0200 BP's - Dealing with Tired Rude Doctors

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Hi Allnurses! New grad RN here, and I've been on my own, out of orientation for a few months now.

I work on a busy med-surg floor that does it all, and wow, what a roller-coaster ride this has been. So I just have to share a recent experience with an MD that left me baffled. It actually happened to a fellow nurse, but I think it sums up perfectly the difficult position we nurses are often placed in, when dealing with tired grumpy doctors, and trying to take care of our pts with due diligence.

So another nurse took his pt's BP at around 0200. The pt was on tele, so it's commonplace on our floor to take BP's on such pts around that time, esp. if the nurse has a concern. So the nurse got a bp of 170+ systolic, on a pt who's baselines is about 125 - 135 sbp. He called the night-time hospitalist to let him know, as per hospital policy, and the doctor's response? "What are you doing taking a BP at two in the morning!?!" The nurse began stammering out a response, when the doctor hung up on him.

Wow... so what do you say to that???? The nurse handled it well, I guess as well as can be handled. I asked him what he was going to do, and he said he would chart the conversation, and let the charge nurse know. What else could he do?

I feel that we nurses are often put in impossible situations when dealing with doctors who are tired, overworked, and just don't have time or want to deal with our patients. But the worst part is that this type of behavior by doctors seems to be tolerated. But God forbid if the nurse didn't follow up on that elevated BP, or even fail to take an 0200 bp in the first place. And lets not forget the most important part, the pt's health and well-being, who is at the center of all of this.

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Specializes in General Internal Medicine, ICU.

You mention that it is common place on your unit to check vital signs at 0200 for patients you are concerned about. I would tell the doctor the reason I took the blood pressure was because I was concerned about the patient. It is unit policy. It is really no different than taking vitals for a patient who have vitals ordered every XYZ hours--if it falls at 0200, then it will be done at 0200.

Also I would repeat to the doctor that he wanted nothing done--Id say something like "so just to clarify, you want nothing done even though the blood pressure is significantly higher than the patient's norm? Just wanted to document this properly,"

After I'd document in the chart as well as alert the manager for the unit.

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Specializes in Critical Care.

I usually just remind the Doc that they admitted the patient to the hospital so that we will assess them which includes vital signs, if they were confused about what being an inpatient involves and they don't actually think the patient needs to be in the hospital I'll be happy to point them in the direction of the discharge process. As for what they want to do about the BP, I'll clarify their order with them; "do not treat SBP >170".

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I think the nurse would gave had a better response if she had said.....I took pt x's 3 times over a 30 minute period and it was consistently between 170 and 180. He is not in pain. His admitting BP was such and such, he received his lisinopril at 2100 his BP was 136/78.

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Hi Allnurses! New grad RN here, and I've been on my own, out of orientation for a few months now.

I work on a busy med-surg floor that does it all, and wow, what a roller-coaster ride this has been. So I just have to share a recent experience with an MD that left me baffled. It actually happened to a fellow nurse, but I think it sums up perfectly the difficult position we nurses are often placed in, when dealing with tired grumpy doctors, and trying to take care of our pts with due diligence.

So another nurse took his pt's BP at around 0200. The pt was on tele, so it's commonplace on our floor to take BP's on such pts around that time, esp. if the nurse has a concern. So the nurse got a bp of 170+ systolic, on a pt who's baselines is about 125 - 135 sbp. He called the night-time hospitalist to let him know, as per hospital policy, and the doctor's response? "What are you doing taking a BP at two in the morning!?!" The nurse began stammering out a response, when the doctor hung up on him.

Wow... so what do you say to that???? The nurse handled it well, I guess as well as can be handled. I asked him what he was going to do, and he said he would chart the conversation, and let the charge nurse know. What else could he do?

I feel that we nurses are often put in impossible situations when dealing with doctors who are tired, overworked, and just don't have time or want to deal with our patients. But the worst part is that this type of behavior by doctors seems to be tolerated. But God forbid if the nurse didn't follow up on that elevated BP, or even fail to take an 0200 bp in the first place. And lets not forget the most important part, the pt's health and well-being, who is at the center of all of this.

