MD's orders - page 2
..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... Read More
Oct 5, '11Sometimes, 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.
Oct 5, '11Also, 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..)
Oct 5, '11Quote from BA_anthropologyTell him, "You may gladly take over" and hand him the syringe...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.
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?
Oct 5, '11Just 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. Atleast until we get more experience and are able to think more independently.
And hey, you gained the pt's trust in the process.
Oct 5, '11I 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!"
Oct 5, '11<confused look> 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!<change to innocent look>
Oct 5, '11He 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.
Oct 6, '11I 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.
Oct 6, '11You 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.
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.
Oct 6, '11Im a nursing student too, how in the world are you pushing meds without your instructor or another licensed nurse present. You really shouldnt be doing that at all. I wait forever for my clinical instructor to even give medication PO b/c she has to supervise each and everyone one of us. I cant fathom pushing meds without a NURSE present. That is a dangerous practice.
Oct 6, '11You did the right thing andI think you did a great job handling the situation. BTW, did the doc need your pt to get up and do jumping jacks as part of his assessment? Not sure why he couldn't do his bit while you were pushing your med.