Paging Doctor Borderline...

Finally! A day off to catch up on things.

Work has been sort of stressful - the new charge nurse flits around the unit going 12 ways at once and pretty much accomplishing nothing. When I work with her I don't feel we're a team. Although I try to remind her of things she has to do it feels like there's no back-up for me (there are only two floor RNs, one med-nurse and about 6 mental health specialists for each floor).

To top that off, we've got several psychiatrists here and one of them is just losing it all the time. He's had to apologise to the whole day shift staff once, and to me personally about 3 times. It's like he gets a difficult patient and gets upset with them or doesn't pay as much attention to them as another doc might, and they don't get good care. He gets stressed out about anything and takes it out on nurses, saying rude things and raising his voice.

I came in the other morning and there was a new patient on this doc's team who was admitted at 7pm the evening prior. He was actually the doc on call for the whole hospital that evening anyway, so he made the initial orders over the phone. He knew he would be doing an admit in the morning. The patient was living in a group home and according to staff there had been med compliant. The doc didn't order any meds for her except PRN Ativan and Ambien. I called him on his cell phone at about 10:45 in the morning, asking if we could get this patient started on her normal meds because she had basically missed the noon (while she was being detained and medically cleared), pm, hs, and am doses and it was approaching noon again. He went off on me that he doesn't give phone orders, and I responded with "Well, its 10:45 now and the pt's been here since 7pm - when can we expect you in to assess her?" he went on to say that I didn't have the experience to know that in most facilities they never made phone orders and "when you've been doing this for longer" and other crap like that (all of our good docs get right on new admits first thing in the morning).

He did come in about 11am but wanted to play some sort of power struggle game and didn't assess her even though she was running down the hallway screaming and cussing out other patients and making a big scene (well, yeah, now she's off all her meds...). We could only give her Ativan, which sedates a person and does nothing for the psychosis. I don't know about anyone else, but in my opinion being unwilling to order her own meds for her was about the same as ordering "hold all meds" - and this counted for the psych AND medical meds. I don't mind that so much, sometimes they want the pt off meds for a bit, but this was without assessing her! It is so frustrating to work with someone who has to prove a point at the cost of care of the patient. I mean, if she got in a fight or had to be restrained for safety because she was out of control, this would have bearing on her court case and she might be there longer or worse yet, she could be injured. I spoke to my nurse manager, and she told me to inform the medical director, who was ALSO wondering about this patient who is so out of control. He speaks with Dr. Attitude and nothing happens. At 15:30 when our shift is leaving she still has no orders. I'm in the back office with the medical director (aka PsychDoc from my previous posts) and a discharge planner and Dr. Attitude comes in and says "I want to talk to you" and I say "I was supposed to be off at 15:30, I'm 15 minutes overtime" and he just starts talking anyway: "You don't want this to turn into one of those things where people talk shit about each other behind their back and try and hurt each other - you don't need to go over my head, you can call me if you need something!". OMG oh well whatever now I know you're messed up. I only asked when we could get some meds for this pt.

Anyway, after I leave I guess he has a chance to think about how it's not nice to threaten your nurse - and he tells PsychDoc he wants to call me at home to say he's sorry! I'm glad he didn't because I would have told him to .... well, I'm just glad he didn't. Maybe I should call him Dr. Borderline. The next day we worked together, he tried to say he was sorry and I told him I didn't need his "sorry" and that if he could control his own behavior he wouldn't have to keep apologising to me. At lunch he bought pizza for the staff.

Yeah, you're a swell guy.

Thank god the rest of the people I work with are so cool.