MD's orders

Nurses General Nursing

Published

..and I don't mean the official type. I mean the type that gets you into FIGHTS!

Today, I was so studiously administering 80mg Lasix IV push over 8 minutes, and the patient's doctor walked in the room and told me to "just push it," in regards to the last 30mg (in 3mL), because he needed to assess the patient.

Now, I'm a nursing student. I can't even take REAL verbal orders from a doctor at this point, let alone administer something incorrectly because the doctor told me to. Whaaaat was going on here? I don't know if "just pushing" Lasix IV is something nurses do regularly, but I was pretty taken off guard by such a suggestion. What about deafness?? What about irritating the veins??

He added, "we don't do that in the real world." And he said, "real world," like my administering lasix was the behavior of those in of la-la land, but specifically meaning that people don't actually follow a 10mg/min for Lasix IV. This is probably true to some extent, and if he's done that a million times and nothing bad happened, that's his b'ness, but I certainly wasn't going to take any chances.

My mind kind of blanked and I tried to explain, "I'm actually a nursing student and I can't take verbal orders, sooooo sorry." (as though this was *that* type of order).

He continued to get agitated and repeated, "Just push it!! Just push it!!" I didn't know what to say or do, but I knew I wasn't just going to push something incorrectly and hurt the patient. Again told me that this isn't how things work in the real world, in a really mean and frustrated tone.

I just told him, "I can push it over 2 minutes." (We'd already been arguing for one minute and 1 mL at that point).

Oh boy, was he MAAAAAAAD.

And just and added note to the story, this all occurred in front of the patient's family as well as the patient. The family later thanked me and expressed that they were frustrated that he'd been so impatient, and didn't know anything about what was going on with the patient.

After I gave the Lasix, the doctor listened to the patient's lungs from her back side, which was EASILY accessible to him the entire time and left...so I was pretty confused as to the purpose of our whole beef. :confused:

Anyway, the point of this huge post, aside from venting is: in hindsight, the best thing to do would probably have been to stop administering the med and continue after he assessed the patient, right? I would have been open to that as a compromise, but I didn't even think of it at the time. I mean, this is about the 3rd time I've ever given it, and the first time I was ever pushed around by a doctor.

Any thoughts on how you've handled similar "orders," as experienced nurses?

Specializes in Pediatrics, Step-Down.

Where was your instructor at this time, or the nurse you were working with? They should have come in the room with you if you were giving meds, then they would have also been able to help you in this situation. With that said, I think you did the right thing. If the MD doesn't give meds regularly himself, how does he know if the nurses usually give it fast or slow? Personally, I would give it slow just like you did and I wouldn't let him tell me otherwise. Like others said, he could give it himself if he wants it done faster (and just document that the md gave it). Still, why couldn't he still do the assessment with you giving it slow? Couldn't have have just gone to the other side of the bed? Sounds to me like he was just trying to be difficult. Families definitely do appreciate when you stand up for the patient's safety like you did. It sounds like you will make a great patient advocate and a great nurse :)

Sometimes, I'm just a witch. This would be one of those times. I would have told him to step outside for a couple minutes and he could come back when I was through.

Specializes in Pediatrics, Step-Down.

Also, I had a doctor the other day that ordered a fairly large (but safe) dose of morphine IV push. She came in with me while I gave it to assess the patient while it was going in, watched patiently while I gave the dose over 5 minutes, and assessed the patient immediately after. She was excellent, very involved with the patient, and respected my opinion. Most doctors are great, but you'll come across a few bad apples (you'll find that the same is true about nurses too..)

You handled it well. You will do just fine.

Specializes in Oncology; medical specialty website.
..and I don't mean the official type. I mean the type that gets you into FIGHTS!

Today, I was so studiously administering 80mg Lasix IV push over 8 minutes, and the patient's doctor walked in the room and told me to "just push it," in regards to the last 30mg (in 3mL), because he needed to assess the patient.

