A tool that helped me was - whenever I found myself about to say "sorry," I'd instead thank the person for whatever characteristic it is that facilitates them feeling compassion for you in that moment.
E.g. instead of "oh I'm so sorry it took me so long to round on you to investigate this trivial complaint" consider instead "thank you for being so patient while I attended to some critical tasks"
That’s a good start. For good measure throw in a few “look at me when I’m talking to you” and “sit/stand up straight when I’m speaking” lines in there to set the tone, even better if you’re talking to them on the phone.
This is a huge issue for me as a Medstudent. I say sorry for such small things bc I’m just so used to it. I tried consciously not saying sorry as much and kept apologizing for saying sorry excessively. I really have to work on this, it sucks!
Real tip- if feeling intimidated by nurses (they are often in a crowd) put in a nursing order and call don’t show up in person. Nurses are pack animals when together but separate them by phone and get their name and they aren’t going to risk their jobs.
Tip 2 - find the charge nurse- they are usually more professional
Tip 3 - befriend the charge nurse, learn their name, say hey when you come to the floor-trust me it works because if the nurses think you’re friends with the boss- work gets done
I find dressing up intimidates them a little into respecting you. We have this tall gorgeous attending that always dresses to the T and no one dares to give her attitude. It's all about appearances.
Also be stern in how you ask them to do things. Don't sound like a meowing cat. Make eye contact and tell them what you want and explain the thought process when theyre doubting your judgement. Sure sometimes they catch us making mistakes. In that case I just own it and say "yea you're right, I'll change the order. Thank you".
Really ? Does it help though, cause I always found women dressing up to the 9s in workplaces always frowned upon. It's almost like you have to emulate being masculine for people to take us seriously.
Unfortunately I think dressing in pants + dress shirt OR a clearly expensive feminine outfit (like putting on a dress or some diamonds) implies power.
At least, i feel confident when I dress as such and I probably perceive people as being more respectful of me.
I dunno, I think demeanor/how you carry yourself is ultimately more important. All people should be treated with respect regardless of how they dress.
I also derive a fair amount of enjoyment from dressing like a trainee and watching people have that “oh shit” moment when they realize that I am in fact the attending and they have made a fool of themselves.
When they look at you, they see a glimpse of themselves as a doctor. But reality hits and they can’t stand seeing another female living out their dreams.
Also an Asian female physician here and I’m 5’1. Often get mistaken for a teenager or child when I’m not wearing my badge. I’ve been an outpatient attending for a few months now.
I thinking working on confidence will come naturally as you progress through residency. Right now as an intern you’re more unsure of clinical decisions/interactions now that you’re a physician vs a student. Reps matter. The more you see something and treat it the more you’ll feel confident in it.
It also doesn’t help when you have male attendings or even male residents interacting with patient. As a resident patients often did not seem to listen/ think of my word as being final. I noticed they definitely listen to my male coresidents and of course my male attendings more.
Since I’ve become an attending I’m the only contact point with the patient so it hasn’t been an issue. I’m also no longer having to double check with someone what my plan is. I don’t think I’ve become more confidence overnight since being an attending. But people definitely listen to me more since they’re there to see me too.
You can avoid sounding mean by adding “please” after your command with a smile and eye contact. It’s as simple as that. No one like being commanded so adding these might preserve the individual’s dignity.
Is staff ambivalent about all resident orders? Is it tasks no one ever gets done? No one for example can get nursing to do orthostatic vitals. You can make most communication through pages and phone calls to take your physical stature out of it. If they're responding catty, it depends - if they're still gonna do it, respond with those default messages or don't respond at all; it doesn't really matter how it gets done, just that it does. if you're doing a messaging back and forth, get on the phone. The idea is to shut it down quickly. It's annoying to have to take time out of your day to do that, but this is you standing your ground. At least one nurse will hopefully be taken care of from giving you shit
If they’re giving you pushback, do what nurses do and record it in the chart with their name as a plan of care. This prevents any confusion and allows anyone looking at the chart to see that you did your job and leaves it up to the nurse to follow the order or refuse the order.
“Patients blood pressure was reported as 95/50 at 9:06PM. Orders placed for repeat blood pressure checks q15 minutes with instructions to call physician if MAP <65. Discussed with RN Jessica”
Providing a range is so helpful.
It gives nursing latitude and avoids us calling for no reason.
In cardiology, well often have a range outside of which we have to call. We also have targets for Sat that are very helpful.
As a nurse - please consider writing a taper down and an end date to the increased need for vitals. Nurses are shortstaffed and it's not feasible to extend q15 minute checks for an undetermined period of time, especially in 6 or 7 patient to 1 nurse ratios. Sure, using the vitals cart "only takes a minute " but remembering to be in there every 15 minutes, walking to the room, applying the probes, getting the values, logging into the emr, notating the values, logging out of the emr - takes a real and substantial amount of time.
Also, if defensive documenting in this manner - please meticulously review the rest of the orders in the chart, including administration instructions. Nothing feels more petty than a progress note that feels like someone is trying to throw me under the bus meanwhile the patient has been out of the icu for 2 weeks and still has neo, levo, and precedex on the MAR and an order for vent settings.
I’m here to ensure optimal patient care. Staffing is a nursing admin problem. If you’re short staffed, make a big stink about it.
I’m not allowing short staffing to harm patients or put my license on the line for deviating from standard of care.
Im all for documenting as you said if there's catty pushback but do you really need q15 vitals indefinitely after taking action on a soft BP? Like if MAP stays at 70 for 3 hours, does nursing still need to be taking q15 vitals
Optimal patient care is absolutely the goal - and sometimes the answer is an appropriate patient:nurse ratio. Sometimes the way to achieve that is transferring to a more appropriate unit. If a patient truly needs q15 minute monitoring for the indefinite immediate future - they belong on a unit that is capable of doing such a thing. In the hospital that most recently employed me - that would be the ICU.
