If you think you need to call the MD, CALL THE MD!!!! - Page 2

I do some legal nurse consulting on the side and at the heart of a medical malpractice case is the fact that a nurse did NOT call the physician concerning a significant change in a patient's status. Avoid harm to your patient and being deposed to explain your negligence in a court of law (which is a lot more traumatic than having an irate doctor "yell" at you for making that call in the middle of the night). When in doubt, make that call!

This was something that I really had to get over when I was a new grad. Now that I'm in icu I feel like the docs are a bit more receptive and respecting of the nurses, they value our input for the most part.

On the floor was a completely different story, I work in a large teaching hospital where (some not all) of the residents present with a god complex of sorts and a 'how dare this lowly nurse try to advise me' attitude. The difference between me now and me 3 years ago is I do not tolerate being belittled by arrogant docs anymore.

I can remember a time when I would call for something important and doc would basically speak to me like I was a child. That's something I will no longer accept, but it took a while before I was confident enough in my practice to tell them so.

One incident I remember occurred on another nurses patient around change of shift about 630. All the docs were coming onto the floor...long story short, i was sharing the room with this other nurse and walked in to see my patient. His roommate seemed..off, wasn't making much sense.

I poked my head into the hallway and asked the nurse 'is 30a ox3?' apparently he had been. I said we might need a rrt stroke alert, come see him. Resident walking down the hall says not to bother with rrt bc he's here to see patient. I didn't feel right about it so I called it anyway to get neuro on board. Rrt comes, neuro comes, resident throws me under bus saying that I overreacted and wasting time because patient was 'talking funny when he woke up' as he rolled his eyes like a teenager.

So at this point patient had come wandering out of his room and was basically walking into a wall..(think windup toy that hits a wall) yep that's normal. So end result, yep patient went to stat head ct and this nurse learned to never let belittling docs make me question my best judgement! Sorry this was so long

Kind of off topic, but I get irritated by some of my fellow day shift nurses who I don't think have ever worked nights (or haven't for years) -- who don't realize that there are certain non-emergent issues that I'm not going to bring up with the doc at 3 AM. I got chewed out the other day because I mentioned in report that I'd gone back over a pt's records and he hadn't pooped in three or four days. (Everything else was normal. He was just on a lot of narcs.) So maybe she'd want to bring it up with the team that he needed some senna/miralax. Well, why didn't *I* call the doctor?? (I probably would have if it had been 8 PM instead of 4 AM when I realized the issue.)

It can go to the other end of the spectrum though...we've had nurses on my unit call the docs at 3am- "I wanted you to know that baby X's morning labs are normal." Personally I try to page (I work days) the docs if I need something that isn't emergent, but then 30 minutes later they still haven't returned my page, so I call them, "Oh, I didn't have my pager on today."

Well I guess the best way in this situation is to document the crap out of this, you need to protect YOUR license. It seems sometimes the doctors don't understand we also have a license to protect. We also have a doc that states we can't call him after 10 p.m. Are you kidding me?? It's a joke, thank God I work in a large teaching hospital because many times things happen in the middle of the night and I have to call the docs on call. I actually had a doctor yell at me once for paging him and I said, "hey I don't have to take this abuse I'm hanging up." I hung up and that person called back and apologized. I'm sorry but it's there job to answer pages, If they don't want to answer them when they are on call then maybe they should have picked a different career!

As a new grad I work in a large university teaching hospital. My interactions, mostly positive, have been solely with interns and residents as they are first in the chain of command to page. The great thing is that the services (transplant and several surgery services) common on our unit have residents in-house and often they're in the conference room on our unit. Patient needs a Tums at 0300 but no order? No problem. On the other hand, I've had a situation where the resident was reluctant to notify the attending of a significant change in mental status of a patient... Ultimately I got my charge nurse and RRT/stroke team involved, but at no time did I feel that contacting the attending myself would have been "okay."

When I was first out of nursing school, I worked in a teaching hospital with residents (mostly first year interns) with med students in tow. I was in critical care at the time and for the most part enjoyed working with the "newbie" docs. It was a fast and furious ride there and they had to hit the ground running. Every now and again you would get the hot dog intern who thought he was all that and a piece of cake, and would try the don't call me for stupid stuff in the middle of the night thng. One particular night he pulled his ***** pants on good and tight and decided to scream at anyone who called him because he had a long day and was tired. Understanding that as a challenge, I proceeded to call him every 10-15 mins for things that were not so emergent but gave cause to chart "MD aware" in the medical record. After about the 5th call, he asked how long was I going to do this to him. I responded by saying "are you done being a jerk about being awakened?" In the morning before rounds he brought the nursing staff donuts and apologized for his behavior. Apparently he complained to the chief resident and a fellow intern about his night and how the nurses kept him up all night with calls. The chief (who had known us for a long time) told him DUDE, you have to respect the nurses. They will be invaluable to you. They take care of the patients, they will teach you about the patients, they will take care of you, they control your sleep. The sooner you realize it, the better. He became one of our favorites very quickly. He learned and learned well.

I work night shift medsurge and one doc told me, "why cant you nurses all call at once instead of at different times?!"-lol

Aw. I work nights on a mixed burn unit (ICU, teli, floor) and we definitely do try to coordinate our calls. It's a small unit so that helps.