Stubborn Docs, New Docs

  1. 0
    I'm wondering if anyone has encountered experienced doctors who will never change their orders, even after you explain to them why and how their orders are inappropriate - nicely, courteously, reasonably, of course.

    And inexperienced doctors - how do you deal with their orders? I find that they're usually too stubborn, embarrassed, whatever to listen to a nurse. But one that I remember vividly was, it seemed, inattentive to the patients, busy with too many irons in the fire in his personal life, and inexperienced to boot. Not a good combination. That one always got angry when nurses asked questions - even if you couldn't quite understand the order and were only asking for clarity so you could carry it out.

    Any examples?
  2. Get our hottest nursing topics delivered to your inbox.

  3. 23 Comments so far...

  4. 3
    oh boy and how! Usually their response is to belittle the nurse. I give them a blank face and read the order out loud so that everyone in the area can hear it and hope to get some comments on it or hope that by reading the order out loud that the MD can hear what he is ordering and understand that there is a need for clarification.

    I love it when you call a rapid and the MD walks in, looks at the pt and acts like you are stupid for calling a rapid until you prove, by EKG that the pt is in rapid afib with a bp of 198/113 and completely unconcious and all on a med/surg floor. Hello MD can you come back into the room please! Sorry, end of rant here.

    Some of them are so caught up in the other things that they are worried about and not attending what you are saying. Just have to keep pushing until you have the answers that you need to take care of your pts. All about the pts is my motto!
  5. 1
    Some new docs are just too arrogant to listen to the questions/suggestions of more experienced nurses. Some welcome it due to their insecurities. I got canned because of some know-it-all doc who went to my supervisor because I was questioning his treatment on a situation I was all too familiar with. I was classified as "being difficult/not being a team player" Then I have also have those who ask or welcome my opinion, though few and far between. If I have a hardcore opinion on the the way things are going, I am humble in offering suggestions, or just talk it over with my cooworkers or boss, then question the doc, before I carry out an order. I HAVE had an ED doc tell me "ok, but if she goes home and dies, it's on you":uhoh21: You just have to really know a doc after working closely with them for a while to get them to gain your trust.
    Kooky Korky likes this.
  6. 9
    Documentation to the dot is essential.I document everything the doctor verbalizes. When the Dr ignores a nursing questions I type: Dr "..." notified of pts vital signs, o2 saturations being "_ "" , or pain status...etc. NO MEDICAL ORDERS GIVEN AT THIS TIME. Cover yourself cause when it boils down to it,they will throw you under the bus.
  7. 5
    Quote from emmanewgrad
    Documentation to the dot is essential.I document everything the doctor verbalizes. When the Dr ignores a nursing questions I type: Dr "..." notified of pts vital signs, o2 saturations being "_ "" , or pain status...etc. NO MEDICAL ORDERS GIVEN AT THIS TIME. Cover yourself cause when it boils down to it,they will throw you under the bus.
    I have reviewed charts for litigation and the next questions the attorney will ask is why didn't you call someone else because you clearly did not think that the physicians actions were appropritate.
    anotherone, carolmaccas66, GrnTea, and 2 others like this.
  8. 8
    Absolutely! Some of the doctors especially the new young doctors think they are hot shots with god complexes.

    Just the other day we had a new patient come to the floor after spending a couple of days in the ICU for a skull fracture and swelling on her brain due skateboarding without a helmet on. Luckily she didn't need surgery, decadron brought the swelling down on it's own. So she was stable enough to come to the Neurology/Neurosurgery floor. But we had to get her orders changed, in the ICU she had a PCA of dilaudid, was given ativan 1mg IVP for agitation and to prevent seizures, 4mgs IVP of decadron to prevent swelling, Ambien to help sleep and flexeril TID due to muscle spasms in her neck. When a patient comes to us from the NSICU or MICU they come down with the PCA and it's up to US to D/C it. Then we get the rest of the orders that the patient was getting changed/adjusted. But for some reason the ICU D/Cd the PCA themselves, which in my opinion was odd.