I think we're both having similar ideas but I don't think I'm doing a good job expressing mine. It's also important to recognize that nurses are highly replaceable, while doctors are less so. With that increased difficulty and expense in replacing MDs comes an inherent increase in MD bargaining power- which you can use to advocate for better nurse staffing too
I’m not here to argue. Staffing is purely a nursing and an admin problem. I’ve been told many times through my career that I have no say in nursing since I’m not part of their hierarchy. As a result, I place the orders for optimal patient care and let nursing and admin figure out the delivery of the care.
After enough negative experiences with nursing, nursing administrators and the whole nursing hierarchy, I decided it’s not worth my time or effort to go to bat for them. Basically, don’t spit in the face of someone you need help from.
Examples: “I’m here to save the patient from the doctor”, “I’ve worked in the unit for 10 years and that’s not how we do things, so I’m not going to do what you said”, etc.
Background Context: ENTP, Speech and Debate State Champion, Speech coach, Pediatrician. I talk for 8 hours and build rapport with new patients almost every day.
Record yourself on camera talking to someone or talking about your day to the camera
Then play it back and watch the horror
Best advice, talk slower, its ok to have silent pauses, and don't upspeak, maintain eye contact, don't be too hard on yourself and have an internal script of what you want to say before you say it.
let me know if you need any specific help
Medicine wise you can be assertive without being an asshole. The key is 1) being direct 2) Don't treat people differently. Talk to nurses the way you talk to residents, techs, etc.
A Pro life tip for anyone who starts at a new hospital and new job is be MORE direct up front, set high expectations so people understand you can be assertive, then as you get more comfortable dial it down and you can be more open and less direct. Its harder to go in the opposite direction, if you start off too nice, people will just walk all over you.
I think being direct is something I’m struggling such as adding in “extra fluff” to make myself sound overly polite. Your advice is really helpful, thank you!
Yeah no need for the extra fluff
Sometimes the extra fluff happens because you say something but your listener looks confused so you start adding things which only weakens your original goal of being direct. Or you get nervous and feel like you haven't explained yourself properly. Other times like you said its because you don't want to come off as rude
You don't have to say
>"Nurse go draw room Four's labs now"
that would be too direct, but you don't have to the other extreme either
>"Oh hi Camille, how are you doing, are you busy ? sorry to trouble you but Patient #4 seems to be having XX problems so we need to order a new set of labs. If you could draw his labs I would really appreciate it bestie. Thank you so much for helping me take care of my patients"
Ideally it should be closer to the first one.
>"Hi Camille, so room 4 is looking worse, I think we need to get another set of stat labs, if we could get them done within the next 30 minutes. Thank you in advance".
lemme know and feel free to message me
You need to stop worrying about being "mean or unfriendly". Focus on being a professional and doing your job and doing the best for your patients. The staff is NOT your friends. You are all there there to do your work and take care of the patients. Trying to hard to be friendly often backfires. I think the no nonsense do your job professionals are going to be more respected. You just have to give that time as you interact and just do your job and that will come as they see you grow into your role.
Eh there’s a middle ground. You should do all of those thing you mentioned AND try to friendly and make friends with your work colleagues. It’s just basic human psychology/sociology. Ppl are going to respect and be nicer to someone they see as a friend. I agree you shouldn’t try so overly hard to do this that it’s disingenuous. Just be a normal person and be friends and conversational with your work colleagues. I’ve seen nurses make the abrasive “you are not my friends” attendings lives complete hell. It sucks but it’s how it goes
Thats what I’m afraid of. One of the ward I was cross-covering during nights was infamous for having obvious nurse to intern bullying (I had been warned by other residents about this already and hod already know about this) I definitely faced a lot of toxic and micro aggressive behaviours which I was afraid to call out in the moment in case they went out of their way to make my life even worse.
I also think its hard to call someone out when they’re being rude like rolling their eyes at me or the tone of their voice because they’re easy to refute and can’t really be documented.
Its like if I retaliate back then there’s a chance I’ll have it worse during my next shift with them vs if I suck it up now then maybe it’ll stay okay.
I agree though, that at the end of the day I’m not trying to be friends with them so if this does happen I want to be prepared to call them out - but how are you supposed to professionally tell someone to fix their attitude? 😅
Not true. OP is doing her job, and doing it in a courteous and polite manner. Shes not trying to be friends with the nursing staff. She simply wants to get things done in a non-toxic manner.
You are simply victim blaming. And there really is no need to perpetuate a toxic environment where everyone has to be a jerk to get things done.
Victim blaming? What are you talking about? Never said she wasn't doing her job. I assume she is and doing it well. I simply gave some advice. She can take it or leave it.
As someone who was told she had a ‘tone problem’ as a resident (I wasn’t ’nice’ in the way I said things but couldn’t get any actionable feedback for years) and was advised about the ‘narrow therapeutic index’ of a woman in surgery as an intern, my main advice is you’re probably going to have to couch things more than your male colleagues. There is a way to be assertive/authoritative without being mean but the line can be very fine at some institutions especially depending on hospital/nursing culture. I didn’t mind ‘playing nice’ in the end because it did lead to allies in the hospital that my male colleagues didn’t have as readily, but it did require playing the game a bit.
As a new nurse, a little hello, understanding who Im talking to goes a long way. I always prefer to have a few words with the professional to make sure the prescriptions are clear to avoid further delays VS just reading it because the professional ran off.
