Awful Doctors

[JKimRN]

As a newly graduated nurse, I am still in the midst of trying to grow in self confidence and improve my critical thinking skills. I have only been working as a nurse for four months now and there is this horrible doctor that works on my floor. This is not the first time this same particular doctor has chewed me out but this time, this was by far the worst.

Early in my shift, I received a critical potassium level of 2.8 and reported it to this doctor. She ordered me to start an IV 60meQ of potassium and to draw a potassium level stat after the IV was completed. To start off complications, the patient's IV site was infiltrated and I wasn't able to take the time to start a new IV until three hours later. She complained that the site was burning too much so I started it off at 50ml/hr instead of the prescribed 88ml/hr.

Later in the day, this doctor comes up to the floor and demands why the potassium level hadn't been drawn yet. I explained to her the situation and it was just horrible. This doctor raises her voice at me in front of the whole nursing station and says, "Then you should have called me and I could have easily written an order for KCl po! That her potassium was this low and that it's taking this long to get her potassium is ridiculous. This is just unacceptable!!" Silence fell from the whole audience and I just nodded my head and walked away. It took all the strength I had to not burst into tears.

Quite a few of my coworkers came up to me to hug me afterwards and it's well known that this doctor has a tendency to be this rude. I understand my mistake and it was a learning experience. If she had a problem that needed to be addressed, she could have easily taken me aside and I would never make the same mistake twice.

My day just went downhill from there. I had a new admit and a million new orders for my other patients. As soon as I clocked out for the night, I burst into tears. I dread going back into work tomorrow.

[Jessicalynn]

Hugs to you! Keep your head up! There was no need for the MD to be that rude. I know it's easier said than done but these experiences will make you tough ;-) you sound like a very good and contentious nurse. Best wishes for the future.

Sent from my iPhone using allnurses.com

[RNperdiem, RN]

This is a situation in which you need to make use of your charge nurses or your co-workers.

If you cannot get an IV restarted right away, ask your charge nurse to help you.

I can't really condemn the doctor though, her commentary was centered about a legitimate concern for the patient.

We were all new once and do remember how fragile confidence is; I hope you feel better soon.

[gcupid]

If it was that crucial the patient would be dead. Don't beat yourself up about it. Why didn't the doctor order PO from the beginning as well as an IV infusion just to be on the safe side?

If the patient is not harmed, say to yourself "these !"@&;# can kiss my ;($.... Overtime you will learn what to allow to stay on your mind. If you let many things get to you, it will harm your well being psychologically, emotionally, spiritually and physically. Do not let nursing steal your joy in life bc it has the potential to do so no matter how much of a calling you assume it to be.

[Tait, MSN, RN]

While it sucks to be yelled at, by anyone, and I don't agree with her approach use it as a learning lesson. Similar to med errors, you feel bad for a time, but learn a valuable lesson. Remember to ask for help, especially with critical values. Also, ask other nurses what to do for situations for painful KCl infusions. There are options for diluting it by running it into other existing fluids, using warm packs on the site etc.

Tait

[eatmysoxRN, ASN, RN]

Remember to prioritize. What took you 3 hours to get back around to starting another IV site? A low potassium is serious stuff. What was their rhythm? Unless you were in a code, taking the ten minutes to restart an IV and start the potassium should be pretty close to the top of a to do list. She was probably upset because it was serious. She shouldn't have yelled at you though. Get help when you need it. Ask another nurse to help you. I will take the time to help others if it's important. Use it as a learning experience and continue to improve your prioritization. Hugs =D

[Esme12, ASN, BSN, RN]

Welcome to AN! The largest online nursing community!

While the MD's behavior is not excusable.....she is right to be unhappy. You are not going to like what I have to say........ You were in the wrong here she at least deserved a call back.

A potassium of 2.8 is CRITICAL. These must be addressed immediately as the patient can exhibit arrhythmia muscle weakness, cramping, and paralysis.

Three hours to start the IV with an intervention is not acceptable. This lab value is not one that can wait. This is where you ask for help....go to your charge nurse a co-worker to help with the next task or start the line for you. Do you have a rapid response team? an IV team? Being a good nurse is also knowing when to ask for help and learning what to prioritize. Call the supervisor to ask her what other resource is available. I know I have started many IV's as a supervisor for situations just like this.

I know being a new grad is all about treading water and not drowning....((HUGS)). The first year (or so) is the hardest....but what new grads also need to remember are those "critical thinking" skills that were pounded into your head. If I do not so this right now can the patient die from this.....the answer is yes, so this becomes your priority.