Just curious- If sbp was consistently WNL, why does the pt get woken up at 0200 for a BP?

And, what is the treatment for a one time SBP of 170?

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Not sure why this pt was woken up, you would have to ask the nurse taking care of her, and even though I took care of this particular patient the week before, I don't feel at liberty to discuss her case here.

I also don't feel the need to explain any of the particulars... you all seem to be missing the point, and in fact, I find it disconcerting that the incivility perpetrated by the night time hospitalist is being put on the RN's shoulders.

Bah... nevermind. This is one of those things, if I have to explain it, you'll never understand.

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Not sure why this pt was woken up, you would have to ask the nurse taking care of her, and even though I took care of this particular patient the week before, I don't feel at liberty to discuss her case here.

I also don't feel the need to explain any of the particulars... you all seem to be missing the point, and in fact, I find it disconcerting that the incivility perpetrated by the night time hospitalist is being put on the RN's shoulders.

Bah... nevermind. This is one of those things, if I have to explain it, you'll never understand.

You're not giving enough information to really judge. Should the hospitalist have said that? No. Should you have called for a SBP of 170 in an otherwise asymptomatic patient at 0200. Probably not.

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Specializes in ICU.
Bah... nevermind. This is one of those things, if I have to explain it, you'll never understand.

That is a very condescending statement. If you want people to agree with you, this is the wrong way to go about it.

I feel like the question of why the patient's BP was being taken at 0200 was a reasonable question, though the hanging up was rude on the part of the hospitalist - if the patient has been running normal, why would the patient need to be woken up for a BP at that time of night? If this patient has been normotensive and has been in the hospital for greater than a week, as your last post would suggest, I would have suggested to the rounding physician to change the frequency of BP measurements.

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Not at my hospital, and not on my unit. Maybe unsymptomatic sbp of 170+ is okay where you work, but not where I work- interesting though, I never said this SBP was unsyptomatic, I actually don't know. It wasn't the point.

This is the only hospital, let alone unit, I've ever worked, and this load gets put on the RN's shoulder, and she/he has to answer to the charge why their pt has such a high BP and the doctor was never called.

But I'm explaining all of this, being put between this rock and a hard place, and this is not the response I was expecting. Sorry I ever brought it up.

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But I'm explaining all of this, being put between this rock and a hard place, and this is not the response I was expecting. Sorry I ever brought it up.

*ding ding ding* and this folks is what it all comes down to. So common on here nowadays.

Don't post something on a public forum and then get mad when the response isn't what you wanted.

P.S. depending on the circumstances (of course), SBPs

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Not at my hospital, and not on my unit. Maybe unsymptomatic sbp of 170+ is okay where you work, but not where I work- interesting though, I never said this SBP was unsyptomatic, I actually don't know. It wasn't the point.

This is the only hospital, let alone unit, I've ever worked, and this load gets put on the RN's shoulder, and she/he has to answer to the charge why their pt has such a high BP and the doctor was never called.

But I'm explaining all of this, being put between this rock and a hard place, and this is not the response I was expecting. Sorry I ever brought it up.

Did I miss the post where someone was being over critical of the nurse? Im pretty sure you are taking the posts the wrong way. I too was curious why the BP was taken at 0200. My guess would be that there was a change in condition warrenting a BP check. Calling a hospitalist to update regarding a change in condition with vitals out of normal parameters is something I would absolutely do and the reaction the hospitalist had was inappropriate.

I would do what many others suggested and verify exactly what the BP+ symptoms were and that they didn't want anything ordered.

I would document and then get my charge involved. If there is no night charge then you just notify up the chain of command.

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I never worked acute care but why is the pt being awaken at 2am for BP. Isn't sleep part of healing/recovery?

Then calling the MD for SBP 170 @ 2am?

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