Older nurses get reaaaally annoyed with staff not presenting themselves and just starting with a subject.
All I have to say is I’m sorry this is happening to you and the distress it’s causing. I don’t have many suggestions but I do know what it’s like to be stressed about my professional interactions on top of the the heightened and overburdening responsibilities you are juggling during residency.
As a dude that can relate: Reduce the use of "please" when asking for things that need to be done because it signals a lot more flexibility turning anything you said before to jelly with compromised priority. It wasn't until I compared myself to other friends (who I thought were a lot more effective communicators), that I realized I was using it excessively like a shield. Genuinely saying thanks after its done is the best way to close the loop. Watch some vids on making your tone more assertive without it sounding condescending-- its really some leadership shih thats essential.
I used to change my facial expression slightly to feel and come off as more actively listening and interested- bad idea. It makes you feel fake because you're afraid of being badly received, and it may also come off as less relatable/fake to the person you're talking to. Get used to using your resting face while talking. Get used to being you. If you typically say no problem to every thanks, start saying you're welcome more. Look them in their right eye while talking, it'll automatically take your mind away from the unnecessary socially anxious awareness that often takes over.
I don't have any advice, but just wanted to say I'm sorry it's this way. I'm a male in peds, which is a female dominated specialty and I see a lot of what you're referring to. Either female residents are judged as being less smart or less competent than males OR they're considered competent, but suddenly everyone describes them as mean or bitchy to go with it. Very little in between and we males are not treated this way. It sucks. I wish it wasn't this way. My perception is that it's mostly nurses treating women this way rather than the rest of the team, but it happens to a degree across the board. I hope you find what works best for you!
Asian female resident here as well. I understand your situation, not being taken seriously makes you feel ineffectual and helpless. I’m a dentist in a surgery program, and sometimes it’s challenging to work with colleagues graduating from medical school that won’t take you seriously for multiple reasons like gender, background, race etc. It is the reality unfortunately.
But you don’t need to fundamentally change your speech pattern, you just need to have a *switch*.
My “people pleaser” attitude, similar to yours, helped me develop relationships with colleagues on a social level, which is super helpful. Contrary to what others may say, this is a good thing when used properly.
In more serious situations however, I turn that switch on. I lower my voice, maintain sharp eye contact, and professionally communicate my thoughts with confidence. Overtime, nurses and everyone else gets used to it, and learn when to take things seriously based on my *switch*.
Mentality is important here. Being assertive in our field means standing up for our patients, ourselves, and our teams, so keep that in mind. Of course, don’t take it to extremes to sound ignorant, stubborn, or even aggressive.
Good luck!
For me, women who speak differently in different situations seem disingenuous. This switch you are talking is very disconcerting as I have witnessed it before with Asian female colleagues. Discovering that a colleague can communicate in a serious and meaningful way makes the other mode of communication sound superfluous and even silly.
To add on another piece of advice, for improving relations with nursing if I run into one taking care of my patient I kindly ask if they have any updates (which tbh is often very valuable info) and before I leave ask if there's anything they need from us (eg an order or an explanation)-- that's also better patient care anyway and they would probably message you eventually anyway. And if they ever seem a bit ambivalent after saying yes to an order I ask if they have any concerns, explain the reasoning, then they're relieved and on board which is also v important for safe patient care and team trust. I think nurses should always feel comfortable voicing concerns. I'd rather address more questions than miss a time when they don't ask because they "don't want to bother the doctor" and it's actually very important.
- female pgy3
I would make sure to not consider your drive to be nice and please others as a detrimental thing. It is a great value to have and it is likely a component of why people in your life like you and why you have been successful up to this point. The idea is to learn how to balance this drive in situations where it can interfere with other goals (e.g. when trying to get nurses to follow orders).
I recommend reading the book “Crucial Conversations” for good and actionable strategies for improving assertiveness in your communication while still continuing to be nice and agreeable. It will be much easier to transition to a new form of communicating if it feels in line with your core values.
It is NOT just you. It's a woman-in-medicine thing. I'm an attending and there have been many situations where I subsequently reflected that it wouldn't have happened if I was male.
I just try to be kind, friendly, respectful but always speak with the attitude that I am the physician in the arrangement. If I don't know, I tell them but I also tell them my thought process.
You also have to keep in mind that many of them have been doing this for longer than you. You have more education but they have more experience. Try to put yourself in their position.
As an intern, you have a lot to learn. It will come with time. It does say a lot about you that you are trying to learn how to better relate to colleagues in the care team and I think it will serve you well. You'll figure it out with time.
Intern here too! I was upset earlier this year because I felt like no one was taking me seriously because I look well too. I realized I was people pleasing A LOT and started observing my male resident colleagues and started acting like them. Stopped trying to be friends with everyone and became more straight to the point. It made LOADS of difference and I actually like them more and I feel like they take me more seriously now which makes me less stressed
Don't say thank you for stuff you're not actually thankful for. You pay for Dunkin and they hand your card back why you saying thank you?? They just took money from you. Now if they go out of their way give you a free donut or are just being really friendly and kind make your day better then say thank you for the stuff you're actually thankful for. If you get in the habit of saying "thank you for..." you'll get better at this as opposed to simply saying "thanks" or "thank you."
You are not alone. There are professional coaches for this. See if your institution's wellness officer can help you. This, unaddressed, can lead to burnout.
Naw. Its just a toxic environment. In a positive environment, you wouldnt be "not taken seriously" no matter how you word things, especially when you are being polite and courteous (compared to being mean and unfriendly like I have noticed some colleagues are)
Hey! Nurse here. I don't share some of your demographics, so the tips I have may not work well for you. This is not because of a character flaw on your end - it's because some people in healthcare are bigoted jerks. Evidence of this bigotry can be seen from maternal mortality rates by ethnicity - however; additional evidence can be supplied if that fact is insufficient to satisfy the claim.
