WhiteCoat

How a Captain Affects the Crew

During a shift a while back, I was having a bad day and became frustrated with a patient who appeared to be drug seeking.

A patient with chronic migraine headaches who happened to be visiting from out of town came in for “9.5 out of 10″ pain. Apparently she had been around enough to know that if she complained of the worst headache in her life, she’d be signing consent for a spinal tap.
I ordered an IV and some subcutaneous Imitrex.
The nurse came back after going in the patient’s room. “She can’t take Imitrex. It gives her palpitaions.”
“Fine. Giver her IV Toradol and IV Reglan.”
A few minutes later, the nurse returns. “Toradol doesn’t work for her headaches.”
“Give her IV Stadol instead.”
The nurse walked back out of the room. “She wants IV Demerol.”
“Tell her she’s not getting IV Demerol. She can have the Stadol or she can leave. This isn’t McDonalds – you don’t get things your way.”
The patient took the medications I prescribed, her symptoms resolved and she left.

I didn’t think much about the interaction until a week or two later when I overheard the following discussion between another staff member and a patient in the waiting room.

“This is bullsh**! I’ve been waiting here for three hours and I still haven’t seen the doctor.”
“He’s taking care of several very sick patients now. We’ll call you back as soon as possible.”
“Yeah? Well it’s still bulls**t! I have seen people get called back before me and I’ve been waiting longer.”
“You know what? This isn’t McDonalds. You don’t always get things your way.”
“You’re right about that! At McDonalds, they give you service … with a smile.”
“Yeah? Well at McDonalds, the customers pay for their food.”
[string of obscenities as the patient walked out the door]

After hearing that interaction, I never used the “McDonalds” comment again. The witty comebacks stuck in my head, but it also made me realize how my offhand comments could be taken to heart by others and used pejoratively.

More recently, one of our nurses did an excellent job managing a critically ill patient. As she wheeled the patient up to the ICU, I passed her in the hall, gave her a high five, and said “Strong work with Ms. Jones, here. You saved her life!” The patient looked up at her with a smile. The nurse blushed and smiled. The rest of her shift you could see that she was happier. Don’t know if it was my comment or not, but I like to think so.

So I started making a conscious effort to compliment people when they’re doing a good job.
I say “strong work” a lot more. Now I hear other people saying it to each other.
I go into the rooms and tell patients things like “It’s lucky you have this nurse taking care of you. See how much better she’s making you feel?” The patients seem happier.
When secretaries are getting frazzled from all the work, I go up to them and say “I’m sure glad you’re working today. Otherwise we’d never be able to keep up with all the chaos. I don’t know how you do it.”

The funny thing? Even when the morale is low in the rest of the hospital, everyone is pretty happy in the emergency department. Sure, we complain about things like everyone else. But everyone likes working together.
While the rest of the hospital has been trying desperately to hire nurses to work on the floors (with a 20+ percent vacancy rate), in the past 5-6 years we’ve only had a few nurses leave our emergency department – a couple because they moved, and one because she got a significantly higher paying job at a hospital closer to her home. And there’s a waiting list for nurses in the hospital who want to work in the emergency department.

Amazing what a little recognition and teamwork can do.

15 Responses to “How a Captain Affects the Crew”

  1. GrumpyRN says:

    After one very busy shift I thanked the staff for their hard work, was completely deflated when one of them replied “We were just doing our f***ing jobs.” Can’t win sometimes.

  2. Out of curiousity any reason the 20% vacancy rate on the floor?…our floor is hemmorhaging staff due to workload and paperwork. Just as an example I will be working this weekend as nurse, tech and secretary.
    You’re right…everybody wants validation.
    Good job.

  3. Chris P says:

    Great post. Absolutely, the attitude of the Captain will infect the crew, for good or evil. Hard to notice it in the midst of a crappy day, and sometimes it really is all about me and how irritated I am, but we must realize what we are saying, both with our words and our non-verbal communications, and how that affects everyone in our lives.

    One of my mentors taught me to always refer to patients as, “the lady in room 5″ or “the gentleman in room 7″, NEVER to refer to a person as a diagnosis – i.e. “the migraine in room 3″ – as a simple way to remind everyone that we are working with people with diagnoses, not the other way round.

  4. Ryan says:

    Thanks for the encouragement. Sometimes I need the reminder of how contagious attitudes can be. Sort of like this….

    http://www.despair.com/burnout.html

  5. Felix Kasza says:

    I do not see a problem with the McD’s comment (yours, or the second conversation). To the contrary, I think it answered the purpose wonderfully!

