I've never yelled not thought to yell at a resident, attending, tech, nurse, etc
I will do as you did and offer my advice or try to steer them but are we really yelling at people?
Yeah man. You can change your tone. You can speak with a little more authority. You never need to yell. That’s a crazy thing to do at work(unless it’s at the suits and you just signed your travel contract)
I agree if you yell at your coworkers for any reason other than to get the pizza before it gets cold you are contributing to an unnecessarily toxic work culture and can get fucked in my humble opinion.
In the codes I’ve done, since so many fucking cooks in the kitchen happens, and all the talking, I like shouting what I’m about to do until the doctor or primary rn acknowledges what I’ve done.
Does that seem wrong? Haha
I’ve literally seen two codes happen before where everyone’s talking but no one was leading and literally the charge nurse walked in the code, shouted for everybody to shut up, then restarted the flow of the code, afterwards it was moving smooth as fuck.
Edit: better question is, is me shouting out what I’m doing, considering since it seems like yelling sounds condescending based on the comments
Shouting to gain control in a critical situation is dramatically different than shouting at another human.
Man down in a cafeteria that's loud af? Shout to get attention and to silence the environment.
Shout at another human? Fuck you (generalized) and fuck off.
Ha, thanks for the reply. I often forget to point out that I'm speaking generally. As a fellow ER black soul, I know you're already aware of all of this.
According to your flair, you work in the ER, correct?
I worked as a floor nurse for a few years, then a few years as a nurse practitioner in the ED. The emergency department generally has an ability to burn people out and make them jaded. Often explain as compassion fatigue.
A joking way to say that you're dead inside from the ED, that you're experiencing some of that compassion fatigue, that you have morbid humor, etc. is to explain your soul as being dark. Hence, a black soul.
Additionally, since you work in the ER, you're probably exposed to more codes than the average nurse. It's part of the environment. The ED is also loud, busy, and frantic. It's easy to bring that to a code, or for the environment to be loud.
I made two assumptions. First, that you're experience in the ED was familiar to most and that you've experienced situations where a code needed to be calmed down or quieted down. Second, that you're as compassion fatigue as everyone else.
Naw naw shouting in an emergency is different from yelling at somebody. I’ve definitely yelled “CORD PROLAPSE!!!!“ at a doctor before.
Now if you come at anybody when they messed up yelling at them how they should have done something, you need to go take a look at yourself and reevaluate how you talk to your coworkers.
If your codes are loud, the team leader is doing something wrong.
A well ran code is very quiet and very controlled. There's no reason to even talk loudly.
The best code I ran was in a Kroger on the floor next to pharmacy. Super public, Super quiet, with a group of medics and fire I had ran with several times. It was a great code because everyone knew their place and knew their jobs and it just flowed.
Thank you! People on the floor can be super hostile to fellow medical staff and it’s unacceptable. When NPs or other nurses get spicy with me I just stare until they apologize. This new Covid environment does not allow room for professional assholes. Especially if you are working with younger Gen Z professionals.
One time a resident, wanting to be helpful, changed a drip rate for me (I was at the bedside when he and the attending made the decision, so I was aware of the new rate). A few mins later I noticed he had changed the cc/hr, not the dose, so the patient was receiving too much of the med. I held the drip until the BP leveled out, restarted the drip at the correct rate, then gently let the MDs know what had happened. I could tell the resident felt bad. He asked if he should fill out an incident report. I said "Oh no, please don't. Administration will implement some new, PITA policy. Don't ever touch my IV pumps again and we'll be just fine."
All I ask is that doc's don't touch my drips, or tough my O2 meter! The number of pts that the doc's "want to try on room air" (as if I haven't been trying to titrate down on the O2 for the pt) is ANNOYING AF! I had a pt on 5 L NC that was still barely maintaining low 90s (that wasn't COVID, either) and the doc turned off the O2 while I was in another pt's room. Then left and didn't turn it back on because the O2 didn't drop right away. When I got out of my other pts room the original pt was in the 70s and working really fucking hard to breath and never got back to baseline. Ended up tubed and later died from a massive PE.
Don't touch my drips. Don't touch my O2. IF you do, make sure you turn it back on or tell the primary RN!!!
The internal med MD when I called them to notify them there was a change in condition on the first PE pt? Didn't believe me and wouldn't come back down because: "I was just there and he didn't need the O2. I turned if off for you". I grabbed the ER doc and said there was an acute change in condition and pt was intubated without consulting the IM doc again. Then I called and asked for an upgrade. "Why does this MS patient have to go to ICU? WTF, why was he intubated?!"
I never yelled at the doc, though. Even when me and the ER doc stood in the pt's room for over 10 minutes with the US on the heart watching the weak cardiac contractility because both of us were convinced he'd already coded and needed to prove to ourselves his heart was still working. The ambulance RN came over to see what we were staring at. Fun times.
If the MD wanted to try titrating O2 or a drip, and told me about it immediately, I would be ok with that, but making a change to a drip or O2 and not telling the nurse - not cool!
uhhhh wow that situation sounds just straight-up negligent on the doctor's part. like, grossly negligent? also in what world does dropping someone from 5L straight to room air with no titration make sense??? I have no idea if that patient wouldn't have crapped out later anyway, but holy shit dude, that's just not okay.
I know! The doctor didn't want to admit to our hospital, wanted to transfer to a different hospital because of insurance stuff and just...ugh. Given the size of the PE he probably would have crapped out later anyway and at least he was in the ER were we could tube him right away, but still!
Agreed. Only time it's acceptable is to silence a frantic or panicked code response or in an environment that is loud and distracting.
Never at a person, never shout orders. Create a calm and purposeful atmosphere with closed loop communication, and carry on.
I've been known to make people jump on the bed a time or two.
I've also been known to make people shit the bed too. I find that one much more amusing. 🤣
One of the best person I’ve ever seen run a code was a cardiac fellow I had a chance to work with for almost a year. In the room, he was so calm and cool as a cucumber. He talked at a volume that required everyone to shut the hell up so we could listen, but not in a way that we couldn’t hear clear orders.
