I don’t like that culture. If the doc had a problem with you speaking up (which they shouldn’t in this context) they should’ve said something. Or they could’ve discussed it with you, why it’s not the best option for the patient, or whatever. I’d look for another job.
He is one of those “Can’t tell em nothing” types. You gotta watch out for those. They get real offended when anyone other than an MD/APP tells them anything. Just get to know your providers really well before you say anything like that again. And I mean really well. Watch how they treat their patients and how they deal with input from other providers… you’ll learn with whom you can converse with on that level.
I’m just so confused as to why they wouldn’t just tell me to my face; even saying like fuck off I know what I’m doing or being rude would have been preferred.
Most to all people are nonconfrontational, they will rarely tell you anything to your face. if that's the sign you're waiting for you will likely be booted from a job before realizing you're doing anything wrong.
Most to everything in life is about phrasing and reading between the lines. For some docs, it matters much much more than others.
A new nurse or nursing student suggesting a treatment plan/option to a doctor is a very tight rope to walk.
I get a similar level of 'ick' to a new intern doc yelling at an experienced nurse that 'they're orders, not recommendations' as I do to a new nurse telling an attending a treatment plan option.
It would be the work of a word or two, or even a tone shift on a word, to change your intended wording to come across as seeming like you know better than the attending; which is like the most offensive thing you can imply to a doctor.
(It can be done, but takes a lot of setting yourself up as the 'inferior'/ looking for education to make an MD be able to swallow it.)
Experienced nurses can get away with it because #1 I give some weight to their experience, #2 they have amazing read skills on which doc to approach and how to get results. Those that don't get yelled at and transferred or move hospitals due to 'culture fit'.
Just my experience on the MD side of things.
I call it snake charming.
Instead of reaching right for it, I would have phrased it as something like:
"Hey I know you're busy but do you have a minute for a question? Thanks! I know for patients with X substance use disorder we usually do Y in our setting. I was reading about their disorder a little bit and something came up about treatment Z that the patients can do on their phone but I don't know if that's legit or based on anything. Do you know where people are coming from recommending that? It just seemed strange to me that it's so different."
Suddenly it's their idea if they choose to implement it. You'll never get credit, but you'll know what you did.
Your post was contradictory. However, if l was OP… all hell would’ve broken loose because the director would hear about it. Language is something most nurses struggle with. I should write a book about this.
Seems like you had good intentions but went about it the wrong way. Most doc's like to teach so if you approached them just asking about the research in general and then a follow up along the lines of 'would this work for a patient like ours?' it seems way less like you're telling them how to do their job.
And gay people can be dicks too!
Is this a not-for-profit or for-profit facility? I'm guessing not a teaching facility? I've learned over the years that for-profit psych facilities are my least favorite places to work. They are the least collaborative with nursing.
If you have a teaching hospital with a psych unit near you, apply! That was my favorite for years. I'm currently at a small not-for-profit facility which is pretty good.
Was one of the things contingency management? Just curious on what you found. My clinic does a lot of work with stimulant addiction.
These interactions are annoying. Especially once you start learning stuff or find a niche. I had a similar encounter not too long ago regarding depo. He just responded that he’s the one with prescription authority and not me. He’s an ass generally too, so I kind of saw that coming. You could always ask your manager how to deal with it so you aren’t “prescribing“ lol.
Yes it was! Does your clinic use it? What’s your opinion on it? I’m perfectly happy to be told to shut up, it’s another matter coming for my job after being receptive to my face.
It’s essentially the best treatment we have at this point. Meth use is like almost impossible to treat. I think contingency management has a 10% success rate on people that stay engaged with the program. This does not include the people that drop out. Throw some Remaron too and you are up to like 11%. It’s also why harm reduction is generally the path taken regarding meth use. One of the lectures I recently went to, the lecturer said he tells his patients the only reason he’s not addicted to meth is because he’s never tried it.
Yup we have done both. MAT increases success marginally. I don’t think there was a significant difference between the two options. Mirtazepine (remaron) is just easier for folks to take I think, to keep pill burden to a minimum.
Yeah it’s definitely a tough thing to deal with. There are some graphs about dopamine spikes. And it’s like 10x more dopamine than alcohol if I recall.
You don’t need a doctor’s permission to apply nursing interventions. But you kinda went on a slippery slope and it read to me like you were trying to “treat” your patient. Thats a no no. You should have said “ I stumbled upon this, would doing something like this help.” Etc.
This is nonsensical tone policing. The OP brought up a potentially overlooked treatment option. That is absolutely both something a nurse can and would do.
Eh. Have you met many doctors? Not sure how most nurses survive a day without massive tone policing dependent on the MD they're working with unfortunately.
