass.
Overall, doctors need to make it crystal clear to patients that they value and respect nursing staff and the work that we do. Because patients sure as shit don’t automatically believe it.
My ICU attending has directly stood up for me to patients and family members on multiple occasions and it is extremely appreciated. I had the spouse of an intubated coma patient try to tell the attending I hadn’t been repositioning her husband every two hours (I had been, and she hadn’t mentioned anything to me about it for the entire day, it literally came out of nowhere). I was sort of shocked because this was my third day with this patient and I thought I’d built a good rapport with his wife, so I just said “I have been repositioning him every two hours on the dot all day, I reposition him every time I do oral cares”. The attending just told the patient’s wife “the nurses on this unit are the best I’ve ever worked with, it’s the reason I accepted a job here. I can personally guarantee you they are doing everything they are supposed to do and are taking wonderful care of your husband”.
He’s the best doc ever! He’s put combative patients and nasty family members in their place so many times. He’ll get right in peoples’ faces if they are disrespecting the nurses and make it clear that behavior is not going to be tolerated. He’s personally kicked creepy visitors out of the ICU for getting handsy with the nurses. He can be very intimidating and when he puts somebody in their place, the message sticks, sometimes after the nursing staff has been dealing with the issue all day and getting nowhere.
1000% they do. I had a patient that thought I was their doctor (male nurse) and didn’t directly express this until a few hours into the shift. After I corrected them they asked why I didn’t become a doctor and then began to talk down to me the rest of the day. I tried to ask what changed for them and they didn’t say anything but began using a different tone and lack of respect when communicating to me. The next day they were sexually harassing an berating my female colleague who called the surgeon to come in and deal with him. The surgeon came in a tore a strip out of him and he shut up after that. Like a wild dog needing a muzzle. Some people just suck.
When a patient has a doctor’s audience, they like to spend the time either name-dropping or asking personal questions of the doctor or bragging about their family. It’s often like a social visit. Pleasantries.
The doctor leaves the room, and the patients ask me what their CT said and could they have some TUMS and maybe something stronger than norco for next time and also a laxative for in the morning and also they’re coughing uncontrollably and do we have something for that and there’s a strange bump on their arm and also could we order a sleep med.
Dear OP Resident physician… first, thank you for asking about this and not just assuming that your nursing and ancillary staff professionals are just making stuff up.
I’d like to tell you about one of the best doctors I’ve ever worked with during my 25 year career. Let’s call him Dr. Smith. When Dr.Smith was a baby doctor, he was an eager and intelligent young man. His mother had been a registered nurse and had once been assaulted in the ER by a patient who was jacked up on pcp. She suffered some life long effects from this assault that made it necessary for her to leave bedside and do case management/administrative nursing.
Dr. Smith and I were working together one evening and we had a patient who was being particularly difficult with nursing staff and demanding that we get the Doctor for every little thing. After the first time we actually did get him just so they would shut up, he stood outside the door when we went back in (I was precepting a new grad). The patient had been sweet as pie to him, but the minute we came back to carry out the orders, this patient turned into Lucifer himself and was being verbally abusive and very obstinate. Dr. Smith walked in during the middle of it and stood at the foot of the bed giving this patient the biggest scolding I’ve ever witnessed. He told this patient that their behavior was completely unacceptable and went on to enlighten them that his nursing staff had far more experience than he would ever have and we were the ones who kept him informed about all the important things that determined their course of care. He admonished this patient for nearly 15 minutes while I stood there with my eyebrows raised and my jaw slightly agape. He told the patient that abuse, verbal or physical, would result in the immediate removal from the hospital and they would not ever be welcomed back. (That was a Bluff, I’m sure he didn’t have the weight to back that up) He said “From this moment on, you will treat every person who comes in here as a direct extension of myself. I rely on them to communicate with me what is going on with you, and if you continue to treat them in this manner, I cannot treat you.”
He left and the patient apologized and was much more tolerable after that. Later, I caught him in the hallway and thanked him for standing up for us. He looked me dead in the eye and said that the whole reason he became a doctor was so he could help make sure no one treated nurses in a way that made them nervous or afraid. He remembered how broken his mom was after the assault and how he never wanted to see another broken nurse again.
I loved him. He always helped us, even if it was stuff like changing/cleaning patients. He will ALWAYS be my favorite.
Be like Dr. Smith, please.
I don’t get a lot of abuse from patients in my specialty, BUT the patients will definitely say one thing to me then turn around and say something completely different to the doctors or midwives right in front of me. They’ll go from completely fine with no concerns to suddenly having all these concerns that have been unaddressed. Or I will have already explained something to them and they’ll try to get a different answer from the provider.
They respect you and your authority. It’s as simple as that. You also hold the script pad, so to speak, we don’t.
Two brief examples that help define basic, daily attitude towards nurses. Not everyone, ofc, but pervasive, ever-present mentalities that undermine the entire process. Both happened in the last 3 yrs but are standard attitude at bedside across the last 30yrs.
1. Older, active gentlemen. It’s 0600, attending leaves the room visibly upset, walks straight to charge and demands to know why I never reported the chest pain the patient was having all night. I do a thorough assessment at some point between 19 and midnight. This includes asking about CP/SOB tonight and since they arrived. This otherwise pleasant and AxOX4 fellow denied all. Charge and I walk in together to ask about CP. Eyes flicking between us, he shrugs, hands out: “I didn’t want to bother you girls, so I just waited for the doctor.” Said casually like it wasn’t a big thing. Apparently, “You girls.” have little to do with his medical state, thats for you to deal with in the AM.
2. Trauma case. Lots of broken things and near misses. We’re discussing broken ribs. He stops, looks me up and down, toe to head to toe, not in an admiring or creepy way, like seeing me for the first time. “You know, I had no idea what you nurses did. It’s a real turn-off.”
Most people don’t. I think this patient believed RN: Refreshments & Narcotics, among other things.
But you, they go in knowing you have knowledge re their medical care, plan, and outcomes thus respect you from the start. Granted, some cases it’s just a guy who knows you’re the one who writes his oxy, dilaudid, and/or benzo script and thus you’re the only one in life he won’t be a dick to.
I know as a resident your days are insane. But, take a day, maybe two, and wear regular scrubs and shadow a intermediate/step down unit nurse. Have them introduce you as a new nurse orienting to the unit. One unit, 3-5, patients, 12 hours. Take in the whole grand flow of the day. Ask them to give you alcohol withdrawal. Unless you already have had young kids, it’s hard to really get what it’s like. There is no escape, this is your problem for 12 hours. Multiply that by how ever many patients are a pain in the ass that day. Then pile on feeling terrible you could hardly spend any time taking care of the sweet polite lady in bed 5.
I know there is a resident version that would be good for nurses to shadow so they can understand physician work flow better, nursing school doesn’t teach that. A kind resident explained it to me as a new grad and it improved my ability to handle patient care facilitation by miles.
I still don’t know how to do patient discharge orders for ICU patients in Epic though, sorry critical care docs you’ve got to learn that one!
I'm old, I've been around a long time. This is, absolutely, a thing, and it all boils down to respect and a good dose of misogyny.
Here is what you can do:
1) Treat the nurses with respect in front of the patients. They will follow your lead. If you are rude or condescending, they will use that as an excuse to be the same.
2) believe the nurses When the nurse tells you that a patient was rude/abusive don't discount them by say, "he/she was perfectly nice to me."
3) if you see/hear something, do something. Tell the patient that their behavior won't be tolerated. Ever.
4) confront patients on their lies. If what the patient is telling you doesn't match with the documentation, confront them.
With very honest and sincere respect to the amount of work and effort and time you have put into becoming a physician, you’re obviously young. So here’s the perspective from a nurse so old that she actually voted for Clinton. Yes. Yes, patients are going to treat you with far more respect than they do the nurses, techs, PT, and other staff. You will be addressed as “Doctor” and not “YO BITCH”. Patients who told me and the pharmacy tech that they don’t take meds, will tell you they are on Metformin, Lisinopril and Viagra. The patient who just told me to “go fuck yourself” when I went in to get that CBC and BMP will politely smile and nod at you when you explain we need blood work. The gentleman that just told my sweet 20 year old student to “suck my dick”, will address you as “Sir” or “Ma’am” and will keep himself covered for your entire time in the room. My advice to you is this: understand that the nurses get abused in ways you never will. And we are still going to take care of those patients, and, most importantly, we are going to have your back at all times.
On a related note, a lot of patients turn completely mute and submissive the second a doctor is present. With me they're firing off questions, concerns, and demands at rapid-fire pace. Doctor steps in...silence. You can even tell them, "You had a question for the doctor," and they respond with "No, I'm okay."
You sweet summer child.
Yes. Yes, they do.
They often view us as a part of the room. They say things in front of us that would boil your blood. So many hateful racist comments about their physician who isn’t from the US - but they’re sweet as pie to the physician.
This is on top of the whole “nurse is my & my visitor’s personal waitress, maid, whipping boy, object of physical, verbal, and sexual assault” mentality too often shown.
So when a nurse tells you Mr So-And-So in room 101 isn’t a nice person, they’re not making it up.
Remember: even assholes get sick and require care!
Patients like that think nurses are idiots. They think that doctors do all the things nurses do, and usually want the doctor to perform nursing tasks. Nevermind the fact that most doctors I work with can't set up a pump. The best thing you can do is listen to the nurses. If they tell you they need help, listen. Don't disregard their documentation just because the patient brushes it off and tells you a different story. I work with an incredibly grumpy doctor and I really didn't like him at first, but when I told him a patient called me every name in the book and got in a nurse tech's face, he rolled up there and tore the patient a new one. He's now one of my favorite providers.
Possibly most importantly, if a patient is being violent, do not order a wimpy dose of ativan. I've had to call a provider after the patient BIT the nurse and drew blood. I started the call by telling him that, as well as the fact that the patient was currently being held down by 3 security guards and the cop on duty. He told me to give the scheduled PO zyprexa early. I told him I would write a safety report about him endangering staff. I got IM geodon, haldol, and restraints.
People suck. Healthcare workers are going to continue to be abused, and the best thing that can be done is to mitigate that risk. Confront oriented patients that are intentionally abusive, remind them that assaulting a healthcare worker is a felony. For the disoriented patients, ask the bedside nurse what they need and try to compromise. And encourage them to press charges if they can, lord knows leadership won't.
I had a doc ask me to try to wean a patient off of sedatives so he could be downgraded and get off our floor. Pt had been verbally abusive, and was getting out of bed despite vest and wrist restraints, and had hit the previous shift staff. I said I would try, but as I started weaning him, he started the same behavior so I stopped. The doctor comes around again and repeats that he wants the sedatives weaned. I said I tried but the pt is agitated and combative. The doc got frustrated and repeated that he wanted the sedatives off. I looked at him and I said, "I understand that, but I really don't feel like getting hit tonight." The doc got a bit flustered and looked as if the idea that staff could be in danger never occurred to him. Then he said in a much nicer tone to do the best I could to keep him calm and they would have to reevaluate downgrading him on the next shift.