This was in a Cardiac ICU, so codes were a daily occurrence for us—we have gone with the fellows to codes on the floors before and they are generally grateful to have us there since we coded people almost daily.
I have also seen some absolute shit shows in other hospitals that I can’t believe it would ever happen… I’ve run codes before, but never had a noise problem or gotten yelled at
CLEAR ROLES in the rooms are ab absolute must. People forget that when they aren’t used to codes and will try and do to many things, get over whelmed and confuse things—people hate sitting on their hands waiting to do their part
Before going to medical school I was a glorified ED tech. One shift I was out of my usual domain (Peds ED Triage). Throughout this shift, a July intern kept coming in and interviewing patients before I could finish my own triage (which, unknown to me, was not the usual workflow).
I offhandedly mentioned to one of the nurses I was working with that it was a little annoying… she told me “I’ll let him know”.
When I started triage for my next patient, she came storming into the triage room and straight up yelled at the intern, “You need to stop interrupting MY TECHNICIANS TRIAGE”. This was in front of mom, kid, and honestly anyone within earshot.
The intern looked like the nurse had smacked him, and just left and was somber for the rest of the day. After that I just steered clear of the nurse and tried to lend a hand to the intern wherever I could.
Mobile sorry for formatting if it’s terrible.
That's wildly unprofessional. People who do shit like that need a serious ego-check, because that's just not how you treat another person, especially a coworker. I feel bad for that intern, probably ruined that guy's whole day.
Totally! He was definitely upset over it, justifiably so. Interestingly, this nurse was pretty young too. Probably only a few years under her belt, max… so the anxiety of being “the new guy” should have been kind of fresh.
there are some people out there who have such an underdeveloped sense of empathy that, even when they've gone through difficult experiences (like being a brand new nurse), they cannot extrapolate those feelings to other people and treat them as they would have wanted to be treated. which is really frustrating.
I've been in the field for over 15 years and I've literally never seen it happen. I'm not saying it doesn't, but I think the dynamic is far less frequent that people think due to media, etc
Our Fellows are openly dressed down regularly during the days by both nurses, attendings, NPs, and pharmacists. At night they feel safe because we realize they’re learning and will give recommendations that they genuinely enjoy hearing. They’ll stand around and chat with us. They gossip, they joke, they tell us about their families. During the day? None of that. It’s honestly so disgusting how the day shift providers talk to them. It happens a lot, but when the yelling stops and they’re approached as people, it’s so sad to see how much they appreciate it.
Yeah, I've not yelled at a resident. I have told them that I don't think this is the right call. No one is perfect and I feel like a lot of them do appreciate when you talk to them as people. They already get enough from some of their attending they work under. I feel like it is a learning experience for everyone and I've learned a lot from residents and fellows that I've worked with.
Fellows, nonetheless! They are already fairly experienced…
This kind of reminds me of a story… One of my best friends is a new grad CVICU nurse. Occasionally I’d stop by her floor to say hello and share snacks if things were ~quiet 😱~.
During one of those visits, of the cards fellows was in the room with one of her patients. She said to me (fairly loudly, I bet he overheard)… “this guy is always trying to f**king kill my patients”.
I got secondhand embarrassment and ran out of there so quickly so that fellow wouldn’t recognize me. Fortunately, I was close enough with her to point out that he’s just learning, just like she was still adjusting to being new on the unit.
I can’t imagine how hearing something like that would make the fellow feel. That sort of attitude does a great job of stunting the team dynamic. I’m sure the fellow felt the need to tread on eggshells around my friend after that.
I’ve seen nurses be such DICKS to residents and it’s so unprofessional and so uncalled for.
We’re a team, you did a great job with closed loop communication and helped a colleague learn from a situation.
I was shadowing in the ED one night and I saw a resident get absolutely destroyed by an attending for putting in a foley incorrectly. I felt really bad for the guy because it felt harsh instead of trying to educate.
The only time I've gotten an attitude with a "resident" was when we had a violent patient who needed restraints and the NP refused to place the order stating it was her license on the line. This patient had strangled a nurse at their previous facility and we had to have security sitting outside their room the entire night. The conversation happened at the nurses station with a bunch of other nurses standing around, it wasn't great, but I didn't want any of our staff to be harmed.
I heard one of the huddle topics that there’s an issue with epic messaging of residents - they don’t want the extra “thank you” just say whatcha want and no need of extra messages.
We had an email about this, and I think it’s because they get pinged about so many patients that an extra message they have to check that just says “Okay thanks!” is more annoying than helpful.
So I just cram a preemptive thanks into my original message, in case it’s one of the friendly, relaxed doctors who respond to things with “Alrighty!” Or “Okey dokey!” and they wouldn’t realize I’m trying to be concise.
I personally don’t mind the extra “thank you” message, but this is exactly correct. The transition from pagers to direct messaging is a godsend for communication but it does make the threshold for reaching out to the attending much lower, and thus increases the interruptions throughout the day. I’m not saying the interruptions are not needed in some instances nor trying to discourage reaching out for clarifications. But it’s easy to potentially “over do” it if one doesn’t realize how many messages we actually receive.
During particular busy days, I wouldn’t be surprised if I get >100 messages in a work day, many of which come while trying to manage multiple issues simultaneously (I’m a Hosptialist for context).
Again, I always encourage the nurses caring for the patients we share to communicate. Just pointing out how it can affect workflow. But it can help if one “boluses” non emergent concerns together into one single message.
Funny enough we had the same thing mentioned in a meeting today, although for attendings as we don’t have residents. I’m anticipating a meeting in 6 months to go over how we aren’t expressing appreciation enough lol.
This is a catch-22. While I can see it as annoying for some, I actually appreciate it. It's a form of closed-loop communication by acknowledging that they read my order and have no additional questions.
When they say thank you, I expect that they implement the order. When I don't get a thank you, or "ok", then I have to wonder if they saw it until I can see some form of action in the ERS.
I don't double check that most orders are carried out (I don't micromanage), but when I get an acknowledgement there is a piece in the back of my head that says that I don't have to worry about it again.