Now, I'm a nursing student. I can't even take REAL verbal orders from a doctor at this point, let alone administer something incorrectly because the doctor told me to. Whaaaat was going on here? I don't know if "just pushing" Lasix IV is something nurses do regularly, but I was pretty taken off guard by such a suggestion. What about deafness?? What about irritating the veins??

He added, "we don't do that in the real world." And he said, "real world," like my administering lasix was the behavior of those in of la-la land, but specifically meaning that people don't actually follow a 10mg/min for Lasix IV. This is probably true to some extent, and if he's done that a million times and nothing bad happened, that's his b'ness, but I certainly wasn't going to take any chances.

My mind kind of blanked and I tried to explain, "I'm actually a nursing student and I can't take verbal orders, sooooo sorry." (as though this was *that* type of order).

He continued to get agitated and repeated, "Just push it!! Just push it!!" I didn't know what to say or do, but I knew I wasn't just going to push something incorrectly and hurt the patient. Again told me that this isn't how things work in the real world, in a really mean and frustrated tone.

I just told him, "I can push it over 2 minutes." (We'd already been arguing for one minute and 1 mL at that point).

Oh boy, was he MAAAAAAAD.

And just and added note to the story, this all occurred in front of the patient's family as well as the patient. The family later thanked me and expressed that they were frustrated that he'd been so impatient, and didn't know anything about what was going on with the patient.

After I gave the Lasix, the doctor listened to the patient's lungs from her back side, which was EASILY accessible to him the entire time and left...so I was pretty confused as to the purpose of our whole beef. :confused:

Anyway, the point of this huge post, aside from venting is: in hindsight, the best thing to do would probably have been to stop administering the med and continue after he assessed the patient, right? I would have been open to that as a compromise, but I didn't even think of it at the time. I mean, this is about the 3rd time I've ever given it, and the first time I was ever pushed around by a doctor.

Any thoughts on how you've handled similar "orders," as experienced nurses?

Tell him, "You may gladly take over" and hand him the syringe.

Specializes in ICU.

Hmmm, we couldn't push meds in nursing school.

Just a student myself. Sounds like you handled it better than I would. I know a lot of things are different in the *real world* of nursing but, the way I see it, there is a reason we learn to do things a certain way. You know, patient safety and all that silly business. :rolleyes: Atleast until we get more experience and are able to think more independently.

And hey, you gained the pt's trust in the process. :)

Specializes in Med Surg - Renal.

I would have completely ignored his order, but tried to work with him.

RN: "Go ahead and start your assessment, I'll be just a couple minutes."

MD: "Just push it!"

"RN:"I am. It's almost done. Did you see that ankle edema?"

ME:"I'll look at that later. We don't push that slow in the real world."

RN: "I know. Almost done. You can do the heart and lung sounds now while I finish?"

MD: "I can't work with you in my way."

RN: "No problem, I'm done!"

Ummm, am I so fat you can't see around me? I know I need to lose a few pounds, but I'm not blocking the entire bedside!

He was pushing his weight around, or swinging his, well - you know. You did well to stand your ground. Next time, yes, I think finishing when he's done would be better. After all, he IS God. And a legend in his own mind.

;)

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I think you handled it perfectly. The doctor was being a jerk. If he needed you to step aside so he could run a code, that would be a different thing. You advocated for the safety of your patient, you kept your cool and didn't allow yourself to be intimidated or goaded into doing something in anger.

You are on your way to being an excellent nurse.

Specializes in Trauma, Teaching.

You did fine, and remained professional. But I too wonder your instructor or primary nurse was, we never allow students to give meds unsupervised.

All the snarky comments are what we'd like to say, but don't because we don't lower ourselves to the poor behavior. :smokin:

and I have had a patient who had permanent hearing loss because her Lasix was pushed too fast in another facility; so handing the doc the syringe was not a viable option as he may well have caused harm to the patient. He could easily have interviewed the patient while you finished; talking to someone before physically assessing is expected.

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