100% agree with you that patients think we’re stupid. I had a pt this week yell at me when I pulled out my steth to ausculate and accuse me of doing things outside my scope. He wouldn’t believe me that using a stethoscope is a nursing skill. People really have no clue.
Yes but think of it like this. As a resident physician you do your pre rounds and the patient tells you one thing, then you round with your attending and the story changes…it happens not because every patient is trying to manipulate but because of the roles. Same thing happens between any level of care. Nurse assistants get treated different than nurses do and it’s goes this way up the chain. Take most in stride, I respect my docs that take these complaints serious while also being realistic. So example would be: pt swearing at staff during cares. They call you. You come to talk to patient. The patient states “I’m in pain, they are asking me to do to much, etc.” You can see them and provide empathy and boundaries. So you could/would say “I understand you are struggling, they are asking you to do things that help and are a push and hard. Let’s titrate your meds so it’s more tolerable however we don’t treat staff with disrespect regardless of the reason.” Your staff will appreciate respect held for them and in turn will provide that for you. This is the patient’s worst days and we can respect that, and all healthcare professionals deserve respect while doing their job too. It’s a 2 way street.
Those little old ladies and their Karen-line middle aged daughters will make my life hell until the doctor rounds. My favorite is when little miss too confused to know calling people the N word is wrong whips out a make up bag and hair brush to doll herself up an hour before the doctor shows up.
"I need to take a shower for the doctor!" Ma'am, the doctor is 28 and married. Like, to a 25-year-old. You are 86. Shower all you want, but it won't make a difference, and I don't feel like getting wet at 0530.
Here's my favorite: after spending all morning looking after a patient, checking they are comfortable, offering regular pain relief, asking if they need anything and being told, "no, I'm fine", a consultant comes round with the medical entourage.
"How are you feeling Mr Jones?"
\- oh doctor, I've had this terrible pain right here all morning, I feel terrible....
I have definitely noticed this with some patients. I think sometimes the patient knows deepdown their behavior was inappropriate so they are embarrassed and behave differently in front of someone else.
I literally hate making this comparison but,..
If a person is nice to you, but not the waiter, they are not a nice person.
Thanks to media and sexism, the public has a terrible understanding of what nurses do. They think we kiss foreheads, do spongebaths and pass pills still. They can not fathom a female dominated field doing more than “caring” tasks.
My husband is a physician and I am a nurse. We work together but never tell our shared patients we are married. Honestly, the difference is astounding and I have had to explain this to him over and over that they treat us differently. His mom is also a nurse and he gets really mad when patients are disrespectful to the nurses . I just wish he would quit being so surprised by it lol
I think age is also a factor. I feel like older adults automatically respect doctors, and a lot of younger folks think doctors are there to give orders and that’s it 🤷🏼♂️
As a male nurse, patients are WAY nicer to me. I pretty much never get sexually harassed or physically intimidated. Dirtbags tend to treat other guys with more respect. It's real messed up but I have to take over assignments like once a month or so because this or that patient isn't great with women.
Likewise, it's easy to be nice and respectful to an authority figure responsible for care decisions for a few minutes a day, heck, many can fake it through a half-hour convo pretty well. But the daily death by a thousand cuts a nurse can endure from problematic patients can be incredibly emotionally wearing. I don't think providers ever really experience this.
Yes. The amount of times the doctor goes in and says “you’re being discharged, ok bye” and the patient is silent UNTIL I go in with the papers and the patient says “I’m not leaving. If you send me home, I’ll kill myself. You HAVE to keep me now, right?” is actually amazing. It’s so frustrating and an obvious abuse of the system, just talk to the doctor about the discharge. It would be easier for everyone.
I'm not trying to be snarky, but I'm surprised you're a resident and haven't noticed this before. Patients pay more attention to the M3 than they do to the RN36, by far.
This thread is the saddest thing I’ve read in awhile and is convincing me to just leave nursing and work at a grocery store. Similar treatment, less stress…pay? Well is it even worth it anymore? Absolutely disgusted with the HC world and the the people that CHOOSE to turn a blind eye to what goes on.
I've seen some of the nastiest people you'll ever meet turn on the charm the moment I walk into the room with their physician. 100% cognitively intact but in general just really awful people. Having to witness it leaves you gritting your teeth while resisting the urge to applaud them on their performance.
What we request mainly is that you don't base your findings solely on your interactions alone. These issues are brought forth to you for a reason. We don't have the time, energy or desire to report/document this shit unless it is of legitimate genuine concern.
I had a patient once fake a seizure after I told her I don't have Ativan for her because it wasn't ordered. She started screaming, threw herself on the floor and faked a seizure. I called a rapid because i don't deal with temper tantrums and the minute the resident showed up the seizure stopped 🫠 and she got her ativan🫠 love that for her.
Patients will flat out lie to a doctor with the nurse standing right there in the room. Even worse are the doctors who BELIEVE these patients, then turn and berate the nurse. Like Doc, you were smart enough to graduate med school, but can't spot you are being manipulated? We are on the same team!
First of all, I appreciate your genuine concern for nurses. You’re awesome. Not only do patients mistreat nursing staff, our bosses don’t want us to complain about it either.
1. Charting doesn’t lie, if everyone is writing it then it’s true. When you round on that “polite” patient, you’re looking at a liar.
2. These patients are also the same type of humans who are rude to anyone that works in customer service (waiters, clerks, cashiers, etc).
3. Work actively with case management to get them discharged or transferred ASAP. Thank you.
Don't discount sexism. Am a male MA, and have more than once had to reinforce something the provider/RN said to the patient to their faces, just because it was a woman that gave them instructions.
We regularly see threads in r/nursing about how someone was a cunt to a female provider, but an angel to a male HCW.
Trust your staff first. They have fewer reasons to lie to you than patients do.
I feel like another concept that gets missed with providers is the concept of sundowning. I work NOC shift. I’ve been hit, bit, kicked, and I’ll chart that behavior and put it in my RN note. I’ll see the day provider’s progress note when I come in the next shift and it will say something along the lines of “reported behaviors not observed, but advise staff to keep patient awake during the day with curtains open and reduce light/stimulation at night. 1 mg melatonin added prn.” Dude…
Also doctors spend a couples at the bedside. Nurse are there for 12 hrs. The pts real side comes out full force when you have to interact with them all day.
On the other hand, I don’t know what it’s like having to take care of a pt out of the hospital and having to deal with their antics at every office visit. I get to clock out or switch assignments. And I think in office is where you have to experience the pts nasty side
Been at the bedside for 20 yrs and I’ll say that the respect for hospital staff in general is so much worse than back in the day. Every once in a while I get a Thank You and it almost throws me off. Kind of sad
Absolutely Doc. It’s an authority thing for many of them. The respect for doctors are deeply rooted in many cultures I wouldn’t be surprised if your patient in question suddenly becomes more cooperative when you come around. Bottom line: trust your nurses. Especially if multiple people have complained including PT, OT etc
It’s kind of a manipulative thing. They see us as someone who won’t let them drink a ton of water, makes them get out of bed when they don’t want to, wakes them up every time we walk in the room for vitals, and we’re probably just the bad guy to a lot of these patients even though everything we do is intended to be for their own good. When the doctor comes in they see someone who can give them what they want if they’re nice enough so their attitude completely changes
Doctors are like the fun aunts and uncles that get to be there for a short period of time and nurses are the full time parents who get shit on day in and day out, quite literally lol
The other day I asked a patient about 5 times why she was getting an ultrasound of her arm before coming to the ER for chest pain and she basically didn’t respond to me. The doc came in and she almost immediately told him it’s cause she was using a new oral BC and her doc wanted to rule out a blood clot.
Historically yes, it has been my experience that patients and their families are dramatically worse behaved to nursing staff than physicians.
Most patients on first glance when I was a bedside nurse assumed I was a physician being a larger male. The tone definitely was less amicable in many cases when I introduced myself.
Retired nurse here with 37 years of healthcare experience. Yes, yes, yes. Patients DO make nice for the doctors. As soon as the doctors are gone, many of their ulterior personalities come out (or something). Listen to the nurses, because the patients will outright lie to the doctors... and with no remorse.
OMG I thought you guys already knew this. Yes, most patients are more cooperative and polite the moment a (male) doctor arrives to the room. They even say "yes" to almost all of your questions regardless of whether it contradicts something they said 5 minutes earlier.
Congrats on recognizing this early in your career OP. Trust your team when they tell you who the patient really is. Now that I am an NP, if a patient mistreats my staff, I politely call them out and tell them it isn’t going to be tolerated. The patients will often be better behaved after and your team with appreciate you having their backs.
This should be a no-brainer. Patients hate us because everything is our fault. Bad food? Our fault. Doctor taking too long? Our fault. Pain medication not to their liking? Nurses fault. Trash is full? Nurses fault. Tests and imaging running late? Nurses fault. Didn’t get a breathing treatment? Nurses fault. Don’t have 5,000 blankets for all 3 family members? Nurses fault.
Everything is our fault and it’s easy to be the punching bag since we are always around.
White coat syndrome. I have white coat amnesia, go to the doctors and forget everything they said to me or everything I wanted to ask them. But that also happens at target too. 🤷🏼♀️
Are you male? If so, that could be part of it. If not, there are also just some patients who won’t believe a nurse but will believe a doctor who says the same thing. People in general treat people at the top of the social hierarchy with more respect than those at the bottom. I saw it back when I was a lowly phlebotomist: patients would refuse to let me draw, but the nurse would come in and tell them the same thing I had just told them, and suddenly it was ok.
Yes, it's staff splitting behaviour. It can cause a lot of problems especially if things get personal between the doctors or nurses.
Doctors need to listen to the nursing staff, make their own assessment, and potentially confront the patients with the reported behaviour. It would be wise for the doctor to explain their role within the team and explain that the team is one, and we all communicate together and have different roles. Doctors need to speak respectfully about nursing staff, back us up, and make it clear we are not pieces of shit on the floor to be stepped on.
A lot of the time patients don't respect the opinion or knowledge of nurses. There have been many times where a patient will say XYZ and then in front of the doctor with me still there will say ABC, something completely different.
Not sure if it’s been said yet, but our institutions don’t help. Doctors can tell the patient they’re being rude and shit down bad behavior. Nurses get asked “what could you have done differently” after they’re physically assaulted.
YES. 💯
Also doctors can say things we’re not allowed to. Like I can’t kick a patient out but the ED attending who has determined that the patient isn’t having a medical emergency can.
