loud and unclear
witnessing a scene wherein an RN and a resident are literally yelling at each other is not good. all mouths were open as C, an RN, and Dr. P, a resident shouted at each other like they thought everybody else in the unit was deaf, or blind, or just didn’t care.
to be honest, i don’t think i really cared, i was just a little embarassed. i mean, it was a hospital unit after all, and there were patients. and there were family members visiting the patients. i wanted to disappear, but i couldn’t. so we all stood there, looked the other way, and wished it would be over soon.
one of C’s patient was refusing a very important procedure. the reason the patient refused was not because she didn’t care about the result of the MRI, it was because she was not in the right state of mind to think things over. she believed she is the current president of the united states, and that every yellow pill was created by the demons to kill her. besides, whatever it was that was bothering her will get better once she takes a white colored muscle relaxant. plagued with an ethical dilemma, of the procedure that needed to be done as soon as possible, to prevent harm to the patient, and a mentally unstable, refusing patient, C asked the opinion of our acting nurse manager, who told her to call the nursing supervisor, who told her to call the patient’s attending.
after paging the attending, C’s fiance called. he was on the ground, has excruciating pain on his back, and was unable to get up. panicked, C put her fiance on hold, called 911, and sent the ambulance to their place. i was standing behind C when she got back on the phone with her fiance, (a surgeon) who despite my inability to hear, obviously found the idea of an ambulance on the way, to be ridiculous. C argued about at least having the paramedics check his vitals, and after a few repeats of saying she will NOT cancel the 911 call, said she will now hang up.
this was when she got the phone call from the attending, who wanted to talk to the resident because really, what is going on here? the resident took the phone, and apologized to the attending endlessly, because “i know you should have not been called, but i had no idea about this issue, and i was never told until now”. of course, with escalating emphasis on the “sorry”, and “i was never told”, that made it clear she was both trying to save her behind from trouble, and at the same time trying to indirectly express her frustration that she was placed in a very awkward situation, by C, the RN.
C was furious, took the phone and told the attending that she was told by the supervisor to call her. when C was done talking to the attending, Dr. P reiterated that she should have been called first, instead of the attending. to which, C, replied: “MY FIANCE IS ON THE GROUND, I DON’T KNOW WHAT HAPPENED TO HIM, YOU DON’T UNDERSTAND ANYTHING!”
P was furious she was yelled at, then the beat went on. i will spare you the details of the ugly exchange. just take my word for it when i say that it was not pretty.
an RN who was trying to save the night explained to Dr. P that it is not really her. that C was upset about the situation that her fiance is awaiting an ambulance. Dr. P said she understood that, “but if she is unable to deal with things at work right now, because she has personal problems, why didn’t she just go home?”
the whole soap opera episode ended with C crying in the hallway, talking at a relatively loud voice to the outgoing and incoming charge nurses, about how Dr. P did not understand anything. at the other end of the hallway, Dr. P was talking to the other nurses, in a relatively loud voice about how wrong C was, in every account.
let me get the record straight by saying that i believe every person is entitled to react to any stressor in his own unique way. i believe C has the right to panic and get upset, and Dr. P has every right to get upset too. to be stressed out is normal, but is it too much to ask that medical professionals remain professional even at the most stressful of times?
when i try to analyze what happened, i don’t really know what the yelling accomplished. all i know is that most, if not all of the people who witnessed it felt sort of embarassed to be a part of the team. while the exchange of angry voices was going on, everybody pretended not to care, but for the next 11 hours, the discussion was unending.
i was glad that my patients pretended they didn’t care, because if they did ask me what the commotion and the shouting was all about, it would have been easy for me to lie and just say ” i don’t know”.
well, what do you expect me to do? let my patients understand that that’s just the way we are in our unit? that we don’t really mean to be rude and loud, but it just happens when things get out of hand? then what? explain to my patients that professionalism is really overrated, and that by all means, we all should just start yelling when we feel that things are getting a little out of control?
i don’t know. maybe i’m just too indifferent to care, or too selfish to understand. it’s just that, just like everybody else, i didn’t really believe the elevated voice volume served a purpose.


I’ve seen that happen before, its not pleasant that’s for sure. Unfortunately it takes place a bit too often these days. Lack of respect maybe?
Comment by Anna — November 22, 2006 @ 1:32 am
It seems that the resident should have been consulted before the attending was called, if the resident was covering. On the other hand, it is the attending’s job to manage the patient. At the same time, if nurse C was distraught about her fiance’s accident, she should have handed off her patient and gone home.
The bottom line is that NO ONE SHOULD EVER BE YELLING AT ANYONE ON A HOSPITAL FLOOR. EVER. The focus of being on the hospital floor is to take care of patients. In the case, the focus should have been on the patient who was incapable of making the decision to have the MRI — if she was incompetent, someone else needed to make that decision for her. That would have avoided the entire incident.
Sounds like the entire hospital needs to have some communications training, including the attendings, residents, nurses AND their supervisors. There needs to be a policy in place covering occasions like this so everyone knows what the next step is.
