A nurse just yelled at you at the nurses station. You’re angry and humiliated. What you do next could be the most critical moment of your entire shift.
Dear Director: I recently had a nurse yell at me in front of everyone at the nursing station because I didn’t clean up after repairing a lac. It was an incredibly busy shift; I threw out the sharps but wanted to get back to work quickly so I left everything else for her to clean up. It had already taken her an hour to get everything out of the locked supplies closet so I could do my work. I think her behavior is inappropriate. What should I do?
I’m sure you’re frustrated and embarrassed by the situation. No one wants to be belittled, especially publicly, particularly when you’re viewed as a leader in the department. But your role as a leader breaks down if you can’t maintain professional relationships at work. When you bring a variety of personalities together in a high-stress arena, flare ups are almost inevitable. But how you respond is up to you, and a few small choices can make all the difference.
Know Your Role
Before we cast all the blame on the inappropriate nurse, let’s reconstruct the event and consider what you contributed to the situation. To begin, there are few things more frustrating than mentally getting ready to start a procedure and then not being able to complete it. Finding a free 15-minute window when there’s no new patients to see and when you’re not expecting a phone call is relatively rare, so whether it’s the equipment not being available or the patient being stuck in CT, you feel thwarted. Tack on your additional frustration of not having access to your supplies because you think the nurse is ignoring your request. Put it all together and you start thinking, ‘the nurse wasted so much time, could she at least help me by bandaging the patient and throwing out the lac kit?’ Does that sound familiar? We all have shifts where the chaos of the ED is getting the better of us.
Let’s admit it—you may have used some passive aggressive behavior — and it backfired. It could have been extremely busy, and it was just an oversight. Of course, the nurse never should have yelled at you, particularly in public, but acknowledging the role that you played is the first step in fixing the problem. Plus, casting blame won’t heal the relationship with your nurse.
Improving Communication in the Department
While CPOE has decreased our need to actually talk to our nurse colleagues, it doesn’t eliminate the importance of effective and timely communication. It’s one thing to write an order, but it’s another to take a minute and find out what’s going on with the individual nurse to determine if there is a delay in the order being completed. You may not realize that the nurse is helping one of your colleagues intubate or is busy with a code. As a chairman, it’s nearly impossible to design a policy for how communication should happen when nurses can’t complete an order in a timely fashion.
That said, it’s all about culture. Beginning with orientation of all new hires, the ED’s culture should include a clear understanding of effective communication and the process for getting help. This is particularly important in the care of a critical patient or in getting needed supplies. Could a tech or another nurse have helped you? Remember that the charge nurse is always there to help you troubleshoot problems. You could have just as easily have asked the charge nurse for help, noting that the nurse has been busy, and, as a result, you’ve been waiting for lidocaine.
Clean Up Your Own Mess
As an ER volunteer during college, I cleaned up countless lac trays. As a resident, I heard stories of how community attendings would walk into a room with the patient prepped, irrigated, and covered in sterile drapes and that I would only need to spend a few minutes suturing before a tech placed a bandage, cleaned up and I could move on to the next patient. After working in several ERs since residency that ranged from inner city to more well-heeled communities, I’ve yet to experience this phenomenon.
As a result, I am a strong advocate for cleaning up my own mess (at least in the ER, apologies to my wife). If everything goes in the trash or sharps box, it’s just as easy for you to throw it out as it is for the nurse. The staff appreciates it, and this act humanizes you in front of the patient. Also, there’s something a plastic surgery resident said to me that’s stuck with me since I was a third-year med student: Because patients typically only see the bandage covering the lac repair, you want to make sure that it looks beautiful and everything else is cleaned up. They won’t judge your repair for a couple of days, but if the bandage looks good, they’ll think the whole thing looks good and they’ll leave happy. Therefore, before you clean up the trash, take the time to clean up the patient and dress the wound carefully. Or at least explain to the patient that the nurse will come in and put the appropriate dressing over the wound.
Repairing the Relationship
Although a chairman or nurse manager is sometimes asked to pull two people into a room and referee while they sort out the issue, my initial approach is to step back and not get into a “he said-she said” situation. Once you’ve understood your role in this situation, and before going to ED administration, I suggest you take the first step and approach the nurse to discuss the interaction. Do this face-to-face, off the unit, without patients or other staff nearby. While it doesn’t hurt to be friendly with people you work with, you don’t have to be friends. At the very least, however, you must maintain a relationship that allows for professional success. Starting with an apology is probably appropriate, even if it’s to say that you’re sorry for leaving a mess. Indicate that you want to discuss the entire situation and that you accept part of the blame. However, you also can say to the nurse that if she has a problem with you, it’s appropriate to address it directly with you, and not at the nurses’ station.
It’s also important to focus on the productivity of the team and not on emotions or personal attacks. Start by having her tell you what happened from her point of view, just like you would listen to a patient complain about their ER visit. It’s important to let her talk and then paraphrase her issues so she knows that you’ve really heard her. Then you can tell your side of the story. But remember, keep your emotions in check. Finally, try to establish a mutual, cooperative understanding that includes a solution about what to do and what not to do in similar circumstances in the future.
The reality is that conflict between docs and nurses happens all the time in the ER. However, because the success of the ED is usually so intertwined in the doc-nurse relationship, we need to quickly resolve these conflicts and maintain or improve our professional relationships. As we understand each other’s jobs and responsibilities and agree how future potential difficult situations should be handled, we are building communication patterns that avoid potential conflict while building our team.