Decisions to call the MD need to be made on the basis of, "Does the MD need to be aware at this time. Does the patient need interventions that are not ordered? Tests that are not ordered?" And that decision needs to be made by the nurse caring for the patient. (With input from others if necessary, but the decision needs to be made by the nurse caring for the patient.)
Never on the basis of, "Will someone be mad at me for calling?"
So often I hear, "It's Dr. X on call, she's nice, go ahead and call." The only time the identity of the doc on call matters is if it's, "This MD wants to know this immediately, this one would rather hear when they make rounds."
If you're afraid of being yelled at for doing your job, GET OVER IT.
And don't let a coworker talk you out of calling if you feel a call should be made. I've worked on units where you're supposed to get the charge nurse's permission. Those units will throw YOU under the bus along with the charge nurse if things go south. You're the nurse. YOU have the letters after your name. Make the decision. Get input if needed. I'll often have new grads tell me they want to call, and after discussing the situation, we work out that it's "just ..." or something that doesn't actually need a call once we think it through together. But if you think you need to call, it's YOUR patient being cared for under YOUR license, which makes it YOUR decision.
I agree with you, wooh, and I make the call if it's something that can and should be taken care of right then, but no one likes to be yelled at.
I got yelled at by a doc one night for a long-ish run of (surprisingly) asymptomatic V-tach. No orders given. I had to stay over to chart, and guess what? The doc came in earlier than usual and made the patient his first visit of the day. So he yells at me for calling, then makes the patient his priority round? Yeah, thanks, *******.
This is the only place I've worked, but I have heard talk of some hospitals that will counsel doctors for less-than-professional treatment of nurses, and the collaboration between nurses and doctors is superior in those hospitals. As I said, I agree with you, but the root of the problem also needs to be addressed. Medical directors and DONs need to grow a pair and face this issue head on in community hospitals. Docs yelling at nurses results in less-than-optimal PATIENT CARE.
Last edit by dudette10 on Jun 13, '12
This was something that I really had to get over when I was a new grad. Now that I'm in icu I feel like the docs are a bit more receptive and respecting of the nurses, they value our input for the most part.
On the floor was a completely different story, I work in a large teaching hospital where (some not all) of the residents present with a god complex of sorts and a 'how dare this lowly nurse try to advise me' attitude. The difference between me now and me 3 years ago is I do not tolerate being belittled by arrogant docs anymore.
I can remember a time when I would call for something important and doc would basically speak to me like I was a child. That's something I will no longer accept, but it took a while before I was confident enough in my practice to tell them so.
One incident I remember occurred on another nurses patient around change of shift about 630. All the docs were coming onto the floor...long story short, i was sharing the room with this other nurse and walked in to see my patient. His roommate seemed..off, wasn't making much sense.
I poked my head into the hallway and asked the nurse 'is 30a ox3?' apparently he had been. I said we might need a rrt stroke alert, come see him. Resident walking down the hall says not to bother with rrt bc he's here to see patient. I didn't feel right about it so I called it anyway to get neuro on board. Rrt comes, neuro comes, resident throws me under bus saying that I overreacted and wasting time because patient was 'talking funny when he woke up' as he rolled his eyes like a teenager.
So at this point patient had come wandering out of his room and was basically walking into a wall..(think windup toy that hits a wall) yep that's normal. So end result, yep patient went to stat head ct and this nurse learned to never let belittling docs make me question my best judgement! Sorry this was so long
Last edit by MLMRN1120 on Jun 13, '12
: Reason: Added paragraphs