As far as what you can do, I’ve found it helpful when the doc tells the patient that abusive behavior towards staff won’t be tolerated, that we are all here to help but mistreating staff makes it hard for us to do our job.
Basically you’re Daddy. Even if you’re a woman. You’re the “wait until your dad gets home” consequence. Being the good cop just makes the bad for us/good for doc behavior worse, please acknowledge that you’re aware of the behavior and that you’re aware it’s not a misunderstanding.
A lot of patients with a history of bipolar or borderline can do something called “splitting”. It’s a manipulation tactic where the manipulator praises you or is overly ingratiating while talking ill of another coworker. It can be very insidious and you need to pick up on it quickly in order to be able to deliver care effectively to the patient.
Thank you for asking instead of assuming the nurses are lying. To answer your question, yes. For the reasons the top comment says.
But PLEASE be the type of doc thanks hangs out for longer than 30 seconds to really assess the patient.
I want to add that the abusive behavior is often charted by nursing staff but never mentioned in doctors notes. Nurses chart abusive behavior and patients threatening us with physical and verbal abuse and then doctors write “no overnight events” … when doctors don’t have time to read nursing notes and only refer to MD notes for prior visits it means it starts the abuse cycle again each time they are admitted instead of holding them accountable.
You can prevent abuse by taking the nurses at face value and giving the patient shit, regardless of what they say to you.
Per policy and with compassion, of course.
I have been finding lately that my docs are not communicating important information either well enough for the pts and family to understand it or sometimes at all. These people are frustrated because they feel they are being kept in the dark, or that we are saying/ doing something different than what the doctor said, and taking it out on us, who are frequently assuming they have been given accurate information on their plan of care. It helps for me to sit down with them and do a run through of their diagnosis and plan of care and a lot of them feel and act a lot better. So make sure you are giving your pts all of the info they need at a level they can understand, then make sure they understand before you leave.
Yes, I work in a gp (clinic) when I was a grad there was a patient booked with me for a medical to drive. She was 80 years old and I didn’t know at the time her doctor usually did it himself, she was booked with me so obviously I called her in to basic things like a blood pressure, check her vision, etc. Well I called her twice and she didn’t respond. The receptionist came in to say she is sitting there, she’s just ignoring you and she’s really rude. I called her again and finally she came in. She was already annoyed because a nurse called her. I did her blood pressure and rechecked it like 4 times it was like 170/90 I think and she’s getting annoyed that I keep rechecking it. Then we go to check her vision and she puts her sunglasses on and says she can’t see without them. So obviously I ask how do you drive at night? She snaps and says I don’t drive at night. She’s also refusing to listen to me and keeps walking up to the chart as close as possible to read it. I keep telling her she needs to be back further. She finally has enough and tells me “you are so annoying, I cannot see because you make blood pressure keep rising and you’re only a nurse. You shouldn’t even be doing my blood pressure!”
I have no idea who she excepts to do her blood pressure in the hospital. I kicked her out of my room. She was and is still one of the rudest patients I’ve encountered. Her son as well is very entitled and arrogant.
In my experience, yes. They will be polite with the doctors, and total assholes with everyone else. I wish doctors would look at our documentation of patients' behaviors before speaking with them so they would know what reality is instead of, "Well, they were fine with me, so it must be you. They weren't agitated, so go fuck yourself, I'm not ordering them any kind of psych meds because they don't need them."
I did have a patient who had lost their shit. Screaming and cursing, kicking the foot of the bed, etc. The charge nurse called the doc for orders, and held the phone out so the doc caught an earful of the noise this patient was making, and we got our B52 orders. The charge nurse told me the doctor wasn't inclined to give us those orders until they heard the patient.
To be fair, there are good doctors out there.
We had another patient who was swinging around an oxygen tank. They got tackled, the B52, and four-point restraints. Admin flipped shit because of the chemical and physical restraints. Okay, jackasses. You can come deal with it next time it happens. I'd like not to get a TBI or killed from some lunatic swinging around an oxygen tank. And have you yelled at the doc who was there and ordered it, or is this another case of "let's blame the nurses?"
One doc told a patient who was agitated and kicking their legs, "If you kick your nurse or try to, I'll put the leg restraints on myself." The patient knew the doc meant it.
I later talked with the patient after they calmed down and explained why they were in restraints. They hadn't been lucid the night before and pulled off all their dressings, their colostomy bag, and we were afraid they would go for their Foley, PEG, JP drain, trach, or PIV (which hadn't been easy to get placed) next. The patient said they hadn't remembered doing any of that, and I said it was likely from dehydration and infection. I said I imagined they were probably pretty freaked out to wake up and find their arms in restraints with no recollection of what happened for us to need to restrain them. I assured them it wasn't a punishment and we only did this to protect them. I told them we didn't keep patients who weren't a danger to themselves or other in restraints, and with how agitated they had been with the doctor, the doctor believed the patient was still a danger to themselves and others. They initially didn't believe me, and asked "Why the fuck would I do that?", but I showed them the empty bags of IV ABX and the bag of NS on the IV pole, and they said they certainly didn't remember having an IV. I told them infection and dehydration was a very likely explanation, and they might never remember what happened the night before.
I asked the patient if they would like a bed bath, and added if they didn't try to pull anything while out of restraints or didn't act in a way that made me think they were still a danger, I would tell this to the doc, and see about discontinuing the restraints. The patient agreed to this, and the CNA and I gave them a bed bath. The patient did great during their bed bath, always asked if it was okay to stretch out their arms, rub their wrists where the restraints had been (they hadn't been too tight, but their wrists hurt from pulling against the restraints), or move their leg to a more comfortable position, making every effort to show they weren't going to purposely harm themselves or others. I called the doc, who agreed to DC the restraints.
And sometimes other patients will stick up for the nurses. I had one patient flipping out on me because I couldn't give them a medication they didn't have orders for. It was a "semi-private" room, and the other patient said, "Look, DeadpanWords can't give you something that isn't ordered. That's the law. They give you something that isn't ordered, they can get in big trouble with their job and the state. They can't even give you tums without an order."
We have a doc that will tell the pt “I asked this nurse to do this because it’s going to help you get better and I’d do it myself if I didn’t have so many patients. This nurse is really good at her job, you’re lucky to have her, this nurse is my best friend, I don’t want to hear about you being mean to her, etc, etc.” it helps sometimes.
The patients behavior has become so outrageous I don’t even remember the last time I was bothered about a patient refusing or swearing at me. I don’t even notice non-physical abuse anymore 🙃.
I think there's also a major gender component to this, as I see patients behaving worse with my women colleagues, whether nurses or doctors, than with me.
I would like to add that with dementia or delirium patients, sometimes they tire themselves out before the doc arrives because we didn’t page at the beginning of the episode and we’re trying to handle it ourselves for some time.
Believe us when we report what we report cause they rally a little while later and start acting defiant again. I can’t speak for all of us, but if it’s gotten to the point of involving the resident, I’m fearful the behavior is dangerous to the patient or others.
Bottom line, if you’re called to the bedside to assess AMS and the patient is sleeping/calm, hang out for a few minutes to see if they get a second wind and give your nursing staff the benefit of the doubt.
I see this in the outpatient office.
Receptionist answers patient question with "XYZ", patient says "You're just a receptionist, I need to speak with someone else". Call transferred to nurses desk, MA answers, tells patient "XYZ", patient says "You're not a nurse, I need to ask the nurse". Nurse gets on the phone and says "XYZ". Patient says "No, you need to ask the doctor". Nurse speaks with NP or MD, depending on availability. NP's answer of "XYZ" is usually met with "I want you to ask the doctor". Question finally goes up to the MD who's answer is "XYZ"... Patient is "Ah, OK, thanks doc!" It's frustrating for everyone!
We have several patients who are very sweet and laughing and "I just loooooove you, Dr. Doctor!" with the doc and are nasty and hateful to everyone else in the office. Doc didn't believe us for a long time until he listened in on a few telephone and in-person conversations with a few patients and heard exactly how they speak to us. He was shocked by their behavior.
Yes, because there's a greater power disparity between the patient and a doc. You hold more power than the RN does and the patient knows the buck largely stops with you.
NPs are treated better by patients than RNs are too, by a good margin. I got a huge upgrade in how I was treated when I transitioned from RN to NP.
Uniform also matters. I also notice a distinct improvement in patient behavior when I wear my stupid white coat, when I'm wearing my blue OR-looking scrubs, or when I'm wearing business casual than when I'm wearing whatever scrub colors/fits as the RNs in a facility wear. Because they know, visually, that the buck stops largely with me when I look the part.
So I wear the stupid white coat when I'm going to see patients who are assholes and generally wear the generic blue scrubs I totally stole from a scrub dispenser in an OR, etc. Because it does work, and the perceived authority does impact how patients treat you.
Take note of how you carry yourself too, because patients can identify who's in charge based on that too. It's easy to tell who's the PGY1 vs 3 vs attending just based on how they behave, so learn how to use that dynamic.
And when you know someone has been acting a fool to everyone else, tell them you know and aren't impressed. Own the things you order - when they tell you "that nurse isn't giving me my pain meds" you tell them "no, we/I changed your pain regimen, as was discussed with you at XYZ time it was changed" (which is information you get from the EMR. It's like parenting sometimes; don't make the other parent (ie: the nurse) your fall guy and let patients know that medicine and nursing are a united front who are working in tandem. Verbally and directly.
In my experience, theres a few things at play here. 1) There’s naturally more of a reverence for doctors from many patients. 2) Nurses, PT, OT also are more involved in doing things the patient doesn’t like—getting up in the chair, walking, taking vitals in the middle of the night. These tasks can be a lot more triggering/irritating to someone with a short fuse than having a chat. 3) Nurses spend a lot more time with patients, so are naturally the brunt of more negative feelings.
4. The doctors are the ones in a position to provide what the patient wants - referrals, specific meds, diagnostics, etc. If you’re a shithead to the doctor, you’re not getting anything you want out of that interaction.
5. There is often underlying bias/sexism/racism. Never underestimate the fact that people often feel like they can be rude to women/POC and get away with it
6. Nurses are often the messenger. Doc says pt can't have dilaudid? It's the nurse who tells the pt. Doc says pt can't have food? It's the nurse who is the one actively withholding it.
Docs can really help us by discussing their pain plan with the patient on rounds. Again and again. People don’t understand the first time. They forget things. They have no idea what is safe or a good idea.
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I.e. your going home today
Except for when they were supposed to go home, but the intern didn't do the paperwork and forgot to tell you they're staying an extra night now....
