Anyone have hospitalists that are just plain dangerous Docs?

[grinnurse]

I am fairly new to nursing (3mos) on the floor. We have a hospitalist that is downright dangerous. Daily, he comes in and changes the pts meds, treatments, d/c pt that really need to be transferred to another facility or are not ready to go. and gets extremely angry when you simply ask why did you decide to go that way. He usually mutters something under his breath and dances around the answer like a politician. You get an order to d/c a med only to get an order 30 minutes later to reinstate it!! I don't think that he can explain what he is doing b/c he doesn't know!! I am always having to check the meds that he prescribes to make sure they are compatible b/c I have found several times where he has made dangerous choices combining drugs and when you try to let him know that this can't be given together he gets really mad!! Then retaliates with changing all the orders again!! Everybody on the floor knows that he is dangerous and vindictive to the nurses including the nurse manager but upper management won't do anything about it!! I make sure in my nurse notes that I CMA b/c he also lies about the things that nurses do!! And forget the DON standing up for us!! She's about worthless too!!

I am always trying to remain calm around him all the while I am having thoughts about poking pencils in his eyes.

Any suggestions on how we nurses can get him outta there?

[jnette, ASN, EMT-I]

The little one was funny . . . the 16 year old was not.

steph

:rotfl:

My thoughts exactly....

[AttagirlRN]

Jnette,

Lord, YES!!! Especially the 80 year old who has had Dr. So&So for the last 5 decades as their primary physician. They want to see that familiar face walk through that door, even if he comes through the door on a walker and doesn't know how to write orders for an insulin drip (I've seen that happen)! Funny thing, the daughters/sons of these 80 year olds actually appreciate these Hospitalists (even if their mom doesn't) and the fact that these doctors are there 24 hours a day. Familiarity can be a hard hurdle to cross.

It's been so interesting to see this shift in how medicine is delivered, watching nurses who were quite leary of these new "specialists" taking over the entire hospital. Then finding out how much patient care and patient satisfaction increased, and seeing their own jobs get easier to perform. Again, that's been my experience.

There have been a few hold outs, doctors who do not want to sign up for the Hospitalists to care for their patients. They feel they can still see 40 patients in their clinics plus come back and round at night or early am and be on call. I'm sure it's an ego thing. Then there's the docs who refuse to ask for Hospitalist coverage, but refuse to answer their ER pages...have their cake, eat it too mentality.

Anyway, five years ago I didn't know what a Hospitalist was either!! Glad to oblige!

Attagirl RN, BSN

[jnette, ASN, EMT-I]

Jnette,

Lord, YES!!! Especially the 80 year old who has had Dr. So&So for the last 5 decades as their primary physician. They want to see that familiar face walk through that door, even if he comes through the door on a walker and doesn't know how to write orders for an insulin drip (I've seen that happen)! Funny thing, the daughters/sons of these 80 year olds actually appreciate these Hospitalists (even if their mom doesn't) and the fact that these doctors are there 24 hours a day. Familiarity can be a hard hurdle to cross.

It's been so interesting to see this shift in how medicine is delivered, watching nurses who were quite leary of these new "specialists" taking over the entire hospital. Then finding out how much patient care and patient satisfaction increased, and seeing their own jobs get easier to perform. Again, that's been my experience.

There have been a few hold outs, doctors who do not want to sign up for the Hospitalists to care for their patients. They feel they can still see 40 patients in their clinics plus come back and round at night or early am and be on call. I'm sure it's an ego thing. Then there's the docs who refuse to ask for Hospitalist coverage, but refuse to answer their ER pages...have their cake, eat it too mentality.

Anyway, five years ago I didn't know what a Hospitalist was either!! Glad to oblige!

Attagirl RN, BSN

Thanx again, Attagirl.. surely an interesting concept.. I do believe I like it ! :)

How many docs do these hospitalists cover for ? And is there just ONE hospitalist in the hospital at all times, or several? And they cover all kinds of docs and specialties? That WOULD require being on top of things, now, wouldn't it? Quite a responsibility.

Again.. interesting to see how things are changing.

[AttagirlRN]

Thanx again, Attagirl.. surely an interesting concept.. I do believe I like it ! :)

How many docs do these hospitalists cover for ? And is there just ONE hospitalist in the hospital at all times, or several? And they cover all kinds of docs and specialties? That WOULD require being on top of things, now, wouldn't it? Quite a responsibility.

