Who is in charge of my pt

DDRN4me · Aug 25, 2008

first you need to stop beating yourself up!

you were following a surgeon's direction..did the ER doc not call in the trauma surgeon????

I am sure that you did what you thought was the best for this unfortunate man at the time. I would have followed what the surgeon said too ; most likely..he obviously didnt think there was a fracture.

RNsRWe, ASN, RN · Aug 25, 2008

I'm sorry, where was your mistake??

The ER doc, who said you shouldn't cath, CALLED IN a trauma surgeon to see the guy. Presumably, that surgeon would have an order or two to give, right?

The problem lies in the communication between the two physicians, NOT with you. In the future, knowing these two godlike figures might not agree, you COULD say to one (when the other has given a conflicting order) that you'd like it if they could confer, and then get back to you on their JOINT preference. If the one giving the orders gets huffy, you simply say "ok, this is going in, and I'll be letting Dr.X know you didn't want to speak to him about it, to just DO it." See if he decides to confer, or continue to play Heavenly Creator.

Either way, you didn't do anything illegal, immoral, or in poor judgment. It's not your problem they disagreed!

UM Review RN, ASN, RN · Aug 25, 2008

Ummm.... Question?

Why can't you cath a hip/pelvic fx? We do it to the old folks who come in with s/p falls all the time here.

towntalker · Aug 25, 2008

i have been in the middle of two docs who didn't communicate with each other

nursing sometimes feels like you are walking on eggshells, take a big breath and put it behind you

FERN-tastic · Aug 25, 2008

Ummm.... Question?
Why can't you cath a hip/pelvic fx? We do it to the old folks who come in with s/p falls all the time here.

A pelvic fracture can cause trauma to the urethra or bladder, in which case you don't want to shove a tube up there

FERN-tastic · Aug 25, 2008

To the OP, I've found that when the ER doc calls in the surgeon/specialist/etc., these new orders take over the ER orders. For example, I've had the ER doc start a heparin gtts just to have it dc'd a few hours later by the admit doc. So when the trauma surgeons come in, I take pt orders from them. If the ER doc has a problem with something I'd tell them to chill and talk to the surgeon. I don't know if it's the same at your hospital, but our trauma surgeons write their own admit orders, not just consult stuff, so we kinda have to listen to them.

RN1989 · Aug 25, 2008

Every place I have worked, surgeon's orders trump all the other docs orders.

Vito Andolini · Aug 25, 2008

I'm sorry, where was your mistake??
The ER doc, who said you shouldn't cath, CALLED IN a trauma surgeon to see the guy. Presumably, that surgeon would have an order or two to give, right?
The problem lies in the communication between the two physicians, NOT with you. In the future, knowing these two godlike figures might not agree, you COULD say to one (when the other has given a conflicting order) that you'd like it if they could confer, and then get back to you on their JOINT preference. If the one giving the orders gets huffy, you simply say "ok, this is going in, and I'll be letting Dr.X know you didn't want to speak to him about it, to just DO it." See if he decides to confer, or continue to play Heavenly Creator.
Either way, you didn't do anything illegal, immoral, or in poor judgment. It's not your problem they disagreed!

No, don't do this. Just inform the 2nd doctor of the conflict and tell him, "Here's the cath if you want to do it yourself. I have been caught in the middle like this before and I can't let myself be put there again. Go talk to Dr. 1, you 2 decide, and give me a written order." Then, I'd give him the cath stuff and exit, stage left. I'd go tell Dr. 1 about the conflict and tell him to go talk to the surgeon. I'd inform the Charge Nurse and Supervisor of my dilemma and then get myself out of there until they decided. If you could safely leave the patient that long. I know it might be hard to do. I think you did nothing wrong. The order was from a legitimate consultant.

BLSQUEEN · Aug 25, 2008

Working in the ED with multiple physicians involved in pt care is indeed frustrating at times. Whenever I was told NOT to do something I made a mental note and moved on. When the physician of the hour showed up and told me to do what I was already advised NOT to do I would go back to the first physician and have a chat. Hard I know in a busy environment but it almost always paid off.

I would say something like hey you know you told me NOT to do such and such and now physician number 2 says I should. Could you please share your thoughts about why I should NOT do such and such. Often times I got educated about something, the first physician was made aware that there was a change in the patient care plan and sometimes a potential bad outcome was avoided.

If I still had questions about what I was asked to do I would head back to physician 2 and say...I was told not to do such and such for these reasons is it still ok do go ahead with your orders. If I was told to go ahead and do it anyway I felt that I addressed the concerns and was able to document my attempts to maintain patient safety.

Like the others said...do not beat yourself up. You are ok and the patient is ok. You will learn from this and be more mindful of conflict in physician approaches in the future. The lesson you learned from this patient may very well save a patient down the road!

Altra, BSN, RN · Aug 25, 2008

A pelvic fracture can cause trauma to the urethra or bladder, in which case you don't want to shove a tube up there

OT -- but that is not the practice everywhere. We cath.

Mulan · Aug 25, 2008

A pelvic fracture can cause trauma to the urethra or bladder, in which case you don't want to shove a tube up there

so what do you do then if they have a full bladder and can't pee?