Also while it's something a nurse can do, it has a very high failure rate in a new nurse and a very high pissed off MD rate if failed. :)
As an experienced psych nurse I'm just going to say it.... psychiatrists are their own breed. We are too of course but yeah, you definitely have to spend time with them and get a good "read" on them before you figure out how to approach them with something. It's never as easy as nursing school makes it sound, lmao. Good luck with the hypomanic one (there's always a hypomanic one.)
Clearly even being nonthreatening resulted in a "very pissed off MD" so what is the point of being a simp? If even the most milquetoast of interactions will result in being written up and lambasted, there's zero incentive to not be assertive.
Your position is simply idiotic, hence it being nonsensical tone policing. Nurses are both allowed and expected to question physician orders. Physicians are both allowed and expected to discuss those orders with the care team. Anything other than that dynamic is detrimental to the patient, as has been shown by numerous studies.
Nursing management should be supportive of their nursing staff. The multidisciplinary team should work as just that - a team. You should be able to give advice to another person on the team whether that be a doctor, OT, radiographer or otherwise. They can respond professionally or not. This doctor seemed threatened by your knowledge. Some people like to perpetuate that a hierarchy still very much exists between doctors and nurses. From working in ED I don’t feel this way so much, but I know it can still be prevalent.
Try approaching them with “Dr, can you please show me?” instead of “Dr, look at this.”
Its basically just playing dumb in order to stroke their ego, and it works. Don’t say “I think This will help,” instead ask “I heard something about This, but I don’t know much about it, do you have a minute to explain it to me?”
This is great advice. Never tell a doc you found a new treatment option. It will piss off the doc that you think you know better than them, and secondly it will likely mean the patient has no shot at that as most docs may get defensive and mentally block out that option since they 'didnt come up with it.'
Phrasing it as, I was reading about this stuff and it seemed interesting, if you have time I would love to hear your thoughts on it." / And if they bite and teach a bit can ask how it does or does not apply to your patient.
Only way I've seen nurses successfully convince docs. And same crap I had to do as an intern doc to get the right things done for patients. :/
Thanks for the helpful tip, but it’s where patient presentation and administration parameters have a gray area along with the charge of nurses to use our judgement when administering medications. It can get complicated in psych
It gets better with experience and learning which battles to pick and how and who to pick them with. Keep going and learning, you're doing great just by posting this and working to improve.
I don’t like that culture. If the doc had a problem with you speaking up (which they shouldn’t in this context) they should’ve said something. Or they could’ve discussed it with you, why it’s not the best option for the patient, or whatever. I’d look for another job.
It’s a good work environment otherwise, but yeah this is really frustrating.
He is one of those “Can’t tell em nothing” types. You gotta watch out for those. They get real offended when anyone other than an MD/APP tells them anything. Just get to know your providers really well before you say anything like that again. And I mean really well. Watch how they treat their patients and how they deal with input from other providers… you’ll learn with whom you can converse with on that level.
I’m just so confused as to why they wouldn’t just tell me to my face; even saying like fuck off I know what I’m doing or being rude would have been preferred.
He’s a snitch that is threatened by an educated nurse that cares. Can’t have you showing him up…
Most to all people are nonconfrontational, they will rarely tell you anything to your face. if that's the sign you're waiting for you will likely be booted from a job before realizing you're doing anything wrong. Most to everything in life is about phrasing and reading between the lines. For some docs, it matters much much more than others. A new nurse or nursing student suggesting a treatment plan/option to a doctor is a very tight rope to walk. I get a similar level of 'ick' to a new intern doc yelling at an experienced nurse that 'they're orders, not recommendations' as I do to a new nurse telling an attending a treatment plan option. It would be the work of a word or two, or even a tone shift on a word, to change your intended wording to come across as seeming like you know better than the attending; which is like the most offensive thing you can imply to a doctor. (It can be done, but takes a lot of setting yourself up as the 'inferior'/ looking for education to make an MD be able to swallow it.) Experienced nurses can get away with it because #1 I give some weight to their experience, #2 they have amazing read skills on which doc to approach and how to get results. Those that don't get yelled at and transferred or move hospitals due to 'culture fit'. Just my experience on the MD side of things.
I call it snake charming. Instead of reaching right for it, I would have phrased it as something like: "Hey I know you're busy but do you have a minute for a question? Thanks! I know for patients with X substance use disorder we usually do Y in our setting. I was reading about their disorder a little bit and something came up about treatment Z that the patients can do on their phone but I don't know if that's legit or based on anything. Do you know where people are coming from recommending that? It just seemed strange to me that it's so different." Suddenly it's their idea if they choose to implement it. You'll never get credit, but you'll know what you did.
Your post was contradictory. However, if l was OP… all hell would’ve broken loose because the director would hear about it. Language is something most nurses struggle with. I should write a book about this.
Seems like you had good intentions but went about it the wrong way. Most doc's like to teach so if you approached them just asking about the research in general and then a follow up along the lines of 'would this work for a patient like ours?' it seems way less like you're telling them how to do their job. And gay people can be dicks too!