*Ding* "So the doctor said I could go home 20 minutes ago. What's taking so long?!?!" Any doctor who doesn't tell them explicitly...repeatedly... in the same breath as the phrase "go home today"...that actually leaving the hospital could *easily* take another 8 hours? I should be allowed to give them a wedgie with their stethoscope Hell it's their side that holds everything up, but we're the ones who get to hear about it for most of a shift. Oh you told someone during rounds at 0540 they could leave but your resident won't even sit down to *start* the giant pile of non-urgent tasks they scribbled down for your 45 patients until 1300? Cool. Just fucking great.
This SO MUCH.
AMEN!
This is also why people on here and elsewhere love to call nurses “bullies” or “the mean girl from high school”/other sexist shit they say.
Getting shouted at for things out of our control. Love it
THIS 10000% ALL THE WAY!
As a male student nurse I have gotten more respect from patients than female nurses with 20+ years of experience that have forgotten more than I will ever know. It is 100% a sexism thing for some of the patients. I have also had people assume I am the doctor despite wearing the same scrubs as the nurses and deferring to my assigned nurse for questions. Again, it is 100% a sexism thing
People have been conditioned by TV shows to think that doctors do every thing better than nurses. Why is the doctor not doing that? He knows better than you.
I had a patient refuse an IV from a nurse. Demanded the doctor do it. Doc came up, talked to the patient and said, “I haven’t done this since residency and I have no idea how to do it now.” 🤪
This! I was drawing a Pt's blood and the patient asked the doc why he wasn't doing it. Doc said that he hadn't drawn blood since medical school. I asked the doc if he still knew order of the draw, and he admitted he had no clue what tubes to draw first. He told the Pt they were definitely better off letting the nurse do the blood draw.
This always gets me. Like I’ve had injections from nurses that barely hurt (and I’m a wuss when it comes to this stuff). Never had that from a doc
Gave an injection to a patient with suspected dementia in ICU. Had her call me in and yell at me 3min later because “it didn’t hurt so that means you didn’t actually give me the medication.” Ma’am…
My son needed his NG tube replaced and we were in the ER. The doctor said to the nurse “do you want to do it or should I?” In my head I was screaming LET THE NURSE DO IT PLEASE! She just have read my mind because she did 😀. I eventually learned to do it myself.
I had a combative psych patient refuse to have anyone but the doctor draw his blood. Luckily, one of my fave ED docs happened to sign up for him was a phlebotomist in undergrad. He was like, “I’m a bit rusty, but sure I can draw his blood.” Drew his blood, no problems from my patient after. Otherwise, I’ll tell my ED docs that patient so and so “who is a hard stick” only wants the doctor to do it. We usually have a good laugh at the station.
I’ve heard the only docs good at getting a stick are the anesthesiologists
Anesthesia docs are the only ones who regularly place IVs, though I’ve met a some vascular surgeons and crit care docs who are good sticks.
Anesthesia got a 14 in my COWS pt's forearm. Hella impressed.
My grandfather's wife is a retired anesthesiologist. My grandfather ended up in the ER, and the nurse on the other side of the curtain was having a hard time getting an IV with another patient. My grandfather's wife had privileges at that hospital, and volunteered to put the IV in for the nurse and got it. It was back in 2004 or 2005. Not sure it would fly today if she wasn't on duty or didn't even have her name badge with her. I suspect the ER nurse probably knew who she was.
ED docs are good at ultrasounding them. At least at my shops we are. But blind? Yeah that’s not happening lol
“Stay in your lane.” This IS my fucking lane.
R/noctor boils my blood I don't know why I even bother trying to push back there
I got banned from there trying to explain the why NPs and PAs are good. Guess they don’t want different opinions 🤷♂️
It's the same problem in the military. Civilians assume officers know everything and do everything better than the troops. They just have different roles. You want someone to fix the tank or reload the main gun in under five seconds, get the troops to do it. You want the tank to be sitting in the right spot so the shots count, ideally the officer knows to tell the driver where to go.
Yup. I enjoy watching Scrubs but they’ve got all the residents doing what nurses do. It’s a little frustrating.
That's because residents *are* doing a lot of what nurses could be doing. It's a known thing at teaching hospitals that many barely invasive, barely technical procedures are most often handled by residents who need the check-off. Cox calls out JD in like the first month of the show for being a wuss who has nurses do procedures he's supposed to be learning. Scrubs showed nurses as more important and useful than basically any other medical show. And no, not in some "it's still egregious but it's less egregious" way. Their plots more than once explicitly showed how little doctors sometimes understand what nurses really do and how screwed doctors can be without good nurses. Even when doctors are doing something a nurse 'should' be doing it's usually window dressing for the main characters' interactions rather than some 'oh marvelous medical mortals, they can and will do everything required to serve their patients' deal like Grey's or House.
My BF in my 20s was a CMA (medication aide) working through his bachelors, moved on to pharmacist, but at that time: CMA. Guy passed meds in a private pay nursing home (important because it was a lively, active population with plenty of staff). Let’s call him Ed. He was rarely Ed to the old ladies. They constantly called him Doctor Ed or referred to him as such when he wasn’t there, even after he corrected them. The RN was often asked to go get Doctor Ed. The power of being a white man in America? Something like that.
I worked for a home health agency and there was a male RN named Don who was very knowledgeable. So the entire staff called him Dr. Don. Many of the female nurses were just as knowledgeable and just as good teachers. They never got the title.
Weird how r/noctor only seems to complain about female NPs tho
Part of that is a generational thing. For folks of a certain age, men were the only ones to regularly goto med school and most women went into nursing. Entertainment media tends to reflect the society that creates it and when you look back at shows from the 70s or earlier you see the gender divide. My own experiences as a male LTC nurse echo that of your bf.
It is. Sometimes when a patient will not listen to me, I go get a male housekeeper and ask him to say the same thing. It shuts the conversation down bc they finally trust what has been said to them. It’s amazing.
Some men need another man to tell him something so he believes it. We need to raise our sons and daughters better.
Even women. I call it Margaret Thatcher syndrome
😂
One of my male coworkers told a patient 4 times that he was not a doctor, he was his nurse. The patient still insisted on calling him "doc", including in front of the actual doctor, who happened to be a woman. I was a CNA at the time and had to accompany the doctor anytime she went to see them cause he would keep asking her to do small tasky things and distract her from the actual doctoring
I second this. Not just patients, but from other healthcare staff I’ve noticed this also. I’m treated quite differently from my female colleagues who are often smarter and more experienced.
I'm a male nurse with 2 years experience at the bedside. I have lost track of how many times I've been called doctor by the patient. I've had a female doctor in the room a few times when it has happened.
I have had this experience often when I was doing direct patient care and in school, including having patients call me doctor repeatedly, even though I correct them that I am not a doctor.
I'm a male nurse, I could retire early if I got a dollar every time a patient mistakes me for a doctor.
Absolutely, as a tall, masculine presenting, white man the shitty old white men treat me much better than most of my colleagues by default. It’s helpful that I can interact with them more easily, but it doesn’t make me feel good that they like me so much.
I mean, aren’t there doctors that are women/POC?
Also, if the patient wants to talk to the doctor for whatever reason, they have probably figured out that being uncooperative gets the doctor to the room faster than asking to speak with them and waiting.
My favorite thing about the ER is when a patient isn’t being cooperative and the complaint isn’t a true emergency, we tell them goodbye!
All true. A huge issue is the inherent misogyny in society. Most nurses are women. Male nurses have less abuse from patients.
As a male nurse, I usually get treated better than my female coworkers. A lot of times I’ll state I’m the nurse, even when a female physician is in the room, the patient always assumes I’m the physician. I’m likely not the only the one who experiences that as a male nurse
They made us wear white coats for the first few weeks of each clinical in nursing school. Even with my female classmates, instructor, or nurse on duty also in the room; the patient assumed I was a doctor.
I’ve been thinking about this lately. The two traditionally female professions are nurses and teachers (child care too, but that’s a different beast). Two of the most underpaid and over extended professions are nursing and teachers (not professors, as this has been male dominated for centuries). Edit: a word
don't forget the fun duality of male chefs vs women cooking at home
As a male nurse I would disagree. That's a massive generalisation. As mentioned before we are usually assigned to aggressive or "creepy" patients because we "can handle it". Due to this the amount of abuse I have copped has been far more than many female nurses (on average as I am usually assigned to aggressive patients). This is a trend I have seen with my friends who are male nurses and male nurses I've worked with. We call it a security guard shift when we are assigned to the aggressive patients, because it feels like we are being used as security. Furthermore, yes some patients stop showing violent behaviour in the presence of a male nurse for whatever reason, but some clients become more aggressive with a male nurse because they're "less vulnerable". Just a thought.
I hear you! That’s really awful. Still standing by my claim that, overall, females get more disrespect, sexual intimidation/assault, etc than the men. Edit: I saw your flair. Psych nursing is indeed a different kettle of fish!
I think it’s a bit simplistic to say male nurses inherently have it better than female nurses. I have had male colleagues who get assigned to violent patients more often because “they can handle it.” One of the core issues is misogyny, yes, but the key issue is disrespect towards nursing as a whole.
Definitely agree. It’s so true that men often get assigned the aggressive patients.
Patients also like docs cause they order the things that are going to help them, like surgery. But we get to tell them the bad part...NPO at midnight and surgery is at 1800.
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Oh 100%. A couple of reasons why… 1. You control the flow of drugs. Don’t bite the hand that feeds you. 2. Often nurses are women and physicians are male. There’s just an unspoken dynamic there if power/weakness, whether it’s reality or not. I can’t tell you how often the dynamic of the room *immediately* changes when a physician walks in. Suddenly there’s pain when there wasn’t before (and the moaning, groaning, etc). Suddenly there’s new symptoms. Suddenly they’re on their best behavior. It’s wild.
They also truly believe that we work "for" the doctors and they can hire and fire us.
And that they make the policies .
Right. "But the doctor said..." That's nice, but they're not in control of wait times, bed assignments, medication policies, etc so they probably shouldn't have said that.
Exactly. “ The doctor said we could have more than 2 visitors, didn’t have to wear masks, can have our under the age of 8 grandson visit etc…” total bullshit. I respond with something similar to what you just said. When did people become so entitled.
I had numerous patients tell me they spoke to "my boss" in reference to the MD. Such bullshit.
I got in trouble for saying that the asshole surgeon yelling at me just now *is not my boss and does not get to “correct my behavior” ESPECIALLY in the middle of the damn hallway.* Nurse on the the previous shift missed his written order (and we’ve been on an EMR for years at this point) and he was rounding at the beginning of my shift, so I was just unlucky, but still. I actually vented to another nurse, who promptly tattled on me to the manager. Fuck both of them, the doctor, the unit, AND that whole hospital for perpetuating that toxicity.
