Doctors who dont listen or dont care

Nurses Safety

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Anyone ever been faced with trying to be patient advocate with a doctor who obviously doesnt care or is too ignorant to know? Thursday night, I almost decided to quit nursing altogether. I had a patient with massive ascites (no obvious ascites the night before) who was on a regular diet and also had a dobhoff receiving tube feedings at 70 ml/hr. He was receiving IV fluids at 125 ml/hr. He should have been on low Na diet with fluid restriction. He was in severe resp. distress with massive lung crackles. I called the hospitalist on call and I had to tell him what orders I wanted! (chest xray, KUB to verify dobhoff placement, etc) He had no clue! I had to call this doc approx. 12 times through the night over this situation. I finally had to INSIST he come to the floor to take a look at this patient. While on the floor, the pt codes. What does the doc do? He just stands there! He leans against the wall and watches me call code, frantically running to get suction and supplies/crash cart. Then what does he do....HE LEAVES! I reported him. Unfortunately, nothing will come of it. This happens all the time here at this hospital. The same night, another pt's blood glucose was bordering 600 all night, he was on solumedrol for resp. probs with hx of DM. Insulin was making no difference because his fingersticks were only QID. I did a fingerstick about q 2 hr and called this doc every time. His response, "give him 10 units of whatever kind of insulin you want to". OMG! During this whole time, my charge nurse just sits back and watches, would NOT help me! I didnt get to leave until 3 1/2 hours post shift. I called in sick the next night because I just couldnt go back so soon after all this. Im just sick about it. MRSA and VRE are rampant and pt's die left and right. Anyone else work in a hospital like this?

Mona Mona, BSN, RN

1 Article; 90 Posts

Oh my! All I cay say is maybe write up your night in a non-emotional way, and keep going up the chain of command until you find someone who will listen.

I am only taking my pre-req's, not even in nursing school as of yet, but this horrifies me!

And here I was thinking of moving to KY or Tennessee....I definitely have to not work at your hospital! EEEK!!!!

Specializes in Med/Surg, Home Health.

The worst part is that if I want a better job, I will have to travel. I had a meeting with my Nurse Manager, she agreed with me. My charge nurse should have helped because my other pt's had needs too and my time was tied up with this one. I transferred this pt to ICU, he later coded again and died. I have been just sick to death since this happened. I envisioned myself as a nurse making a difference in pt's lives. This is just NOT what I had in mind! Listen, not all jobs are like this. There are some really awesome hospitals with excellent doctors out there, dont let my story scare you. This hospital is reigned by residents who arent properly monitored and hospitalists with poor qualifications. You will do fine and good luck with Nursing school.

lindarn

1,982 Posts

The worst part is that if I want a better job, I will have to travel. I had a meeting with my Nurse Manager, she agreed with me. My charge nurse should have helped because my other pt's had needs too and my time was tied up with this one. I transferred this pt to ICU, he later coded again and died. I have been just sick to death since this happened. I envisioned myself as a nurse making a difference in pt's lives. This is just NOT what I had in mind! Listen, not all jobs are like this. There are some really awesome hospitals with excellent doctors out there, dont let my story scare you. This hospital is reigned by residents who arent properly monitored and hospitalists with poor qualifications. You will do fine and good luck with Nursing school.

I would also be sure to make a copy of the letter, and send each letter registered mail, with a return receipt. I would, as said above, go up the chain of command, and be sure to write, cc: sent to, whoever. That should get their panties in a wad. A copy to the State Board of Medicine, so that they can start a "paper trail", on this physician. He will sure to be trouble in the future. It is the only way for the Board to take action if problems come up in the future.

Lindarn, RN, BSN, CCRN

Spokane, Washington

wildcherry

14 Posts

Chenoaspirit....so sorry about that day/night from hell! I agree....with what's been said already....keep going up the chain until someone listens to you. And start looking for a safer place to work. Remember that it's your license on the line, no one elses. Seriously........start looking elsewhere for a job.

BGgirl

109 Posts

Specializes in Stepdown progressive care.

I find that a lot of the times Residents just don't have a clue as to what to do. We've had patients going bad and they'll just stand and the end of the bed thumbing through their books looking for some sort of answer. We usually call our night manager up who will give suggestions to the resident or will threaten to call the senior if nothing is getting done.