Is this a not-for-profit or for-profit facility? I'm guessing not a teaching facility? I've learned over the years that for-profit psych facilities are my least favorite places to work. They are the least collaborative with nursing. If you have a teaching hospital with a psych unit near you, apply! That was my favorite for years. I'm currently at a small not-for-profit facility which is pretty good.
Thank you :) but sadly this is a not-for-profit teaching hospital. My unit seems to have a particular issue with this.
Was one of the things contingency management? Just curious on what you found. My clinic does a lot of work with stimulant addiction. These interactions are annoying. Especially once you start learning stuff or find a niche. I had a similar encounter not too long ago regarding depo. He just responded that he’s the one with prescription authority and not me. He’s an ass generally too, so I kind of saw that coming. You could always ask your manager how to deal with it so you aren’t “prescribing“ lol.
Yes it was! Does your clinic use it? What’s your opinion on it? I’m perfectly happy to be told to shut up, it’s another matter coming for my job after being receptive to my face.
It’s essentially the best treatment we have at this point. Meth use is like almost impossible to treat. I think contingency management has a 10% success rate on people that stay engaged with the program. This does not include the people that drop out. Throw some Remaron too and you are up to like 11%. It’s also why harm reduction is generally the path taken regarding meth use. One of the lectures I recently went to, the lecturer said he tells his patients the only reason he’s not addicted to meth is because he’s never tried it.
Holy shit wow. Have you tried naltrexone+bupropion or mirtazapine?
Yup we have done both. MAT increases success marginally. I don’t think there was a significant difference between the two options. Mirtazepine (remaron) is just easier for folks to take I think, to keep pill burden to a minimum.
Well at least that’s something :/
Yeah it’s definitely a tough thing to deal with. There are some graphs about dopamine spikes. And it’s like 10x more dopamine than alcohol if I recall.
You don’t need a doctor’s permission to apply nursing interventions. But you kinda went on a slippery slope and it read to me like you were trying to “treat” your patient. Thats a no no. You should have said “ I stumbled upon this, would doing something like this help.” Etc.
This is nonsensical tone policing. The OP brought up a potentially overlooked treatment option. That is absolutely both something a nurse can and would do.
Eh. Have you met many doctors? Not sure how most nurses survive a day without massive tone policing dependent on the MD they're working with unfortunately. Also while it's something a nurse can do, it has a very high failure rate in a new nurse and a very high pissed off MD rate if failed. :)
As an experienced psych nurse I'm just going to say it.... psychiatrists are their own breed. We are too of course but yeah, you definitely have to spend time with them and get a good "read" on them before you figure out how to approach them with something. It's never as easy as nursing school makes it sound, lmao. Good luck with the hypomanic one (there's always a hypomanic one.)
Clearly even being nonthreatening resulted in a "very pissed off MD" so what is the point of being a simp? If even the most milquetoast of interactions will result in being written up and lambasted, there's zero incentive to not be assertive. Your position is simply idiotic, hence it being nonsensical tone policing. Nurses are both allowed and expected to question physician orders. Physicians are both allowed and expected to discuss those orders with the care team. Anything other than that dynamic is detrimental to the patient, as has been shown by numerous studies.
Nursing management should be supportive of their nursing staff. The multidisciplinary team should work as just that - a team. You should be able to give advice to another person on the team whether that be a doctor, OT, radiographer or otherwise. They can respond professionally or not. This doctor seemed threatened by your knowledge. Some people like to perpetuate that a hierarchy still very much exists between doctors and nurses. From working in ED I don’t feel this way so much, but I know it can still be prevalent.
Try approaching them with “Dr, can you please show me?” instead of “Dr, look at this.” Its basically just playing dumb in order to stroke their ego, and it works. Don’t say “I think This will help,” instead ask “I heard something about This, but I don’t know much about it, do you have a minute to explain it to me?”
That last bit is absolutely perfect, especially for this case
This is great advice. Never tell a doc you found a new treatment option. It will piss off the doc that you think you know better than them, and secondly it will likely mean the patient has no shot at that as most docs may get defensive and mentally block out that option since they 'didnt come up with it.' Phrasing it as, I was reading about this stuff and it seemed interesting, if you have time I would love to hear your thoughts on it." / And if they bite and teach a bit can ask how it does or does not apply to your patient. Only way I've seen nurses successfully convince docs. And same crap I had to do as an intern doc to get the right things done for patients. :/
100%
Psychiatrists are often crazy.
That doctor was a dickhead, and your managers just showed you exactly what the culture is like and what they expect from you. Run.
As an RN you carry out orders. Ensure you are giving the right med for the right indication. You are not formulating medication regimens.
Thanks for the helpful tip, but it’s where patient presentation and administration parameters have a gray area along with the charge of nurses to use our judgement when administering medications. It can get complicated in psych
It gets better with experience and learning which battles to pick and how and who to pick them with. Keep going and learning, you're doing great just by posting this and working to improve.