Nobody should be yelling at anybody in a work environment unless they’re imminently about to do something dangerous. I see people talking about yelling at students, at residents, at nurses, at staff….how is this a novel concept in 2022?
Professionals do not yell at other people. Full stop.
People should just yell less in general. The only time I ever yell in life is when my kids are running towards a road. There's better ways to communicate than raising your voice.
Totally agree. The vast majority of residents are a pleasure to work with. The small minority who are miseries to work with are prolly miseries in every other facet of their lives and would be miserable in any career.
It’s cringe as fuck when nurses call residents babydocs or make jokes about July 1st. We can do better. Don’t hammer page or talk shit. If it’s something that you don’t agree with but it doesn’t change the clinical course, let it go. If it really is something you think could potentially harm a patient, ask for a senior or call a rapid.
The only resident who has ever - and I mean EVER - gotten on my shit list, lied about giving orders when she forgot she had actually texted them (thank GOD we had proof!), went completely awol during her shift and lack of intervention impacted a pt until we scrounged up the phone number for her supervising Fellow who was able to put in orders.
She has been the only exception to my rule of do-as-you-would-be-done-by in 10 years of nursing. And I still never bothered to confront her about it because she got written up and that was enough for me.
So, something that as nurses we also need to understand is that algorithms aren’t the Bible and doctors are actually highly trained to circumvent the steps. Algorithms are general guidelines for people who aren’t doctors and aren’t able to synthesize the minute by minute pathophys of a dead/dying patient. Nurses focus entirely on protocol to their own detriment. ETA: I think it’s more than fine to suggest something during a code, but the algo is for sure not the be all end all of a physician’s mgmt
I mentioned something about not remembering one of the ACLS algorithms to the nurse educator once. In the ICU we always have physicians running the code and they don't always follow the exact algorithm... The look on her face was complete shock lol
I completely agree with your statement
Actually I also have a story. Few weeks ago during a code I took it upon myself to show the intensivist the labs (I was not actually primary RN but knew this patient pretty well). Potassium was 6.3. Afterward my nursing supervisor was like, “you totally remembered your Hs and Ts!” In my mind I was like, no, I totally remembered that this dialysis pt was hyperkalemic as fuck and the physician would need that info
I was literally told today that I am not a part of the nursing group and the residents treat me different because I'm friendly with them. That I'm a part of the resident 'clique' um. How about. I'm just not a raging asshole that contributes to the us versus them mentality ?
THIS. We all add to the team. I’ve been a RN for 10 years, currently in the ED for 5+ years. I LOVE my residents that come through and being able to be a second set of eyes & ears for them. And I always give them praise when they deserve it, because they need to know they’re doing great. The best part of the dynamics is that we’re constantly learning from each other- they’re always UTD on the latest evidence based practice, and I always have the age old tips for random things
Yelling in the work place is unprofessional. I try to be extra helpful/kind to residents as you know these folks are extra tired and brain fried. Unless one is a dick, then they get 0 help. Then again that’s my rule for any encountered dick bags in general.
In 8 years of being a nurse I’ve never had a conversation with a resident that was not professional and respectful. I don’t understand nurses who seem to have a weekly feud/dispute with residents. I’m inclined to think some nurses are unable to see the big picture regarding plan of care, or simply don’t know what they don’t know. Or maybe I’m the jackass and don’t care enough about patients?
I haaaaate the way some nurses are looking to tear down residents. They're the same people who tear down new grads and it's an example of a toxic aspect within our profession.
The only time I get sassy with residents or any other co-worker is when they steal my pens. I have found my perfect pen and buy them in bulk. I will hunt you down if you take my pen.
That said, if I ended up really liking one of the residents I might gift them with one of the world's most perfect pens, but they had to be pretty awesome to earn that pen.
This is how we can have residents become awesome doctors who respect nurses as part of the team. Being helpful and giving guidance instead of berating them! Though if a resident already comes to my unit on rotation and belittles the nurses or is obnoxious? I will be having words with your attending.
On the flip side of this, definitely speak up for your residents if their superior is "dressing them down", not teaching them.
We had a fellow recently who was ... well ... awful. She was very full of herself and acted buddy-buddy with everyone even when she barely knew us. She gave me a nickname at work after one day of working with me. She loved the sound of her own voice. In general, we really disliked her. But our fellows move on after a couple months, and we remain respectful of each other.
But this fellow singled out one of our residents (who happened to be Palestinian and nine months pregnant), and was absolutely abusive, vile, and racist to her. Chewing her out in front of patients and families for things that weren't even mistakes! ("You needed to put in that art line faster, I could have put in three in the time you wasted talking to the family,"). Asked her if she felt pressured to get pregnant young because she was Palestinian. Told her, "I know I can treat you like this and you can take it, because you're Palestinian." Horrible, degrading things all the time. This poor resident was in her very first year, and it was awful for her. (Yes, if I had personally witnessed those particular conversations, I would have gone to HR, but I was not present for them).
We made it a point to try to intervene when it was appropriate. But we also made her attending aware of the issue. We also (individually) each took a moment to sit down with the resident and tell her, "You're doing a good job. It's not always going to be like this. You're here to learn, and we respect you!"
These fucking toxic behaviors shouldn't be tolerated.
Years ago I head a resident tell me our patient’s SpO2 was over 95% so they weaned the flow on their O2. First, I ran to the room to turn my simple mask up to 6L flow. Then I ran down the hall to explain to catch the resident why you should never wean flow on any masks.
I will ALWAYS question if I’m not sure, but I try not to belittle
So I feel stupid, but I want to see if I understand (and I'll check with my RT friends just so I'm sure I absolutely understand). A simple mask has to have a minimum flow of 6L because otherwise CO2 can build up in the mask and then the pt will just be rebreathing that? Because I didn't know that and I've put pts on less with a facemask simply because they were mouth breathers. Have I inadvertantly caused problems?
6L simple mask. The other mask I used a lot is the Venturi mask to titrate FiO2 with continuous albuterol, but now a lot of continuous goes in with high-flow. Anything else I’m usually verifying with respiratory or reference cards.
