Awful Doctors

EaglesWings21, ASN, RN · Apr 19, 2013

I am a first semester nursing student but know potassium levels that low can be deadly. I would have taken care of that before anything else. I am sorry that you were yelled at but patients are people and their signs and symptoms may be normal to their condition or they may be deadly. I go to clinical every Friday knowing that within a matter of seconds, a patient can go from ok to worse and I am supposed to know how to handle it. We became/ are becoming nurses to heal people and to not hurt them so when something bad happens to them on our watch it very well may come down on us hard.

EaglesWings21, ASN, RN · Apr 19, 2013

And in response to whoever is saying the MD is at fault, we learn and know that nurses are the last advocate for the patient. When those orders come from the physician, we are to double and triple check them for accuracy and if they are applicable for our patient. If it is common that IVPB potassium burns and the physician didn't order NS to dilute it or whatever (sorry again 1st semester nursing student) why wouldn't the nurse call the physician and say the pt complains of burning and I need an order to hang NS?

Isitpossible, LPN, LVN · Apr 19, 2013

Though you may not like it, Esmes response was absolutely right. The physician had every right to be angry, (not that yelling at you was appropriate)... but please try to understand that physicians dont differentiate between us new nurses and more seasoned nurses... Potassium level that low is critical, and that is something school drilled into us over and over and over. I think you would feel alot worse, if that patient had coded. Please review your critical lab values, and just take this is a learning lesson.. You said it took you three hrs to go back and start that IV, what was going on that time? That should have the top priority. And as your still very new, who is suppose to be your preceptor looking after you? Theres a reason why nurses receive upwards of 6months orientation.. As Esme said utilize your coworkers/supervisors for everything. Your too new to know it all but please know when to seek help. Hugs to you :)

drowningdaily · Apr 19, 2013

I am a first semester nursing student but know potassium levels that low can be deadly. I would have taken care of that before anything else. I am sorry that you were yelled at but patients are people and their signs and symptoms may be normal to their condition or they may be deadly. I go to clinical every Friday knowing that within a matter of seconds a patient can go from ok to worse and I am supposed to know how to handle it. We became/ are becoming nurses to heal people and to not hurt them so when something bad happens to them on our watch it very well may come down on us hard.[/quote']
I am quite sure the OP knows this. As a first semester nursing student, you have the luxury of one or two patients, and time to prepare for clinical. That is quite different from walking into a shift to a full module which you are solely responsible for without an instructor for support. Nurses are not nearly as perfect as nursing students! (This is being said jokingly -not snarky.). Posts like this can be a good learning opportunity. Any nurse, no matter how smart, can make a mistake. Don't worry, though. When you are done school we will be here to support you! Good luck with your studies.
OP - hang in there. We've all been in your shoes. Thankfully, no one was hurt. I promise it will get better.

PMFB-RN, RN · Apr 19, 2013

As a newly graduated nurse, I am still in the midst of trying to grow in self confidence and improve my critical thinking skills. I have only been working as a nurse for four months now and there is this horrible doctor that works on my floor. This is not the first time this same particular doctor has chewed me out but this time, this was by far the worst.
Early in my shift, I received a critical potassium level of 2.8 and reported it to this doctor. She ordered me to start an IV 60meQ of potassium and to draw a potassium level stat after the IV was completed. To start off complications, the patient's IV site was infiltrated and I wasn't able to take the time to start a new IV until three hours later. She complained that the site was burning too much so I started it off at 50ml/hr instead of the prescribed 88ml/hr.
Later in the day, this doctor comes up to the floor and demands why the potassium level hadn't been drawn yet. I explained to her the situation and it was just horrible. This doctor raises her voice at me in front of the whole nursing station and says, "Then you should have called me and I could have easily written an order for KCl po! That her potassium was this low and that it's taking this long to get her potassium is ridiculous. This is just unacceptable!!" Silence fell from the whole audience and I just nodded my head and walked away. It took all the strength I had to not burst into tears.
Quite a few of my coworkers came up to me to hug me afterwards and it's well known that this doctor has a tendency to be this rude. I understand my mistake and it was a learning experience. If she had a problem that needed to be addressed, she could have easily taken me aside and I would never make the same mistake twice.
My day just went downhill from there. I had a new admit and a million new orders for my other patients. As soon as I clocked out for the night, I burst into tears. I dread going back into work tomorrow.

*** Yes you made a series of mistakes. There really isn't any exucse to wait 3 hours before restarting the IV. The irritation to the patient at the IV site is your mistake too. However it sounds like you are aware of your mistakes and know that next time you must use your resourses like your assinged mentor, charge nurse, other experienced nurses etc.

I can NOT BELIEVE you stood there and allowed her to shout at you! Why would you tolerate that? Do you allow other people in your life to shout at you and belittle you like that? Why did your co-workers tolerate that physicians behavior twords you?. Sounds to me like you work in a severly dysfunctional work place.

PMFB-RN, RN · Apr 19, 2013

I am shocked and disgusted at some of the responses here. Obviously the OP made some mistakes, however IT DOESN"T MATTER! what she did it is ALWAYS wrong for a physician to yell at nurses. The OP is not a small child, the physician is NOT her mommy.

Of course the physician had reason to be concerned about the care provided by the RN. She should have immediatly brough the matter to the attention of the RNs supervisor and allowed the supervisor to deal with it.

Some of you are ready to excuse the physicians inappropiate behavior. Reminds me of the bad old days when a rape victims were told it was their fault cause of what there were wearing.

The physician is creating a hostile work enviroment. She need to be delt with by her employer immediatly. Almost as shocking to me is that none of the OP's coworkers stepped in at the moment. Are they all spineless cowards or is this work enviroment so severly dysfuctional that all the nurses are cowed and fearful?

