Doctor vs Nurse

[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 just told me what should he do since she's hospice! As much as I want to talk back on him that we should still treat the resident even if they are hospice I only suggested to increase her insulin. And as soon as I got the order I hung up on him.

Yesterday, I learned from my co-workers that he was infuriated that I logged a pt condition and stating the pt med that might have had a side effect.

I also wrote down that a couple of pt was having early s/sx of flu.

Oh yeah, one of our resident also has an incredibly audible wheezing inspiratory and expiratory but he doesnt want the resident be on a hospital so he ordered a stat cxr. The patient has an atelectasis. He ordered an antibiotic med. My gut feeling is telling me to send that resident into the hospital but I cannot make him give me an approval to send her out.

How can I speak with my DON about this matter?

[Beautiful Mind RN]

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.

[MunoRN, RN]

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".

[BlueDevil,DNP, DNP, RN]

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.

[Vishwamitr]

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.

[BlueDevil,DNP, DNP, RN]

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.

[BlueDevil,DNP, DNP, RN]

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.

[psu_213, BSN, RN]

I'm confused as to why your Hospice patient is "fighting for her life".

Yeah, I was thinking the same thing.

[Beautiful Mind RN]

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.

[SionainnRN]

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.

[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 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.

[anne919]

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.

[BrandonLPN, LPN]

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.