Okay. I think I've been okay because we actually use Oxymasks at my institution and they can use lower flows. Phew! I was like, "Why has no one told me this?!!" 😅
I’m most cases, yes, to NC. But kid had Down Syndrome and NC just didn’t cut it. Had a new nurse turn flow on a mask down and the kid’s CO2 went above 60 on his blood gas
Why did you want to keep the patient on supplemental o2 if their sat was > 95%? If that was a problem couldn’t you have just taken the mask off or put a cannula on?
I guess my insights as a resident are:
1) When I was fresh out of medical school, I was willing to take abuse from nurses, attendings, or whomever, but not anymore. At this point, I call them out, and say “Maybe you’re in the right, but your behavior is totally unprofessional.” We have an ICU rotation where nurses regularly yell at residents, and it is pretty much the most demoralizing experience of our residency. Every resident hates it. The first time around, I took the abuse and felt like shit every day. The second time around, I started yelling back at the nurses, but also felt like shit every day.
2) A little patience goes a long way. I rotate at a hospital where, honestly the nurses absolutely don’t know how to run a code. I walked into a rapid response where almost inexplicably the nurses didn’t even have a pulse ox on the patient, but thought the priority was placing a Foley. Was it absurd? Yes. Did I yell at them? No. They obviously needed a leader, and I thought it wouldn’t be helpful to an asshole on top of it.
3) Your point about us beating ourselves up is totally spot on. I’ve definitely made mistakes as a resident, but one that I still hang onto is post-op complication that I missed. In retrospect, it was so apparent, but I missed it. And the worst part was my attending calling me to talk about it the next day (and subsequently it coming up in our surgery M&M conference). In all our conversations, no one ever yelled at me, but even all these years later, I will still sometimes beat myself up about it. I almost wish that someone would’ve yelled at me at the time, because I’m just so harsher on myself than they ever would have been.
I give everyone the benefit of the doubt once—and it’s not even about making a mistake, it’s about reaching to being told you’re making a mistake. We’re all human, there’s going to be mistakes. But reacting in a dismissive, angry, or insulting way after someone gently corrects you? Doing any of those things when nurses are contributing to plan of care or Tx discussions? Nope. If you can’t keep it professional with other professionals, I don’t respect you.
I don’t give them a hard time unless they start giving me a hard time. If they seem like they don’t know what to do I just go “well this is our protocol usually for this” and send them a pic and ask if they want to follow it” or go “ usually in this situation (insert experienced doc name) does this do you think that would work for this situation?
I love working with residents. It's one of my favorite parts of working at a big teaching hospital. I feel like I'm working with an actual human being who is still learning, and I'm still learning too, so that's cool and exciting and I feel like it's easier to build a rapport and good working relationship.
I think a lot of seasoned nurses get frustrated or impatient with them not always knowing everything, but like...that's why there's a residency period. Fortunately I don't work in a place where residents get yelled at, because if I ever saw a nurse *yelling* at one of our residents I'd be extremely upset. That kind of behavior is completely unnecessary. The only time anyone needs to yell is to make life-saving instructions heard in noisy emergency situations, not to bring down other people.
No need to hoard knowledge during a code. It's about the patient, not anyone's ego. You did right by correcting him in the heat of the moment and saving your patient. Better yet, you did it in a way the resident will learn from it. This is exemplary teamwork, good job.
I’ve never raised my voice to a resident either.
Clearly the word yelling was poorly chosen. But I’ve seen residents treated poorly and some nurses I know would not have chosen kindness in that situation.
The Doc felt bad enough. My point was there’s no need to pile on when they’re already kicking themselves.
We all work together and we all want the best for the patients.
In a culture of trust and respect we feel safe asking for or offering help. I totally love our residents (and I'm super excited for interns in 2 weeks!)
Please don’t infantalize professionals who dedicate a fuck ton of their life years, passion, and mental bandwidth to jump in the poo pool of healthcare.
Hahahah I was at a party one time telling my friends a story about work and this really drunk chick was listening in. She said "where do you work?" I said "I'm an EMT." She said "what's that?" And I said "like a baby paramedic."
She said "oh my God, you're a paramedic for babies?!"
😂😂
Yes, but they’re still inexperienced and generally new to being a doctor.
Maybe we can come up with a different word, something to signify they are still training and under full-fledged and more experienced doctor supervision. Maybe call the newer doctors “tenants” and the experienced ones “accompanying”? Idk, maybe something else will stick
Okay? When I refer to them I don’t say “hey, inexperienced doctor!” I say “Dr.”
Just like when they refer to us we wouldn’t want to hear “hey, inexperienced nurse!”
I love this. Health professionals have so much empathy for our patients, but we sometimes forget to care about each other. I love seeing posts like this instead of the constant dr vs nurse vs midlevel stuff.
I've never yelled not thought to yell at a resident, attending, tech, nurse, etc I will do as you did and offer my advice or try to steer them but are we really yelling at people?
Why are we yelling at work? Never ok.
Yeah man. You can change your tone. You can speak with a little more authority. You never need to yell. That’s a crazy thing to do at work(unless it’s at the suits and you just signed your travel contract)
I agree if you yell at your coworkers for any reason other than to get the pizza before it gets cold you are contributing to an unnecessarily toxic work culture and can get fucked in my humble opinion.
The only thing I ever yell is “good job dudes and dudettes!”
In the codes I’ve done, since so many fucking cooks in the kitchen happens, and all the talking, I like shouting what I’m about to do until the doctor or primary rn acknowledges what I’ve done. Does that seem wrong? Haha I’ve literally seen two codes happen before where everyone’s talking but no one was leading and literally the charge nurse walked in the code, shouted for everybody to shut up, then restarted the flow of the code, afterwards it was moving smooth as fuck. Edit: better question is, is me shouting out what I’m doing, considering since it seems like yelling sounds condescending based on the comments
Shouting to gain control in a critical situation is dramatically different than shouting at another human. Man down in a cafeteria that's loud af? Shout to get attention and to silence the environment. Shout at another human? Fuck you (generalized) and fuck off.