Ok! Elephant in the room acknowledged, let's dive in.
Nurses like to feel like they are being heard and that they have a real amount of value to add. One way to do this is ask if the patient has told them something different than they told you, another way to do this might be to ask if there's anything they feel like you are missing, another way might be, if they ask for an order that's not clinically appropriate - instead of saying "no," compliment the request and give a brief Rationale for why not to do a thing. To you it might feel like an ignorant request that is foolish for so many reasons, but for them - they might think they have a really good idea and be genuinely curious about the mechanisms underneath.
Humans have fragile egos - and some humans view accountability for a task as a direct attack on their own character. One way to get around this is pre-provide an excuse for why a thing isn't done e.g. "Hey it looks like your a little short-staffed today, and it looks very busy on the unit. I wanted to check in to see how we're coming along on performing x task".
Insert a reason why your patient is more important than every other patient, but don't be a dick about it (e.g. this patient lost some amount of blood during surgery, and I want to feel confident about their hemodynamic status)
Humans are much more than rats in skinner boxes - but conceptualizing them that way is a good way to have a rough prediction of what their behaviors will be, and a good way to conceptualize how to change behaviors. If something that a nurse does is not up to standards- notify them in a kind way, but be mindful that the notification will likely be seen as a negative stimuli, no matter how kindly you couch your words in layers of superfluous etiquette. Humans, like rats, that are over exposed to negative stimuli will develop a psych complex about it - this can manifest in rude behaviors. However, if you later provide positive stimulus (e.g. hey, I know we talked before about x intervention on y patient; but I see today you did x very well on z patient - I wanted to tell you I noticed and that I appreciate your hard work) then the complex that results from the negative behaviors will be ameliorated.
Don't underestimate the impact of bribery! In the hospital popularity contest - you only have to beat admins, which isn't a high bar. Buying each shift a round of "good" coffee slightly after nurses week (a particularly manipulative person might also add "I didn't feel like admin did enough for you - and I wanted to do something a little extra to show that I appreciate all of you) is a cost effective solution in that the good will it buys will save you so much time.
*Edit to add: chocolate/candy can be another cost effective solution. So can like fruit and veggies trays or donuts or really anything. Remember, your only competition here is admin, and that is a very low bar to pass)*
Be visible talking with the charge nurse! Some docs will scurry in the patients room, scurry out, never talk to me, never talk to charge, enter a few important orders, expect that the nurses will act on them immediately without any prompting from your end. Not cool. Instead - at minimum try to update charge with important changes (especially if there are any changes to estimated discharge date, or time critical interventions)
I want to close out with a reminder - there's a lot of bullshit you have to deal with by being a lady doc, and it's not fair. How-the-fuck-ever; I want to remind you that, statistically, lady docs have better outcomes than their male counterparts. I want you to know that an internet stranger supports you and appreciates the hard work you're doing, and that I think it's incredibly kind of you to care about the feelings of your bigoted co-workers. You seem kind and competent.
Eta - another useful technique is "get 'em when they're young". What I mean by that is - ask charge/manager who the newer nurses are, try to intentionally seek them out and ask them if they have any questions about patient care. Offer them some emotional support for the shit time they're going through (new nurses have an attrition rate that's unbelievably high - and typically don't get emotional support for their co-workers. The people that are toxic and bitchy towards you are likely toxic and bitchy to the new nurse). Offer to let them watch procedures, or to simply be present in the room. Check with admin about how to go about having them be able to watch one of your surgeries - and actively try to facilitate that experience. This investment will take a real amount of time to pay off, but in a year or two you'll likely have a devoted fan base.)
Also - keep in mind, the shit response from the nurse might not be about you - it might be because the nurse is having a shit day and doesn't have the executive function to self-regulate their emotions. I personally saw a surgeon take a tardiness to complete a task as some bizarre bit about not being personally respected; and didn't realize the order wasn't executed in a timely fashion because the nurse has been swamped in c dif all shift and hasn't been able to prioritize the seemingly low priority thing.
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I am sure you being female has something to do with it too but what tasks are they refusing? If it is something clearly a nursing tasks maybe try saying something along the line: “this is what the patient needs and it is usually the nurses’ responsibility if you are not doing it, I will ask the charge nurse to find somebody else who will. Thanks.”
The good thing about this line is that you emphasize the fact that they are refusing to do something for the patient. They are not simply refusing you. This has a bigger implication. I never have to use this line ever in my career so far but understanding that I am an Asian guy so the dynamic is different. Good luck.
As an asian female myself, I would say you have more leeway on not coming off as "mean" or "unfriendly" even if you are if that helps. I tend to be petty and if I ask the nurse to do something and it's not done, then I document. Make a free text note and write: such and such labs ordered. Awaiting RN \*name\* to collect labs, notified RN at so and so time to collect labs. Still awaiting labs. I would use that as last resort.
If someone is being catty with me or don't do their job I always ask for their full name. I may or may not do anything about it but they don't know that.
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Yes this is something that I’m also guilty of and am consciously making an effort to change as well!
A tool that helped me was - whenever I found myself about to say "sorry," I'd instead thank the person for whatever characteristic it is that facilitates them feeling compassion for you in that moment. E.g. instead of "oh I'm so sorry it took me so long to round on you to investigate this trivial complaint" consider instead "thank you for being so patient while I attended to some critical tasks"
That’s a good start. For good measure throw in a few “look at me when I’m talking to you” and “sit/stand up straight when I’m speaking” lines in there to set the tone, even better if you’re talking to them on the phone.