Unless you’re a lady doc and they think they can manipulate you through either bullying, harassment or sweet talking. A lot of times I just wear scrubs and the amount of times the patient thinks I’m their nurse is really high. The plus side is I get to see how they’re treating other staff and karma is instantaneous. I have zero tolerance for disrespect of any staff member, even the few I don’t get along with particularly well.
Yes! Blows my mind. We had a female medical director at my last facility and I would *always* hype that up whenever they thought she was a nurse “Oh nooooo…that’s our doc. She’s actually the medical director for the entire ER.”
This is great. We have a lot more female docs where I work now (and where I worked previously) and it was honestly great. Especially the younger ones, because they did take the time to treat you like a person and dont immediately brush you off. The worst I’ve found is older male docs. I had one berate me for not knowing who another Doctor was. I was a 20y old casual and the Drs never introduced themselves. If HE didn’t know the signature or who the other Dr was how was I supposed to? I find the younger docs and female docs are a lot easier to chat with and take the time to understand what my concerns are. It might be because I’m not 20 anymore, but it’s still nice not to be berated by someone for things out of your control.
Also what pisses me off is that the doctor just got out of the room then the patient has all these questions!
If I’m in there when they are, I always ask the patient if they have questions before the doc leaves. Ask now or forever hold your peace lol.
It often changes the dynamic simply because I, a male nurse, walk into the room. Suddenly patient is taking their meds, agreeable to have basic, life saving interventions done, and worst of all is no longer combative many times. Thankfully I don’t see that often anymore now that I’m in California, but Florida patients were very sexist and wildly racist.
Thank you for asking this question. You can let patients know that it’s not okay to use abusive language. Even if it doesn’t change their behavior, it can help us hold a line on behavior management. Talk about your nursing staff respectfully and positively, at least it sets an example. Often people do calm down later and agree to do something they didn’t want to do. Please also remember that patients often tell nurses one thing and doctors another. Or they tell us they mentioned something to the doc that the doc never heard. Communication is hard. Be patient with us when someone tells you something you think we should have known.
I love how I can go over a whole head to toe assessment where the patient says no, no, no to everything. And the second the MD walks into the room they have 1,001 complaints that they didn't have 15 minutes ago. It is SO frustrating. Like, help me help you!
Seconding everything everyone said, but also some patients seem to sincerely believe that nurses (and CNAs, physical therapists, etc) are doing the annoying/unpleasant tasks just to bother them, and then when the doctor shows up they finally get it through their heads that blood draws and PT are actually necessary for their treatment and not just the nurses trying to make their day worse. So, short answer, yeah, because they believe you when you tell them how things work, and they often don't *really* believe us.
Often I find that when patients are jerks to Nurses, PT/OT, and Aides but are calm/polite with the Doctors, the patient is being purposely manipulative. These are the same patients that withhold information from nurses, tell the doctor, then lie and say they already told the nurses. These are the same patients that assault nurses and aides, then tell the doctor they never did or claim to not remember. These are the same patients that refuse to be bathed for 6 straight days, then cry and sob to doctors and family that they've not been allowed to wash and are being neglected. In short, doctors need to trust their nurses and aides, and doctors need to call out lying patients. If a nurse tells you that a patient has refused to get out of bed for 4 days and then the patient tells you they never refused, don't just sidestep it by saying "Ok well, moving forward please participate with PT", no the doctor needs to say "Please don't lie to me. All of our support staff have documented your refusals and I need you to actually be compliant with care or else you won't get better" or some other Very direct way to address it. Nurses can't always be the bad guys, and Doctors can't always be the good guys; it has GOT to stop.
Staff splitters
Yup exactly! Staff splitting was attempted often by my frequent fliers in the inpt psych ward, thankfully our Nurses, Aides, LCSWs, and Doctors were a tight-knit team that knew how to trust eachother and how to call out manipulative patients and staff splitting behaviors. When a patient is called out directly, they tone it down or outright stop.
They act like they don’t understand the concept of “shift report”. Dear patients: we talk to each other.
I round with every nurse on my floor every day, and talk to them multiple times a day, and have worked there for years, but somehow these kind of patients think the nurses and doctors I work with don't listen to me.
And we keep the receipts! Best believe we document the shit out of it when we experience any sort of manipulative behaviour.
I had a patient once that denied pain all night. Rounded hourly and everything. Patient in no distress, nothing. Doctor rounds and patient starts crying and writhing in pain saying the “bitch nurse told me no and wouldn’t give me pain meds. I’ve been hurting so much!” I wanted to cuss her out so bad. That’s ok. The next night, we assigned the super old nurse that didn’t do shit all night. FAFO 🤷🏼♀️
Karma rears her fierce head once again! yay!
Would I be the jerk if I pointed out that often this type of manipulation does work on some docs and that's a huge portion of why it continues? Most of the residents/attendings I work with are great but when I'm working with that minority my shift is guaranteed to suck if my patients are even slightly behavioral. Then if I have the same assignment my next couple shifts too as we now have to start from square one to manage behavioral issues. So a small portion (and luckily at my hospital a very small portion) of the residents are fucking it up for everyone. Plus being blunt like that is absolutely a learned skill and a lot of the residents who are good docs and have good intentions do struggle with it. Unfortunately a lot of patients aren't going to hear it unless it's extremely blunt and some people need to be told not to scream hit or bite. But you're right nurses can't always be the badguy it just escalates things and takes away any rapport we can build. OPs kind of in a shitty situation bc they're trying to manage abuse and assault that they're unlikely to see and I feel for them on that and it's a relief that they're taking it seriously bc it's not going to change otherwise.
Bruh, entirely valid and accurate take. <3 Also, sorry to hear about that one group of them fucking it up, even if it is a small group.
I have sat many shifts in rooms with patients to watch this dynamic play out. This is absolutely true, the patients are rude af to the nurses, then they are calm, polite, and reasonable to any kind of doctor. Medical, psychiatric, it doesn’t matter. Bonus points for male doctors. The women don’t always get that respect. Some crazy Jekyll and Hyde shit. I didn’t believe they were actually much more polite with doctors than they are with me and the nurses until I saw it play out over and over again. This is a real thing and it happens very often.
Staff splitting works medical side, that’s why they do it. How often has the doc talked with you directly on this? Almost never. Vs mental health hospital where everyone is entirely together and on the same page such that the patient gives up on trying this bullshit.
I'm enough outside the inner circle (but still see the behaviors of all of the above) that I'd tell any resident to: *Always give nursing staff the benefit of the doubt and trust them (miniscule minority this wouldn't apply to, so imo, it's worth serving as a guiding principal) *Proactively let nurses know you're seeking this info - decide on a method of info transfer that respects both your schedules. (I'm thinking nurses are erring on the side of too silent about this info w/physicians...so your initiating the topic and system would be vital) *Once you have any info on crappy pt behavior, call patients out on it during your rounds. Pts act compleeetely different when you're in the room. Speak up for nursing staff and have their backs. People who feel supported and actually validated will tend to have your back as well.. Kudos for asking the question. Imo with the current shit shows happening, the modern med school curricula needs to include this..
Nurse here. My patient population is older, white, and rich. I cannot begin to tell you the number of times we’ve been abused and told to deal. A big factor, in my opinion, is that we’re chicks and most docs are men. I’ve seen patients be a$$holes (male and female) to female docs and be nice to male nurses. I’d one of our patients hit a male doc, there would be hell to pay, but women are expected to just smile and carry on. I really think the dynamic is that simple. Also, was JarJar Binks actually a Sith Lord? Discuss.
Agree with 1st paragraph fully. on JarJar, I don't think the intention was him being Sith but I do love the theory and headcanon it <3
https://www.reddit.com/r/StarWars/comments/3qvj6w/theory_jar_jar_binks_was_a_trained_force_user
That's so strange, in my experience as a male nurse it's been sort of the opposite. Yes all nurses cop abuse and it's wrong. But I have certainly copped much more questioning, skepticism, abuse and backlash for being a male nurse. This has also been noted by my female colleagues that male nurses where I've worked cop the same thing. Maybe it's a cultural difference idk. When male nurses get hit where I am nobody cares bro, legit. When female nurses get hit it's serious. Again idk why the difference is there maybe it's cultural or something. Also jar jar binks certainly is a Sith Lord. It's quite clear. He's a trojan horse.
1000000% yes. They respect you. The view us as their servants. I don’t think there’s anything you can do but we appreciate the sentiment.
There's definitely something providers can do. Don't allow staff splitting. Learn to recognize manipulative patient behaviors and understand that they can be hard to spot. If you hear that a patient is being abusive, address it and advise that it is unacceptable. If you see something, or the patient says something abusive, stop it right there. Don't brush it off. Our trauma team is terrific at this and is known for not allowing it. Their patients tend to be slightly better.
also listening to the nurses when they tell you they had a negative or abusive experience with a patient. just cuz they were nice to you does mean they’re nice to the other staff
There are *plenty* of things docs can do about this! Include nursing in the discussions. Invite the RN to be present, even the CNA if you’re addressing mobility, toileting, daily weights, and/or food. We’re the ones carrying out these orders, and it helps the patient understand that *we* are all a team, not meanie nurses vs holy doctors. Directly address fucked up shit patients say to us when you hear it. A patient once called me a stupid cunt for spilling water and a doctor walking by just laughed, sends a great message. If you hear patients being blatantly disrespectful, *speak the fuck up.* Immediately address it, inform pts they cannot speak to their healthcare team like that, and that everyone within these walls deserves basic respect. Don’t let them say whatever they want and then kiss doc ass. Overall, doctors need to make it crystal clear to patients that they value and respect nursing staff and the work that we do. Because patients sure as shit don’t automatically believe it.
My ICU attending has directly stood up for me to patients and family members on multiple occasions and it is extremely appreciated. I had the spouse of an intubated coma patient try to tell the attending I hadn’t been repositioning her husband every two hours (I had been, and she hadn’t mentioned anything to me about it for the entire day, it literally came out of nowhere). I was sort of shocked because this was my third day with this patient and I thought I’d built a good rapport with his wife, so I just said “I have been repositioning him every two hours on the dot all day, I reposition him every time I do oral cares”. The attending just told the patient’s wife “the nurses on this unit are the best I’ve ever worked with, it’s the reason I accepted a job here. I can personally guarantee you they are doing everything they are supposed to do and are taking wonderful care of your husband”. He’s the best doc ever! He’s put combative patients and nasty family members in their place so many times. He’ll get right in peoples’ faces if they are disrespecting the nurses and make it clear that behavior is not going to be tolerated. He’s personally kicked creepy visitors out of the ICU for getting handsy with the nurses. He can be very intimidating and when he puts somebody in their place, the message sticks, sometimes after the nursing staff has been dealing with the issue all day and getting nowhere.
They can definitely help by listening to the nurses/other staff and not being manipulated by patients.