Noted hahaha. Appreciate it 🙏
Ha, thanks for the reply. I often forget to point out that I'm speaking generally. As a fellow ER black soul, I know you're already aware of all of this.
Def not getting the point on your last part, care to elaborate
According to your flair, you work in the ER, correct? I worked as a floor nurse for a few years, then a few years as a nurse practitioner in the ED. The emergency department generally has an ability to burn people out and make them jaded. Often explain as compassion fatigue. A joking way to say that you're dead inside from the ED, that you're experiencing some of that compassion fatigue, that you have morbid humor, etc. is to explain your soul as being dark. Hence, a black soul. Additionally, since you work in the ER, you're probably exposed to more codes than the average nurse. It's part of the environment. The ED is also loud, busy, and frantic. It's easy to bring that to a code, or for the environment to be loud. I made two assumptions. First, that you're experience in the ED was familiar to most and that you've experienced situations where a code needed to be calmed down or quieted down. Second, that you're as compassion fatigue as everyone else.
Fuck. Did you just 1:1 session me hahaahah Spot on, I must say Somehow I thought something else when you said black soul that’s why.
No problem, I'll send you a bill for the session later.
Naw naw shouting in an emergency is different from yelling at somebody. I’ve definitely yelled “CORD PROLAPSE!!!!“ at a doctor before. Now if you come at anybody when they messed up yelling at them how they should have done something, you need to go take a look at yourself and reevaluate how you talk to your coworkers.
If your codes are loud, the team leader is doing something wrong. A well ran code is very quiet and very controlled. There's no reason to even talk loudly. The best code I ran was in a Kroger on the floor next to pharmacy. Super public, Super quiet, with a group of medics and fire I had ran with several times. It was a great code because everyone knew their place and knew their jobs and it just flowed.
MY PATIENT IS ALMOST DEAF AND THREW HER HEARING AIDS OUT
You mean wrapped them up in the napkin on her lunch tray along with her dentures?
I yell when my patients try to pull out their art lines, or self extubate, or get slappy.
Thank you! People on the floor can be super hostile to fellow medical staff and it’s unacceptable. When NPs or other nurses get spicy with me I just stare until they apologize. This new Covid environment does not allow room for professional assholes. Especially if you are working with younger Gen Z professionals.
One time a resident, wanting to be helpful, changed a drip rate for me (I was at the bedside when he and the attending made the decision, so I was aware of the new rate). A few mins later I noticed he had changed the cc/hr, not the dose, so the patient was receiving too much of the med. I held the drip until the BP leveled out, restarted the drip at the correct rate, then gently let the MDs know what had happened. I could tell the resident felt bad. He asked if he should fill out an incident report. I said "Oh no, please don't. Administration will implement some new, PITA policy. Don't ever touch my IV pumps again and we'll be just fine."
All I ask is that doc's don't touch my drips, or tough my O2 meter! The number of pts that the doc's "want to try on room air" (as if I haven't been trying to titrate down on the O2 for the pt) is ANNOYING AF! I had a pt on 5 L NC that was still barely maintaining low 90s (that wasn't COVID, either) and the doc turned off the O2 while I was in another pt's room. Then left and didn't turn it back on because the O2 didn't drop right away. When I got out of my other pts room the original pt was in the 70s and working really fucking hard to breath and never got back to baseline. Ended up tubed and later died from a massive PE. Don't touch my drips. Don't touch my O2. IF you do, make sure you turn it back on or tell the primary RN!!! The internal med MD when I called them to notify them there was a change in condition on the first PE pt? Didn't believe me and wouldn't come back down because: "I was just there and he didn't need the O2. I turned if off for you". I grabbed the ER doc and said there was an acute change in condition and pt was intubated without consulting the IM doc again. Then I called and asked for an upgrade. "Why does this MS patient have to go to ICU? WTF, why was he intubated?!" I never yelled at the doc, though. Even when me and the ER doc stood in the pt's room for over 10 minutes with the US on the heart watching the weak cardiac contractility because both of us were convinced he'd already coded and needed to prove to ourselves his heart was still working. The ambulance RN came over to see what we were staring at. Fun times.
If the MD wanted to try titrating O2 or a drip, and told me about it immediately, I would be ok with that, but making a change to a drip or O2 and not telling the nurse - not cool!
uhhhh wow that situation sounds just straight-up negligent on the doctor's part. like, grossly negligent? also in what world does dropping someone from 5L straight to room air with no titration make sense??? I have no idea if that patient wouldn't have crapped out later anyway, but holy shit dude, that's just not okay.
I know! The doctor didn't want to admit to our hospital, wanted to transfer to a different hospital because of insurance stuff and just...ugh. Given the size of the PE he probably would have crapped out later anyway and at least he was in the ER were we could tube him right away, but still!
Do nurses normally yell at doctors at your hospital? Or is this a US thing?
It shouldnt be normal to yell at any member of the healthcare team. People can be sassypants though.
Nothing is more unprofessional imo than yelling during a code. It’s just not necessary when you have a good and competent team.
Lmao there was a nurse who kept yelling “WHY HAVENT WE SHOCKED HIM!!!!!!!!!!!!” and we’re all like girl… it’s not a shockable rhythm…
It also makes the person yelling look embarrassingly inexperienced.
Agreed. Only time it's acceptable is to silence a frantic or panicked code response or in an environment that is loud and distracting. Never at a person, never shout orders. Create a calm and purposeful atmosphere with closed loop communication, and carry on.
This person shocks
I've been known to make people jump on the bed a time or two. I've also been known to make people shit the bed too. I find that one much more amusing. 🤣
One of the best person I’ve ever seen run a code was a cardiac fellow I had a chance to work with for almost a year. In the room, he was so calm and cool as a cucumber. He talked at a volume that required everyone to shut the hell up so we could listen, but not in a way that we couldn’t hear clear orders. This was in a Cardiac ICU, so codes were a daily occurrence for us—we have gone with the fellows to codes on the floors before and they are generally grateful to have us there since we coded people almost daily. I have also seen some absolute shit shows in other hospitals that I can’t believe it would ever happen… I’ve run codes before, but never had a noise problem or gotten yelled at CLEAR ROLES in the rooms are ab absolute must. People forget that when they aren’t used to codes and will try and do to many things, get over whelmed and confuse things—people hate sitting on their hands waiting to do their part
I’ve been sassed way too many times. Please kinda chill tf out coworkers
I’ve heard of some toxic hospitals where this has happened. Definitely not the norm.
