Doctor vs Nurse - page 2

by anne919

I work in a nsg skilled facility and rehab at the same time. Our medical director always orders continue to monitor when I report something to him. One time I reported an extremely high blood glucose level of our hospice pt.he... Read More


  1. 6
    Unfortunately, I'm not sure what all your abbreviations mean (such as dob), so it makes it a bit more difficult to answer. I would avoid communicating that a resident has "flu symptoms." The flu has many symptoms and many of those symptoms are also symptoms of something else. Report to the doctor exactly what symptoms a resident has (for example "short of breath with a cough and a fever"). From there, he is the one who has to decide how to work it up and he decides what medical diagnosis to query.
    Altra, lindarn, SCSTxRN, and 3 others like this.
  2. 0
    My thoughts: how high was the hyperglycemic resident? Was he actively dying? Was he eating? If the doctor didn't order an extra insulin dose, I'm sure he had a reason. Don't be afraid to ask why, but don't approach it in a confrontational way. I've learned a lot by asking the doctor rationales behind his orders.

    As for the resident with wheezes and atelactisis, why do you want to send him to the hospital? Is he febrile? The CXR didn't necessarily indicate pneumonia, right? And the resident is on ABX. So why put him throughout the ordeal of going to the ER? He can be monitored and treated safely in place. I mean, atelactisis and wheezing may just indicate the resident needs a neb treatment and to do some cough/deep breathing exercises to expand the lungs. Unless I'm missing something you seem to be jumping the gun a little.
  3. 0
    The pt with atelectasis is not responsing with the neb treatment and she was supposed to be discharged on the next day but she started wheezing.

    To describe this fully: His inital order was just robitussin. I lied to him that the pt is having difficulty of breathing even though the resident says that everything if fine cause my gut feeling is telling me that it isnt just a regular wheezing since the resident has inspiratory and expiratory wheezing.and so he ordered a stat chest xray and antibiotic. Then the xray revealed that the pt has atelectasis. Case rested with that one cause the doctor does not seem to care to treat if the pt is being discharged or hospice or no code.

    And yes, I basically describe every pt sibjective and objective symptoms with nsg observations. I dont medically diagnose.
  4. 0
    As for the diabetic hospice resident, the pt is fine, eating well and fighting for her life. But the md simply stated 'she is hospice what do you want me to do? She is dying'
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    I wouldn't lie and say the resident reports SOB when they denied it. I guess I'd have to hear the resident's wheezes. If you say they were serious sounding I'll take your word for it. I've told the doctor before that a resident "just doesn't look/acting right" when all the concrete objective data seems harmless. Good doctors will heed the intuition of nurses they trust. But I wouldn't "make up" symptoms in order to get the doc to send a resident out. You're playing with fire there....
    LTCNS, Nascar nurse, wooh, and 7 others like this.
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    I was okay with this thread( assuming the OP is a new nurse that just needs to learn) until the OP admitted that they lied about their assessment.
    Lying is NEVER okay. It seems like you have good intentions however you are going about it the wrong way. If you ever have a gut feeling that something is not right, go to another nurse or your supervisor. As nurses it is out of our scope to diagnosis and medically treat patients.
    I assume you lied on your documentation as well, which is falsifying records. This can cause you to get in big trouble.
    Please take heart to what we are saying. I hope one day you will see what we see and take accountability.
    LTCNS, tewdles, Altra, and 6 others like this.
  7. 6
    Quote from anne919
    As for the diabetic hospice resident, the pt is fine, eating well and fighting for her life. But the md simply stated 'she is hospice what do you want me to do? She is dying'
    If the doctor doesn't want to treat hypo/hyperglycemia then he/she needs to D/C the finger sticks. There is no point in checking BGL if its' not going to be treated. Most of the hospice patients I've had were only comfort care. So we didn't do vitals, labs, FS, etc.
    tewdles, Altra, wooh, and 3 others like this.
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    Quote from anne919
    I lied to him that the pt is having difficulty of breathing even though the resident says that everything if fine
    Yikes, you're heading down a slippery slope with a set of freshly waxed and edged skis.

    And yes, I basically describe every pt sibjective and objective symptoms with nsg observations. I dont medically diagnose.
    ... but you do lie as you see fit...

    We're not talking short skis, either, we're talking 205s or better...
    TeleRN44, tewdles, Altra, and 5 others like this.
  9. 1
    Quote from anne919
    To describe this fully: His inital order was just robitussin. I lied to him that the pt is having difficulty of breathing even though the resident says that everything if fine cause my gut feeling is telling me that it isnt just a regular wheezing since the resident has inspiratory and expiratory wheezing.and so he ordered a stat chest xray and antibiotic. Then the xray revealed that the pt has atelectasis. Case rested with that one cause the doctor does not seem to care to treat if the pt is being discharged or hospice or no code.
    I know others have already talked about this, but I have to mention it too...you are really getting into very murky waters (legally speaking). Not to mention, the doctor might begin to ask himself, why is it that when anne919 calls me, it always seems the resident is in a dire situation....much more so than when I get calls from other nurses? (P.S. what is the difference between regular wheezing and the sounds that this residents lungs were making?)

    Overall, it seems like you are being a bit standoffish over the entire thing. I understand that the doctor may be too, but that does not mean that you can't take the higher road in the whole thing. Starting a thread titled "doctor vs nurse" like it is some sort of a death match is not the higher road. Lying to the doctor is not the higher road. When you call him, present him with the facts. If he does not do why you think he should, document it. Document the call, document what you told him, document what interventions he ordered (even if it is no intervention). If you think he is not doing what is right, show your NM your documentation and hope that she is able to correct it.
    wooh likes this.
  10. 3
    Dear Anne,
    It is my fervent hope that you'd see my comment as constructive criticism rather than malicious in nature.
    As your peer, I want to point out at least 2 items that I take exception to: You wrote
    (1) stating the pt med that might have had a side effect.
    (2) I also wrote down that a couple of pt was having early s/sx of flu.

    1: As a nurse, I would refrain myself from speculating. Nursing documentation need to be purely objective. In a court of law, "gut feeling" and "hunch" do not have a leg to stand on.
    2: I am trying hard to think where exactly you wrote down that a couple of patients were having early signs/symptoms of flu but the answer has been elusive insofar. Please tell me that you did not document that in any patient's chart.

    As a friend, I can only tell you that you will need to be very careful with what you document and whom you question. A vindictive MD can haul you all the way to the portals of the Nursing Board edifice.

    Again, please understand that I am not perfect, and I am not trying to judge you but just alerting you of the pitfalls and landmines that you seem to be jaywalking through.
    LTCNS, SCSTxRN, and psu_213 like this.


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