Doctor vs Nurse - page 3
by anne919 14,228 Views | 89 Comments
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
- 7Dec 29, '12 by Rose_Queen GuideBetween the hanging up on the doctor (your first post) and the admission of lying to the doctor, I seriously think you need better manners and better ethics. Hanging up on the doctor because you've bullied him into giving you what you want isn't right. Lying to the doctor to get you what you want is even more wrong, and very well could result in disciplinary action by your workplace and by the board of nursing. Quite honestly, I think you just might need that to make you wake up and act as an ethical nurse. What you've admitted to are definitely not the actions of an ethical nurse.
- 19Dec 29, '12 by GrnTeaYou cannot initiate oxygen without an order unless you have a standing order protocol in your unit with specific criteria for doing it, signed by your medical director or control.
You cannot chart, "Signs and symptoms of flu." You can chart, "Temp of 101.2degF; aches in neck, shoulders, and back; sore throat; rhinorrhea."
You cannot determine what treatment, besides CPR, is or is not appropriate for a hospice patient; if the physician isn't willing to order more insulin, for example, you cannot slam down the phone on him.
You are wrong that atelectasis (not "an atelectasis") requires hospitalization. Had that CXR showed a roaring pneumonia, different deal. That's why the physician orders the CXR, and makes the determination.
If you think there is a possible side effect of a medication and for some reason you think the physician is unaware of this (a generally unreasonable assumption, and one that is bound to be taken poorly), ask if he could explain to you for your own learning. This is NOT "playing the doctor-nurse game," it's seeking to expand your own understanding and learn something of which you might not be aware. Don't use the log book to lecture him.
And the lying? Dear, you need to take a very big step backwards here, because the ice you have put yourself on is very, very thin.
In short, you have overstepped your bounds and scope of practice on more than one occasion. You have ****ed off the physician doing it, and as a result he may not, in fact, respond to you when he ought to. This burnt bridge will endanger patients if he has to waste time trying to find another nurse to discuss the situation with. And you have endangered your license by falsifying information. You'd better pray you have not mouthed off about any of this to patients or family members, because that is the lawsuit just waiting to happen. It doesn't take much water for the seeds of doubt to grow into nice big flowering hunches, as I read in a book recently; that's what sends families to attorney offices and supervisors to report to BONs.
You ought to have called your supervisor or a more experienced RN for backup before you acted. I can't tell how long you have been a nurse, and what kind of experience cred you have; an experienced physician usually can tell the difference. It doesn't sound like much, though, by your description. I agree that you'd better be looking for a new job, because you might not have this one much longer without a major attitude and performance adjustment. Perhaps it would be better for everyone if you left ... but don't do this sort of thing again wherever you go unless and until you have a great deal more experience and much firmer grasp of nursing ethics.Last edit by GrnTea on Dec 29, '12
- 4Dec 29, '12 by psu_213Quote from GrnTeaI almost did not post what is to follow, for the sake of not wanting to 'pile on' to someone who came here for help; however, I think it does serve a point.You are wrong that atelectasis (not "an atelectasis") requires hospitalization. Had that CXR showed a roaring pneumonia, different deal. That's why the physician orders the CXR, and makes the determination.
Atelectasis can be a chronic condition. If it is chronic for this resident, my guess is they are not treating the atelectasis. The resident's wheezing does not indicate that they have atelectasis and if the wheezing does not go away it does indicate anything (either improvement or worsening) about the state of the atelectasis. The nebulizer treatments will not clear up the atelectasis if the person does not start more deep breathing exercises.
One guess that I have is that the resident is wheezing d/t bronchitis, which would not show up on a chest X-ray If that is the case, the breathing treatments are meant to open up the airways, improve air flow, and reduce/eliminate the wheezing.
Since the bronchitis itself is likely viral, antibiotics would not help. However, if the atelectasis is acute, then pneumonia could develop, hence the order for antibiotics. Point is, there is a whole lot more that just wheezing, atelectasis on the chest X-ray...send them out.
Do I know for a fact that he has bronchitis? No. Do I know for a fact its viral? No. Do I know more than your doctor? Definitely not. And I don't think it is helping your case to act like you do.
- 1Dec 29, '12 by psu_213Quote from anne919What does this mean? Please, please, please don't tell me that this means you think you won. Guess what? You didn't and you can't.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.
- 0Dec 29, '12 by Beautiful Mind-I am not a nurse...quite yet, but the relationship between nurse and doctor is very close to what a pharmacy tech has with a pharmacist. Pharmacy techs prepare the medications that pharmacists ordered. The two double check one another to prevent any medication errors from happening, much like how a nurse and doctor work with one another to give optimal patient care...Just like how a nurse cannot diagnose a patient, a pharmacy tech cannot change the medication orders.
My point is....I would reassess how you are handling things. The Dr. is someone you will have to work with on a daily basis and creating a sour relationship because you do not personally agree with some of the decisions the Dr makes and/or feel(in your opinion) the Dr. does not care about the patients is just not right.
My first piece of advice: Keep it professional! You are there do your job and so is he. You are there to work as a team for one goal...the care of the patient, whether it is to keep them comfortable in their last moments of life (since from what I read this is a hospice situation) or general care.
Second piece of advice: Listen to the voices in this thread you created. They are very wise when they point out your ethics. Having a tantrum (hanging up on the Dr) and lying are big no-no's.
I do not mean to offend in any way. Rather, by pointing out the error of your ways, I hope you evolve from them and become a more well rounded nurse so that the situation becomes smoother for you.
Best of luck.Last edit by Beautiful Mind- on Dec 29, '12
- 4Dec 29, '12 by MunoRNQuote from anne919I'm confused as to why your Hospice patient is "fighting for her life".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'
- 5I see others have already pointed out your errors regarding the medical issues at hand.
Speaking as a provider, I suggest it is possible that the physician does not trust your assessment. I would not hazard to guess why that might be, specifically. However, as an example, there are nurses who have "cried wolf" more than once, and in whose judgement I no longer have any confidence. I don't change patient plans of care based on what they tell me, because I know that I cannot trust them, and it is not likely to be in the patient's best interest to do so.
Regardless, I would suggest that you begin damage control immediately and try to protect what might remain of your professional relationships and reputation. That means no more operating outside your scope of practice, no more lying, and no more unprofessional conduct.
Best of luck.
3:02 pm by MunoRN
Quote from anne919As 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'I'm confused as to why your Hospice patient is "fighting for her life".
OK, gallows humor I guess, but I LOL'd at this.
- 5Quote from ALMERCHANTI don't diagnose people on the internet. The only kind of help I am prepared to give here is aimed at helping Anne hang onto her job and dignity.Dear Dr. BlueDevil,
Would you say that a psychiatric evaluation is in order for Anne? I do. The person strikes me as someone with borderline personality.