Surprise mtg update

[DrSam]

FU money is a good thing

I really really really need to get some of that!

[wideopenspaces]

In retrospect, even though the situation is frustrating, it would have been better to bring the issue to the attention of the nurse’s supervisor and maybe cc’ing the chief of service. I doubt that the OP is the direct boss. Even if he/she is the captain of the ship, he/she is probably not the boss, and directly disciplining the nurse is perceived as a breech of the chain of command.

Asking not to leave a patient waiting 30 minutes is considered discipline? I guess I'd have to see the email to understand. I always thought it was best to address the situation with the person first before escalating and taking it up the chain?

[AR]

Asking not to leave a patient waiting 30 minutes is considered discipline? I guess I'd have to see the email to understand. I always thought it was best to address the situation with the person first before escalating and taking it up the chain?

That is highly dependent on what you mean by "best" and the actual individuals involved.

[wideopenspaces]

I'm so confused by this whole situation.

[familydocPA]

I'm also confused, but, sadly, not surprised. This is the kind of stuff that makes people burned out and want to leave medicine.

[FIREshrink]

Infraction was that a nurse "felt I was annoyed and frustrated" by her. The long story short is as follows:

30 minutes after my patients scheduled appointment for suture removal they were still not seated. So I sat them myself, gathered my own supplies and removed sutures myself (can be difficult removing sutures in the mouth by ones self). As I was visiting with the patient, and basically done, the above nurse interrupted my visit not once but twice asking why I no longer wanted their help and if I needed the patient moved to a procedure room (in front of the patient). I wrote an email, kindly and calmly asking for that situation to never happen again. I've read the email several times now. It can in no way be perceived as hostile. But... that's what my meeting was about. There is obviously a background or inefficient work flow that I'm dealing with, but that is honest to god it. As the COS was explaining the situation to me, I asked if it sounded more ridiculous to him as he was actually verbalizing it for the first time. The message was lost and ultimately I'm the bad guy in the situation because I didn't do a good enough job making the inefficient nurse feel better about being bad at her job. Such is the culture of medicine now so it seems. We as a profession only have ourselves to blame as we basically gave our autonomy over to the administrators. When I say we I really mean our predecessors who cashed out and now our generation has to suffer the consequences.

nevertheless, I did not end up giving my notice. I will negotiate a few more minor details of my next situation and give my 60 day. My partner will be doing the same and that will be the end of the department. As the hospital has acquired more health systems over the past 6 months we have been noticeably more busy with facial trauma. As such, plans will be to gouge the hospital for call coverage as they will likely have a very hard time recruiting any replacement.

thanks again for everyone's advice. I hope we as a profession can figure out a way to take it back. Moving back to private sector, ASCs, etc is the best way I can think of.

I'm confused, too.

Nurse emails that you sounded annoyed and frustrated with her.

You were annoyed and frustrated with her.

And then? After confirming nurse's suspicion, what happened next in the meeting?

[OSman]

Absolutely I was annoyed and frustrated. But also I did not seek out conflict and feel I did my best to dissipate the conflict that sought me. They wanted me to recognize that in the future I could frame the solution as "how can WE improve?" rather than singling out any individual. Which I didn't do but whatever. I rolled my eyes, said okay and assured them I wouldn't send out emails either. Basically just kept quiet knowing I'm out soon. Also I did as much as I could to remind them how fruitless the meeting ultimately was as I had no way to prepare since they wouldn't tell me what it was about. So it was a lot of I don't remember, I had no way to prepare for this, based on what you are telling me I'm having a hard time seeing what I could have done differently etc... really it was a meeting going around in circles.

[Lithium]

Sounds like these kinds of meetings should be declined until an agenda is provided.

[VentAlarm]

Absolutely I was annoyed and frustrated. But also I did not seek out conflict and feel I did my best to dissipate the conflict that sought me. They wanted me to recognize that in the future I could frame the solution as "how can WE improve?" rather than singling out any individual. Which I didn't do but whatever. I rolled my eyes, said okay and assured them I wouldn't send out emails either. Basically just kept quiet knowing I'm out soon. Also I did as much as I could to remind them how fruitless the meeting ultimately was as I had no way to prepare since they wouldn't tell me what it was about. So it was a lot of I don't remember, I had no way to prepare for this, based on what you are telling me I'm having a hard time seeing what I could have done differently etc... really it was a meeting going around in circles.