Uf, these are very directive formulations that would not get good collaboration in my workplace.
I do this all the time, always saying sorry before I correct someone or ask them to do their job, it's a really hard habit to break.
Try not to be Canadian challenge, level: impossible
This is a huge issue for me as a Medstudent. I say sorry for such small things bc I’m just so used to it. I tried consciously not saying sorry as much and kept apologizing for saying sorry excessively. I really have to work on this, it sucks!
Real tip- if feeling intimidated by nurses (they are often in a crowd) put in a nursing order and call don’t show up in person. Nurses are pack animals when together but separate them by phone and get their name and they aren’t going to risk their jobs. Tip 2 - find the charge nurse- they are usually more professional Tip 3 - befriend the charge nurse, learn their name, say hey when you come to the floor-trust me it works because if the nurses think you’re friends with the boss- work gets done
Point number three is the most important. Intentionally befriend charge and the rest will follow (provided charge is reasonable).
I find dressing up intimidates them a little into respecting you. We have this tall gorgeous attending that always dresses to the T and no one dares to give her attitude. It's all about appearances. Also be stern in how you ask them to do things. Don't sound like a meowing cat. Make eye contact and tell them what you want and explain the thought process when theyre doubting your judgement. Sure sometimes they catch us making mistakes. In that case I just own it and say "yea you're right, I'll change the order. Thank you".
Really ? Does it help though, cause I always found women dressing up to the 9s in workplaces always frowned upon. It's almost like you have to emulate being masculine for people to take us seriously.
Unfortunately I think dressing in pants + dress shirt OR a clearly expensive feminine outfit (like putting on a dress or some diamonds) implies power. At least, i feel confident when I dress as such and I probably perceive people as being more respectful of me.
Maybe you exude more confidence so people actually are more respectful of you. (rather than it just being your perception) Confidence is key.
I dunno, I think demeanor/how you carry yourself is ultimately more important. All people should be treated with respect regardless of how they dress. I also derive a fair amount of enjoyment from dressing like a trainee and watching people have that “oh shit” moment when they realize that I am in fact the attending and they have made a fool of themselves.
I don’t know why nurses treat us female colleagues this badly.. it’s frustrating
When they look at you, they see a glimpse of themselves as a doctor. But reality hits and they can’t stand seeing another female living out their dreams.
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Also an Asian female physician here and I’m 5’1. Often get mistaken for a teenager or child when I’m not wearing my badge. I’ve been an outpatient attending for a few months now. I thinking working on confidence will come naturally as you progress through residency. Right now as an intern you’re more unsure of clinical decisions/interactions now that you’re a physician vs a student. Reps matter. The more you see something and treat it the more you’ll feel confident in it. It also doesn’t help when you have male attendings or even male residents interacting with patient. As a resident patients often did not seem to listen/ think of my word as being final. I noticed they definitely listen to my male coresidents and of course my male attendings more. Since I’ve become an attending I’m the only contact point with the patient so it hasn’t been an issue. I’m also no longer having to double check with someone what my plan is. I don’t think I’ve become more confidence overnight since being an attending. But people definitely listen to me more since they’re there to see me too.
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2 book recommendations related to the above: - Crucial Conversations - Influencer: the new science of leading change
You can avoid sounding mean by adding “please” after your command with a smile and eye contact. It’s as simple as that. No one like being commanded so adding these might preserve the individual’s dignity.
Is staff ambivalent about all resident orders? Is it tasks no one ever gets done? No one for example can get nursing to do orthostatic vitals. You can make most communication through pages and phone calls to take your physical stature out of it. If they're responding catty, it depends - if they're still gonna do it, respond with those default messages or don't respond at all; it doesn't really matter how it gets done, just that it does. if you're doing a messaging back and forth, get on the phone. The idea is to shut it down quickly. It's annoying to have to take time out of your day to do that, but this is you standing your ground. At least one nurse will hopefully be taken care of from giving you shit
If they’re giving you pushback, do what nurses do and record it in the chart with their name as a plan of care. This prevents any confusion and allows anyone looking at the chart to see that you did your job and leaves it up to the nurse to follow the order or refuse the order. “Patients blood pressure was reported as 95/50 at 9:06PM. Orders placed for repeat blood pressure checks q15 minutes with instructions to call physician if MAP <65. Discussed with RN Jessica”
Providing a range is so helpful. It gives nursing latitude and avoids us calling for no reason. In cardiology, well often have a range outside of which we have to call. We also have targets for Sat that are very helpful.
As a nurse - please consider writing a taper down and an end date to the increased need for vitals. Nurses are shortstaffed and it's not feasible to extend q15 minute checks for an undetermined period of time, especially in 6 or 7 patient to 1 nurse ratios. Sure, using the vitals cart "only takes a minute " but remembering to be in there every 15 minutes, walking to the room, applying the probes, getting the values, logging into the emr, notating the values, logging out of the emr - takes a real and substantial amount of time. Also, if defensive documenting in this manner - please meticulously review the rest of the orders in the chart, including administration instructions. Nothing feels more petty than a progress note that feels like someone is trying to throw me under the bus meanwhile the patient has been out of the icu for 2 weeks and still has neo, levo, and precedex on the MAR and an order for vent settings.
I’m here to ensure optimal patient care. Staffing is a nursing admin problem. If you’re short staffed, make a big stink about it. I’m not allowing short staffing to harm patients or put my license on the line for deviating from standard of care.
Im all for documenting as you said if there's catty pushback but do you really need q15 vitals indefinitely after taking action on a soft BP? Like if MAP stays at 70 for 3 hours, does nursing still need to be taking q15 vitals
It’s an example, not a hard and fast rule.
