Wrote a doctor up!!!

[ShayRN]

Last week I felt I was verbally abused by a doc. I am probably too nice to some of them at times, so maybe they think it means I am a push over. We had an 89 year old NH patient come to the floor from ER with an IV in her foot. The bag was empty, so ofcourse the site was no good. I told the nurse to just pull it, the last thing we need is a thrombus because we were trying to unclot a site in the foot. She also was dehydrated with an INR>6 and a b/p 88/40's or so. So according to hospital protocol, she tried twice and couldn't get it. Then I (the floor "expert") tried twice and blew the vein. So we called IV team and it was after 10:30, so they weren't taking any more calls. I called the doc and said, what should we do? Any ideas? He started SCREAMING at me. "This is the second time we have had issues on THIS unit. What do you want me to do you say? I say, she needs the site, go put one in, NOW!" I said to him, very FIRMLY, "Doctor, there is no need for you to yell at me this way, I am telling you we cannot get the site in and am asking you what other options you want to consider. So, you can stop it right NOW!" He kept yelling, "I said get a site in her. This is ridiculous, it is just basic medical practice." So I repeated, "there are NO VEINS TO START AN IV, what other options do we have, I can't get a line, what part of that are you not understanding?" He just kept yelling and saying, "just go put a line in her NOW." Like, I didn't want to, right? So, finally, I said, listen, I am going to call a house supervisor because this is getting us NOWHERE. I did call and she happen to know a nurse on the intensive unit who worked as a float on the IV team. She was gracious enough to come up and start a line, (on the inside of her wrist.) That line blew the next day:sniff: So, anyway, I wrote up my conversation with the doctor and sent it to the administration. Someone up there must be pretty upset, because they actually called me on the unit tonight to find out what happened. When I told them, he said, Oh, that was completely inappropriate. I am going to forward this to his chief of staff and I can assure you it will be dealt with....Nothing may ever come of it, but it makes me feel good knowing I stood my ground for myself and MY PATIENT!!!!

[Tweety, BSN, RN]

I can answer your question for you. You NEVER flush a clogged IV--NEVER. .............It really irks me that nurses are the first to say they are advocates of kind, loving care for patients, yet they will abuse the hell out of an existing IV because they don't want to have to re-start it. Veins are part of a person and need care and protection also, not Roger Ramjet coming at them with flush after flush trying to save an IV that is already finished.

Excellent answer. I don't presume the OP just pulled an IV that she didn't try to flush. If there's any resistance whatsoever, you pull it. The op indicated that it was clogged.

It's a poor and dangerous practice to flush a clogged IV. People have strokes, MI's, PE's in the hospital all the time. Whose to say it didn't initially come from a nurse who said "what's the risk of a thrombus in a pt with an INR of 6 (The INR of 6 means there's a small chance of a clot forming, but if the IV is clogged, it's clogged with something)???"

[Tweety, BSN, RN]

I Feel The Nurse Did Not Follow The Correct Line Of Asst. With This Problem. Why Was The Supervisor Not Called To Help With The Situaton Before Calling The Dr At 1030 At Night For A Line. Sorry But I Agree With He Dr Here.

I almost mentioned this, but didn't. I don't agree with the docs behavior however. I'm going to give you the benefit of the doubt that while you agree with the doc you don't agree it was appropriate to yell and brow beat this nurse into getting an IV.

In the end the patient got the IV. Too bad this couldn't have been done prior to calling the doc and getting yelled at.

But I understand, because I don't routinely call our supervisors because we have a hard stick that we can't get. We use all the best people on the unit, and call other units for help (we have no IV team). When I'm sure the best of the best have tried and missed (usually no more than three people), I do what the op did. I call the MD, How could the OP have known there was a good IV team member in another unit?

(P.S. captilizing the first letter of each word makes it a difficult read. FYI. :))

[CrunchRN, ADN, RN]

Shay,

You are totally correct that he was completely out of line, and I am proud of you for reporting him. There is no justifying that kind of behavior. I truly wish more nurses would act like you did and then we would not have this problem.

