Doctor vs Nurse - page 3

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... Read More

  1. Visit  BlueDevil,DNP profile page
    5
    I 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.
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  3. Visit  Vishwamitr profile page
    0
    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.
  4. Visit  BlueDevil,DNP profile page
    0


    3:02 pm by MunoRN

    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'
    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.
  5. Visit  BlueDevil,DNP profile page
    5
    Quote from ALMERCHANT
    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.
    I 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.
    Altra, Twinmom06, SCSTxRN, and 2 others like this.
  6. Visit  psu_213 profile page
    0
    Quote from MunoRN
    I'm confused as to why your Hospice patient is "fighting for her life".
    Yeah, I was thinking the same thing.
  7. Visit  Beautiful Mind RN profile page
    0
    Quote from psu_213
    Yeah, I was thinking the same thing.
    When a patient usually is 'fighting for her life' or improving, doesn't that mean they usually go off hospice care? Honest question...no sarcasm attached.
  8. Visit  SionainnRN profile page
    0
    Quote from brittne
    When a patient usually is 'fighting for her life' or improving, doesn't that mean they usually go off hospice care? Honest question...no sarcasm attached.
    Being on hospice usually just means they have a terminal diagnosis and are expected to pass within 6 months, at least where I am. And just like everything I'm sure there are ups and downs within that time, but their actual diagnosis doesn't change.

    As to the OP, I've found it's much easier to not **** of the docs, especially when you need them for care of your patients. I had a hard time reading and understanding your posts, and I'm wondering if that is where some of the confusion is coming from with the docs too. I'm not going to harp on the lying and hanging up as that has been gone over ad nauseum. If you're having trouble with a docs order, you think more should be done, I would just follow the orders and let the doc know if there's no improvement. If you have to call a second time to let them know the pt isn't improving, ask what they're looking for.
    And I agree, if a pt is hospice and they aren't treating the high sugars they should just dc the fs, no point in poking the pt for no reason. I would take everything everyone is saying to heart and look at how you're interacting with the doc and your coworkers and try to change your behavior.
  9. Visit  anne919 profile page
    0
    Thanks for all your help. I might have had not fully described somethings but the patient denies difficulty of breathing but you can see that the resident is using accessory muscles. So I took that as labored breathing and you can audibly hear her wheezing i theb listened to her lung sound and she has inspiratory and expiratory wheezing. It isnt much of a lie.

    I was not the only one who assessed this resident nor the diabetic resident. I always ask for another nurse to also assess the resident.

    I dont document things outside the scope of nsg. I only document matter of fact so that my license will be covered.I know that you only document what you see what touch what you yourdelf had witnessed.
    Last edit by anne919 on Dec 29, '12
  10. Visit  anne919 profile page
    0
    I also did not hang up on him I said to him that I needed to go off the phone for I have many other patients to tend to. And ill keep on monitoring the pt like the md asked me to.

    We do have a protocol but the protocol isnt much very clear.
  11. Visit  BrandonLPN profile page
    0
    Quote from anne919
    Thanks for all your help. I might have had not fully described somethings but the patient denies difficulty of breathing but you can see that the resident is using accessory muscles. So I took that as labored breathing and you can audibly hear her wheezing. It isnt much of a lie.I dont document things outside the scope of nsg. I only document matter of fact.Maybe it irks me so much that my co-workers and md sees the resident as a do not treat pt. Just time for me to move to another facility.
    So chart that she was using her accessory muscles. Don't chart that she c/o difficulty breathing when she in fact denied it. And documenting the phrase "pt has sings/symptoms of flu" is in fact charting something outside your scope. That's called a medical dx, and it just comes across as sloppy, unprofessional charting. As someone said, chart the symptoms themselves. Are they febrile? Nauseous? Achey? Chills? Chart *that*. I'm not trying to sound snarky or anything, but you seem confused as to your role in the interdisciplinary team.
  12. Visit  anne919 profile page
    0
    Yes for the flu. What I documented was runny nose, febrile and muscle aches.
  13. Visit  VICEDRN profile page
    2
    Will chime in as a emergency room nurse. Please do not send your hospice patient with s/s of flu to us. We won't treat flu but when we draw labs and find all manner of other things, we will treat those. This will hasten the patients death and ultimately cause them to die in the hospital which they don't want. Please do not do this. Otoh, if you and every one else hears wheezing on a non hospice patient, call 911. That's not acceptable.
    cmbuckley and Anna Flaxis like this.
  14. Visit  BrandonLPN profile page
    0
    Quote from anne919
    Yes for the flu. What I documented was runny nose, febrile and muscle aches.
    Ok, fair enough. I think many of us were under the impression you simply charted "pt presents with flu symptoms" or something. Even if you do list the actual symptoms, you should still never chart a phrase stating "pt has the flu" or "pt has a bowel obstruction". Just don't do it. That's diagnosing, never looks good in a nurses note....


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