I really need to talk about this! (long)

got2be · Sep 18, 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

that is very discouraging. she gives docs a bad name. i had a midwife and she was the most wonderful person, she never hesitated to see me or listen to me complain. i think if she thought this pt. was a pain in the *#@ she should have referred to someone else who could deal with her. i read somewhere in one of the many posts i've read that nurses are the patients advocate so you did the job you were supposed to do. so pat on the back to you. who cares if the doc herself is a pain in the @#$. hope you have a better week next week!!!

Super_RN, BSN, RN · Sep 18, 2005

You did everything absolutely right! From your posting, the only one who referred to the patient as a PIA is the doctor, so she has no right to put those words in your mouth. As far as I am concerned, if it is an annoyance for her to be called about critical patients, then she needs to find another profession. It is your job to take note of the changes in condition and notify the doctor--it is their job to give orders and/or come in and assess them. The doctor was probably annoyed because you did everything right and she didn't truly want to have to come in. Tough! I seriously think that sometimes doctors think we overreact on situations. The way I figure is that I am the one with the patient for 12 hours a night, not them. Subtle changes are picked up by ME in the middle of the night, not them. It is ME that notifies them of the condition changes and ME that carries out new orders. Don't let her "annoyance" keep you from doing your job. It's your license and docs won't protect you from losing it the one time you decide not to call. Good luck and I hope you feel better!! :nurse:

RaeT,RN · Sep 18, 2005

Absolutely, you DID YOUR JOB. It doesn't matter if the pt is a pain in the @$$ or not, she still must be cared for, and based on your nursing judgement, the doc needed to evaluate her. I hope you documented, documented, documented EVERY time you spoke to the doc and how long it took her to come in and see the pt. Did the pt end up in the unit during your care, or was it after you had her? Those ones are so hard, too - the ones that don't get it. Way to advocate for a tough pt and that baby who could not advocate for itself. :yelclap:

Jolie, BSN · Sep 18, 2005

Why, oh why do physicians choose to practice OB if they don't wish to be inconvenienced in the middle of the night? That is why dermatology exists.

You absolutely did the right thing. The OB is in the wrong, and everyone knows it. It bothers me that your manager is too much of a whimp to stand up for you, but there seems to be an epidemic of that lately.

I had the unusual fortune of working with a group of pediatricians and OBs who respected the input of nurses, and oftentimes would ask, "Do you think I should come in?" Never did I have to fight to get a patient seen by her own physican.

You did the right thing, and a mother and baby are alive and well thanks to you. If you are ever put in this situation again, document every conversation with the physician, and immediately go up the chain of command to your nursing supervisor and the chief of OB if necessary, in order to get the patient prompt attention.

military spouse · Sep 18, 2005

Unfortunately, sometime we have to beg docs to come in because they don't take our assessments/reports seriously. It sounds like you did a great job! Just remember, she wouldn't have gone to the ICU if your report to the doc regarding the pts condition wasn't correct :)

StatRNNJ97 · Sep 18, 2005

:) You did the right thing! I am sure you have heard about "chain of command." It is the docs choice to say yes or no as to coming in, but being a patient advocate is what its all about when we are caring for someone! Your skills helped you to make the correct decisions for this patient. You cover your butt by not only charting EVERYTHING the doc does and does not do, but by making calls and encouraging the patient to use the oxygen. I would not let this doctor run me out of labor and delivery. If you have to deal with her again just tell her "I am activating the chain of command" and leave it at that because then the ball is in her court so to speak. Lean on your co-workers who you respect and trust for insight. We have a certain OB who gets "grumpy" when he is on rotation and gets awakened at night. The last time this happened as soon as he came on the unit he made a scrunched up face before even speaking. I said something out loud about his face matching his grumpiness (not in an area patients could hear) and he just looked at me. He has been a bit better since.

NurseforPreggers · Sep 18, 2005

Absolutely, you DID YOUR JOB. It doesn't matter if the pt is a pain in the @$$ or not, she still must be cared for, and based on your nursing judgement, the doc needed to evaluate her. I hope you documented, documented, documented EVERY time you spoke to the doc and how long it took her to come in and see the pt. Did the pt end up in the unit during your care, or was it after you had her? Those ones are so hard, too - the ones that don't get it. Way to advocate for a tough pt and that baby who could not advocate for itself. :yelclap:

Yes, she went to the ICU during my shift. Once the doc did come in she spent about 40 minutes doing a BPP, ordering STAT labs and assessing the pt. Then the patient was immediately sent to ICU, which should have been done many hours before then.

Trauma Columnist · Sep 18, 2005

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

fergus51 · Sep 18, 2005

You did your job and may just have to deal with the doc being an idiot. 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.". Usually that gets them in. If not, you just have to keep being a pain in the doc's butt. I really don't care. I'll call them every 20 minutes in the middle of the night if I feel it's necessary. We've all probably done it at some point. Just take comfort in knowing that YOU were right and helped your patient. If she gives you that speech again just point out that while it's her job to decide when to come in and see a patient, it's YOUR job to make sure she is aware of the situation.

allnurses Guide · Sep 18, 2005

Just wanted to add my 2 cents and say YOU DID THE RIGHT THING!

Sorry for shouting . . :)

steph

ksparkman · Sep 18, 2005

I am not a nurse, and I just changed my major to pre-med, but I wanted to tell you that you did what you should have done. That's absolutely ridiculous! And besides, who cares what she thinks! The other people were right. That OB would NEVER come to your rescue if something happened. I'd rather get yelled at knowing that I did the right thing, rather than something worse happening for not calling.

Blow her off. She's probably pissed because she knows she did the WRONG thing and someone had the balls to call her on it. Don't let her get you down.

*hugs*