The Doctor oncall told me not to call him - page 3
I want to know if anyone can help me handle this situation. I work in a small 3 bed ICU where I am the ONLY nurse. I recently had two critically ill patients. One had been on the floor (I had worked... Read More
Jan 8, '03Originally posted by oramar
Does anyone else have issues with a supervisor that takes an order from a physician like that? Shouldn't the supervisor have protested? Easy enough for supervisor to bow to the physicians wishes then not be the one whose butt is in the sling. Even the bad supervisors I have had would not have stood for that.
Jan 8, '03Sounds like the doc had resigned himself to the fact this patient was not going to pull through and he didn't want to do anything else. I see this a lot with elderly nursing home patients with chronic illnesses. Docs used to make these patients DNR's ...but are afraid to do this nowadays without full family support. So.. nurses get stuck between a rock and a hard place, unfortunately.
Without a medical chain of events in the orders and progress notes documenting decline and poor response to treatment, it is fairly easy for a facility or doc to point a finger at a nurse when a family claims negligence or malpractice re a loved one's death. I've seen this happen to several agency nurse acquaintences. Hospitals tend to protect only their own butts.
I've had to insist the charge nurse (in your case the supervisor) get directly involved due to my concern how things might turn out...I didn't want to be there alone when the shyt hit the fan. Document her name in the chart numerous times. Document she has listened in on the doc conversations, or have her make a few herself when you ask for parameters of care.
Show your own chain of events in the chart with names and times. Keep a personal log just for yourself . Go up the chain of command with your concerns. Protect your license. The facility may badmouth you for having a 'bad attitude' (healthcare's term for a nurse with nonconforming behavior) or even offending a doc, (gasp) but with our licenses intact we can always work somewhere else. Good luck to you and be careful out there!
Jan 8, '03The final outcome for this patient was death. I had tried with my earlier phone calls to get a lot of the things you have suggested since there was no protocol. The h&h's were blown off because she had had serial guiacs on the floor when she had diarrhea ( before she developed the ilieus). and I was informed that that was the reason for the huge abdomen, there was no Gi Bleed. I discussed this with the shift supervisor (who was taking patients as someone had not shown up for there shift) and he told me I would just have to call the Doctor. As I had said, they thought she had had a heart attack and moved her to the unit, she hadn't had one, and was confused, so they gave her ativan as a passive restraint, and had also given her ECASA, and lovenox prior to being seen by the cardiologist per order of the primary MD. As the unit Nurse was unfamilar with her prior LOC, and VSS, I guess she assumed she was just a old confused lady. This patient had been bedfast for 10 years at home, she wasn't the picture of health. When I came back to work the next night, they had put in a central line, and ngt (and got back blood, imagine), and ordered PLT's which had not been started yet as they had to come from another city far away, I gave them that night. She had also been made a DNR. I could go on and on about it , but I won't. basically she died that afternoon. I could tell you more , but I am afraid I've already breached the confidentiality of this pt. as it is. The whole thing was scarely enough for me to talk with my husband about severely reducing our income and driving an hour and a half to get to a new, safe place to work. I am the only source of income as my husband is disabled. My agency has told me they talked with the hospital and the Doctor being angry is "no big thing". And the supervisor at the hospital said I was a good Nurse and she liked me, BUT I need to keep my mouth shut. So I still come out the villian in this.How's that for support? I told my agency that I would continue to call the Doctor when it was necessary ( I had already thought of calling at the first of the shift to get EVERYTHING I could), and that I was there to act as an advocate for the patient. I also have decided to have the shift supervisor call this Doctor at night to protect myself.
Jan 8, '03As for the shift supervisors responsibility for telling me the doctor told her to tell me not to call him the next night, well. This hospital uses about any warm body it can to supervise on nights. In this particular case, it was a nurse with experience of less than 5 years and only at this hospital. She doesn't know any better and even if she did, she would not have been backed up by her manager. The employees of this hospital are accoustomed to being served up on silver platters on a routine basis. I am considered to be too vocal, I have worked other places. It is very hard to unnderstand the situation down here until you have lived and worked it. When I first came here I couldn't believe it, it's like time warping back to the 50's or 60's, the relationship between Doctors and Nurses. They don't seem to realize there is a Nursing shortage. The pay here is very low. Lpn's make $9 to 11/hr, Rn's start at 11 and after 20 years you top out at 20/hr. The only way I can support my family is to work agency. There are no unions and they are so brainwashed as to the evils of one, they won't consider it. They are VERY passive. I'm not. It causes problems for me and I have to be very careful. Thus the keep my mouth shut statement. My agency isn't about to get into it with the hospital because then they might lose the contract, and my manager is not a nurse or even a medical person. There is one hospital, quite a drive away, and I am going to work out my next schedule very carefully, and then I am going to try to hire on there at least in the relief pool. They know me and I am acceptable for the most part, to them, They suffer from the same problems as the little hospital, but not to this degree. At least it's a level one trauma center, I miss the technology, the Doctors, the pharmacy open at night, the education, the whole nine yards. I just hate to get into the politics again. But I simply can't stand by anymore and watch patients suffer and die because of inadequate care.