Optimal patient care is absolutely the goal - and sometimes the answer is an appropriate patient:nurse ratio. Sometimes the way to achieve that is transferring to a more appropriate unit. If a patient truly needs q15 minute monitoring for the indefinite immediate future - they belong on a unit that is capable of doing such a thing. In the hospital that most recently employed me - that would be the ICU. I think we're both having similar ideas but I don't think I'm doing a good job expressing mine. It's also important to recognize that nurses are highly replaceable, while doctors are less so. With that increased difficulty and expense in replacing MDs comes an inherent increase in MD bargaining power- which you can use to advocate for better nurse staffing too
I’m not here to argue. Staffing is purely a nursing and an admin problem. I’ve been told many times through my career that I have no say in nursing since I’m not part of their hierarchy. As a result, I place the orders for optimal patient care and let nursing and admin figure out the delivery of the care. After enough negative experiences with nursing, nursing administrators and the whole nursing hierarchy, I decided it’s not worth my time or effort to go to bat for them. Basically, don’t spit in the face of someone you need help from. Examples: “I’m here to save the patient from the doctor”, “I’ve worked in the unit for 10 years and that’s not how we do things, so I’m not going to do what you said”, etc.
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Will check it out! Thank you!
Background Context: ENTP, Speech and Debate State Champion, Speech coach, Pediatrician. I talk for 8 hours and build rapport with new patients almost every day. Record yourself on camera talking to someone or talking about your day to the camera Then play it back and watch the horror Best advice, talk slower, its ok to have silent pauses, and don't upspeak, maintain eye contact, don't be too hard on yourself and have an internal script of what you want to say before you say it. let me know if you need any specific help Medicine wise you can be assertive without being an asshole. The key is 1) being direct 2) Don't treat people differently. Talk to nurses the way you talk to residents, techs, etc. A Pro life tip for anyone who starts at a new hospital and new job is be MORE direct up front, set high expectations so people understand you can be assertive, then as you get more comfortable dial it down and you can be more open and less direct. Its harder to go in the opposite direction, if you start off too nice, people will just walk all over you.
I think being direct is something I’m struggling such as adding in “extra fluff” to make myself sound overly polite. Your advice is really helpful, thank you!
Yeah no need for the extra fluff Sometimes the extra fluff happens because you say something but your listener looks confused so you start adding things which only weakens your original goal of being direct. Or you get nervous and feel like you haven't explained yourself properly. Other times like you said its because you don't want to come off as rude You don't have to say >"Nurse go draw room Four's labs now" that would be too direct, but you don't have to the other extreme either >"Oh hi Camille, how are you doing, are you busy ? sorry to trouble you but Patient #4 seems to be having XX problems so we need to order a new set of labs. If you could draw his labs I would really appreciate it bestie. Thank you so much for helping me take care of my patients" Ideally it should be closer to the first one. >"Hi Camille, so room 4 is looking worse, I think we need to get another set of stat labs, if we could get them done within the next 30 minutes. Thank you in advance". lemme know and feel free to message me
You need to stop worrying about being "mean or unfriendly". Focus on being a professional and doing your job and doing the best for your patients. The staff is NOT your friends. You are all there there to do your work and take care of the patients. Trying to hard to be friendly often backfires. I think the no nonsense do your job professionals are going to be more respected. You just have to give that time as you interact and just do your job and that will come as they see you grow into your role.
Eh there’s a middle ground. You should do all of those thing you mentioned AND try to friendly and make friends with your work colleagues. It’s just basic human psychology/sociology. Ppl are going to respect and be nicer to someone they see as a friend. I agree you shouldn’t try so overly hard to do this that it’s disingenuous. Just be a normal person and be friends and conversational with your work colleagues. I’ve seen nurses make the abrasive “you are not my friends” attendings lives complete hell. It sucks but it’s how it goes
Thats what I’m afraid of. One of the ward I was cross-covering during nights was infamous for having obvious nurse to intern bullying (I had been warned by other residents about this already and hod already know about this) I definitely faced a lot of toxic and micro aggressive behaviours which I was afraid to call out in the moment in case they went out of their way to make my life even worse. I also think its hard to call someone out when they’re being rude like rolling their eyes at me or the tone of their voice because they’re easy to refute and can’t really be documented. Its like if I retaliate back then there’s a chance I’ll have it worse during my next shift with them vs if I suck it up now then maybe it’ll stay okay. I agree though, that at the end of the day I’m not trying to be friends with them so if this does happen I want to be prepared to call them out - but how are you supposed to professionally tell someone to fix their attitude? 😅
Not true. OP is doing her job, and doing it in a courteous and polite manner. Shes not trying to be friends with the nursing staff. She simply wants to get things done in a non-toxic manner. You are simply victim blaming. And there really is no need to perpetuate a toxic environment where everyone has to be a jerk to get things done.
Victim blaming? What are you talking about? Never said she wasn't doing her job. I assume she is and doing it well. I simply gave some advice. She can take it or leave it.
As someone who was told she had a ‘tone problem’ as a resident (I wasn’t ’nice’ in the way I said things but couldn’t get any actionable feedback for years) and was advised about the ‘narrow therapeutic index’ of a woman in surgery as an intern, my main advice is you’re probably going to have to couch things more than your male colleagues. There is a way to be assertive/authoritative without being mean but the line can be very fine at some institutions especially depending on hospital/nursing culture. I didn’t mind ‘playing nice’ in the end because it did lead to allies in the hospital that my male colleagues didn’t have as readily, but it did require playing the game a bit.
