* * Anonymous Doc

Saturday, July 17, 2010

A nurse casually drops by the call room:

"Doctor, just wanted to let you know-- [the patient]'s blood pressure is 60 over 40."


"Yeah, it's been like that for a while."

"What???????????????????" as I get up and RUN down the hall.

"Yeah, I've marked it in the chart every hour."


"I wasn't sure it was accurate."

[Looking at the chart]

"You checked it eleven times, and it went from 80s to 70s to 60s... what made you think eleven readings weren't accurate?"

"It didn't seem like it should be that low."


"Oh, okay. Next time."

"Yeah. Next time."


  1. Your goal for this conversation is to have the nurse inform you sooner about low readings that threaten patients, but you're risking the opposite. If your comments make her think you're calling her stupid or incompetent, she's likely to defensively reject that and come up with reasons she was right after all: hey, the patient lasted the entire shift with no complications, he probably was OK!

    If you can find the time to make her feel safe in the conversation first, like this: "OK, it's good that you're taking a second reading so you don't end up bothering the doctor over everything, and I know you wouldn't have let it slide if you thought it was going to put the patient in any danger. But blood pressure that low can cause [complication X], so I think it'd be better to have two people involved in that judgment call. Just let me know next time."

    Of course, it's a lot easier to put this kind of effort into team relations if you're not already sprinting down the hall to the patient's room!

  2. wow, noumenon, that's appallingly lame and no one wants to hear it.

    this nurse had to have successfully completed and graduated from a nursing school, right?
    she should feel stupid.

  3. OK, it's lame, and some people prefer straight talk. Strike out all the therapy speak then and change the approach to "make sure you already praised her for two things she did right that week, then speak freely." The point is to keep that feeling of safety so she can actually hear what you have to say.

    If your goal is to make sure she feels as stupid as she deserves, go ahead and point that out in withering detail. But if your goal is for her to meet higher standards, you have to be a lot less aggressive. People don't want to hear lame therapy speak but they respond much worse when they feel threatened.

  4. should note that the above "anonymous" comment is not me (anonymous doc). should note that i am more patient with nurses (and patients...) in real life than in blog form. nurses like me, i am non-threatening, and unlike a few of my colleagues, do not call them names.

  5. If the blog were a literal transcription of a conversation it would be amusing to hear the tone of voice/facial expression represented by nineteen question marks in a row. "What???????????????????"

  6. And just to be clear, I wasn't cautioning you against being a jerk, because I don't think you are one, I just view subordinate interactions as a technical skill that you can improve on with practice. I don't know what the turnover is like where you work but I bet after five years of seeing nurses come and go you will be heading off mistakes like these before they even happen. When you see a nurse not telling you about a bad vital sign you'll be like "Oh, that's my fault, I forgot to give her my little training speech about when to come get my attention."

  7. i didn't mean to imply it is necessary to make her feel stupid, but that she hopefully already does....as she should.
    i don't condone putting people down-- especially in a work environment...

  8. The situation is so familiar:
    "Can't log on to check my e-mail and now I am waiting for an important mail. It's about time you guys fix it, I have been waiting for ages to have this fixed!"
    (Rush to the scene. Discover that someone had pulled the network cable out of the computer.)
    "How long has it been this way?"
    "Oh, since August." (It is now February)
    "Why didn't you tell us about it then?"
    "You guys seemed so busy," or "I thought you guys were working on it" are the usual excuses.
    (I plug the cable in, and computer works fine. Getting ready to leave.)
    "Oh wait - what's my user name?"
    "The one you got by SMS when you started."
    "I didn't receive an SMS."
    "What's your name again?"
    (They tell their name, and I look them up in the database. Shockingly, they are not there.)
    "You're not in the database. When did you start working here?"
    "May last year."
    "Obviously, nobody told us. That's why you have no user name."
    (Writes down name of the person, heads of to their department's manager, who tells me that "yes, the person started working for us in May, but you guys were so busy, I thought it could wait")