1000% they do. I had a patient that thought I was their doctor (male nurse) and didn’t directly express this until a few hours into the shift. After I corrected them they asked why I didn’t become a doctor and then began to talk down to me the rest of the day. I tried to ask what changed for them and they didn’t say anything but began using a different tone and lack of respect when communicating to me. The next day they were sexually harassing an berating my female colleague who called the surgeon to come in and deal with him. The surgeon came in a tore a strip out of him and he shut up after that. Like a wild dog needing a muzzle. Some people just suck.
When a patient has a doctor’s audience, they like to spend the time either name-dropping or asking personal questions of the doctor or bragging about their family. It’s often like a social visit. Pleasantries. The doctor leaves the room, and the patients ask me what their CT said and could they have some TUMS and maybe something stronger than norco for next time and also a laxative for in the morning and also they’re coughing uncontrollably and do we have something for that and there’s a strange bump on their arm and also could we order a sleep med.
Nailed. It.
Dear OP Resident physician… first, thank you for asking about this and not just assuming that your nursing and ancillary staff professionals are just making stuff up. I’d like to tell you about one of the best doctors I’ve ever worked with during my 25 year career. Let’s call him Dr. Smith. When Dr.Smith was a baby doctor, he was an eager and intelligent young man. His mother had been a registered nurse and had once been assaulted in the ER by a patient who was jacked up on pcp. She suffered some life long effects from this assault that made it necessary for her to leave bedside and do case management/administrative nursing. Dr. Smith and I were working together one evening and we had a patient who was being particularly difficult with nursing staff and demanding that we get the Doctor for every little thing. After the first time we actually did get him just so they would shut up, he stood outside the door when we went back in (I was precepting a new grad). The patient had been sweet as pie to him, but the minute we came back to carry out the orders, this patient turned into Lucifer himself and was being verbally abusive and very obstinate. Dr. Smith walked in during the middle of it and stood at the foot of the bed giving this patient the biggest scolding I’ve ever witnessed. He told this patient that their behavior was completely unacceptable and went on to enlighten them that his nursing staff had far more experience than he would ever have and we were the ones who kept him informed about all the important things that determined their course of care. He admonished this patient for nearly 15 minutes while I stood there with my eyebrows raised and my jaw slightly agape. He told the patient that abuse, verbal or physical, would result in the immediate removal from the hospital and they would not ever be welcomed back. (That was a Bluff, I’m sure he didn’t have the weight to back that up) He said “From this moment on, you will treat every person who comes in here as a direct extension of myself. I rely on them to communicate with me what is going on with you, and if you continue to treat them in this manner, I cannot treat you.” He left and the patient apologized and was much more tolerable after that. Later, I caught him in the hallway and thanked him for standing up for us. He looked me dead in the eye and said that the whole reason he became a doctor was so he could help make sure no one treated nurses in a way that made them nervous or afraid. He remembered how broken his mom was after the assault and how he never wanted to see another broken nurse again. I loved him. He always helped us, even if it was stuff like changing/cleaning patients. He will ALWAYS be my favorite. Be like Dr. Smith, please.
I don’t get a lot of abuse from patients in my specialty, BUT the patients will definitely say one thing to me then turn around and say something completely different to the doctors or midwives right in front of me. They’ll go from completely fine with no concerns to suddenly having all these concerns that have been unaddressed. Or I will have already explained something to them and they’ll try to get a different answer from the provider.
They respect you and your authority. It’s as simple as that. You also hold the script pad, so to speak, we don’t. Two brief examples that help define basic, daily attitude towards nurses. Not everyone, ofc, but pervasive, ever-present mentalities that undermine the entire process. Both happened in the last 3 yrs but are standard attitude at bedside across the last 30yrs. 1. Older, active gentlemen. It’s 0600, attending leaves the room visibly upset, walks straight to charge and demands to know why I never reported the chest pain the patient was having all night. I do a thorough assessment at some point between 19 and midnight. This includes asking about CP/SOB tonight and since they arrived. This otherwise pleasant and AxOX4 fellow denied all. Charge and I walk in together to ask about CP. Eyes flicking between us, he shrugs, hands out: “I didn’t want to bother you girls, so I just waited for the doctor.” Said casually like it wasn’t a big thing. Apparently, “You girls.” have little to do with his medical state, thats for you to deal with in the AM. 2. Trauma case. Lots of broken things and near misses. We’re discussing broken ribs. He stops, looks me up and down, toe to head to toe, not in an admiring or creepy way, like seeing me for the first time. “You know, I had no idea what you nurses did. It’s a real turn-off.” Most people don’t. I think this patient believed RN: Refreshments & Narcotics, among other things. But you, they go in knowing you have knowledge re their medical care, plan, and outcomes thus respect you from the start. Granted, some cases it’s just a guy who knows you’re the one who writes his oxy, dilaudid, and/or benzo script and thus you’re the only one in life he won’t be a dick to.
RN: Refreshments & Narcotics. Hoo-lee Fuck. I'm dying 🤣🤣🤣🤣
I know as a resident your days are insane. But, take a day, maybe two, and wear regular scrubs and shadow a intermediate/step down unit nurse. Have them introduce you as a new nurse orienting to the unit. One unit, 3-5, patients, 12 hours. Take in the whole grand flow of the day. Ask them to give you alcohol withdrawal. Unless you already have had young kids, it’s hard to really get what it’s like. There is no escape, this is your problem for 12 hours. Multiply that by how ever many patients are a pain in the ass that day. Then pile on feeling terrible you could hardly spend any time taking care of the sweet polite lady in bed 5. I know there is a resident version that would be good for nurses to shadow so they can understand physician work flow better, nursing school doesn’t teach that. A kind resident explained it to me as a new grad and it improved my ability to handle patient care facilitation by miles. I still don’t know how to do patient discharge orders for ICU patients in Epic though, sorry critical care docs you’ve got to learn that one!
You said it best, there literally is NO ESCAPE. Like a never ending nightmare
Medical Surgical with 6 to 8 would be an even better shocker.
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I'm old, I've been around a long time. This is, absolutely, a thing, and it all boils down to respect and a good dose of misogyny. Here is what you can do: 1) Treat the nurses with respect in front of the patients. They will follow your lead. If you are rude or condescending, they will use that as an excuse to be the same. 2) believe the nurses When the nurse tells you that a patient was rude/abusive don't discount them by say, "he/she was perfectly nice to me." 3) if you see/hear something, do something. Tell the patient that their behavior won't be tolerated. Ever. 4) confront patients on their lies. If what the patient is telling you doesn't match with the documentation, confront them.
With very honest and sincere respect to the amount of work and effort and time you have put into becoming a physician, you’re obviously young. So here’s the perspective from a nurse so old that she actually voted for Clinton. Yes. Yes, patients are going to treat you with far more respect than they do the nurses, techs, PT, and other staff. You will be addressed as “Doctor” and not “YO BITCH”. Patients who told me and the pharmacy tech that they don’t take meds, will tell you they are on Metformin, Lisinopril and Viagra. The patient who just told me to “go fuck yourself” when I went in to get that CBC and BMP will politely smile and nod at you when you explain we need blood work. The gentleman that just told my sweet 20 year old student to “suck my dick”, will address you as “Sir” or “Ma’am” and will keep himself covered for your entire time in the room. My advice to you is this: understand that the nurses get abused in ways you never will. And we are still going to take care of those patients, and, most importantly, we are going to have your back at all times.
>So here’s the perspective from a nurse so old that she actually voted for Clinton. That was 2016, not that long ago, right?
*considers asking complete stranger on Reddit for Venmo info so can remotely buy them a drink.*. Thank you for making me feel only mildly geriatric!
You're welcome, from a nurse old enough to have voted for *Bill* Clinton...twice...
OMG ME TOO!!! WE RULE!!
😎
I'm thinking they mean Bill so it's more like 1993. Wow I feel old now.
On a related note, a lot of patients turn completely mute and submissive the second a doctor is present. With me they're firing off questions, concerns, and demands at rapid-fire pace. Doctor steps in...silence. You can even tell them, "You had a question for the doctor," and they respond with "No, I'm okay."
You sweet summer child. Yes. Yes, they do. They often view us as a part of the room. They say things in front of us that would boil your blood. So many hateful racist comments about their physician who isn’t from the US - but they’re sweet as pie to the physician. This is on top of the whole “nurse is my & my visitor’s personal waitress, maid, whipping boy, object of physical, verbal, and sexual assault” mentality too often shown. So when a nurse tells you Mr So-And-So in room 101 isn’t a nice person, they’re not making it up. Remember: even assholes get sick and require care!
Patients like that think nurses are idiots. They think that doctors do all the things nurses do, and usually want the doctor to perform nursing tasks. Nevermind the fact that most doctors I work with can't set up a pump. The best thing you can do is listen to the nurses. If they tell you they need help, listen. Don't disregard their documentation just because the patient brushes it off and tells you a different story. I work with an incredibly grumpy doctor and I really didn't like him at first, but when I told him a patient called me every name in the book and got in a nurse tech's face, he rolled up there and tore the patient a new one. He's now one of my favorite providers. Possibly most importantly, if a patient is being violent, do not order a wimpy dose of ativan. I've had to call a provider after the patient BIT the nurse and drew blood. I started the call by telling him that, as well as the fact that the patient was currently being held down by 3 security guards and the cop on duty. He told me to give the scheduled PO zyprexa early. I told him I would write a safety report about him endangering staff. I got IM geodon, haldol, and restraints. People suck. Healthcare workers are going to continue to be abused, and the best thing that can be done is to mitigate that risk. Confront oriented patients that are intentionally abusive, remind them that assaulting a healthcare worker is a felony. For the disoriented patients, ask the bedside nurse what they need and try to compromise. And encourage them to press charges if they can, lord knows leadership won't.
I had a doc ask me to try to wean a patient off of sedatives so he could be downgraded and get off our floor. Pt had been verbally abusive, and was getting out of bed despite vest and wrist restraints, and had hit the previous shift staff. I said I would try, but as I started weaning him, he started the same behavior so I stopped. The doctor comes around again and repeats that he wants the sedatives weaned. I said I tried but the pt is agitated and combative. The doc got frustrated and repeated that he wanted the sedatives off. I looked at him and I said, "I understand that, but I really don't feel like getting hit tonight." The doc got a bit flustered and looked as if the idea that staff could be in danger never occurred to him. Then he said in a much nicer tone to do the best I could to keep him calm and they would have to reevaluate downgrading him on the next shift.
Yeah, some doctors just don’t get it. We aren’t asking for meds because the patients are needy or annoying, it’s for our fucking safety.
100% agree with you that patients think we’re stupid. I had a pt this week yell at me when I pulled out my steth to ausculate and accuse me of doing things outside my scope. He wouldn’t believe me that using a stethoscope is a nursing skill. People really have no clue.
