I really need to talk about this! (long)

[NurseforPreggers]

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

[justcurious]

AtlantaRN, that's an awesome reply!

NurseforPreggers, no matter what this &%^* of an OB said to you, you just saved a life. Or two lives, to be exact.

Kudos to you.

[RaeT,RN]

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)

Why is it, exactly, that some MD's think a nurse cannot read a monitor strip, anyway??????

[bmoore]

You were very right to insist on the doctor coming in. I hope you documented exactly what you told the doctor and what the doctor told you, as well as the times that you paged her and the times that you spoke with her. Even if we have patients that aren't the easiest to take care of, their safety is still our top priority.

[fourbirds4me]

You did the absolutely correct thing. I agree with the others who have posted... if the MD refuses to come in... it is not enough to document... It the situation warrants it is up to us to implement "chain of communication" to insure the pt is properly taken care of. No one wants a dead pt or a compromised infant... let alone sit on a stand to try to explain how they got that way! (even if it was the drs fault)

[Dayray, RN]

yeah i thought the "is it carrot shaped?" question was pretty disresectful. They should be riminded that we take fetal monitoring tests annualy and have to recert every 2 years. Most docs havent had a fetal monitoring course sceince med school.

[cardiacRN2006, ADN, RN]

Either you get yelled at for the way you called her in, or you get yelled at for not calling her in and it resulting it the pt condition deteriorating. I'll take the "I don't like the way you spoke to me" over the "why didn't you call me-if I had known how sick she really was....."

[daisybaby, LPN]

When I have trouble getting a doc to come to the bedside, I usually just say "OK, I'll just chart that you are aware of everything and aren't coming in to assess the patient yourself at this time. Thanks."

Oooooooh, good one. I'm going to add that to my list of phrases to keep handy. :)

[TweetiePieRN]

Bottom line: You are an AWESOME NURSE!! :wink2: You saved your patient!! You did the absolute right thing!!! I hope that if I am ever in the hospital again, I have a nurse as persistant as yourself!!!

[laurakoko]

Report it to higher management, and chart, chart, chart. Everytime you called, and everything she said. CYA

[mesa0505]

Congratulations on a job well done!

[unikuelady, RN]

I just love all the great replys to you. I actually had a OB MD at the nurses station...just steps away from the patients room, refuse to check the patient when told that the patient (3 hours post-op C/S) was tachy, BP 48/24 tachypnic, difficult to keep awake/talking with o2 sats in the mid 80's with o2 via nc going. I stood firm, looked this MD in the eye and said if you do not immediately go in to check the patient I am going to call a CODE BLUE and you can explain it to the ER Doc/code team why it was necessary! Needless to say, the patient ended up back in OR. A leaking blood vessel was discovered along with 2,000cc of blood in her abdomen.

To my amazement this MD did acknowledge the next morning that the nurse was right.

So stay with it, our patients and co-workers need nurses like you at the bedside.

[SmilingBluEyes]

You did the right thing. If you don't get satisfaction from your nurse manager, I would take it up the chain of command.

exactly right. YOU DID THE RIGHT THINGS!