Pangea Reunited, ASN, RN · Apr 19, 2013

I am a first semester nursing student but know potassium levels that low can be deadly. I would have taken care of that before anything else. I am sorry that you were yelled at but patients are people and their signs and symptoms may be normal to their condition or they may be deadly. I go to clinical every Friday knowing that within a matter of seconds, a patient can go from ok to worse and I am supposed to know how to handle it. We became/ are becoming nurses to heal people and to not hurt them so when something bad happens to them on our watch it very well may come down on us hard.

Dear first semester nursing student,

...before anything else?

I'm glad you've learned a few things, but I'm not sure you're in a position to scold the nurses who've graduated ahead of you. Some humility might be in order.

SoldierNurse22, BSN, RN · Apr 19, 2013

I am a first semester nursing student ....
I go to clinical every Friday knowing that within a matter of seconds, a patient can go from ok to worse and I am supposed to know how to handle it.

To echo a previous poster, you are not a nurse yet.

The RN in responsible for your patient is supposed to know how to handle things in the event that things go sour, not you. You are simply lucky enough to be along for the ride and learn from their expertise, but to compare your situation to the situation of an RN working on his/her own is laughable and insulting to the OP and nurses with licenses everywhere.

turnforthenurse, MSN, NP · Apr 19, 2013

I'm sorry the doctor yelled at you but at the same time, she wasn't wrong.

You're a new grad and you're learning. You need to learn how to prioritize. If you have a bunch of problems, think of your ABC's, or think about what will kill your patient first. A potassium level of 2.8 is critical as the patient could go into life-threatening dysrhythmias or worse, cardiac arrest. That problem needed to be addressed promptly. If you couldn't get the IV started right away, utilize your coworkers or charge nurse - ask them to see if they can get a line started for you.

As for IV KCl vs. PO, PO is the preferred route. We normally get our potassium from our diet and it is better absorbed through the gut. Therefore, PO is better, and faster, too. If a patient can take PO, I would much rather give it that route than IV. Also consider if the patient has CHF. Our IV KCl comes in 20mEq/100mL or 40mEq/100mL. Based on our protocol, with a K of 2.8 the patient would get 60mEq of KCl, and if it's IV, that's AT LEAST an additional 300mL of fluid. IV KCl also hurts like heck so chances are you'll have to run it concurrently with some NS to dilute it even more, which means the patient will be getting EVEN MORE fluid. I would much rather give a CHF patient PO KCl whether it's the Klor-con tablets or the elixir (I love the elixirs! Works very quickly).

Also take into consideration that IV KCl MUST be given slowly - 10mEq/hr MAX through a peripheral line or up to 20mEq/hr through a central line. This why you need to keep an eye on your patient's potassium because if it gets too low and they become unstable, you can't bolus them with KCl now could you? That could lead to cardiac arrest.

One other thing - if you keep giving your patient potassium and they are refractory to treatment, check their magnesium.

Esme12, ASN, BSN, RN · Apr 19, 2013

I am shocked and disgusted at some of the responses here. Obviously the OP made some mistakes, however IT DOESN'T"T MATTER! what she did it is ALWAYS wrong for a physician to yell at nurses. The OP is not a small child, the physician is NOT her mommy.
Of course the physician had reason to be concerned about the care provided by the RN. She should have immediately brought the matter to the attention of the RNs supervisor and allowed the supervisor to deal with it.
Some of you are ready to excuse the physicians inappropriate behavior. Reminds me of the bad old days when a rape victims were told it was their fault cause of what there were wearing.
The physician is creating a hostile work environment. She need to be dealt with by her employer immediately. Almost as shocking to me is that none of the OP's coworkers stepped in at the moment. Are they all spineless cowards or is this work environment so severely dysfunctional that all the nurses are cowed and fearful?

Unfortunately I think many nurses in this job climate are afraid for their jobs. MANY facilties are NOT supportive to their nurses which makes nurses the whipping post of the facility and are low on the food chain.

nrsang97, BSN, RN · Apr 19, 2013

I agree the doc had right to be concerned. She did not have a right to yell at you like that. Take this as a lesson learned. Use your resources on the floor. Replacing po would have been a great adjunct to this. I have turned down many potassium IVPB's because a pt couldn't tolerate it.

The first year is the hardest. I have made mistakes even after being a nurse for awhile. The important thing is to learn from them.

Don't beat yourself up.

PMFB-RN, RN · Apr 19, 2013

I'm sorry the doctor yelled at you but at the same time, she wasn't wrong.
*** It is embarrasing to me as an RN that a fellow nurse would feel this way. Of course the doctor was wrong. It is not her place to YELL or SHOUT at nurses. While she may well have had a legitimate concern about the care (or lack of) provided by the nurse to YELL or SHOUT at nurses is not only unprofessional but degrading and is a hostile act of bullying. That physician is lucky she didn't get slapped upside the head since bullying often begets bullying.
This whole discussion has depressed me. Not only that the physician made a choice to bully a nurse, but that neither the nurse, nor her cowardly co-workers stood up to her. Even worse than all of that is the enabeling comments made by many here.
Sounds like we need some more laywers involved. I bet a properly worded letter to the hospital from a laywer about the hostile work enviroment they encourage (by failing to address the physicians behavior) and the bullying they choose to allow at their work site would get some attention.
I am taking note of the screen names of those nurses here who have provided enabeling-of-bullying comments here. I better never read any of those people complain of being bullied or i will be happy to remind them of when they refused to support their bullied fellow nurse.