Jan 8, '03Your best defense for your license and any potential lawsuits is to document, document, document. You won't lose your license because the DOCTOR didn't do his job. It's hard sometimes to make that distinction when we are very sure what the patient needs, and the orders we want. But, you are obligated only to notify and carry out the orders you receive, including "do not call me" orders. And, yes, I would have written that as an order. Not necessarily to "hang" the doctor, but to show that the patient was entering a "comfort measures only" mode. In the future, though, you might consider when getting these kinds of orders to ask the doctor while you have him on the phone if he'd like you to write the order as "do not recusitate" or "comfort measures only" and that gives him a chance to get his surly personality under control.
Although I agree the doctor's attitude was inappropriate, it can't be easy to go two days without sleep, on-call or not, and carrying the load for all the other doctors in his group that he's taking calls for. That isn't an excuse for him, but a consideration to keep in mind.
I wouldn't worry about leaving your job, or driving forever for less money. Again, the legal criteria is whether or not YOU did what you were suppose to do. Not, whether or not the doctor did what you THOUGHT he ought to do.
Jan 8, '03Originally posted by Youda
Your best defense for your license and any potential lawsuits is to document, document, document. You won't lose your license because the DOCTOR didn't do his job. It's hard sometimes to make that distinction when we are very sure what the patient needs, and the orders we want. But, you are obligated only to notify and carry out the orders you receive, including "do not call me" orders.
I don't agree with "obligated to carry out the...'do not call me' orders." Our first respoonsibility is to the patient. If I receive an inappropriate order like that I simply say that I am refusing to follow that order and I will continue to call. If the doc decides to go so far as to unplug the phone, I can document that he can't be reached and let the chips fall. If it's not appropriate, however, I won't follow an order like that.
Jan 8, '03ED doctors are usually only covered legally to help respond in code situations. I know it is frustrating that there is a doc in the house and he won't come, but if one unit calls the ED doc to do this, then another calls him to do that, it could get abused very quickly. The attendings will start to see the ED doc as the one to provide coverage for them.
Say the ED doc is in the middle of putting a central line in someone and the ED gets a code (it happens all the time). Sure, we can initiate ACLS protocols, but it is going to look pretty bad if the doc isn't there because he is off starting a line on someone. He really can't just drop what he is doing. ED docs are there to see the pts. in the ED, not be the "house doctor."
I don't have a whole lot of sympathy for a doc who doesn't want to be bothered in the middle of the night...it goes with the territory.
Jan 8, '03I don't agree with "obligated to carry out the...'do not call me' orders." Our first respoonsibility is to the patient.
I agree with this very much. The point I was trying to make is the legal criteria, not the moral responsibility or patient advocacy. Your suggestion of informing the doctor that you don't intend to follow that order is a good one. That kind of response takes some time to learn, though, as the original poster was clearly intimidated, frustrated, and upset by the doctor's "order" and the clear lack of support from the hospital. It never ceases to amaze me how being a good nurse is often in direct opposition to being a "good employee."Last edit by Youda on Jan 8, '03
Jan 10, '03I agree with the above posts. In addition, each time I called him, I would have charted "Dr X called, informed of (detailed list of all pertinent data), no new orders received" I would also tell him I was charting this. "I'm charting that you have been informed and don't want anything changed at this time. Is that correct Doctor?"(in my best formal frosty b*tch voice) I've done this and continued to call as often as needed until they finally came in or gave me appropriate orders. Let them yell, let them complain about me - don't intimidate that easy.
One phrase that has stuck with me over the years I heard at a conference "I don't get paid enough to worry alone"
If he didn't want to get called at night, he should have been a dermatologist! (Told a doc that once)
Jan 10, '03Cat, as a Yankee born nurse working in the south, let me say I totally empathize. We talk too fast, too loud and too much. We take too much on ourselves. 'Nurses have no business listening to lung sounds as we don't know what were doing.' (This was from a cardiologist in ICU) Too many facilities here do not support assertive, patient advocate nurses, in fact they tend to punish them.
I had to learn to really walk a line here down south....'Yes doctor' or similar reply to management is the preferred response. I know it's not easy...look out for yourself and be the best nurse you can be in the situation without sabotaging yourself accidentally.
Personally I could not stay at this facility you describe. Eventually I predict your charting will come under fire (you are criticizing the doctors..and eventually the facility will feel the heat when the charting becomes known to the higher ups...and then it's...'you can't do that...we're a family here and you're not being a team player'.. blah blah) Can you tell I've heard this before? LOL!
Hope you move on to a place with a better support system. If you can't I urge you to be very careful. We can't always fight in these situations without becoming a casualty ourselves...not without a union behind us.
Jan 13, '03I don't care how many times you wake up a dr, he's the dr! Always cover your own. No one else will do it for u!
Jan 13, '03wake him/her up! that is what they are paid for..that is how they earn their living..that is why they get the big bucks, and we don't.
call and call again if necessary...you have a responsibility to the patient..
too bad, the doc doesn't think so....