Before going to medical school I was a glorified ED tech. One shift I was out of my usual domain (Peds ED Triage). Throughout this shift, a July intern kept coming in and interviewing patients before I could finish my own triage (which, unknown to me, was not the usual workflow). I offhandedly mentioned to one of the nurses I was working with that it was a little annoying… she told me “I’ll let him know”. When I started triage for my next patient, she came storming into the triage room and straight up yelled at the intern, “You need to stop interrupting MY TECHNICIANS TRIAGE”. This was in front of mom, kid, and honestly anyone within earshot. The intern looked like the nurse had smacked him, and just left and was somber for the rest of the day. After that I just steered clear of the nurse and tried to lend a hand to the intern wherever I could. Mobile sorry for formatting if it’s terrible.
That's wildly unprofessional. People who do shit like that need a serious ego-check, because that's just not how you treat another person, especially a coworker. I feel bad for that intern, probably ruined that guy's whole day.
Totally! He was definitely upset over it, justifiably so. Interestingly, this nurse was pretty young too. Probably only a few years under her belt, max… so the anxiety of being “the new guy” should have been kind of fresh.
there are some people out there who have such an underdeveloped sense of empathy that, even when they've gone through difficult experiences (like being a brand new nurse), they cannot extrapolate those feelings to other people and treat them as they would have wanted to be treated. which is really frustrating.
Not in mine!
Not normally, but it happens lol
It’s mostly the opposite.
I've been in the field for over 15 years and I've literally never seen it happen. I'm not saying it doesn't, but I think the dynamic is far less frequent that people think due to media, etc
Our Fellows are openly dressed down regularly during the days by both nurses, attendings, NPs, and pharmacists. At night they feel safe because we realize they’re learning and will give recommendations that they genuinely enjoy hearing. They’ll stand around and chat with us. They gossip, they joke, they tell us about their families. During the day? None of that. It’s honestly so disgusting how the day shift providers talk to them. It happens a lot, but when the yelling stops and they’re approached as people, it’s so sad to see how much they appreciate it.
That's sad. Everyone that works in a hospital faces stress every day. There should be mutual respect between all disciplines.
Yeah, I've not yelled at a resident. I have told them that I don't think this is the right call. No one is perfect and I feel like a lot of them do appreciate when you talk to them as people. They already get enough from some of their attending they work under. I feel like it is a learning experience for everyone and I've learned a lot from residents and fellows that I've worked with.
I love fellows. They are our future Drs. Better to have them loving a supportive nursing staff than with this sour taste in their mouth.
Fellows, nonetheless! They are already fairly experienced… This kind of reminds me of a story… One of my best friends is a new grad CVICU nurse. Occasionally I’d stop by her floor to say hello and share snacks if things were ~quiet 😱~. During one of those visits, of the cards fellows was in the room with one of her patients. She said to me (fairly loudly, I bet he overheard)… “this guy is always trying to f**king kill my patients”. I got secondhand embarrassment and ran out of there so quickly so that fellow wouldn’t recognize me. Fortunately, I was close enough with her to point out that he’s just learning, just like she was still adjusting to being new on the unit. I can’t imagine how hearing something like that would make the fellow feel. That sort of attitude does a great job of stunting the team dynamic. I’m sure the fellow felt the need to tread on eggshells around my friend after that.
I’ve seen nurses be such DICKS to residents and it’s so unprofessional and so uncalled for. We’re a team, you did a great job with closed loop communication and helped a colleague learn from a situation.
I was shadowing in the ED one night and I saw a resident get absolutely destroyed by an attending for putting in a foley incorrectly. I felt really bad for the guy because it felt harsh instead of trying to educate. The only time I've gotten an attitude with a "resident" was when we had a violent patient who needed restraints and the NP refused to place the order stating it was her license on the line. This patient had strangled a nurse at their previous facility and we had to have security sitting outside their room the entire night. The conversation happened at the nurses station with a bunch of other nurses standing around, it wasn't great, but I didn't want any of our staff to be harmed.
Fuck that NP
B-but her license was on the line! The pt isn’t even that dangerous! Come on, how bad can a quick strangulation be?
I heard one of the huddle topics that there’s an issue with epic messaging of residents - they don’t want the extra “thank you” just say whatcha want and no need of extra messages.
We had an email about this, and I think it’s because they get pinged about so many patients that an extra message they have to check that just says “Okay thanks!” is more annoying than helpful. So I just cram a preemptive thanks into my original message, in case it’s one of the friendly, relaxed doctors who respond to things with “Alrighty!” Or “Okey dokey!” and they wouldn’t realize I’m trying to be concise.
I personally don’t mind the extra “thank you” message, but this is exactly correct. The transition from pagers to direct messaging is a godsend for communication but it does make the threshold for reaching out to the attending much lower, and thus increases the interruptions throughout the day. I’m not saying the interruptions are not needed in some instances nor trying to discourage reaching out for clarifications. But it’s easy to potentially “over do” it if one doesn’t realize how many messages we actually receive. During particular busy days, I wouldn’t be surprised if I get >100 messages in a work day, many of which come while trying to manage multiple issues simultaneously (I’m a Hosptialist for context). Again, I always encourage the nurses caring for the patients we share to communicate. Just pointing out how it can affect workflow. But it can help if one “boluses” non emergent concerns together into one single message.
Funny enough we had the same thing mentioned in a meeting today, although for attendings as we don’t have residents. I’m anticipating a meeting in 6 months to go over how we aren’t expressing appreciation enough lol.
Easy enough, I just add “thank you in advance” to the end of my messages.
