I really need to talk about this! (long)

bagladyrn, RN · Sep 18, 2005

Adding my 2 cents worth - you absolutely did the right thing! I've been in this situation many times over the years - once had to get the house super to call a doc back who refused to come in, yell at him on the phone and hang up on him in mid sentence in order to p*ss him off enough to come in! Now my usual technique is to say "okay, I'm charting that you have been informed of X,Y,Z, are giving no new orders and state that you will be in in the a.m.. Is that correct Doctor?" Since no way do they want that in the chart, that will usually get them moving! (Never really had to chart that as they have always come in). Yes, I've gotten attitude from them, but my shoulders are broad - and my pt. got the care they needed.

Jayla · Sep 18, 2005

Would you really think about quitting a job over one incident with one person? The reason I ask is because sometimes in stressful situations it's very easy to let tempers flare. I'm well acquainted with this from personal experience. :)

From your post (and I wasn't there so cannot be sure) it sounds like the doc was more annoyed with the way you communicated information to her, not so much what you were communicating.

The only reason I say this is because: maybe there's something for you to learn here (aside from the fact that this doc seems incompetent). Maybe in stressful situations you need to take a deep breath and think about how things are being communicated to others.

The only reason I post this is because you seemed interested in input. I'm not trying to by hurtful--but I do think it's good to try to learn and grow personally from crappy situations like this. You were absolutely right to advocate for your patient, and any good nurse would have done so. I hope your manager backs you up!

Long Term Care Columnist / Guide · Sep 18, 2005

You did a magnificent job of advocating for your patient. :) That is exactly what you are SUPPOSED to do. Placating the physician and making sure she gets her beauty sleep on the nights she's on call are not your job. :stone

As for this OB, I say, if she doesn't want to be on call, she shouldn't have become a doctor in the first place, because there are times a physician has to come in to the hospital and make a decision.......that's why THEY make the big bucks. :uhoh3:

lady_jezebel · Sep 19, 2005

This is exactly why I choose to work in university hospitals. If a resident doesn't listen, I can call another doc further up the chain. Attendings have a huge reputation to uphold, and a fear of lawsuits; they'll kick their residents' butts if they don't listen to the nurses. Also, the nurses are hard-core about doing what is best for the pt, and we have a lot of independence; our management supports us 100%.

Judee Smudee, ADN, RN · Sep 19, 2005

What really ticks me off is that the OB spent precious moments giving you a hard time when she should have been on her way in to see the patient. If you ask me that person should be up before the BOM.

Dayray, RN · Sep 19, 2005

Like everyone said "you did the right thing". This is the problem; we as nurses so often work in a "gray area". Our scope of practice is constantly growing and there is no document that accurately describes what we do. This leads to much confusion and allows doc's to pull this kinda crap. However many, many times we make decisions and plans of care that technically are within the physicians scope. Now docs expect us to do these things without waking them up to ask permission but the second you say anything that sounds like decision making they are fast to put you in your place.

I have also seen situations like this where the nurse insisted the doctor come in but they refused and later in review the doc stated "well if they had told me to come in I would have" So you have to insist allot and many times be unprofessional to get your point across. The other option would have been to call the Chief of OB and that would have been a whole lot bigger mess then the one you are in.

It IS in fact your call weather or not they come in weather or not they want to admit it. We as nurses are in effect doing their jobs for them while they sleep. It is your call as to weather or not you continue the course of action they have selected for the patient. Remember we are legally required to exercise judgment in the orders we carry out and if you choose not to carry an order out you need them to either come in and carry it out themselves or give you a new order.

Do not let this women make you feel bad. You need to let her and everyone else know that you did the right thing. I would take her aside and talk about this. Be nice and be professional but let her know that you did the right thing and then tell her that you are watching out for both her and the patient. Tell her that by insisting on her coming in, you were protecting her license and malpractice premiums, had this patient died or lost her baby there would have been a court case and how would it look if you had documented that the doctor had refused to come in. So tell her you are sorry if you offended her but that you knew that had she not been so tiered she would have come in (here's the real hard part) tell her you know she would have because you know that she is a good doc and that she cares for her patients. This may seem like butt kissing but it isn't, people tend to try to live up to others high opinion of them. If you make her think you think she is good she will do her best to keep you thinking of her that way.

I would not seek backing from your manager or hospital. They are way too concerned with keeping the doctors happy. You have to solve this or it is going to come up again. The best way to do that is to get this doctor to think you are on her side and make her want to impress you.