    We have a BRAND new doctor on our floor that transferred from another hospital in Manhattan. He had just finished his residency and was now a new attending on our floor. He was young, cocky, full of himself(though that I will give to him..he is a very good looking guy). But I despised when we were both working at the same time. He just LOVED looking down on the nurses and especially the patient care associates, he treated them like they were his personal servants always asking them to go out and fetch him coffee(but NOT hospital coffee it had to be from starbucks) and order him lunch, meanwhile WE need the patient care associates to take care of the patients.

    So I really had no choice but to go to this doctor get this patients orders put in ASAP, the rest of the stuff could wait a little while but she needed pain medication right away. So the doctor said HE would take a look at her chart and decide what she was to have. I pleaded with him that she needed pain medication, she was tacky and are BP was on the rise. Finally he gave in and put in the orders for 1mg of morphine IVP every 3 hours. REALLY? A skull fracture and brain swelling and this DR thought 1mg of morphine was going to control her pain? After being on a PCA of dilaudid .5mgs bolus every 6 minutes with a basal rate of .4mgs. So I just agreed to disagree and went and got the morphine for her, I pushed it and told her I would be back in 15 minutes to see if her pain was any better. I went out and called the Pain Service to come take a look at this patient. So I went back in my patients room after 20 minutes to see if her pain was better. I didn't even have to ask. The look on her face and tears running down on her face said it all. By that time the doctor put her new orders in and I was completely flabbergasted. He stopped the ativan all together, changed the ambien from 10mgs to 5mgs and the flexeril she had been getting and responded well to had been changed to skelaxin BID. The Decadron orders stayed the same 4mgs IVP and he also added toradol 15mgs every 6 hours(how big of him). As a nurse I am a big advocate of toradol, its a really good medication, but this patient needed a higher dose of narcotics. I went and got the toradol and skelaxin for my patient to maybe help take the edge off her pain until pain service came.

    20 minutes later my favorite pain service doctor came up to access my patient so I knew she would be in good hands. First he looked at her chart orders and what she was getting in the ICU and what she was in for. So he went in and saw my patient and changed all of her orders.

    Her new orders were: 6mgs of morphine IVP every 2 hours around the clock. .5mgs of ativan IVP PRN, Toradol 30mgs every 6 hours, Flexeril 10mgs TID, Ambien 10mgs at bedtime and 15mgs of Oxycodone PO PRN for BTP. The decadron stayed the same. MUCH better than DR "Sting's" orders. I talked to the pain service doctor and he said the plan was to keep these orders in for about two days and then to try to transfer all of her meds to PO and see how she does..if she does well then she would be discharged home on these medications. He said someone from pain service would be back later to see how she was handling the new orders and if for some reason the patient was still uncomfortable than to page him and he would come back up. He knew what she was getting in the ICU and after getting a decent dose of pain medication in the ICU there was no way in hell 1mg of morphine was going to be like water going into her IV(hence the reason I paged pain service)

    After the order went through, I went in to talk to my patient, explained her new orders, gave her the 6mgs of morphine as well as the ativan. I also explained to her if she was having pain breaking through the morphine that she had an order for 15mgs of oxycodone but she had to ask for it. I asked her if she had any questions and she said no and she said that the new dosage of morphine plus the ativan made her feel a bit better, I explained it had been only a few minutes since I gave her the medications and she had to give it a little while to kick in. I also told her not to be afraid to ask for the oxycodone...but only if she REALLY felt like she needed it. I told her I was going to lunch for an hour and another nurse would be covering for me and if she needed anything to just ring the call bell.

    So I went to lunch and came back and Dr "Stingy" was waiting at the nurses station for me. Oh boy he chewed me out as if I did something negligent and killed a patient. He said "HOW DARE I GO OVER HIS HEAD AND CALL PAIN MANAGEMENT WITHOUT ASKING HIM FIRST!" Actually we don't need an MD's permission to page pain service. "MY ORDERS WERE SUFFICIENT!" I respectfully disagreed and told him the patient was still in a lot of pain and going from that amount of medication in a PCA to 1mg of morphine was not going to cover her pain at all. "Oh so your a doctor now?" he asked me."You better keep narcan standing by because I guarantee this patient is going to need it!" I just walked away. He knew I was right and he was ticked off that pain service was called because once they get involved(they are part of the anesthesia team) no one can change their orders but them...and zofran and narcan are standing orders on any patients receiving decent amounts of opiates.