To those of you who made nasty comments - you are preventing nurses from ever moving forward and getting respect. Your behavior allows the doctors to get away with this crap. Did you ever, for even one moment, consider supporting your fellow nurse?

[TweetiePieRN]

Shay,

You are totally correct that he was completely out of line, and I am proud of you for reporting him. There is no justifying that kind of behavior. I truly wish more nurses would act like you did and then we would not have this problem.

To those of you who made nasty comments - you are preventing nurses from ever moving forward and getting respect. Your behavior allows the doctors to get away with this crap. Did you ever, for even one moment, consider supporting your fellow nurse?

BINGO! I don't let my own husband talk to me disrespectfully....so you better believe I wouldn't put up with a dr's disrespectful talk! It's one thing to be venting to someone, but to downright start screaming and cussing too. NOPE!

[kadokin, ASN, RN]

I Feel The Nurse Did Not Follow The Correct Line Of Asst. With This Problem. Why Was The Supervisor Not Called To Help With The Situaton Before Calling The Dr At 1030 At Night For A Line. Sorry But I Agree With He Dr Here.

Sorry, but I thought the same thing.

[Annor]

Last week I felt I was verbally abused by a doc. I am probably too nice to some of them at times, so maybe they think it means I am a push over. We had an 89 year old NH patient come to the floor from ER with an IV in her foot. The bag was empty, so ofcourse the site was no good. I told the nurse to just pull it, the last thing we need is a thrombus because we were trying to unclot a site in the foot. She also was dehydrated with an INR>6 and a b/p 88/40's or so. So according to hospital protocol, she tried twice and couldn't get it. Then I (the floor "expert") tried twice and blew the vein. So we called IV team and it was after 10:30, so they weren't taking any more calls. I called the doc and said, what should we do? Any ideas? He started SCREAMING at me. "This is the second time we have had issues on THIS unit. What do you want me to do you say? I say, she needs the site, go put one in, NOW!" I said to him, very FIRMLY, "Doctor, there is no need for you to yell at me this way, I am telling you we cannot get the site in and am asking you what other options you want to consider. So, you can stop it right NOW!" He kept yelling, "I said get a site in her. This is ridiculous, it is just basic medical practice." So I repeated, "there are NO VEINS TO START AN IV, what other options do we have, I can't get a line, what part of that are you not understanding?" He just kept yelling and saying, "just go put a line in her NOW." Like, I didn't want to, right? So, finally, I said, listen, I am going to call a house supervisor because this is getting us NOWHERE. I did call and she happen to know a nurse on the intensive unit who worked as a float on the IV team. She was gracious enough to come up and start a line, (on the inside of her wrist.) That line blew the next day:sniff: So, anyway, I wrote up my conversation with the doctor and sent it to the administration. Someone up there must be pretty upset, because they actually called me on the unit tonight to find out what happened. When I told them, he said, Oh, that was completely inappropriate. I am going to forward this to his chief of staff and I can assure you it will be dealt with....Nothing may ever come of it, but it makes me feel good knowing I stood my ground for myself and MY PATIENT!!!!

:yelclap: :yelclap: :yelclap: :yelclap: :yelclap: :yelclap: :yelclap: :yelclap:

[gobblers]

In my 41 years as a nurse, I have written several doctors up and probably should have written more up.

The one that stands out in my mine involved a patient on a ventilator. The patient's blood gases were good considering the settings that the patient was on. The doctor gave the order to extubate that patient and the nurse did just that. I was the charge nurse just coming on. When I arrived in the room it was obvious that the patient needed to be reintubated. While one nurse put a call into the doctor, I brought the intubation cart and the crash cart to the room and RT was summoned. The doctor did respond quickly but did not intubate the patient because he was uncomfortable with the procedure. I suggested calling the ER doctor but he refused and began to talk to the patient in Spanish and patted her on her shoulder. Finally, I suggested that we page a pulmologist on staff and he relented. By the time that the pulmologist arrived the patient was coding. The patient died. I was so upset that I could not take care of the body. The head nurse suggested that I leave and she would take care of the body.

