how to deal with this intensivist

Specialties MICU

Published

Hey Everyone,

We all had a horrible week. Acuity is extremely high, we dont have enough nurses. Everyone is burned out and overworked.

On my last day of many consecutive days in a row I missed that my patient should have been on a type of respiratory modality overnight. It was a new order given at change of shift, but I had the patient the night before and she was already on it the night before, so I didnt really think about notifying RT. I didnt catch this until the following morning. I immediately told the charge nurse and head nurse and called the doctor.

I said it was all my fault. I know I read the order. I just was so exhausted that I missed the fact that RT never started the treatment. The patient was respiratory-sound so I didnt have any respiratory distress or desatting to jog my memory.

This is my first really big mistake and I feel horrible, but Im also putting it in perspective, that I need to move on and learn from this. I think there were two major factors to my mistake:

1) being exhausted and overworked

2) getting orders at the beginning of my shift when I will review them quickly because I am stressed and busy

So anyways, I call the doctor and he doesnt yell. He just continues to hang up one me. Even when I had to call him later about another patient who was in 10/10 pain, he continued to hang up on me. I was almost brought to tears when this guy kept hanging up on me while my patient who had major abdominal surgery is suffering because a doctor is mad at me about a totally different patient. I charted all of this and told the charge nurse. Luckily this all happened before change of shift, so the oncoming nurse was able to deal with the client's pain and get orders where I could not.

I feel like Im in a bind having this Dr. be so mad at me. He is our intensivist and guides the overall care for most of our patients. I call him at least once a shift and he charts on our unit. I dont know how to deal with him now.

What if when I come in to work again he continues to ignore me? How will I ever get any orders for my patients? What if he comes on the unit and acts like nothing happened? Or even worse, what if he sees me on the unit and chastises me further?

Thanks for the advice.

Specializes in ER/ICU/Flight.

sorry you had that experience and like others have said, you definitely should not be made to feel like you're expected to "throw yourself under the bus"...especially if you're in an environment where others aren't coming over to save you.

as for making mistakes, anyone that says they don't make mistakes is a liar. fact, simple as that. we just try to avoid mistakes and make them as minimal as they can be...but still they happen. maybe you've heard of a book called "Complications"? it's written by a surgeon from Harvard. he talks about how the medical community in general has a hard time admitting mistakes. it's an excellent book, quick read and has some great pearls in it that can apply to our everyday lives.

hope things are better for you!!

Specializes in ICU, Education.

I'm sorry for the suffering of the OP, but I have a problem with everyone saying it is entirely RT's responsibility to check the vent settings. It is nursing's job too. The correct vent settings, and how the patient is tolerating them is a huge part of nursing assessment. While recognizing there was no negative patient outcome, and not excusing the doc's behavior, I need to point out that nursing is responsible for that and I am glad the OP started by taking accountability for it. Please don't teach this new nurse NOT to take accountability.

Specializes in critical care, PACU.
I'm sorry for the suffering of the OP, but I have a problem with everyone saying it is entirely RT's responsibility to check the vent settings. It is nursing's job too. The correct vent settings, and how the patient is tolerating them is a huge part of nursing assessment. While recognizing there was no negative patient outcome, and not excusing the doc's behavior, I need to point out that nursing is responsible for that and I am glad the OP started by taking accountability for it. Please don't teach this new nurse NOT to take accountability.

well I do agree that it was my fault. Im the one supervising the entire care of the patient. Even if RT should have been reviewing the orders, I still should have noticed the orders werent enacted. To solve this problem, I do 24hr chart checks every shift so that way, once Ive slowed down a bit, I can review all the orders to make sure I didnt miss something when I was busy during the first few hrs of the shift.

thanks again everyone for such wonderful advice and support.

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