Again.. interesting to see how things are changing.

There are officially 90 family practice physicians/NP's/PA's signed up for Hospitalist coverage. In addition, they "unofficially" cover everyone from the cardiologists to ortho to neurology who have requests for a Hospitalist to help them admit or consult.

We have 3 on during the day, two of them carry a load of about 20 patients a piece, the 3rd one carries a smaller census but has the ER cell phone and admits during the day, does procedures (like LP's or central lines), and does consults for a variety of other physicians who need an internist to handle, for instance, a total knee that has diabetes or hypertension or whatever. That 3rd Hospitalist also will run to the code blue calls. The census varies from day to day, but averages around 50. They don't do peds, OB, or babies. At night, there is usually one admitting from 5pm to 5am, covering the folks who are in house, plus code blues. The ones who are on their 7off schedule take turns keeping their cell phones on in case they need to come in a help the night Hospitalist if he/she gets slammed.

As you can see, it is a stressful job. Still, I can't imagine going back to the way it used to be...

Attagirl, RN BSN

[jnette, ASN, EMT-I]

Wow... that is quite a patient load for them, yes?

Even on a "slow" day/night... still quite a load. Considering all they do. Wow.

Do you think that's safe?

I like the idea of hospitalists, but can't help but wonder if that's not too many patients.... ?

[AttagirlRN]

Wow... that is quite a patient load for them, yes?

Even on a "slow" day/night... still quite a load. Considering all they do. Wow.

Do you think that's safe?

I like the idea of hospitalists, but can't help but wonder if that's not too many patients.... ?

Jnette, Your right, that's probably the biggest concern facing Hospitalist medicine...what is a reasonable load? I personally think 20 is too much, maybe 15 is a more manageable number. I've heard of one program that caps their Hospitalist's at 30...now that's dangerous. Can you imagine? 30 acutely ill patients???

Attagirl RN, BSN

[jnette, ASN, EMT-I]

Jnette, Your right, that's probably the biggest concern facing Hospitalist medicine...what is a reasonable load? I personally think 20 is too much, maybe 15 is a more manageable number. I've heard of one program that caps their Hospitalist's at 30...now that's dangerous. Can you imagine? 30 acutely ill patients???

Attagirl RN, BSN

Thirty?????????????? No way. Totally unacceptable and irresponsible.

No more than twelve would be my say. Considering what all is involved, and the other things they do as well.. (codes. etc.)... they cannot afford to spread themselves too thin. :uhoh21:

Very scary.

[Thunderwolf, MSN, RN]

AttagirlRN, I just want to say that you give a very excellent description as to what Hospitalists are and how they are often used. In my hospital, we use BOTH Hospitalists and Intensivists. How you describe the Hospitalists is pretty much true to form how they are utilized here. The exception is that here, the Intensivists (old term: house doc-- med or surg) are utilized for the codes, to evaluate acute patient episodes that need stat medical management, and the nurse calls for simple meds, such as Tylenol or sleepers. The Hospitalists here have their own hours often from 7 am to 5-7pm and perform much as you describe. The Intensivists are here 24/7. Having both has been a God send.

Wolfie

[grinnurse, RN]

Thanks for all the info that you have shared regarding what hospitalists are supposed to do. Unfortunately at my hosp., there is only 1, he carries almost all the pts on the floor, takes all the ER pt admits, ICU pts, OP surgeries. He is the ONLY one that we have. He has some really "bogus" admissions to say the least too!! A kid with "acute bronchitis" that has clear lung sounds. WTH is that about. $$$ for this crappy company called Resurgence that now owns the hosp unfortunately.

Prior to this fool, we had a group of 3 that came in and rotated shifts from week to week. They were great for the hospital, pts loved them, staff loved them etc............. Then in the name of all mighty dollar, they cut them and hired just the one!!

Thanks everybody and I will continue to document on him until he is gone!! And use the chain that you mentioned on trying to get his butt out there!!

[suzanne4, RN]

Each facility that I have worked at over the past year has used hospitalists and they have been great. One facility, the hospitalists worked for the insurance company, and the other are hospital-based. Not one complaint about any of them. They were extremely aware of each and every patient assigned to them, answered calls or pages in a timely fashion, and were in-house, not at their office. They actually do not have offices, they only see patients when they are in the hospital.

I love them.................:)