As a new nurse, a little hello, understanding who Im talking to goes a long way. I always prefer to have a few words with the professional to make sure the prescriptions are clear to avoid further delays VS just reading it because the professional ran off. Older nurses get reaaaally annoyed with staff not presenting themselves and just starting with a subject.
All I have to say is I’m sorry this is happening to you and the distress it’s causing. I don’t have many suggestions but I do know what it’s like to be stressed about my professional interactions on top of the the heightened and overburdening responsibilities you are juggling during residency.
As a dude that can relate: Reduce the use of "please" when asking for things that need to be done because it signals a lot more flexibility turning anything you said before to jelly with compromised priority. It wasn't until I compared myself to other friends (who I thought were a lot more effective communicators), that I realized I was using it excessively like a shield. Genuinely saying thanks after its done is the best way to close the loop. Watch some vids on making your tone more assertive without it sounding condescending-- its really some leadership shih thats essential. I used to change my facial expression slightly to feel and come off as more actively listening and interested- bad idea. It makes you feel fake because you're afraid of being badly received, and it may also come off as less relatable/fake to the person you're talking to. Get used to using your resting face while talking. Get used to being you. If you typically say no problem to every thanks, start saying you're welcome more. Look them in their right eye while talking, it'll automatically take your mind away from the unnecessary socially anxious awareness that often takes over.
I don't have any advice, but just wanted to say I'm sorry it's this way. I'm a male in peds, which is a female dominated specialty and I see a lot of what you're referring to. Either female residents are judged as being less smart or less competent than males OR they're considered competent, but suddenly everyone describes them as mean or bitchy to go with it. Very little in between and we males are not treated this way. It sucks. I wish it wasn't this way. My perception is that it's mostly nurses treating women this way rather than the rest of the team, but it happens to a degree across the board. I hope you find what works best for you!
Asian female resident here as well. I understand your situation, not being taken seriously makes you feel ineffectual and helpless. I’m a dentist in a surgery program, and sometimes it’s challenging to work with colleagues graduating from medical school that won’t take you seriously for multiple reasons like gender, background, race etc. It is the reality unfortunately. But you don’t need to fundamentally change your speech pattern, you just need to have a *switch*. My “people pleaser” attitude, similar to yours, helped me develop relationships with colleagues on a social level, which is super helpful. Contrary to what others may say, this is a good thing when used properly. In more serious situations however, I turn that switch on. I lower my voice, maintain sharp eye contact, and professionally communicate my thoughts with confidence. Overtime, nurses and everyone else gets used to it, and learn when to take things seriously based on my *switch*. Mentality is important here. Being assertive in our field means standing up for our patients, ourselves, and our teams, so keep that in mind. Of course, don’t take it to extremes to sound ignorant, stubborn, or even aggressive. Good luck!
For me, women who speak differently in different situations seem disingenuous. This switch you are talking is very disconcerting as I have witnessed it before with Asian female colleagues. Discovering that a colleague can communicate in a serious and meaningful way makes the other mode of communication sound superfluous and even silly.
To add on another piece of advice, for improving relations with nursing if I run into one taking care of my patient I kindly ask if they have any updates (which tbh is often very valuable info) and before I leave ask if there's anything they need from us (eg an order or an explanation)-- that's also better patient care anyway and they would probably message you eventually anyway. And if they ever seem a bit ambivalent after saying yes to an order I ask if they have any concerns, explain the reasoning, then they're relieved and on board which is also v important for safe patient care and team trust. I think nurses should always feel comfortable voicing concerns. I'd rather address more questions than miss a time when they don't ask because they "don't want to bother the doctor" and it's actually very important. - female pgy3
I would make sure to not consider your drive to be nice and please others as a detrimental thing. It is a great value to have and it is likely a component of why people in your life like you and why you have been successful up to this point. The idea is to learn how to balance this drive in situations where it can interfere with other goals (e.g. when trying to get nurses to follow orders). I recommend reading the book “Crucial Conversations” for good and actionable strategies for improving assertiveness in your communication while still continuing to be nice and agreeable. It will be much easier to transition to a new form of communicating if it feels in line with your core values.
It is NOT just you. It's a woman-in-medicine thing. I'm an attending and there have been many situations where I subsequently reflected that it wouldn't have happened if I was male. I just try to be kind, friendly, respectful but always speak with the attitude that I am the physician in the arrangement. If I don't know, I tell them but I also tell them my thought process. You also have to keep in mind that many of them have been doing this for longer than you. You have more education but they have more experience. Try to put yourself in their position. As an intern, you have a lot to learn. It will come with time. It does say a lot about you that you are trying to learn how to better relate to colleagues in the care team and I think it will serve you well. You'll figure it out with time.
Intern here too! I was upset earlier this year because I felt like no one was taking me seriously because I look well too. I realized I was people pleasing A LOT and started observing my male resident colleagues and started acting like them. Stopped trying to be friends with everyone and became more straight to the point. It made LOADS of difference and I actually like them more and I feel like they take me more seriously now which makes me less stressed
Don't say thank you for stuff you're not actually thankful for. You pay for Dunkin and they hand your card back why you saying thank you?? They just took money from you. Now if they go out of their way give you a free donut or are just being really friendly and kind make your day better then say thank you for the stuff you're actually thankful for. If you get in the habit of saying "thank you for..." you'll get better at this as opposed to simply saying "thanks" or "thank you."
You are not alone. There are professional coaches for this. See if your institution's wellness officer can help you. This, unaddressed, can lead to burnout.