    Perfect example of a brand new doctor thinking he is a hot shot, being sadistic(in my opinion) with his orders, let alone chewing me out at the nurses station in front of my colleagues, patients and their families. I have a steel spine so I wasn't embarrassed at all, which made this doctor even madder. What kind of a doctor gets off on embarrassing and belittling nurses?
  9. 2
    Quote from Laurie52
    I have reviewed charts for litigation and the next questions the attorney will ask is why didn't you call someone else because you clearly did not think that the physicians actions were appropritate.
    It's a good question. It tells us that we have to advocate all the way or not chart everything and maybe just do some watchful waiting to see how the pt does. Of course, we can't do that in a true emergency.

    Call the Nursing Sup and let her in on the problem, get her to try reaching the doc or the Chief of the Service. I'm thinking of the after hours situation (evenings, nights, weekends, holidays) and a non-teaching hospital where the nurse is it, not even an ER doc around.
    carolmaccas66 and DixieRedHead like this.
  10. 7
    Quote from Munch
    Absolutely! Some of the doctors especially the new young doctors think they are hot shots with god complexes.

    Just the other day we had a new patient come to the floor after spending a couple of days in the ICU for a skull fracture and swelling on her brain due skateboarding without a helmet on. Luckily she didn't need surgery, decadron brought the swelling down on it's own. So she was stable enough to come to the Neurology/Neurosurgery floor. But we had to get her orders changed, in the ICU she had a PCA of dilaudid, was given ativan 1mg IVP for agitation and to prevent seizures, 4mgs IVP of decadron to prevent swelling, Ambien to help sleep and flexeril TID due to muscle spasms in her neck. When a patient comes to us from the NSICU or MICU they come down with the PCA and it's up to US to D/C it. Then we get the rest of the orders that the patient was getting changed/adjusted. But for some reason the ICU D/Cd the PCA themselves, which in my opinion was odd.

    We have a BRAND new doctor on our floor that transferred from another hospital in Manhattan. He had just finished his residency and was now a new attending on our floor. He was young, cocky, full of himself(though that I will give to him..he is a very good looking guy). But I despised when we were both working at the same time. He just LOVED looking down on the nurses and especially the patient care associates, he treated them like they were his personal servants always asking them to go out and fetch him coffee(but NOT hospital coffee it had to be from starbucks) and order him lunch, meanwhile WE need the patient care associates to take care of the patients.

    So I really had no choice but to go to this doctor get this patients orders put in ASAP, the rest of the stuff could wait a little while but she needed pain medication right away. So the doctor said HE would take a look at her chart and decide what she was to have. I pleaded with him that she needed pain medication, she was tacky and are BP was on the rise. Finally he gave in and put in the orders for 1mg of morphine IVP every 3 hours. REALLY? A skull fracture and brain swelling and this DR thought 1mg of morphine was going to control her pain? After being on a PCA of dilaudid .5mgs bolus every 6 minutes with a basal rate of .4mgs. So I just agreed to disagree and went and got the morphine for her, I pushed it and told her I would be back in 15 minutes to see if her pain was any better. I went out and called the Pain Service to come take a look at this patient. So I went back in my patients room after 20 minutes to see if her pain was better. I didn't even have to ask. The look on her face and tears running down on her face said it all. By that time the doctor put her new orders in and I was completely flabbergasted. He stopped the ativan all together, changed the ambien from 10mgs to 5mgs and the flexeril she had been getting and responded well to had been changed to skelaxin BID. The Decadron orders stayed the same 4mgs IVP and he also added toradol 15mgs every 6 hours(how big of him). As a nurse I am a big advocate of toradol, its a really good medication, but this patient needed a higher dose of narcotics. I went and got the toradol and skelaxin for my patient to maybe help take the edge off her pain until pain service came.

    20 minutes later my favorite pain service doctor came up to access my patient so I knew she would be in good hands. First he looked at her chart orders and what she was getting in the ICU and what she was in for. So he went in and saw my patient and changed all of her orders.