Do you know if you’ll have an exit interview? I feel like saying “you are what is wrong with this job, and you embody what is wrong with medicine today” might mean a lot. You have little to lose. And it sounds like the admin is a bunch @sshats.

[AR]

Do you know if you’ll have an exit interview? I feel like saying “you are what is wrong with this job, and you embody what is wrong with medicine today” might mean a lot. You have little to lose. And it sounds like the admin is a bunch @sshats.

He still does want to operate there even if he doesn't want to be employed by them. So, in this case, best to leave quietly, I think.

[G]

Do you know if you’ll have an exit interview? I feel like saying “you are what is wrong with this job, and you embody what is wrong with medicine today” might mean a lot. You have little to lose. And it sounds like the admin is a bunch @sshats.

yeah, might feel good at the time but aside from a funny story over beers, that would do little to help and actually a fair bit to lose.

OP, nice work for not pointing out that hiring nitwits who are ineffectual at their jobs -- both the nurse in question as well as apparently the administrators -- does not help the system deliver a quality product while garnering stellar customer satisfaction (the goal of most highly reliable organizations).

[FIREshrink]

Absolutely I was annoyed and frustrated. But also I did not seek out conflict and feel I did my best to dissipate the conflict that sought me. They wanted me to recognize that in the future I could frame the solution as "how can WE improve?" rather than singling out any individual. Which I didn't do but whatever. I rolled my eyes, said okay and assured them I wouldn't send out emails either. Basically just kept quiet knowing I'm out soon. Also I did as much as I could to remind them how fruitless the meeting ultimately was as I had no way to prepare since they wouldn't tell me what it was about. So it was a lot of I don't remember, I had no way to prepare for this, based on what you are telling me I'm having a hard time seeing what I could have done differently etc... really it was a meeting going around in circles.

Lack of an advance agenda is absolutely a no no, and a fair criticism of the meeting. I understand you are on your way out the door and so be it. My early career response to this stuff was to sign up for admin so I could run the meetings and keep accountability as I saw fit - according to my code of ethics/values/morality/how medicine should be practiced, etc. It hasn’t really failed me. And as a shrink, I need to stay on good terms with a hospital about 1% as much as you need to.

anecdote: early in my career the hospital made a medical decision about a patient I vehemently disagreed with (essentially, put a surgical patient on the psych floor because of behavior problems). I said my peace, angrily, and stormed out of the meeting. Later my VP, who I highly respected, told me in no uncertain terms not to pull a stunt like that again; that as a leader I was entitled to my opinion, even an unpopular one, but also as a leader I had an obligation to model the behaviors and communication skills I expected from others; and that in the long run respected leaders created more change. Despite my anger and shame at that moment I took his advice to heart and whenever I get frustrated I still replay that conversation in my head. It’s saved me from many embarrassing moments.

[StarTrekDoc]

Issue these days in employed situations -- chain of command. Docs to COS doc. Nurses to Nursing sup. Nurses don't report to docs. Nursing admin doesn't either.

Docs and put in a complaint to the nursing admin and then report to his/her doc sup to get Follow up with the nursing sup level.

This is a KEY primary difference between W2 work and true private practices.

OP gave direct email feedback to a nurse and the nurse didn't care for it. Unions get involved. 'talking to occurs' in the absolute wrong direction.

Yeah, logical folk should be confused.

OP - glad it wasn't something more than you doing the right medical thing. As others stated, the best response is 'I did what is best medical care for the patient and our our medical system's reputation and exposure'. I understand the feedback being given here on chain of command, and I am inquiring on what the action plan is for the root cause of this situation is to avoid another exposure risk to our system. Please let me know what this is and when I should be expecting an action plan on that.

[AR]

OP - glad it wasn't something more than you doing the right medical thing. As others stated, the best response is 'I did what is best medical care for the patient and our our medical system's reputation and exposure'. I understand the feedback being given here on chain of command, and I am inquiring on what the action plan is for the root cause of this situation is to avoid another exposure risk to our system. Please let me know what this is and when I should be expecting an action plan on that.

You are clearly very proficient in adminspeak.

[Lithium]

Be careful what you wish for. The action plan would possibly be monitored daily huddles with a recited mission moment, coupled with weekly check ins with a new associate manager.