Let me preface this by saying that for most of the doctors I work with, these tactics are unnecessary. Before this turns into a butthurt shit show, let me acknowledge- yes. Most adults will usually listen to reason from another adult with similar experience, even if one of those adults went to school for less years. Some of the doctors that I have a really good report with the respect me as a nurse will actually solicit my opinion just to get another perspective on a patient. Unfortunately, others seem to think more experience makes them the one smart person in a sea of bumbling idiots, which... good for you, let's see how that works out. In my experience, there are a couple of young, cocky doctors out there who still haven't really gotten much real world experience, but won't take any input from anyone ever, especially not a lowly nurse and especially especially one that looks like a high school kid. I've dealt with several of these guys in my career and watched some of them make some pretty catastrophic decisions in relation to patient care. Like, shit that'll get you sued decisions related to patient care. Anyone can miss something, but most people are humble enough to think twice about it when faced with overt concern. The ones that won't- well. That's where the power of manipulation comes in, which I am really just kind of sad to say I've mastered at this point.
The key to all of this, sadly, is to feed the arrogance. Gross. I know. But let's say, for example, you have a patient, who is, say, obviously septic. Their vitals aren't in the shitter yet, but you know they're headed in that direction. If Dr. Arrogance is taking care of your patient, you can usually gauge how seriously he takes this in proportion to how many billable procedures are done on the patient/ how many times he actually goes back into the patient's room. When I know something legit is getting blown off, I usually try to nip it in the bud by trying to intervene/test the waters early. This is the important step- planting the seed without blowing your cover. It may seem to make more sense to just go on the record saying, "this dude is totally septic and shit's about to go down", but with people like this, that can very easily backfire. See, the Dr. Arrogants of the world have to be right about everything, and nothing feeds their egos more than shooting you down when you throw out a medical diagnosis like "septic"or "anxiety" or "A-fib with RVR". Nope, with these people, as a nurse, especially a young one, you have to trick them into thinking it was their idea as to not disrupt their fragile self-image.
I generally start by touching base before any kind of decision has been made, because it's a lot easier to subliminally steer them in another direction before they publicly proclaim a decision, say to discharge a patient you know is sick, than to convince them to go back on it. I'll usually catch them at a stopping point and pretend to pick their brain. "Geeze, Dr. Arrogance, what do you think of that patient in bed ten?" If the response they give me is obviously not the one I want, I usually put on my best worried/sad face and act like I'm trying to do long division in my head. Then I'll say something like, "Man, I don't know, I just have a bad feeling. " At this point I will drop all my empirical evidence in the form of a question and be like, "Yeah, like, he got that fluid bolus from EMS, but his blood pressure keeps dropping a lot from when he came in, and he's real sleepy and just acting different and I just don't like how he looks." At that point I usually bite my lip and shrug, and ask "What do you think we should do?' This performance 90 percent of the time gets me what I want. When it does, I nod my head emphatically and run off like I'm going to do something that I've probably done anyway. If it doesn't, I usually just stall discharge until the vital signs are actually abnormal enough to get an admission and then play stupid like I didn't know I was supposed to let them go, or I'll play the "patient wants to talk to you" card to trick them into going back in the room and seeing how shitty they look now.
Part of me feels disgusted with myself for playing dumb, but I take comfort in the fact that 1- I got shit done for the patient that needed to be done- and 2-that I have the ability to play an arrogant douche into being putty in my hands.
So, there it is guys. The power of tricking someone who doesn't listen into doing what you want. Only use these tricks for good.