    Her new orders were: 6mgs of morphine IVP every 2 hours around the clock. .5mgs of ativan IVP PRN, Toradol 30mgs every 6 hours, Flexeril 10mgs TID, Ambien 10mgs at bedtime and 15mgs of Oxycodone PO PRN for BTP. The decadron stayed the same. MUCH better than DR "Sting's" orders. I talked to the pain service doctor and he said the plan was to keep these orders in for about two days and then to try to transfer all of her meds to PO and see how she does..if she does well then she would be discharged home on these medications. He said someone from pain service would be back later to see how she was handling the new orders and if for some reason the patient was still uncomfortable than to page him and he would come back up. He knew what she was getting in the ICU and after getting a decent dose of pain medication in the ICU there was no way in hell 1mg of morphine was going to be like water going into her IV(hence the reason I paged pain service)

    After the order went through, I went in to talk to my patient, explained her new orders, gave her the 6mgs of morphine as well as the ativan. I also explained to her if she was having pain breaking through the morphine that she had an order for 15mgs of oxycodone but she had to ask for it. I asked her if she had any questions and she said no and she said that the new dosage of morphine plus the ativan made her feel a bit better, I explained it had been only a few minutes since I gave her the medications and she had to give it a little while to kick in. I also told her not to be afraid to ask for the oxycodone...but only if she REALLY felt like she needed it. I told her I was going to lunch for an hour and another nurse would be covering for me and if she needed anything to just ring the call bell.

    So I went to lunch and came back and Dr "Stingy" was waiting at the nurses station for me. Oh boy he chewed me out as if I did something negligent and killed a patient. He said "HOW DARE I GO OVER HIS HEAD AND CALL PAIN MANAGEMENT WITHOUT ASKING HIM FIRST!" Actually we don't need an MD's permission to page pain service. "MY ORDERS WERE SUFFICIENT!" I respectfully disagreed and told him the patient was still in a lot of pain and going from that amount of medication in a PCA to 1mg of morphine was not going to cover her pain at all. "Oh so your a doctor now?" he asked me."You better keep narcan standing by because I guarantee this patient is going to need it!" I just walked away. He knew I was right and he was ticked off that pain service was called because once they get involved(they are part of the anesthesia team) no one can change their orders but them...and zofran and narcan are standing orders on any patients receiving decent amounts of opiates.

    Perfect example of a brand new doctor thinking he is a hot shot, being sadistic(in my opinion) with his orders, let alone chewing me out at the nurses station in front of my colleagues, patients and their families. I have a steel spine so I wasn't embarrassed at all, which made this doctor even madder. What kind of a doctor gets off on embarrassing and belittling nurses?
    This sounds more like a case of him being embarrassed, not so much like enjoying belittling nurses. So glad you stood up for your pt and that calling Pain Mgmt was an option.

    If your aides are running to Starbuck's for this guy, they need to be told never to do this without the Charge Nurse's permission. Have a Nurse Mgr or Clinical Sup talk to this doctor and let him know the aides have to stay on duty or they will be disciplined/fired.
    nrsang97, canoehead, noahsmama, and 4 others like this.
  11. 3
    Quote from Kooky Korky
    This sounds more like a case of him being embarrassed, not so much like enjoying belittling nurses. So glad you stood up for your pt and that calling Pain Mgmt was an option.

    If your aides are running to Starbuck's for this guy, they need to be told never to do this without the Charge Nurse's permission. Have a Nurse Mgr or Clinical Sup talk to this doctor and let him know the aides have to stay on duty or they will be disciplined/fired.
    Yes, please tell me that nobody went to Starbucks for this guy.
    nrsang97, carolmaccas66, and Munch like this.
  12. 9
    i just say "are you sure you really want to do that, doctor?" since i never call anyone "doctor" unless they're doing something stupid, it gets their attention. in the rare case when they do really want to do that, i ask for a rationale. if it makes sense, i go along with it. if not, i go up a step in the ladder. rarely have i had to go all the way to the top, and when that happened, the medical director called the intern, resident and fellow together and asked them why they saw fit to ignore an experienced icu nurse without giving him a call. i rarely have issues anymore.


Top