Comment by Candy — November 22, 2006 @ 7:00 am
IMHO toxic behavior is inexcusable around the sick bed.
sad to say, ignorance rules out in these situations…
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enjoy and happy thanksgiving!!
kate loving shenk
Comment by kate loving shenk — November 22, 2006 @ 6:45 pm
HA - must be something in the air today! At work today we had a 3-way yelling match between a doc, a front staff, and a patient’s mom. As my patient attempted to corral her roaming toddler in the middle (literally) of this, I said to her, “As you can see, we are having a fun day-before-Thanksgiving here!” Yeesh!
Comment by Lisa — November 22, 2006 @ 6:51 pm
Yelling like that strikes me as being selfish and immature. Regardless of what the problem is, people should be able to communicate in a low voice.
Comment by Melissa — November 22, 2006 @ 8:38 pm
the frustration i understand… but the shouting could have been avoided if someone had just taken a minute to think and suggested that those involve do their ’shouting’ in a private soundproof room
Comment by Rygel — November 22, 2006 @ 9:00 pm
i’m at work right now and just this evening, a few hours after we started our shift, we also had some shouting episode between our ward physician and our nurse. i was inside one of the rooms at the very end of the hallway and i could hear them arguing! it was so loud and i felt ashamed because it was also visiting hours. i wanted to get out of this place the moment i heard them shouting at each other ‘coz i felt that i’m in a very hostile and unprofessional place!
Comment by andre — November 23, 2006 @ 2:48 pm
Loud and clear sometimes isn’t lud and clear enough.
Comment by Weapon of Mass Disturbance — November 24, 2006 @ 6:59 am
I don’t know and I’m not a medical professional but as a patient, I say …So what! They are as human as the rest of us, and it seems alot of stressors were happening all at the same time. No time to really take care of them before the other started.
I did witness something of this order, RIGHT IN MY HOSP. room once. It was also an RN and a resident. She had removed my pain pump, and not put it back in. She said something was wrong with my vein, although I doubt it, as it did not hurt and was not swollen. The resident came in to remove both of my JP drains. I had them in for 3 days following a radical hyst. He said for me to push my pain pump med. I told him I didn’t have one right now and he went ballistic. He didn’t even leave the room, he just started yelling for the nurse.. When she came in he asked her “Where in the hell is her pain pump” He was looking at my arm. She said she had removed it and just hadn’t started it back yet and that something was wrong with my vein. He proceeded to raise my arm up in her face and told her there is nothing wrong with her vein…I was mortified at this exchange.
He then “Barked” at her to get demerol and give me an IM injection of it. He stood at my bed while she did so and waited for it to take effect. She was almost in tears and I felt horrible.
Maybe she shouldn’t have removed it, but either way, she didn’t deserve what he did. He was as nice as could be to me, but I just wanted those damn drains out, so he could leave my room. I had a feeling these two had screaming matches quite often.
It happens.
Anyway, I just came by to say I hope you had a good Thanksgiving.
Comment by cathy — November 24, 2006 @ 7:19 pm
I usually try to walk away and pray they don’t spew their venom at me next.
I think it comes down to stress.
Comment by kimmyk — November 25, 2006 @ 12:13 pm
I’m surprised that no one offered the alternative for these two to go into a room to air their diferences. I’ve been a nurse for 25 years and a supervisor for a good portion of them and the first thing I always do when issues arise in the hallway is get these folks into a private area as far away from patients as possible. Let’s face it, stress can bring out the worst in us and letting off a little steam can be healthy, but we also need to remember that this needs to be done in a mature way and that means take it “off stage!”
Comment by Sarah Hile — November 26, 2006 @ 9:14 am
I agree with Sarah Hile–move the yellers to a private place. On a more personal note, I came “uncorked” once at work in front of patients and a physician. I was yelling at my boss (not a good thing to do). The entire situation was a culmination of weeks of stress and something finally pushed me over the edge. I felt horrible after it was over. I would have appreciated it if my co-workers had stepped in–instead they all stood there with horrified faces as they witnessed the melt-down. The bad thing is that my boss never forgave me for my melt-down, even though I sincerely apologized to her, to the physician, to the patients, and to my co-workers.
But, I learned much about myself through the experience. First, don’t let things build up on the inside. I now try to identify (name) the problem and actively seek a solution. Second, if I feel like blowing up, I will step out of the situation and take a breather. As a nurse, there are times I have to just step out mentally–because I cannot physically leave. And a mental de-stressor for me is asking “Five years from now, will I even remember this?” or “This moment will not last forever, and this situation does not define me.” Those mental statements help me get ahold of myself again. Third, when I witness somebody else melt down, my previous reaction would have been to scuttle away like a cockroach. Now (unless they have a weapon), I will approach the arguers and say something to try to defuse the situation or move the stiuation out of the public eye.
Just some thoughts…
Comment by Yvonne — November 27, 2006 @ 4:35 pm