Doctor vs Nurse - page 4

by anne919, BSN, RN | 14,579 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


  1. 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.
  2. 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.
  3. 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.
  4. 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
  5. 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.
  6. 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.
  7. 0
    Yes for the flu. What I documented was runny nose, febrile and muscle aches.
  8. 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 ~*Stargazer*~ like this.
  9. 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....
  10. 6
    Quote from VICEDRN
    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 deathand 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.
    Am I misunderstanding, or are you really saying we should call 911 on all full code residents who have audible wheezing? That's one way to clear out my hallway fast!
    Altra, Nascar nurse, wooh, and 3 others like this.


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