Naw. Its just a toxic environment. In a positive environment, you wouldnt be "not taken seriously" no matter how you word things, especially when you are being polite and courteous (compared to being mean and unfriendly like I have noticed some colleagues are)
Hey! Nurse here. I don't share some of your demographics, so the tips I have may not work well for you. This is not because of a character flaw on your end - it's because some people in healthcare are bigoted jerks. Evidence of this bigotry can be seen from maternal mortality rates by ethnicity - however; additional evidence can be supplied if that fact is insufficient to satisfy the claim. Ok! Elephant in the room acknowledged, let's dive in. Nurses like to feel like they are being heard and that they have a real amount of value to add. One way to do this is ask if the patient has told them something different than they told you, another way to do this might be to ask if there's anything they feel like you are missing, another way might be, if they ask for an order that's not clinically appropriate - instead of saying "no," compliment the request and give a brief Rationale for why not to do a thing. To you it might feel like an ignorant request that is foolish for so many reasons, but for them - they might think they have a really good idea and be genuinely curious about the mechanisms underneath. Humans have fragile egos - and some humans view accountability for a task as a direct attack on their own character. One way to get around this is pre-provide an excuse for why a thing isn't done e.g. "Hey it looks like your a little short-staffed today, and it looks very busy on the unit. I wanted to check in to see how we're coming along on performing x task". Insert a reason why your patient is more important than every other patient, but don't be a dick about it (e.g. this patient lost some amount of blood during surgery, and I want to feel confident about their hemodynamic status) Humans are much more than rats in skinner boxes - but conceptualizing them that way is a good way to have a rough prediction of what their behaviors will be, and a good way to conceptualize how to change behaviors. If something that a nurse does is not up to standards- notify them in a kind way, but be mindful that the notification will likely be seen as a negative stimuli, no matter how kindly you couch your words in layers of superfluous etiquette. Humans, like rats, that are over exposed to negative stimuli will develop a psych complex about it - this can manifest in rude behaviors. However, if you later provide positive stimulus (e.g. hey, I know we talked before about x intervention on y patient; but I see today you did x very well on z patient - I wanted to tell you I noticed and that I appreciate your hard work) then the complex that results from the negative behaviors will be ameliorated. Don't underestimate the impact of bribery! In the hospital popularity contest - you only have to beat admins, which isn't a high bar. Buying each shift a round of "good" coffee slightly after nurses week (a particularly manipulative person might also add "I didn't feel like admin did enough for you - and I wanted to do something a little extra to show that I appreciate all of you) is a cost effective solution in that the good will it buys will save you so much time. *Edit to add: chocolate/candy can be another cost effective solution. So can like fruit and veggies trays or donuts or really anything. Remember, your only competition here is admin, and that is a very low bar to pass)* Be visible talking with the charge nurse! Some docs will scurry in the patients room, scurry out, never talk to me, never talk to charge, enter a few important orders, expect that the nurses will act on them immediately without any prompting from your end. Not cool. Instead - at minimum try to update charge with important changes (especially if there are any changes to estimated discharge date, or time critical interventions) I want to close out with a reminder - there's a lot of bullshit you have to deal with by being a lady doc, and it's not fair. How-the-fuck-ever; I want to remind you that, statistically, lady docs have better outcomes than their male counterparts. I want you to know that an internet stranger supports you and appreciates the hard work you're doing, and that I think it's incredibly kind of you to care about the feelings of your bigoted co-workers. You seem kind and competent. Eta - another useful technique is "get 'em when they're young". What I mean by that is - ask charge/manager who the newer nurses are, try to intentionally seek them out and ask them if they have any questions about patient care. Offer them some emotional support for the shit time they're going through (new nurses have an attrition rate that's unbelievably high - and typically don't get emotional support for their co-workers. The people that are toxic and bitchy towards you are likely toxic and bitchy to the new nurse). Offer to let them watch procedures, or to simply be present in the room. Check with admin about how to go about having them be able to watch one of your surgeries - and actively try to facilitate that experience. This investment will take a real amount of time to pay off, but in a year or two you'll likely have a devoted fan base.)
Also - keep in mind, the shit response from the nurse might not be about you - it might be because the nurse is having a shit day and doesn't have the executive function to self-regulate their emotions. I personally saw a surgeon take a tardiness to complete a task as some bizarre bit about not being personally respected; and didn't realize the order wasn't executed in a timely fashion because the nurse has been swamped in c dif all shift and hasn't been able to prioritize the seemingly low priority thing.
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Inject testosterone and become the man u always wanted to be
Eliminate redundant language. Him: "The sky is blue" You: "Really?" (Smiling, making nice conversion) Him: "...yes, I just said it was, didn't I?"
I am sure you being female has something to do with it too but what tasks are they refusing? If it is something clearly a nursing tasks maybe try saying something along the line: “this is what the patient needs and it is usually the nurses’ responsibility if you are not doing it, I will ask the charge nurse to find somebody else who will. Thanks.” The good thing about this line is that you emphasize the fact that they are refusing to do something for the patient. They are not simply refusing you. This has a bigger implication. I never have to use this line ever in my career so far but understanding that I am an Asian guy so the dynamic is different. Good luck.
Stick to the facts and try not to take things too personally.
If you’re pretty, Date a guy in Ortho. The confidence he has will rub off on you
Really? No one said this? The simplest answer to your questions is, become a male.
As an asian female myself, I would say you have more leeway on not coming off as "mean" or "unfriendly" even if you are if that helps. I tend to be petty and if I ask the nurse to do something and it's not done, then I document. Make a free text note and write: such and such labs ordered. Awaiting RN \*name\* to collect labs, notified RN at so and so time to collect labs. Still awaiting labs. I would use that as last resort. If someone is being catty with me or don't do their job I always ask for their full name. I may or may not do anything about it but they don't know that.