Screaming at someone doesn't help them learn. Shame on her.

I am sorry you experienced this....we all make mistakes but what is important is that we learn from them. Know that the next time you will be better..:)

Sometime extra organization is helpful...here are some brain sheets to help you organize/prioritize.

mtpmedsurg.doc

1 patient float.doc‎

5 pt. shift.doc‎

finalgraduateshiftreport.doc‎

horshiftsheet.doc‎

report sheet.doc‎

day sheet 2 doc.doc

[applewhitern, BSN, RN]

I agree that the doctor was right in this case. A critical potassium level takes precedence over other tasks. As a side note, our hospital policy states that potassium can run at only 10 mEq per hour. Regardless of how it is mixed, the potassium can only run at 10 mEq per hour. If it burns, we will run saline or the primary maintenance fluids with it, to reduce the burning effect. However, if your patient cannot take add'l fluids (like CHF) then don't do this. Some of our cardiac docs will simply order p.o. potassium, to be given every 2 hrs x so many doses.

[NurseOnAMotorcycle, ASN, RN]

4 months... so you've just gotten off orientation recently? Someone experienced should have been keeping half an eye on you for support. I know with a super critical level like that the charge nurse knew what was going on and that you are still new. I would think they would have checked on you or sent someone to check to see if everything was ok.

I'm glad the pt is ok, and I'm sorry you got yelled at. I think that the pt was talking and performing ADLs so you probably didn't understand just how sick the pt was. I think someone dropped the ball by leaving you alone to struggle under the workload.

Give it a week, there is too much going on for coworkers to dwell on the new kid's issues for more than a day or two. It's not fun or interesting to harp on a new person doing new person things.

Story time:

Had a new nurse come to surgical floor and drain full JPs every half hour or so and overheard her report "that's just how he is, he just needs nausea meds". I ran into the room to find a pale, sweaty, nauseous pt who was immediately put into modified trendelenburg for systolic in high 70s. (Didn't yell, btw.)

Coworker tells me she accidentally discharged a pt with their IV still in (long sleeves, pt even forgot it was there) and had to drive to their house to d/c it.

As a first year nurse, I had a pt of a very protocol loving MD who always ordered exactly the same thing on every single pt, including discharge criteria. Accidentally discharged a pt who was supposed to stay for a day longer than normal. The MD was ok with it and just called them at home the next morning to verbally assess them, but still...

as Vivalasviejas and others wrote: anyone who has never made an error is lying or too new to have made one yet.

[SwansonRN]

Trust me, been there done that, but at the end of the day your patient is okay! The first year is a roller coaster, there have been days when I have cried my whole 45 minute car ride home. I've made mistakes, been embarrassed, gotten chewed out, had a patient fall, had a self extubation, and made a mistake with medication. Nursing is not a perfect science. Lesson learned: communication. Don't drown silently. Shout out to a neighbor or charge and don't be afraid to call the MD so she can stay in the loop or modify the plan. Prioritization will come easier with time. Feel better and walk into work with your head held high because every single nurse has been in your shoes and you ARE good at what you do.

[claireswish]

Addressed to gcupi:

Your statement of "If it was that crucial the patient would be dead." is unacceptable and ignorant.

My little boy died due to a seemingly non-crucial mistake a nurse made. It worries me a nurse would make a statement like this. I would fire you had I heard you make this comment in my hospital. It is calloused.

[Ginger35]

Wow - I can see that people are commenting on seemingly both ends of the spectrum. Yes - the k was critically low and yes you were doing what you can to intervene with what you know. And yes, the physician did have merit to her rant. However, I would like to *think* that since this physician has "been there done that" with replacing potassium - that there should be critical thinking on both sides. What I mean to say is that the MD is culpable too and should have addressed any potential noncompliance issues such as burning at the IV site on the front end with you. This is a very common complaint with many patients having this done. Some patients tolerate it more that others. Some patients need their IV diluted or have the warm packs. Then there are others that need a little lido added for IV administration. Then there are some MDs that will order on the front end to give IV then if patient can not tolerate to do......... I have seen that too. So the MD should have had a little foresight on this too. Yes - communication is key. With that being said there is plenty of blame to go around. Tomorrow is another day. You have learned from this and will most likely not do it again. Trust me there will be a day where you will be preventing this doc or others from preventing harm to a patient. When we practice nursing or when docs practice medicine - there are risks associated. It comes with the territory. Now, go home get some rest and kick some butt on the floor tomorrow. Take care, Ginger