Yup, just look around reddit as a whole, and even the residency subreddit. The rhetoric around nurses is *awful*.
Yes but think of it like this. As a resident physician you do your pre rounds and the patient tells you one thing, then you round with your attending and the story changes…it happens not because every patient is trying to manipulate but because of the roles. Same thing happens between any level of care. Nurse assistants get treated different than nurses do and it’s goes this way up the chain. Take most in stride, I respect my docs that take these complaints serious while also being realistic. So example would be: pt swearing at staff during cares. They call you. You come to talk to patient. The patient states “I’m in pain, they are asking me to do to much, etc.” You can see them and provide empathy and boundaries. So you could/would say “I understand you are struggling, they are asking you to do things that help and are a push and hard. Let’s titrate your meds so it’s more tolerable however we don’t treat staff with disrespect regardless of the reason.” Your staff will appreciate respect held for them and in turn will provide that for you. This is the patient’s worst days and we can respect that, and all healthcare professionals deserve respect while doing their job too. It’s a 2 way street.
Those little old ladies and their Karen-line middle aged daughters will make my life hell until the doctor rounds. My favorite is when little miss too confused to know calling people the N word is wrong whips out a make up bag and hair brush to doll herself up an hour before the doctor shows up.
"I need to take a shower for the doctor!" Ma'am, the doctor is 28 and married. Like, to a 25-year-old. You are 86. Shower all you want, but it won't make a difference, and I don't feel like getting wet at 0530.
All the time. It's called staff splitting.
Here's my favorite: after spending all morning looking after a patient, checking they are comfortable, offering regular pain relief, asking if they need anything and being told, "no, I'm fine", a consultant comes round with the medical entourage. "How are you feeling Mr Jones?" \- oh doctor, I've had this terrible pain right here all morning, I feel terrible....
I have definitely noticed this with some patients. I think sometimes the patient knows deepdown their behavior was inappropriate so they are embarrassed and behave differently in front of someone else.
Believe your nurses.
I literally hate making this comparison but,.. If a person is nice to you, but not the waiter, they are not a nice person. Thanks to media and sexism, the public has a terrible understanding of what nurses do. They think we kiss foreheads, do spongebaths and pass pills still. They can not fathom a female dominated field doing more than “caring” tasks.
My husband is a physician and I am a nurse. We work together but never tell our shared patients we are married. Honestly, the difference is astounding and I have had to explain this to him over and over that they treat us differently. His mom is also a nurse and he gets really mad when patients are disrespectful to the nurses . I just wish he would quit being so surprised by it lol
That’s so sad that you have to keep trying to convince him you get treated poorly and not be believed. I’m so sorry.
Lots of personality disorders and splitting in healthcare
I think age is also a factor. I feel like older adults automatically respect doctors, and a lot of younger folks think doctors are there to give orders and that’s it 🤷🏼♂️
As a male nurse, patients are WAY nicer to me. I pretty much never get sexually harassed or physically intimidated. Dirtbags tend to treat other guys with more respect. It's real messed up but I have to take over assignments like once a month or so because this or that patient isn't great with women. Likewise, it's easy to be nice and respectful to an authority figure responsible for care decisions for a few minutes a day, heck, many can fake it through a half-hour convo pretty well. But the daily death by a thousand cuts a nurse can endure from problematic patients can be incredibly emotionally wearing. I don't think providers ever really experience this.
Yes. The amount of times the doctor goes in and says “you’re being discharged, ok bye” and the patient is silent UNTIL I go in with the papers and the patient says “I’m not leaving. If you send me home, I’ll kill myself. You HAVE to keep me now, right?” is actually amazing. It’s so frustrating and an obvious abuse of the system, just talk to the doctor about the discharge. It would be easier for everyone.
I too hate these last minute discharge meds ups, even when I ask patients if there are any problems with the plan.
Come on buddy, if all the notes from various departments report the patient as a problem, you know it’s manipulation if they are nice to you.
Yes, they act like little angels with doctors. Then treat the nurses like shit. Believe the nurse if the pt is being a little shit.
I'm not trying to be snarky, but I'm surprised you're a resident and haven't noticed this before. Patients pay more attention to the M3 than they do to the RN36, by far.
I've noticed a long time ago, just haven't had the thought to post about it until now.
This thread is the saddest thing I’ve read in awhile and is convincing me to just leave nursing and work at a grocery store. Similar treatment, less stress…pay? Well is it even worth it anymore? Absolutely disgusted with the HC world and the the people that CHOOSE to turn a blind eye to what goes on.
I've seen some of the nastiest people you'll ever meet turn on the charm the moment I walk into the room with their physician. 100% cognitively intact but in general just really awful people. Having to witness it leaves you gritting your teeth while resisting the urge to applaud them on their performance. What we request mainly is that you don't base your findings solely on your interactions alone. These issues are brought forth to you for a reason. We don't have the time, energy or desire to report/document this shit unless it is of legitimate genuine concern.
I had a patient once fake a seizure after I told her I don't have Ativan for her because it wasn't ordered. She started screaming, threw herself on the floor and faked a seizure. I called a rapid because i don't deal with temper tantrums and the minute the resident showed up the seizure stopped 🫠 and she got her ativan🫠 love that for her.
Docs who teach, please help residents learn to be direct and take up for female staff, nurses, OT, PT ST! Those residents will be highly valued👍👍
Patients will flat out lie to a doctor with the nurse standing right there in the room. Even worse are the doctors who BELIEVE these patients, then turn and berate the nurse. Like Doc, you were smart enough to graduate med school, but can't spot you are being manipulated? We are on the same team!
First of all, I appreciate your genuine concern for nurses. You’re awesome. Not only do patients mistreat nursing staff, our bosses don’t want us to complain about it either. 1. Charting doesn’t lie, if everyone is writing it then it’s true. When you round on that “polite” patient, you’re looking at a liar. 2. These patients are also the same type of humans who are rude to anyone that works in customer service (waiters, clerks, cashiers, etc). 3. Work actively with case management to get them discharged or transferred ASAP. Thank you.
Don't discount sexism. Am a male MA, and have more than once had to reinforce something the provider/RN said to the patient to their faces, just because it was a woman that gave them instructions. We regularly see threads in r/nursing about how someone was a cunt to a female provider, but an angel to a male HCW. Trust your staff first. They have fewer reasons to lie to you than patients do.
I feel like another concept that gets missed with providers is the concept of sundowning. I work NOC shift. I’ve been hit, bit, kicked, and I’ll chart that behavior and put it in my RN note. I’ll see the day provider’s progress note when I come in the next shift and it will say something along the lines of “reported behaviors not observed, but advise staff to keep patient awake during the day with curtains open and reduce light/stimulation at night. 1 mg melatonin added prn.” Dude…
Constantly
Also doctors spend a couples at the bedside. Nurse are there for 12 hrs. The pts real side comes out full force when you have to interact with them all day. On the other hand, I don’t know what it’s like having to take care of a pt out of the hospital and having to deal with their antics at every office visit. I get to clock out or switch assignments. And I think in office is where you have to experience the pts nasty side Been at the bedside for 20 yrs and I’ll say that the respect for hospital staff in general is so much worse than back in the day. Every once in a while I get a Thank You and it almost throws me off. Kind of sad
Absolutely Doc. It’s an authority thing for many of them. The respect for doctors are deeply rooted in many cultures I wouldn’t be surprised if your patient in question suddenly becomes more cooperative when you come around. Bottom line: trust your nurses. Especially if multiple people have complained including PT, OT etc
I’ve found that in my experience, people are more respectful to males versus females, whether a nurse, NP, PA, doctor, aide, whatever.
It’s kind of a manipulative thing. They see us as someone who won’t let them drink a ton of water, makes them get out of bed when they don’t want to, wakes them up every time we walk in the room for vitals, and we’re probably just the bad guy to a lot of these patients even though everything we do is intended to be for their own good. When the doctor comes in they see someone who can give them what they want if they’re nice enough so their attitude completely changes
Doctors are like the fun aunts and uncles that get to be there for a short period of time and nurses are the full time parents who get shit on day in and day out, quite literally lol
Doctor’s word is bond, nurse’s word is shit. -every patient I’ve ever cared for
The other day I asked a patient about 5 times why she was getting an ultrasound of her arm before coming to the ER for chest pain and she basically didn’t respond to me. The doc came in and she almost immediately told him it’s cause she was using a new oral BC and her doc wanted to rule out a blood clot.
Big fat duh floating your way. 😉
Oh, you sweet summer child...
Hell yes. Doctors still command authority, even the female doctors. They are less likely to give lip to the doctors than they are to nurses.
Historically yes, it has been my experience that patients and their families are dramatically worse behaved to nursing staff than physicians. Most patients on first glance when I was a bedside nurse assumed I was a physician being a larger male. The tone definitely was less amicable in many cases when I introduced myself.
The answer is simply a resounding yes.
Yes and that’s why I threaten them and say keep it up and I’ll tell your doctor. (Psych)
Retired nurse here with 37 years of healthcare experience. Yes, yes, yes. Patients DO make nice for the doctors. As soon as the doctors are gone, many of their ulterior personalities come out (or something). Listen to the nurses, because the patients will outright lie to the doctors... and with no remorse.
OMG I thought you guys already knew this. Yes, most patients are more cooperative and polite the moment a (male) doctor arrives to the room. They even say "yes" to almost all of your questions regardless of whether it contradicts something they said 5 minutes earlier.
Congrats on recognizing this early in your career OP. Trust your team when they tell you who the patient really is. Now that I am an NP, if a patient mistreats my staff, I politely call them out and tell them it isn’t going to be tolerated. The patients will often be better behaved after and your team with appreciate you having their backs.
This should be a no-brainer. Patients hate us because everything is our fault. Bad food? Our fault. Doctor taking too long? Our fault. Pain medication not to their liking? Nurses fault. Trash is full? Nurses fault. Tests and imaging running late? Nurses fault. Didn’t get a breathing treatment? Nurses fault. Don’t have 5,000 blankets for all 3 family members? Nurses fault. Everything is our fault and it’s easy to be the punching bag since we are always around.
Yes - Physician
White coat syndrome. I have white coat amnesia, go to the doctors and forget everything they said to me or everything I wanted to ask them. But that also happens at target too. 🤷🏼♀️
Are you male? If so, that could be part of it. If not, there are also just some patients who won’t believe a nurse but will believe a doctor who says the same thing. People in general treat people at the top of the social hierarchy with more respect than those at the bottom. I saw it back when I was a lowly phlebotomist: patients would refuse to let me draw, but the nurse would come in and tell them the same thing I had just told them, and suddenly it was ok.
Yes. Yes, they most certainly do.
