Clinical Corner

Professionalism question:

A current PL-3 resident in my program has been the source of multiple complaints and now four separate PSN (Patient Safety Network) reports filed by nurses and nurse practitioners in the NICU, where this resident currently is the over-night senior resident. According to the complaints, the resident has been abrasive and curt when approached with patient issues (ABGs, nutrition changes, ventilator changes, etc.) and has progressed to the point of going straight into the call room after night-time tuck-in rounds, closing the door, and turning off the phone/pager. Although a NNP is on-duty and available all night, the responsibilities of the resident are to be “first-call” for all patient issues and emergencies. Several complainants feel that patient safety has been compromised by their inability to reach the resident for acute issues.

When I discussed these complaints with the resident, in conjunction with the Chief Residents, my initial concern was that the resident might be depressed, overwhelmed, suffering from anxiety, or other resident-wellness concerns. However, the resident denied any such feelings and instead expressed extreme frustration that the role of the overnight NICU senior was useless: nurses typically bypassed the resident in favor of the NNP, nurses questioned every order, nurses chose not to carry out resident’s orders in favor of expediency for their patients or themselves, etc. I did not elicit any sense of awareness from the resident that these acts and perceptions were unacceptable from both professionalism and patient safety perspectives, nor did I sense any insight or acceptance of “fault” regarding the resident’s actions and choices in response.

Clearly, this lack of perception and insight is very concerning. However, this resident has otherwise been a relatively “low maintenance” resident with no concerns from other clinical rotations. It is clear the NICU experience is challenging to some residents, and especially to this particular resident. However, do I let this performance “slide” since the resident won’t be involved with a NICU ever again? Do I suspend the resident and begin a program of professionalism remediation? Or, since patient safety concerns are now part of the official, hospital record, do I have cause to immediately dismiss this resident from the program, effectively terminating the pediatrics career of an otherwise promising physician? How have others approached this kind of scenario?

Thanks,

Sean Elliott (PD- University of Arizona Pediatrics Residency)

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