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Power & Authority
Stunned into Silence
When you know the doc is wrong.
By Brittany Heck
It was the ninth hour of a 12-hour night on Labor & Delivery when my fourth patient presented with complaints of vaginal bleeding. Exhausted, I told myself this had to be another worst-case scenario—probably placenta previa or abruption.
I initially performed a comprehensive review of symptoms and thorough patient history, which I presented to the resident. He was a cocky first-year resident, just starting his first clinical rotation. After I presented, he ordered me to perform a manual exam to see if the patient had dilated her cervix.
I was trained never to check a patient who presented with vaginal bleeding. So I questioned the order. Tactfully, but perhaps too timidly, I asked, “Are you sure?”
“Why are you questioning me? You are just a nurse. You didn’t go through medical school.”
I froze. Maybe he is right, I thought. I’m not competent. I am merely a nurse. Weeks later, the negative self-talk continued and I second-guessed my assessment of patients and ability to provide the best possible patient care.
Many new nurses can be stunned into silence by an intimidating physician. With practice, though, you don’t have to—nor should you—stay silent. When I know the doc is wrong, and I’m right, I try to follow these steps:
• I take a few moments to collect my thoughts and emotions before engaging in further discussion;
• I always try to remain professional, no matter how uncomfortable the situation;
• I ask the physician if he/she would take a few minutes to discuss the situation in more detail—outside of the patient’s room;
• I explain to the physician that nurses, as a patient’s advocate, are obligated to act in the best interest of the patient. I supply evidence to back my stance;
• If my authority is still questioned, I ask the physician to supply evidence-based guidelines upon which his/her order is based;
• If there is an impasse, I research the hospital’s policy; and
• When necessary, I utilize senior nursing staff to support my actions.
I wish I could say a doctor has never demeaned me since, but it occasionally still happens. The difference is I don’t let my confidence take a dive. I work out the issue—and so can you.
Brittany Heck, RN, MSN, FNP, is a nurse at Swedish American Hospital in Rockford, IL and a RealityRN Nurse Advisory Board Member.
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October 15th, 2007 at 6:18 am
If you are right, you are right.
If the junior doc, thinks otherwise you can always refuse to do it as “not in the patients best interest”.
At best the doctor will go crying to his seniors who will probably back what you’ve said. Lesson soon learnt!
Max
November 29th, 2007 at 5:57 pm
grad-itis, demi-gods… to bad the doc forgot he is human and is capable of making mistakes…
December 22nd, 2007 at 7:35 am
He’ll learn his lesson the hard way. Fortunately not too many new grads are like that, in fact most doc’s are terrified, but what goes around comes around.
I get around bad direction by a doctor by asking a question that will make him think he has come up with the idea himself.
eg I say things like “What do you think about.. or Have you tried…”
July 22nd, 2008 at 3:04 pm
I think this nurse is rude and lyier. As a nurse dealing with residents, they are very nice and want our approval, they only become stubern when the nurse is rude and cocky as the one above.
July 24th, 2008 at 11:48 am
that’s too bad, tina. i think that as nurses we often put blame or fault other nurse’s too quickly, only to harm our image. And what you said is not true. We recently moved our whole hospital to a new location and afterwards were extremely busy for 6 straight months, which meant people were very tired and under a lot of pressure-and unfortunately these feelings were taken out on nurses-not because the nurse was rude or cocky to the interns/residents but because the doctors didn’t always want to deal with non-life threatening issues like tylenol for a headache.
July 28th, 2008 at 10:00 am
Tina,
Your argument is as well formed as your grammar. However, to pull the crucial element from your post; there is definitely a need to maintain a mutual respect.
Unfortunately, as nurses, it is often the case that medic-nurse interactions take the form of parent-child rather than adult-adult interaction. I have very rarely seen a nurse take the dominant stance against a doctor. That usually only (successfully) occurs when the nurse is experienced enough to know they are right and refuses to compromise their standard. This is not being rude - this is being a professional.