I'm not sure anyone can give me advice in this situation, but I need to vent and am curious if those of you have experienced anything similar. I'm a peds hospitalist in the U.S. and have been practicing for a long time. I currently work in a small private hospital where the work is divided between ED consults, inpatient admissions and newborn care. I have worked in private settings and academia in the past and have generally had collegial relationships with coworkers, and in particular have had almost uniformly excellent working relationships with nursing staff…..until I got here. Let me just say that I trained in aggressive academic residency and fellowship programs and I have never been shy about forcefully advocating for my patients, and I do not suffer fools lightly. When I started this job 8 years ago I did have fairly regular altercations / disagreements with ED docs, but we were able to fix these issues as they learned to trust my judgment and advice, and my relationships in the ED are very good at this point.
Relations with nursing is another story and events recently have really blindsided me and forced me to consider if there is something wrong with how I approach and deal with confrontation in the hospital setting or whether times really have changed and I'm just an old doc who is really out of step now.
Strike 1. A nurse failed to carry out an order in a timely fashion and I confronted her about it. It was important for the care of the patient and could have harmed the patient, so I was pointed in my criticism. She didn't really respond to me (no excuse, no explanation, no promise to get the order done). Because of her inexplicable lack of response to my concerns I was not touchy-feely about dealing with the situation; I did raise my voice but was not abusive or demeaning. Nevertheless, she complained in writing and the complaint bypassed me and my boss and went straight to the CMO. My boss covered for me to the extent that I was completely correct in my clinical judgment and that there was a nursing problem in the failure to complete a necessary medical order. Nurse was not reprimanded (so far as I know) and I had to apologize.
Strike 2. An infant with a minor respiratory illness was admitted to my service (bronchiolitis). During the night, he decompensated and required transfer to a PICU at a nearby hospital. I managed the infant, arranged the transfer, everything went smoothly, good outcome. No arguments or contentious behavior, it seemed to me that we all just did what need to happen. Much to my surprise, another report gets written to the CMO (again bypassing me and my boss, who is the department head for peds), apparently criticising me for not anticipating this patients decline and refusing the admission in the first place, or transferring sooner. At least amongst my medically trained colleagues the concensus was that management was appropriate and timely. To top things off, the nurse manager for the unit called a large case review meeting for this meeting, attended by about 15 nursing administration types and me and my chief. It was not indeed about reviewing the case but devolved into a communist style criticism and re-education session. Fortunately there was a newly recruited VP of Nursing in attendance and he seemed genuinely horrified and quickly put an end to this shitshow. Nevertheless, the report stands as a second strike.
Strike 3. An infant (one week old) was sent over to the hospital from an outside NP for concerns about FTT, dehydration, hyperbilirubinemia. We received no phone call or communication from the referring provider, family just showed up and somehow got put in a newborn unit room without being 'put into the system'. They didn't go the the ED (as should have happened) or directly admitted somewhere (which would have required a phone call to me as the potentially admitting doc). So I have a sick looking newborn sitting on the unit who is too sick to put on our peds unit. I consulted with the NP in the NICU and she told me to just send the kid home with formula supplements (note that she had not seen this baby and refused to come over to newborn to take a look at him). I told her that her judgement was wrong and that the infant needed admission. In the meantime, nursing heads of NICU and newborn are arguing about what to do with this baby and I basically just said fuck this, baby needs evaluation and care, so we put him in an isolette and wheeled him down to ED. Eventually we got a hold of one of the NICU docs (not always in house) who prevailed to get him admitted to NICU when I told him that the baby either needed admission to our NICU or would be transferred to another hospital because he was too sick for our general peds unit. And guess what? Not one, but two reports get written, again bypassing me and my chief, and they go directly to the CMO again.
Outcome. So I got summoned to a meeting recently 'to review recent NICU events', so I assumed I would be recounting what happened in this episode of truly execrable patient care. When I arrived, the presence of someone from HR immediately tipped me off that a case review was not going to be on the agenda, and indeed they are proceeding to get rid of me on the basis of these issues. I am actually surprised that I was not escorted out on that day but apparently some technical screwup in following hospital policy made that impossible and I still have a job for at least a little longer.
There is more context to the story that supports a general sense of pervasive toxicity here, the like of which I have never seen in any of my other jobs through the years. I have been vocal in criticizing institutional policies and nursing policies that I disagree with and that I feel undermine good pediatric patient care (I could write volumes about the stupid shit that happens here) and feel that I have now been targeted for my views. I know that I likely have no legal recourse and that the best response to being in an intolerable position is to find a another situation and hope for the best. I'm not a paranoid person but it seems awfully ironic that I am being hounded out for contributing to a hostile environment when I feel that I am the victim of it instead because of my aggressive desire to be an effective doc for my patients.
Source: Original link