I agree that you need to report this doctor so that this unfortunate incident doesn't happen again with another patient. You did great as a patient advocate.

Dorito, ASN, RN

311 Posts

Specializes in Med-Surg, , Home health, Education.

Also, make sure your documentation is thorough. If the chart comes under scrutiny your best defense is in there about the numerous times you notified the MD. If you do notify him/her and they don't give you any orders-make sure this is documented in the chart. You sound like a great pt advocate!

grinnurse, RN

767 Posts

Specializes in Med/Surge.
Anyone ever been faced with trying to be patient advocate with a doctor who obviously doesnt care or is too ignorant to know? Thursday night, I almost decided to quit nursing altogether. I had a patient with massive ascites (no obvious ascites the night before) who was on a regular diet and also had a dobhoff receiving tube feedings at 70 ml/hr. He was receiving IV fluids at 125 ml/hr. He should have been on low Na diet with fluid restriction. He was in severe resp. distress with massive lung crackles. I called the hospitalist on call and I had to tell him what orders I wanted! (chest xray, KUB to verify dobhoff placement, etc) He had no clue! I had to call this doc approx. 12 times through the night over this situation. I finally had to INSIST he come to the floor to take a look at this patient. While on the floor, the pt codes. What does the doc do? He just stands there! He leans against the wall and watches me call code, frantically running to get suction and supplies/crash cart. Then what does he do....HE LEAVES! I reported him. Unfortunately, nothing will come of it. This happens all the time here at this hospital. The same night, another pt's blood glucose was bordering 600 all night, he was on solumedrol for resp. probs with hx of DM. Insulin was making no difference because his fingersticks were only QID. I did a fingerstick about q 2 hr and called this doc every time. His response, "give him 10 units of whatever kind of insulin you want to". OMG! During this whole time, my charge nurse just sits back and watches, would NOT help me! I didnt get to leave until 3 1/2 hours post shift. I called in sick the next night because I just couldnt go back so soon after all this. Im just sick about it. MRSA and VRE are rampant and pt's die left and right. Anyone else work in a hospital like this?

Sure you're not in a small town in East Texas? We have a hospitalist just like this!! D/Cs all meds on psych patients and then wonders why they are having psychotic delusional episodes!! Diabetics come in w/ high BS and no fingersticks nor coverage ordered!! OMG-I just keep reporting him and having patients complain to the highest level. Think it may finally be working in our case.

Keep on keepin on for your patients!!

SarasotaRN2b

1,164 Posts

also, make sure your documentation is thorough. if the chart comes under scrutiny your best defense is in there about the numerous times you notified the md. if you do notify him/her and they don't give you any orders-make sure this is documented in the chart. you sound like a great pt advocate!

exactly what i was going to state...document, document, document! it definitely seems that you had done everything in your scope of care. also, as the other posters have suggested, get out of there...since the md is a hospitalist, you'll have to deal with him from time to time.

i would have probably would have become a little indignant when the code was occurring and would have requested that the doctor help with the code. i would try to say it with as much respect as i can muster...doctor, would you mind helping and then give him the evil eye if he just proceeded to view instead of getting involved:angryfire .

the charge nurse should be doing what she could to help without being asked.

lindarn

1,982 Posts

Also, make sure your documentation is thorough. If the chart comes under scrutiny your best defense is in there about the numerous times you notified the MD. If you do notify him/her and they don't give you any orders-make sure this is documented in the chart. You sound like a great pt advocate!

And if I may add to my above post, make copies of all of the nurses notes, and medical notes, so they don't disapear from the chart.

Lindarn, RN, BSN, CCRN

Spokane, Washington

lindarn

1,982 Posts

And if I may add to my above post, make copies of all of the nurses notes, and medical notes, so they don't disapear from the chart.

Lindarn, RN, BSN, CCRN

Spokane, Washington

I mean, IN CASE , they disappear from the chart. I have heard if that hsppening to nurses who write notes concerning physicians, and concerning negligent occurrences by the hospital administrators and/or nurse managers.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Specializes in Med/Surg, Home Health.

Tomorrow (thursday) will be my first time back since this happened. I dread it so much. I have no respect for this facility and its hard to go back and do my job, knowing in the back of my head that if this happens again the outcome will probably be the same (it usually is). I can do everything possible for my patients and always will, but my strength and regards to the other staff is gone. My respect for this hospital is gone. I still owe them my sign on bonus.

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