It is flu season, it is winter, and it is 2017. It seems as though every hospital in the US is struggling with capacity problems and nowhere is this more evident than emergency departments. Across the country patients are being admitted to hospitals for further care and then discovering nothing is happening. There is no room in the hospital, inpatient staff are overwhelmed, and there is no one to immediately care for them. Time to sit and wait. In some emergency departments patients find themselves being continuously cared for by emergency physicians and nurses. You may have heard the inpatient team respond with statements like these:
- The ED physician is a doctor! They graduated medical school… right? They can do it.
- Isn’t this the same physician that was caring for the patient just a few hours ago? Why can they suddenly no longer care for the patient ?
- I can’t do two things at once. Either you want me treating and discharging patients upstairs or seeing new ones in the ED? Which is it?
- Hey… I didn’t cause this problem. I can only move so fast. Stop calling me.
- I don’t know this patient, I haven’t seen this patient, and I don’t know any more about them than the ED doc, maybe even less!
- Can’t the ED doc just drop some orders for us? All we are asking for is some help. It’s just a medication request!
- If they hadn’t called so soon for admission you would not be calling me right now. I’m stuck managing all this now!
The frustration is palpable. We have all heard these comments and unfortunately they are often directed at our nursing colleagues. These answers do not stem from a careful, contemplative review of medical literature and discussions with medical staff. These comments stem from frustration and being overworked. Recognize the statements for what they are, venting. It is a symptom of exhaustion and burnout. I have several colleagues prone to this type of release, almost reflexively, before taking a more calm approach to problem solving. We all feel it at some point when we are maximally stressed and stretched in numerous directions at once. Learn to recognize it and address it as such. It is easy to fire back with a harsh comment or come to a quick conclusion about a physician after hearing these statements. However, it will gain you and your patient far more if you diffuse the situation. Ask to speak to the physician directly and take the nurse out of the conversation. Address the frustration with “yes, it is very frustrating… I hear you. I know you are swamped. I know you are being asked to do so many things.” This approach acknowledges what your colleague is experiencing but also takes the spotlight away from the patient and places it on the problem, hospital crowding.
Once you’ve defused the physician, you can address the concern. Is the hospital supporting you? Is the hospital hiring more staff for inpatient work? Do you have a PA or NP working with you? Are you maximizing that person? Or are you short staffed today because someone called out sick? and if you are not at your maximum capacity as well, offer to help. I can recall several times where I just needed help. Too many sick patients to treat at once to really dive into the heart of why an elderly patient had 3 visits to the ED in 3 days for a seemingly non-emergent problem. Those are times when I’ve thrown my arms up in defeat, called my hospitalist colleagues and said “I’m sorry, I just need help with this patient. I can’t figure out what is wrong but clearly what we are doing in the outpatient setting isn’t working. Would you please see this patient ?”
The next time you want to reach through the phone and slap your colleague for their behavior, take a deep breath and try this approach instead. A little insight into the heart of our frustration allows us to commiserate with our colleagues instead of fighting them. The grass is not greener on their end of the phone.