Quote from neurontin
the pt i had last night had a. fib, HR went to 130; due to he had had a.fib two days ago so that i did not call doctor at 0300 am. plus, pt was asymptomatic.
when i called the doctor later, i tried to make myself clear by saying, "he started to have a.fib at 0300 am, asymptomatic; i held metoprolol because his SBP was less than 90 last night. when his SBP increased to 94, i gave him the med at 0530. right now he is still a.fib. HR 80's."
the doc was not satisfied with what i was saying. he asked me, "why didn't call me at 0300 am (he forgot that this was not new to the pt)? is there any critical thing (to call me)? what do you want me to do?" to be honest, except for letting him know what was going on the pt, i do not know why i called him.
call him or not call him?
any suggestion on how to do if you were me? I would appreciate any input.
Sometimes it is how you say it and not what you say....I would say Dr. Crabby......
Your patient in 304-2 had uncontrolled AFib last night with a heart rate in the 130's that was self limiting and the patient was asymptomatic.....I called because he is still having episodes of self limiting A Fib....I initially held the metoprolol, @ what ever time, due to the B/P being 90 and outside the parameters....I was able to give the metoprolol @ what ever time when his B/P was in the parameters.
The MD says....fine why didn't you call me at three.....say.....I didn't call you at three because the Afib was self limiting...... but thought you needed to know before I leave this morning and before you make rounds.....do you need/want any labs/lytes/Ca/Mg/enzymes, EKG on this patient? No? Ok...have a nice day...
I asked the charge nurse whether I needed to call and what to say. He said I needed to call the doc at the end of the shift (0700), and let him know what happened. As a new nurse on the floor, even though I was not sure what the doc could do, I thought it probably won't hurt to call him. But I was wrong. the doc was unsatisfied with my call and complained it to the charge nurse (not sure whether he complained it to the manager or not).
What I learned from this lesson (please correct me if I am wrong)
1. when I am not 100% sure, do not do it.
2. do not do exactly what the colleagues say; they can make a suggestion. However, i am the one who take full responsibility. Even though the charge nurse told me what to say, he won't tell the doc, 'I told her to say something like that.'
My vote.....when in doubt call. You can't be sued for calling the MD but you sure can be sued for NOT calling the MD.
I could care less if they are ....unhappy..... with my phone calls. That is their job to tell me what I have to say is not important. You need to develop a bit of a thick skin. Call to protect your behind. I would rather be asked why I called than why I didn't call. They don't like it? Whatever....I need to do what is right for me so I can go home and sleep well. I wouldn't say to the MD...the charge nurse told me to...but I would have a talk with your boss about a lack of support from your charge.
Their personal pet peeves (the MD's) mean nothing to me.