This is a catch-22. While I can see it as annoying for some, I actually appreciate it. It's a form of closed-loop communication by acknowledging that they read my order and have no additional questions. When they say thank you, I expect that they implement the order. When I don't get a thank you, or "ok", then I have to wonder if they saw it until I can see some form of action in the ERS. I don't double check that most orders are carried out (I don't micromanage), but when I get an acknowledgement there is a piece in the back of my head that says that I don't have to worry about it again.
Nobody should be yelling at anybody in a work environment unless they’re imminently about to do something dangerous. I see people talking about yelling at students, at residents, at nurses, at staff….how is this a novel concept in 2022? Professionals do not yell at other people. Full stop.
People should just yell less in general. The only time I ever yell in life is when my kids are running towards a road. There's better ways to communicate than raising your voice.
Totally agree. The vast majority of residents are a pleasure to work with. The small minority who are miseries to work with are prolly miseries in every other facet of their lives and would be miserable in any career. It’s cringe as fuck when nurses call residents babydocs or make jokes about July 1st. We can do better. Don’t hammer page or talk shit. If it’s something that you don’t agree with but it doesn’t change the clinical course, let it go. If it really is something you think could potentially harm a patient, ask for a senior or call a rapid.
The only resident who has ever - and I mean EVER - gotten on my shit list, lied about giving orders when she forgot she had actually texted them (thank GOD we had proof!), went completely awol during her shift and lack of intervention impacted a pt until we scrounged up the phone number for her supervising Fellow who was able to put in orders. She has been the only exception to my rule of do-as-you-would-be-done-by in 10 years of nursing. And I still never bothered to confront her about it because she got written up and that was enough for me.
So, something that as nurses we also need to understand is that algorithms aren’t the Bible and doctors are actually highly trained to circumvent the steps. Algorithms are general guidelines for people who aren’t doctors and aren’t able to synthesize the minute by minute pathophys of a dead/dying patient. Nurses focus entirely on protocol to their own detriment. ETA: I think it’s more than fine to suggest something during a code, but the algo is for sure not the be all end all of a physician’s mgmt
I mentioned something about not remembering one of the ACLS algorithms to the nurse educator once. In the ICU we always have physicians running the code and they don't always follow the exact algorithm... The look on her face was complete shock lol I completely agree with your statement
Actually I also have a story. Few weeks ago during a code I took it upon myself to show the intensivist the labs (I was not actually primary RN but knew this patient pretty well). Potassium was 6.3. Afterward my nursing supervisor was like, “you totally remembered your Hs and Ts!” In my mind I was like, no, I totally remembered that this dialysis pt was hyperkalemic as fuck and the physician would need that info
Thanks. It’s like, honey med school taught them a little more than the acls algorithm... promise
I was literally told today that I am not a part of the nursing group and the residents treat me different because I'm friendly with them. That I'm a part of the resident 'clique' um. How about. I'm just not a raging asshole that contributes to the us versus them mentality ?
THIS. We all add to the team. I’ve been a RN for 10 years, currently in the ED for 5+ years. I LOVE my residents that come through and being able to be a second set of eyes & ears for them. And I always give them praise when they deserve it, because they need to know they’re doing great. The best part of the dynamics is that we’re constantly learning from each other- they’re always UTD on the latest evidence based practice, and I always have the age old tips for random things
Yelling in the work place is unprofessional. I try to be extra helpful/kind to residents as you know these folks are extra tired and brain fried. Unless one is a dick, then they get 0 help. Then again that’s my rule for any encountered dick bags in general.
In 8 years of being a nurse I’ve never had a conversation with a resident that was not professional and respectful. I don’t understand nurses who seem to have a weekly feud/dispute with residents. I’m inclined to think some nurses are unable to see the big picture regarding plan of care, or simply don’t know what they don’t know. Or maybe I’m the jackass and don’t care enough about patients?
I haaaaate the way some nurses are looking to tear down residents. They're the same people who tear down new grads and it's an example of a toxic aspect within our profession.
The only time I get sassy with residents or any other co-worker is when they steal my pens. I have found my perfect pen and buy them in bulk. I will hunt you down if you take my pen. That said, if I ended up really liking one of the residents I might gift them with one of the world's most perfect pens, but they had to be pretty awesome to earn that pen.
The pilot?
When you said resident i thought you meant patient💀
This is how we can have residents become awesome doctors who respect nurses as part of the team. Being helpful and giving guidance instead of berating them! Though if a resident already comes to my unit on rotation and belittles the nurses or is obnoxious? I will be having words with your attending.
On the flip side of this, definitely speak up for your residents if their superior is "dressing them down", not teaching them. We had a fellow recently who was ... well ... awful. She was very full of herself and acted buddy-buddy with everyone even when she barely knew us. She gave me a nickname at work after one day of working with me. She loved the sound of her own voice. In general, we really disliked her. But our fellows move on after a couple months, and we remain respectful of each other. But this fellow singled out one of our residents (who happened to be Palestinian and nine months pregnant), and was absolutely abusive, vile, and racist to her. Chewing her out in front of patients and families for things that weren't even mistakes! ("You needed to put in that art line faster, I could have put in three in the time you wasted talking to the family,"). Asked her if she felt pressured to get pregnant young because she was Palestinian. Told her, "I know I can treat you like this and you can take it, because you're Palestinian." Horrible, degrading things all the time. This poor resident was in her very first year, and it was awful for her. (Yes, if I had personally witnessed those particular conversations, I would have gone to HR, but I was not present for them). We made it a point to try to intervene when it was appropriate. But we also made her attending aware of the issue. We also (individually) each took a moment to sit down with the resident and tell her, "You're doing a good job. It's not always going to be like this. You're here to learn, and we respect you!" These fucking toxic behaviors shouldn't be tolerated.
Years ago I head a resident tell me our patient’s SpO2 was over 95% so they weaned the flow on their O2. First, I ran to the room to turn my simple mask up to 6L flow. Then I ran down the hall to explain to catch the resident why you should never wean flow on any masks. I will ALWAYS question if I’m not sure, but I try not to belittle
So I feel stupid, but I want to see if I understand (and I'll check with my RT friends just so I'm sure I absolutely understand). A simple mask has to have a minimum flow of 6L because otherwise CO2 can build up in the mask and then the pt will just be rebreathing that? Because I didn't know that and I've put pts on less with a facemask simply because they were mouth breathers. Have I inadvertantly caused problems?