I wrote this doctor up and it was refered to an ad hoc committee and as a result he could not admit patients to the units without a consultant.

One of the physicans on the committee ask me why he extubated the patient? I had no answer.

A number of years later I had to take care of this physician in Day Surgery.

Someone ask me what I was going to do. I told them that he was a patient and I would give him the care that I gave other patients.

I do think that nurses have a responsibility, obligation, etc. to the cleints that we care for.

[Thunderwolf, MSN, RN]

uh, hem...i need to bring something up for all's attention. i needed to edit out a specific (non pg13 phonetic) out of several posts on this thread, 5 to be precise. much of this was done because of the use of the quote feature we have. one member used it and and three others carried it over in their own posts (one member elaborated in jest in own post after quoting). i need to remind folks the "f' word or any phonetic of its use is against tos. i edited it out. not fun. i bring this up for two reasons.

1) our board is viewed world wide. we discussed here the need for professionalism and the use of profanity and the lack of respect we receive from such physicians, but use profanity (even by accident via quote button) and commit the same sin when we discuss it right now. not good. if we want respect, we also need to be respectful...even on this board.

2) for those who had the phonetic in their post, you could have been all easily dinged for its use by the board's program and issued points for foul language..regardless if you were just quoting someone else...the computer knows no difference. if it is in "your" post, it is like you said it yourself. so, be very careful when you quote other members...no use of non pg13 words or phonetics. the "f" word or phonetic is always forbidden. somehow, the program didn't pick up the phonetic....but, it does not make it ok nevertheless. if it had, 4 members would have been issued warning points.

i found, i edited, and i'm giving this post as my educational portion to this thread. no points assigned by me to any, but i feel strongly that we need to be more mindful how we discuss on the board and how we quote. i am not such a bad guy :) , but i am concerned about what just took place here.

the portion of the tos related to this is:

foul language

contrary to popular belief, this is not a public board. you are all guests here. we have the right to edit posts that violate our forum guidelines or remove members at any time. nothing should ever be posted here that you would not say in front of a crowd of strangers. don't post anything distasteful or anything you feel might offend someone else. pg-13 type language in all forums, including off -topic.

as many of you know, in addition to the discussions we have for our own benefit, we also present a showcase to the lurkers and fence-sitters (and we do have one lurker per three to four registered users). we do have a word filter which will catch a few foul terms, but it is not the solution nor should it be the solution.

using faintly disguised obscenities with creative or phonetic spelling basically shows disrespect for your hosts. we are here voluntarily, including the moderators and the forum admins, because we are trying to maintain a forum worthy of the tradition started on allnurses.com. please show your appreciation for the venue we provide.

if it is not deliberate disrespect for the others, then it could be the inability to express a thought without spicing it indiscriminantly with foul language. while strong words have their place and time, a public forum in which polite conduct has been requested is not the time or the place for them.

so, as a mod, all i ask is be professional in your discussion as dictated above in the tos, and be respectful to each other. be careful in the use of the quote button. believe me, i don't like issuing points. i really don't. i prefer, if i can, to be informative and to be supportive under the tos guidelines which we all are subject to as members and have agreed upon.

thanks to all members thus far who have contributed to the thread. i guess you already know my stance regarding this physician's behavior as previously discussed. :chuckle

thank you for your understanding,

and sorry for this interruption,

wolfie

---------->> on with the thread discussion!

[galfromnairobi]

we wrote up one surgical resident last week. he had ordered a pca continous only,no boluses. when making his rounds, he found the pca button hanging on an iv pole. he yelled at the nurse,demanding to know why the pt did not have the button in his hand or within reach. onother nurse tried to point out the obvious to him, the surgeon told her to shut up,by the way, all this was going on at the pts bedside. even after he realized his mistake,he did not apoligize his only excuse was that he had been in the OR for hours. the pts pain had been well controlled and the nurse had no reason to call for bolus orders.