Is The Doctor Missing It? Stepping on Doc's Toes

Kooky Korky, BSN, RN · Apr 23, 2011

Does this pt have an assigned endocrinologist? If not is it possible to get a different attending who is covering for Dr. "I can't hear you" to write an order for a consultation with an endocrinologist. An endo would not tolerate that & it would be out of primary care doc's arena if an endo was brought into the mix.

I like, I like!

AmericanRN · Apr 24, 2011

No, this is inappropriate. Nurses cant/shouldnt be calling physician consults. The only exception would be for a crashing patient who needs an ICU doc to assess for possible transfer to the unit.
Calling a endocrinology consult for a patient with poorly controlled diabetes is the doctors' job, not in the nursing autonomy/scope of practice. Your job is to document the pooorly controlled sugars and that the primary doc is not addressing the issue. Later you can try to talk to the program chief or head of staff; but calling a consult is out of the question.
P.S. High blood sugars is RARELY cause for an urgent consult in the middle of the night. Most endocrinologists I know would be ****** off if they got paged at 4 AM because a known diabetic has a sugar of 500. They'd be happy to add on a sliding scale regimen or increase Lantus dosing in the morning.

I never said for the nurse to CALL a physician consult, what I said was to ask ANOTHER doctor who is covering for the regular attending that night if they think an endo should be brought in based on the current nursing documentation. There is absolutely nothing wrong with asking a different MD who is covering for the regular attending what their medical opinion is, then bring out all the nursing notes to show them where the current regimen is NOT effective for the pt. That doesn't throw the other doc under the bus it just gets another set of medical eyes looking at the situation and so what if its nursing eyes that gets the new set of medical eyes into place.

I also never suggested calling an Endo at 4 am, if there was a damn consult put in with an endo to begin with the endo would be there during day shift to evaluate the patient and start getting the situation under control for night shift. They would order a sliding scale, start doing Concarb counts. The endos I know would be beyond p**sed at the fact that no one thought to bring them in to begin with for a KNOWN diabetic. No where did I state an URGENT consult in the middle of the night. it doesn't take a medical degree to know that in our current climate of specialists thryroids & diabetes are the domain of Endos not PCPs in an acute care setting. Nursing scope of practice should also include that lesser known quality that is not in proedural manual "comon sense." Nursing common sense is also knowing over time spent on a unit which doc to go to get certain orders written without hurting the feelings/ego of the original one. Many places now use hospitalists who work for multiple organizations so good freakin luck tracking down a program chief. Most of those folks are photographs on the wall in the main lobby & rarely set foot inside the facility. I've also seen nurses document to death & while it saved their license it didn't save their jobs. Let a pt continue to rise into the 400s known diabetic or not & have no sliding scale ordered it will be the nurse who gets blamed if they end up in ICU for not pushing the physician harder to write an order for a scale. Thats not paranoia its a cold hard fact of nursing today.

Glad I don't work with you since you implied a whole bunch of stuff that wasn't in my original post at all.

Kooky Korky, BSN, RN · May 1, 2011

I never said for the nurse to CALL a physician consult, what I said was to ask ANOTHER doctor who is covering for the regular attending that night if they think an endo should be brought in based on the current nursing documentation. There is absolutely nothing wrong with asking a different MD who is covering for the regular attending what their medical opinion is, then bring out all the nursing notes to show them where the current regimen is NOT effective for the pt. That doesn't throw the other doc under the bus it just gets another set of medical eyes looking at the situation and so what if its nursing eyes that gets the new set of medical eyes into place.
I also never suggested calling an Endo at 4 am, if there was a damn consult put in with an endo to begin with the endo would be there during day shift to evaluate the patient and start getting the situation under control for night shift. They would order a sliding scale, start doing Concarb counts. The endos I know would be beyond p**sed at the fact that no one thought to bring them in to begin with for a KNOWN diabetic. No where did I state an URGENT consult in the middle of the night. it doesn't take a medical degree to know that in our current climate of specialists thryroids & diabetes are the domain of Endos not PCPs in an acute care setting. Nursing scope of practice should also include that lesser known quality that is not in proedural manual "comon sense." Nursing common sense is also knowing over time spent on a unit which doc to go to get certain orders written without hurting the feelings/ego of the original one. Many places now use hospitalists who work for multiple organizations so good freakin luck tracking down a program chief. Most of those folks are photographs on the wall in the main lobby & rarely set foot inside the facility. I've also seen nurses document to death & while it saved their license it didn't save their jobs. Let a pt continue to rise into the 400s known diabetic or not & have no sliding scale ordered it will be the nurse who gets blamed if they end up in ICU for not pushing the physician harder to write an order for a scale. Thats not paranoia its a cold hard fact of nursing today.
Glad I don't work with you since you implied a whole bunch of stuff that wasn't in my original post at all.

Don't get mad, just explain - as you have.