  6. WWWebb says:

    Strong post, Dr. WhiteCoat.

  7. Nurse K says:

    One of the best compliments I ever got was from ‘Favorite Doc’…he was scamming/begging to try to get me to switch to his side of the ER…

    He said something like, “I want you to work over here…you actually DO something.”

    It was sort of a combo insult to the nurse he wanted me to replace and compliment to me, but I still remember that! Damn right I do something!!

  8. ERP says:

    I still like the McDonald’s line. But yeah, complement when complements are due….

  9. John says:

    I gotta say, in medical school “strong work” was the absolute worst thing someone could say. It sounds so friggin’ shallow in a clinical context, and I’m disappointed nowadays whenever I hear someone bandying it about. Ugh.

  10. SeaSpray says:

    WC – I agree with you 100%! Words can have impact ..ripple forward one way or the other. And we never know how we inspire someone who really needed to hear it.

    That being said ..given the situation ..your McDonalds comment was funny. I think your coworker was wrong to do that and should have known better ..even tho the patient seemingly deserved it. You’d think common sense would’ve prevailed ..but I’ve seen it time and again ..they just don’t always understand the dynamics of an ED …. or don’t care. But if they didn’t understand ..then that coworker added to their frustration unnecessarily.

    I will do a post soon in which one part of it mentions a dour nurse. Involved my very afraid and anxious friend with the lung CA who had to wait very long in nuclear after coming back 2 hrs later again for the test. She never had a bone scan before and is afraid for her very life.

    Well as fate would have it .. there was a very serious emergency in which a patient brought in by ambulance had to go ahead of them, someone explained it to the patients in the waiting room ..but it was a long wait. When the nurse came out to get her ..her adult son said Finally ..about time … and the nurse shot them a dour look… which in turn made my friend very uncomfortable to have to go in with her. My friend didn’t complain and her son was just frustrated and he is worried about his Mom and just didn’t think of what the med staff was dealing with in the back.

    My point is that the medical staff are the professionals and even tho not fair and short sighted ..the patient should never be put in an uncomfortable position because they are already compromised or wouldn’t be there.

    We are all human …but professionals sometimes forget ..the public is not privy to the knowledge medical staff has.

    And jerks or really bad patients ..I know need to be handled. But there are times ..it should not be taken out on the patient… or their families.

    Grumpy RN ..THAT person is an IDIOT ..at least on that shift. Good for you! Don’t let someone like that deflate you. Most people would be appreciative ..because if anything ..people are more prone to complaining than being positive… and you set a good example.

  11. skpchk says:

    Dr WC,

    Many years ago I was doing a rotation through the ER of a Peds Hosp for Paramedic school I found myself directly assisting the attending on a Trauma resus. After the patient was stabilized I walked out of the room; the attending took the time to stop me in the hallway and thank me for for my assistance.

    Because of that one incident I applied to work there as an ER Tech and stayed for 4 years before leaving to move out of state. The day I left I made a point of letting that Doc know exactly what the one offhand comment meant to me and thanking him for showing me that working in a department that practiced professional respect and courtesy makes even the worse shift bearable.

    I’ll never forget the feeling of being thanked for the first time in 10 years for doing what I had been trained to do and I promised myself that I would make a habit of saying Thank you to co-workers.

    Even when I would get the same response as Grumpy RN received I made a point of saying that was exactly why I was f****** say Thank You. We don’t hear it enough from our patients, co-workers, employers or outside of work

  12. Ali says:

    Now I am sitting here wondering the last time my boss or supervisors told me that I did a good job, strong work, or anything along those lines. The worst part is that I can’t think of it….

  13. Anonymous says:

    Engineers are kinda on the other end of the spectrum of nurses then. We don’t really need “good jobs” because we keep track internally whether or not we did a good job. It almost reminds me a bit of taking a test…everyone usually knows walking out of one how well (or bad) you did. And the icing on the cake is when lots of people stop by your office to get your opinion/advice on a design (etc).

  14. Gardenqueen says:

    Some people lead from the front, by example. Some people lead from behind, with a stick. I’ll leave it to you as to which is the most useful.

  15. William says:

    No matter where on the totem pole I happen to be, I always try to thank people who make my job easier or contribute to the patient’s experience. It improves the day of everyone who hears it and it improves my work environment.
    I agree with SeaSpray that, irreguardless of our mood, we need to keep in mind that the patient is there because there is a problem, even if it is only in their own mind…..
    GardenQueen, most people respond to the carrot, some, unfortunately, require the stick. At least to begin moving in the desired/required direction.

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