NurseNora, BSN, RN · Sep 19, 2005

The doctor's complaint was that you kept asking if she was coming in. Did you tell her what you wanted directly? "The patient's condition is deteriorating and I want you to see her now." Then you get to ask how soon you can expect the doctor to arrive. If the answer is still "No" then you get to say, "I believe this patient needs to be evaluated by a physician immediatly, so I am activating the Chain of Command." (I've never in my life been that articulate in a real conversation, but you get the idea.)

Be sure you are familiar with your hospital's Chain of Command and how it works. It is there for your patient's saftey and your protection. Make it your friend.

You did well. You got the doctor to her patient, where she needed to be. Your patient and her baby were taken care of effectively because of your efforts. Good job!!

lindarn · Sep 19, 2005

I am so upset about a situation that happened last week, I just can't get it out of my head. I had a pt that was admitted for pylo/PTL and while in the hospital developed pneumonia and eventually pulmonary edema. When I was taking care of her I was also assigned 2 other high risk patients.
A pulmonologist came to see this pt and ordered several meds based on lab values. Specifically a critically low potassium of 2 point something, her ABGs showed an O2 of 53. Her sats were running in the 80s on room air, she refused to wear her O2 most of the time. I would educate her and put it on and when I would come back in the room it would be off again. She was extremely noncompliant.
I saw the OB about 2 or 3 hours into the shift and told her everything that was going on with the pt. She refused to see the pt at that time because "she's a pain in the @$$", although I told her that in my opinion the pt needed to be in the unit. Throughout the shift the pt stayed very sick, breathing approx. 40-60 times per min. She was on KCL drips, Bicarb drips and Mag.
At 0100 the baby started looking really really crappy. The pt refused to do anything to help the situation. I called the doctor and spent about 10 minutes on the phone with her trying to convince her that she needed to come in and see the pt as well as view the strip. I'm sure I sounded a little anxious on the phone with the doctor, and she was obviously dead asleep when she returned my call, but what happened next just blows my mind.
She called me back from her cellphone, drug me out of the pt's room to tell me this ... "I want to talk about this now because when I get there I want to focus on the patient. You acted extremely unprofessional on the telephone, you were very annoying and you pissed me off. I know that you are having a difficult time because the patient is a pain in the @$$, but you need to calm down. If you are going to continue to work there then you need to know that it is my responsibility to decide whether or not I come to see a patient. If I decide not to come see a patient that is my decision to make, not yours. You asked me at least 5 times when we were talking if I was coming and I don't know if you realize how very annoying that is. I'm telling you this because I want you to know how you sounded. Now ... Is your charge nurse there?"
Well, this pt ended up in the ICU on a vent! The next day she got sectioned. I know that I was right in insisting that the pt be seen, but I just can't get over how the doc treated me. I of course wrote the incident up, and talked to my manager. She's pretty worthless though. Its just really really bothering me still, and I needed to talk about it. I don't think I've accurately described how terrible this situation was, because it would be waaaay too long. It was bad enough that I really seriously thought about quitting and never coming back. I never got so much as a "you were right" or "I'm sorry for overreacting" from the doc. :angryfire

You have every right to be upset about this incident. I do Legal Nuse Consulting for attorneys, and I have personally been involved in three cases that have to do with nurses not calling physicians and insisting that they come in to see their patients. It is not "her call" to come in and see this patient. It was a professional judgement on your part that the patient needed to be seen. It is part of the nurse practice act in every state.

I would go further that just righting a letter to your nurse manager. By the way, I hope that you kept a copy for yourself. I would write an incident report for risk management, make a copy for your self (don't listent to the hospital when they tell you not to- just don't tell anyone that you did), and also write a letter to the State Board of Medicine concerning this physician.

She was completely innappropriate the way she responded to you. This is a pet peeve of mine. Doctors get paid alot of money to do what they do. Factored into their fee schedule, is the incinvenienience to their lives, and the lives of their families with the hours, and on call responsibilites that they have. In other words, they are getting paid for the inconvenience of being on call. They are not doing anyone a favor to respond to a nurse's phone call in the middle of the night because a patient needs to be seen by their doctor. She is trying to bull you in the worst way. Stand your ground and show them the nurse practice act where it states that you are responsible to report changes in a patient's condition to a physician. She is trying to intimidate you. I would not let this go. If she gets away with bullying the nursing staff this time, it will cause nurses to hesitate to call a physician when the patient needs to be seen by a doctor.