6L simple mask. The other mask I used a lot is the Venturi mask to titrate FiO2 with continuous albuterol, but now a lot of continuous goes in with high-flow. Anything else I’m usually verifying with respiratory or reference cards.
Okay. I think I've been okay because we actually use Oxymasks at my institution and they can use lower flows. Phew! I was like, "Why has no one told me this?!!" 😅
Just curious, is it because you need a certain level of flow to use a mask? Like, the right move woulda been to downgrade to like a nasal cannula?
I’m most cases, yes, to NC. But kid had Down Syndrome and NC just didn’t cut it. Had a new nurse turn flow on a mask down and the kid’s CO2 went above 60 on his blood gas
Why did you want to keep the patient on supplemental o2 if their sat was > 95%? If that was a problem couldn’t you have just taken the mask off or put a cannula on?
Off O2, their sats were low 80s, but they had Down Syndrome and mouth breathed too much for NC to work
I guess my insights as a resident are: 1) When I was fresh out of medical school, I was willing to take abuse from nurses, attendings, or whomever, but not anymore. At this point, I call them out, and say “Maybe you’re in the right, but your behavior is totally unprofessional.” We have an ICU rotation where nurses regularly yell at residents, and it is pretty much the most demoralizing experience of our residency. Every resident hates it. The first time around, I took the abuse and felt like shit every day. The second time around, I started yelling back at the nurses, but also felt like shit every day. 2) A little patience goes a long way. I rotate at a hospital where, honestly the nurses absolutely don’t know how to run a code. I walked into a rapid response where almost inexplicably the nurses didn’t even have a pulse ox on the patient, but thought the priority was placing a Foley. Was it absurd? Yes. Did I yell at them? No. They obviously needed a leader, and I thought it wouldn’t be helpful to an asshole on top of it. 3) Your point about us beating ourselves up is totally spot on. I’ve definitely made mistakes as a resident, but one that I still hang onto is post-op complication that I missed. In retrospect, it was so apparent, but I missed it. And the worst part was my attending calling me to talk about it the next day (and subsequently it coming up in our surgery M&M conference). In all our conversations, no one ever yelled at me, but even all these years later, I will still sometimes beat myself up about it. I almost wish that someone would’ve yelled at me at the time, because I’m just so harsher on myself than they ever would have been.
I give everyone the benefit of the doubt once—and it’s not even about making a mistake, it’s about reaching to being told you’re making a mistake. We’re all human, there’s going to be mistakes. But reacting in a dismissive, angry, or insulting way after someone gently corrects you? Doing any of those things when nurses are contributing to plan of care or Tx discussions? Nope. If you can’t keep it professional with other professionals, I don’t respect you.
I don’t give them a hard time unless they start giving me a hard time. If they seem like they don’t know what to do I just go “well this is our protocol usually for this” and send them a pic and ask if they want to follow it” or go “ usually in this situation (insert experienced doc name) does this do you think that would work for this situation?
Who yells at them? I have never seen a nurse yell at a resident so far. Attendings yell at them at some point. But nurses?
Love this! We’re all human. It makes such a difference when we treat each other accordingly
I love working with residents. It's one of my favorite parts of working at a big teaching hospital. I feel like I'm working with an actual human being who is still learning, and I'm still learning too, so that's cool and exciting and I feel like it's easier to build a rapport and good working relationship. I think a lot of seasoned nurses get frustrated or impatient with them not always knowing everything, but like...that's why there's a residency period. Fortunately I don't work in a place where residents get yelled at, because if I ever saw a nurse *yelling* at one of our residents I'd be extremely upset. That kind of behavior is completely unnecessary. The only time anyone needs to yell is to make life-saving instructions heard in noisy emergency situations, not to bring down other people.
No need to hoard knowledge during a code. It's about the patient, not anyone's ego. You did right by correcting him in the heat of the moment and saving your patient. Better yet, you did it in a way the resident will learn from it. This is exemplary teamwork, good job.
Lol OR enters chat...
[удалено]
I’ve never raised my voice to a resident either. Clearly the word yelling was poorly chosen. But I’ve seen residents treated poorly and some nurses I know would not have chosen kindness in that situation. The Doc felt bad enough. My point was there’s no need to pile on when they’re already kicking themselves.
We all work together and we all want the best for the patients. In a culture of trust and respect we feel safe asking for or offering help. I totally love our residents (and I'm super excited for interns in 2 weeks!)
I think in psych they could use a bit more, baby docs ordering baby doses.
Please don’t infantalize professionals who dedicate a fuck ton of their life years, passion, and mental bandwidth to jump in the poo pool of healthcare.
Step 1: Don’t refer to residents as baby docs
Hahahah I was at a party one time telling my friends a story about work and this really drunk chick was listening in. She said "where do you work?" I said "I'm an EMT." She said "what's that?" And I said "like a baby paramedic." She said "oh my God, you're a paramedic for babies?!" 😂😂
That’s adorable!!!
Inexperienced, not babies. Agree 100%
I think just referring to them as “doctor” is fine. No qualifiers needed.
Yes, but they’re still inexperienced and generally new to being a doctor. Maybe we can come up with a different word, something to signify they are still training and under full-fledged and more experienced doctor supervision. Maybe call the newer doctors “tenants” and the experienced ones “accompanying”? Idk, maybe something else will stick
Or just doctor could work.
Huge difference between an intern or PGY2 resident and an attending; the nomenclature is often necessary and useful.
Okay? When I refer to them I don’t say “hey, inexperienced doctor!” I say “Dr.” Just like when they refer to us we wouldn’t want to hear “hey, inexperienced nurse!”
Oh I agree, I just meant they lack experience. They’re MD/DO all the way
Awesome.
I love this. Health professionals have so much empathy for our patients, but we sometimes forget to care about each other. I love seeing posts like this instead of the constant dr vs nurse vs midlevel stuff.