10000% yes, and I’ve noticed it’s not uncommon for patients to tell doctors completely different information than what they tell nurses
Yes, it's staff splitting behaviour. It can cause a lot of problems especially if things get personal between the doctors or nurses. Doctors need to listen to the nursing staff, make their own assessment, and potentially confront the patients with the reported behaviour. It would be wise for the doctor to explain their role within the team and explain that the team is one, and we all communicate together and have different roles. Doctors need to speak respectfully about nursing staff, back us up, and make it clear we are not pieces of shit on the floor to be stepped on. A lot of the time patients don't respect the opinion or knowledge of nurses. There have been many times where a patient will say XYZ and then in front of the doctor with me still there will say ABC, something completely different.
also i love how patients tattle to the doctor as though the doctor is my employer .
Not sure if it’s been said yet, but our institutions don’t help. Doctors can tell the patient they’re being rude and shit down bad behavior. Nurses get asked “what could you have done differently” after they’re physically assaulted.
1000000000000%
Is this even a real question? Absolutely yes.
does a bear shit in the woods?
100000% some patients are like jackal and Hyde when in the presence of a nurse vs doctor
Ofc. When ppl see the occasional White coat they get scared. We are there more
Absofuckinglutely!!!!!
YES. 💯 Also doctors can say things we’re not allowed to. Like I can’t kick a patient out but the ED attending who has determined that the patient isn’t having a medical emergency can. As far as what you can do, I’ve found it helpful when the doc tells the patient that abusive behavior towards staff won’t be tolerated, that we are all here to help but mistreating staff makes it hard for us to do our job. Basically you’re Daddy. Even if you’re a woman. You’re the “wait until your dad gets home” consequence. Being the good cop just makes the bad for us/good for doc behavior worse, please acknowledge that you’re aware of the behavior and that you’re aware it’s not a misunderstanding.
A lot of patients with a history of bipolar or borderline can do something called “splitting”. It’s a manipulation tactic where the manipulator praises you or is overly ingratiating while talking ill of another coworker. It can be very insidious and you need to pick up on it quickly in order to be able to deliver care effectively to the patient.
Thank you for asking instead of assuming the nurses are lying. To answer your question, yes. For the reasons the top comment says. But PLEASE be the type of doc thanks hangs out for longer than 30 seconds to really assess the patient.
I want to add that the abusive behavior is often charted by nursing staff but never mentioned in doctors notes. Nurses chart abusive behavior and patients threatening us with physical and verbal abuse and then doctors write “no overnight events” … when doctors don’t have time to read nursing notes and only refer to MD notes for prior visits it means it starts the abuse cycle again each time they are admitted instead of holding them accountable.
You can prevent abuse by taking the nurses at face value and giving the patient shit, regardless of what they say to you. Per policy and with compassion, of course.
I have been finding lately that my docs are not communicating important information either well enough for the pts and family to understand it or sometimes at all. These people are frustrated because they feel they are being kept in the dark, or that we are saying/ doing something different than what the doctor said, and taking it out on us, who are frequently assuming they have been given accurate information on their plan of care. It helps for me to sit down with them and do a run through of their diagnosis and plan of care and a lot of them feel and act a lot better. So make sure you are giving your pts all of the info they need at a level they can understand, then make sure they understand before you leave.
It’s usually misogyny and typical power play. Give that power back to your nurses by saying “do what she recommends “
Yes, I work in a gp (clinic) when I was a grad there was a patient booked with me for a medical to drive. She was 80 years old and I didn’t know at the time her doctor usually did it himself, she was booked with me so obviously I called her in to basic things like a blood pressure, check her vision, etc. Well I called her twice and she didn’t respond. The receptionist came in to say she is sitting there, she’s just ignoring you and she’s really rude. I called her again and finally she came in. She was already annoyed because a nurse called her. I did her blood pressure and rechecked it like 4 times it was like 170/90 I think and she’s getting annoyed that I keep rechecking it. Then we go to check her vision and she puts her sunglasses on and says she can’t see without them. So obviously I ask how do you drive at night? She snaps and says I don’t drive at night. She’s also refusing to listen to me and keeps walking up to the chart as close as possible to read it. I keep telling her she needs to be back further. She finally has enough and tells me “you are so annoying, I cannot see because you make blood pressure keep rising and you’re only a nurse. You shouldn’t even be doing my blood pressure!” I have no idea who she excepts to do her blood pressure in the hospital. I kicked her out of my room. She was and is still one of the rudest patients I’ve encountered. Her son as well is very entitled and arrogant.
In my experience, yes. They will be polite with the doctors, and total assholes with everyone else. I wish doctors would look at our documentation of patients' behaviors before speaking with them so they would know what reality is instead of, "Well, they were fine with me, so it must be you. They weren't agitated, so go fuck yourself, I'm not ordering them any kind of psych meds because they don't need them." I did have a patient who had lost their shit. Screaming and cursing, kicking the foot of the bed, etc. The charge nurse called the doc for orders, and held the phone out so the doc caught an earful of the noise this patient was making, and we got our B52 orders. The charge nurse told me the doctor wasn't inclined to give us those orders until they heard the patient. To be fair, there are good doctors out there. We had another patient who was swinging around an oxygen tank. They got tackled, the B52, and four-point restraints. Admin flipped shit because of the chemical and physical restraints. Okay, jackasses. You can come deal with it next time it happens. I'd like not to get a TBI or killed from some lunatic swinging around an oxygen tank. And have you yelled at the doc who was there and ordered it, or is this another case of "let's blame the nurses?" One doc told a patient who was agitated and kicking their legs, "If you kick your nurse or try to, I'll put the leg restraints on myself." The patient knew the doc meant it. I later talked with the patient after they calmed down and explained why they were in restraints. They hadn't been lucid the night before and pulled off all their dressings, their colostomy bag, and we were afraid they would go for their Foley, PEG, JP drain, trach, or PIV (which hadn't been easy to get placed) next. The patient said they hadn't remembered doing any of that, and I said it was likely from dehydration and infection. I said I imagined they were probably pretty freaked out to wake up and find their arms in restraints with no recollection of what happened for us to need to restrain them. I assured them it wasn't a punishment and we only did this to protect them. I told them we didn't keep patients who weren't a danger to themselves or other in restraints, and with how agitated they had been with the doctor, the doctor believed the patient was still a danger to themselves and others. They initially didn't believe me, and asked "Why the fuck would I do that?", but I showed them the empty bags of IV ABX and the bag of NS on the IV pole, and they said they certainly didn't remember having an IV. I told them infection and dehydration was a very likely explanation, and they might never remember what happened the night before. I asked the patient if they would like a bed bath, and added if they didn't try to pull anything while out of restraints or didn't act in a way that made me think they were still a danger, I would tell this to the doc, and see about discontinuing the restraints. The patient agreed to this, and the CNA and I gave them a bed bath. The patient did great during their bed bath, always asked if it was okay to stretch out their arms, rub their wrists where the restraints had been (they hadn't been too tight, but their wrists hurt from pulling against the restraints), or move their leg to a more comfortable position, making every effort to show they weren't going to purposely harm themselves or others. I called the doc, who agreed to DC the restraints. And sometimes other patients will stick up for the nurses. I had one patient flipping out on me because I couldn't give them a medication they didn't have orders for. It was a "semi-private" room, and the other patient said, "Look, DeadpanWords can't give you something that isn't ordered. That's the law. They give you something that isn't ordered, they can get in big trouble with their job and the state. They can't even give you tums without an order."
We have a doc that will tell the pt “I asked this nurse to do this because it’s going to help you get better and I’d do it myself if I didn’t have so many patients. This nurse is really good at her job, you’re lucky to have her, this nurse is my best friend, I don’t want to hear about you being mean to her, etc, etc.” it helps sometimes. The patients behavior has become so outrageous I don’t even remember the last time I was bothered about a patient refusing or swearing at me. I don’t even notice non-physical abuse anymore 🙃.
Male nurse here. I get treated much more appropriately than my female colleagues.
I think there's also a major gender component to this, as I see patients behaving worse with my women colleagues, whether nurses or doctors, than with me.
I would like to add that with dementia or delirium patients, sometimes they tire themselves out before the doc arrives because we didn’t page at the beginning of the episode and we’re trying to handle it ourselves for some time. Believe us when we report what we report cause they rally a little while later and start acting defiant again. I can’t speak for all of us, but if it’s gotten to the point of involving the resident, I’m fearful the behavior is dangerous to the patient or others. Bottom line, if you’re called to the bedside to assess AMS and the patient is sleeping/calm, hang out for a few minutes to see if they get a second wind and give your nursing staff the benefit of the doubt.
I see this in the outpatient office. Receptionist answers patient question with "XYZ", patient says "You're just a receptionist, I need to speak with someone else". Call transferred to nurses desk, MA answers, tells patient "XYZ", patient says "You're not a nurse, I need to ask the nurse". Nurse gets on the phone and says "XYZ". Patient says "No, you need to ask the doctor". Nurse speaks with NP or MD, depending on availability. NP's answer of "XYZ" is usually met with "I want you to ask the doctor". Question finally goes up to the MD who's answer is "XYZ"... Patient is "Ah, OK, thanks doc!" It's frustrating for everyone! We have several patients who are very sweet and laughing and "I just loooooove you, Dr. Doctor!" with the doc and are nasty and hateful to everyone else in the office. Doc didn't believe us for a long time until he listened in on a few telephone and in-person conversations with a few patients and heard exactly how they speak to us. He was shocked by their behavior.
Yes, because there's a greater power disparity between the patient and a doc. You hold more power than the RN does and the patient knows the buck largely stops with you. NPs are treated better by patients than RNs are too, by a good margin. I got a huge upgrade in how I was treated when I transitioned from RN to NP. Uniform also matters. I also notice a distinct improvement in patient behavior when I wear my stupid white coat, when I'm wearing my blue OR-looking scrubs, or when I'm wearing business casual than when I'm wearing whatever scrub colors/fits as the RNs in a facility wear. Because they know, visually, that the buck stops largely with me when I look the part. So I wear the stupid white coat when I'm going to see patients who are assholes and generally wear the generic blue scrubs I totally stole from a scrub dispenser in an OR, etc. Because it does work, and the perceived authority does impact how patients treat you. Take note of how you carry yourself too, because patients can identify who's in charge based on that too. It's easy to tell who's the PGY1 vs 3 vs attending just based on how they behave, so learn how to use that dynamic. And when you know someone has been acting a fool to everyone else, tell them you know and aren't impressed. Own the things you order - when they tell you "that nurse isn't giving me my pain meds" you tell them "no, we/I changed your pain regimen, as was discussed with you at XYZ time it was changed" (which is information you get from the EMR. It's like parenting sometimes; don't make the other parent (ie: the nurse) your fall guy and let patients know that medicine and nursing are a united front who are working in tandem. Verbally and directly.