Saturday, August 6, 2011

5 Tips for Working with a Difficult Physician

5 Tips for Working with a Difficult Physician

Working with a difficult colleague is tough enough – but when the colleague is a physician, it can be all that much harder. For the most part, doctors are great colleagues, and when doctors and nurses work well as a team, the best of care can result.  But, as much as some doctors are fantastic both personally and professionally, others, well, they can leave a lot to be desired.
First, we need to define what we mean by “difficult.”  If we’re talking about a physician with a rough bedside manner, but who is still doing his or her job and isn’t causing too much uproar in the nursing station or on the floor, I don’t think I’d call that difficult.  If the patients are happy with the care, and you’re getting what you need in terms of orders and support when you need it, I’d probably let that pass.
Second, we need to separate “difficult” from difficult for us as colleagues or difficult with the patients.  When a physician is difficult with the patients, then we have an obligation to step in; we are the patients’ advocates, and we can’t allow less than professional behavior from the physicians towards our patients.  When we have a physician who is difficult to work with, we have to decide how and when to deal with the situation.
5 Tips for working with a difficult physician:

1.  Own your reaction:
  How you react to the physician is your own action. You can choose to react calmly or angrily; you can choose to walk away or confront. Which ever you do choose, it is your choice.

2.  Examine why the actions of the physician are difficult for you:
  Is it because he or she reminds you of something; is he or she being difficult to just you or to the whole floor?

3.  Refuse to accept bad treatment: 
 You can choose to do this in a few different ways:

   •  Say calmly, “I don’t appreciate you speaking to me like that."

   •  Walk away without saying a word.

   •  Walk away while saying, “Please come speak to me when you can speak to me respectfully.”

   •  Stand there and don’t say a word.

4.  Document:  You have to document bad behavior.  If you have a paper trail of the behavior, you can back up your claims if you choose to go on to the next step.

5.  Report the behavior:
  Often, a physician with a bad attitude or who behaves badly gets away with it because he or she is not reported.  When someone does get fed up and does report it, the administration says that they can’t do anything because there haven’t been any previous complaints.
None of the above tips may be easy; there are lot of work dynamics that differ from institution to institution, and even from floor to floor.  But a work environment has to be comfortable for everyone, and if you work with a bully, be it a fellow nurse or a physician, it must be dealt with before it goes too far. 

Sunday, July 31, 2011

Should There Be a Dress Code in Nursing?

Should There Be a Dress Code in Nursing?

By: Rachel Clements
I have the distinction of being nicknamed “Rapunzel” by one of my previous nursing supervisors.  The reason is really straightforward:  I have waist-length blonde hair that I often wear down. Fortunately, no one has climbed into it and it has only been pulled once, by a little boy who told me I looked like an angel. Knowing all of this, you should conclude that I am a violator of one of the many laws, written and unwritten, of the nursing dress codes:  nurses must always wear their hair up.
Now, let me qualify this:  the hair goes up before I do procedures, assess patients, complete cares, and even chart.  Sometimes I even do it unconsciously when work gets particularly intense, like when dealing with difficult families or trying physicians.  A couple of co-workers have observed that I am getting down to, and mean business, when I pull my hair up into a bun or a pony tail.
I am a firm believer in form following function, and am something of a pragmatist.  Here are my thoughts on some of the more controversial aspects of the nursing dress code:
Nails:  I honestly don’t believe that long acrylic nails have a place in nursing if you are a staff nurse.  Why?  Because germs hide out under your nails, you could scratch someone (including yourself), and if they get torn off, those puppies seem to hurt even more than breaking a regular nail.  That being said, I think that nurses should have nice nails.  There is something out there called a nurse’s manicure that will remedy this, but the basic idea is to have neatly trimmed nails with healthy cuticles.  As for color, some facilities insist that nails be free and clear of this.  Nurses need to be aware of what their hospital policy is for this.  My opinion is that your nails should reflect how you want to be perceived.  I was told long ago that pink is a good color for professionals, but it’s really up to you.  To be on the safe side, leave the flashy stuff for your toes.  I myself have purple sparkly ones.
Scrubs:  The controversy rages on about going back to a standard uniform for nurses, namely whites.  Being a self-proclaimed pragmatist, I’d like to point out that white is very difficult to keep clean.  This is an argument I have made since nursing school, when I was required to wear whites.  Many of us can’t keep a white t-shirt free of ketchup; how will we keep a white uniform free of blood stains?  Whites may represent nursing from the not-too-distant past, but we are a different group of people from back then.  We care for more critically ill people, we deal with more diseases, and we are responsible for completing more tasks and procedures.  With that comes quite a bit of messiness… As for scrubs themselves, I think that these should be tasteful to ourselves and the groups of people we work with.  You’ve got to know who you are working with.  There are some people, young and old alike, who totally dig the Marvel and DC Comic characters.  They are the start of some great icebreakers, also with young and old alike.  But, above all, try to avoid being provocative with low cut tops or bottoms; if you don’t want people looking down your shirt or at your butt, wear something else or cover it up.
Tattoos and Piercings:  I really love tats…on other people.  They have yet to create the Mood Tattoo, something that will change shape to match how I feel.  When they come up with this, I will be the first in line for one, something alternating between angel wings and dragon wings.  As for wearing body art and piercings, I think you need to consider who you are caring for.  Some people are ok with it, and others only see the stud in your nose or the ink on your arm and not that you are the most skilled nurse on the floor.  Most importantly, can you cover it up if needed?  If you have a patient who is afraid that the Terminator is hunting him down, it would be good to cover your cybernetic arm that was so meticulously inked before becoming a nurse in order to keep them calm.  Along those lines, you might have a patient who is trying to remove the little bug from your nose and is leaping from the gurney to get to you.  Covering these up will prevent a lot of paperwork, administering prns, and even injury.
Hair:  At last we come full circle.  I can tell you now that I will not cut my hair, but I am more than willing to wear it up in a ponytail or bun, or back in a braid.  If you can pull off a perfectly bald, shaved head I say go for it, whether you are a man or a woman.  My scalp is envious because of all its bumps and scars; there are always nice “do rags” out there if you get cold or funny looks.  But, as I’ve said before, how you present yourself to the world is how most people perceive you.  Once I had an ER doctor who wore dreadlocks and immediately I made the assumption that she wasn’t cut from the same cloth as many of her colleagues.  I was right, and as it turned out, she could also tap dance and sing goofy songs as well as provide me with the best medical care I had ever received.  I have never had problems with dreadlocks, but I know that this might not be the case for others.  If you want people to think you are the kindest, gentlest, most approachable nurse in the hospital, the day glo green Mohawk probably won’t reinforce this image. 
So, it all comes down to this:  awareness of hospital policy regarding dress code, awareness of how you are perceived by other people, and awareness of society’s norms regarding what is “proper” for nurses.  There are variations within these, as some hospitals have psych units that do not require nurses to wear scrubs, some people may be used to seeing you without your hair down, and patients may have grown up with the nurse in the white uniform but like your mauve scrubs much better (“that is definitely your color, sweetie”).  All the same, just be aware and consider that you may have to make some changes.  Whatever happens, let people see you as an individual, a professional, and as a nurse.
Should there be a dress code in nursing?  What do you think? 
About the Author: Rachel E. Clements is one of those "second winders" who began training in one career field and chose nursing instead; she has been a nurse for 5 years in May.  Rachel lives and works in Boise, Idaho, and is currently enrolled in Montana State University's online Psychiatric Mental Health Nurse Practitioner program.  In her spare time, Rachel enjoys hiking, savoring the sunshine with her two kitties, and tending to the yard of her relatively new house!

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