In the cases that I have worked on, this is exactly what happened. You might mention to the hospital, that THEY ARE ALSO AT RISK AS IF THE PATIENT SUFFERS AN INCIDENT BECAUSE THE NURSES WERE BULLIED AND INTIMIDATED INTO NOT CALLING PHYSICIANS WHEN THE PATIENT CLEARLY NEEDED TO BE SEEN. The hospital is also beeing sued by the family, in addition to the nurse, and the doctor. It is YOUR LICENSE ON THE LINE. The heck with the doctors license. Let her hang. If you need to call a lawyer to support you, do so, Nothing makes a hospital back off quicker than a nurse who asserts her legal righs.

Refuse to talk to her, adimistration, and your manager without a witness. Also document the phone calls, and her language. If you can, have someone on another line listening in to validate what she says, refuses to do, and the threatening language she uses towards you. Good luck.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Jolie, BSN · Sep 19, 2005

The doctor's complaint was that you kept asking if she was coming in. Did you tell her what you wanted directly? "The patient's condition is deteriorating and I want you to see her now." Then you get to ask how soon you can expect the doctor to arrive. If the answer is still "No" then you get to say, "I believe this patient needs to be evaluated by a physician immediatly, so I am activating the Chain of Command." (I've never in my life been that articulate in a real conversation, but you get the idea.)

NurseNora,

You stated this beautifully! We should all copy and paste this onto a card that we carry in our pockets!

NurseforPreggers · Sep 19, 2005

The doctor's complaint was that you kept asking if she was coming in. Did you tell her what you wanted directly? "The patient's condition is deteriorating and I want you to see her now." Then you get to ask how soon you can expect the doctor to arrive. If the answer is still "No" then you get to say, "I believe this patient needs to be evaluated by a physician immediatly, so I am activating the Chain of Command." (I've never in my life been that articulate in a real conversation, but you get the idea.)
Be sure you are familiar with your hospital's Chain of Command and how it works. It is there for your patient's saftey and your protection. Make it your friend.
You did well. You got the doctor to her patient, where she needed to be. Your patient and her baby were taken care of effectively because of your efforts. Good job!!

What I said when I called her is ... "Dr. XXX this is XXX, I'm calling about Ms. XXX. In the last several minutes her baby has started looking very flat and having late decels. She is still tachypneic, her O2 sat is X, she refuses to wear her O2 and she is having very labored breathing. I really think she needs to be seen." .... the doc starts asking questions i.e. "what shape are the decels", blah blah blah .. it was obvious that she was trying to find a way that she didn't have to come in. I said, "they are classic late decels with no variability" ... she kept asking me the same questions over and over, "are they carrot shaped or .. blah blah blah" ... "No Dr. XXX they are not carrot shaped, I really think you should view the patient as well as her FHT strip". This went on for about a good 5-7 minutes, in which time I did say more than a couple times that I felt she needed to just come in and see for herself. ( I didn't use those words, but I sure did want to)

gypsyatheart · Sep 19, 2005

:angryfire OMG! AFter reading your OP, my bp must've just gone up! You have gotten great feedback from the rest of the posters, You did great! I am just so peeved off at these kind of MD's! Really! And doesn't it just blow you away....here they are making the $$$$$, getting all the kudos, recognition, etc and we are treated like scum! :angryfire Document documeent document. Save a copy, like previously mentioned. Also, always (maybe you did) enlist the aid of your charge nurse, and chain of command. Administration generally won't back you, but sure they kiss that MD's @$$!

Please don't be run off of OB, use this to strengthen yourself, you did good, kid, ya did good! :yelclap:

PS That doc s/b ashamed to look you in the face.....wonder if she'll try and kiss your patootey, now! :rotfl:

AtlantaRN, RN · Sep 19, 2005

I had a doc say to me "you're just calling me to cover your @ss," my reply was

"YES, I AM...NOW WOULD YOU LIKE TO COVER YOURS?"

ALWAYS do what is right, you did by being the patient advocate...

it IS the docs call as to whether or not she comes in to see the patient,

and it IS your call as to whether or not you explain the deteriorating situation

with your patient to the lame doctor!!!!

you DID the right thing!!! and don't be suprised if management doesn't back you up...

most the time, managers just want to keep the docs happy, even if they are giving

substandard care (they bring IN money to the hospital, we take money OUT).

NEVER doubt yourself...you DID the right thing and the patient is ALIVE as a result...

linda