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.
I have to disagree with PP about that blood pressure not being treated aggressively. Every hospital/unit I've ever worked would say that leaving a SBP 180 untreated is unacceptable. It leaves the patient at high risk of stroke and acute renal impairment. I would have notified the hospitalist that on a tele floor VS are done Q4 (or whatever the interval) and that if he wasn't going to assess/treat the patient then I'd be waking up the attending. I cannot imagine any circumstance that a BP that far from baseline is acceptable and should go untreated.
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?
Hence you've never worked acute. It is VERY standard to do VS q4 on tele or any patient that needs close monitoring. I've never worked on a unit that does not take vital signs at least once through the night (unless pt refuses, whereas you'd document that).
I don't know why this nurse took this BP at 0200. But on my unit, it is not uncommon to take a 0200 BP for a pt on tele. Maybe it will happen at 0000, maybe 0300, we try to cluster it with meds, or other ordered treatments. Not that it even matters... because this nurse felt the need to check this BP at 0200, and it was way off baseline, and on our unit, high enough to warrant a call to the night-time hospitalist... For which he was treated with workplace hostility.
You don't have to explain yourself to anybody here, anyone who works acute care and/or tele knows very well how common middle of the night vitals are. It's a valid concern you have, unfortunately some hospitalists are too new or too grumpy to be of much help.
I understood your point being that, regardless of what time the BP was taken or why, the answer from the MD was completely inappropriate. If the MD doesn't want middle of the night phone calls, don't take on call or don't admit patients! It is as simple as that. If he/she is going to admit patients, then he/she needs to be prepared to have his/her phone ring in the middle of the night for concerns re said pt. I have wondered since the day I started nursing school over a decade ago, why MDs are allowed to speak to nurses in a manner in which most people would not address a fellow human being. I don't take it. I will quickly ask them to speak to me in a respectful tone or to call me back when they are able to discuss the issue like a professional in the best interest of the patient. Shocks them into remembering their manners when they are called out on it. Verbal abuse creates a hostile work environment and if my facility wants to fire me for calling a MD out on it, then I don't want to work there anyway.
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?
Ideally we'd just not bother patients at all at night, although if the patient really didn't need any sort of monitoring or assessments all night we'd just discharge them and have them come back in the morning.
And actually the need for good sleep would be a good reason for doing vitals at 0200. Typically, q 4hr vitals are needed, and the most important time to be asleep to avoid the effects of lack of sleep is at 0400, which makes 0200 and 0600 vitals not a bad idea.
I don't know why this nurse took this BP at 0200. But on my unit, it is not uncommon to take a 0200 BP for a pt on tele. Maybe it will happen at 0000, maybe 0300, we try to cluster it with meds, or other ordered treatments. Not that it even matters... because this nurse felt the need to check this BP at 0200, and it was way off baseline, and on our unit, high enough to warrant a call to the night-time hospitalist... For which he was treated with workplace hostility.
Seriously, I'm very sorry I ever brought this up.
Raising the issue of the BP with the MD and receiving a response you didn't want or raising the topic on here and receiving a response you didn't want?
I'm being flippant but you've hit the same road block in both of these situations. No-one should be rude to each other but it raises the question...how do you react when you believe what you've said should receive a certain reaction but instead you don't receive the response you think you deserve?
I don't always find this easy myself and consistently rude doctors boil my **** to be frank.
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.
There are usually not other symptoms involved with a high BP, which is why many people live with it undiagnosed. An SBP of 170 is a reason to call the doc. This is not really a thing that requires someone to be "symptomatic".
When reporting ANYTHING.. remain cool , calm and collected. The off shift doctor's response is not personal. Document the hospitalist's response . If the nurse feels additional orders are necessary, move on up the chain. If a call to the the attending is necessary, THEY will deal with the hospitalist.
In my facility, any patient on tele is also on q4h vitals. This is hospital policy. Since I'm a stepdown nurse, this goes for >90% of my patients. Our standard is also to call the doctor on any SBP higher than 160, but our docs frequently change the parameters and write for PRNs to cover if needed. Most of our hospitalists want to be called if the patient is still out of range after a PRN is given, but otherwise they pretty much trust our judgement.
I don't know why this nurse took this BP at 0200. But on my unit, it is not uncommon to take a 0200 BP for a pt on tele. Maybe it will happen at 0000, maybe 0300, we try to cluster it with meds, or other ordered treatments. Not that it even matters... because this nurse felt the need to check this BP at 0200, and it was way off baseline, and on our unit, high enough to warrant a call to the night-time hospitalist... For which he was treated with workplace hostility.
Seriously, I'm very sorry I ever brought this up.
You have asked for professional advice on a public nursing forum. You are getting EXCELLENT advice.
RNtoACGNP
48 Posts
I have to disagree with PP about that blood pressure not being treated aggressively. Every hospital/unit I've ever worked would say that leaving a SBP 180 untreated is unacceptable. It leaves the patient at high risk of stroke and acute renal impairment. I would have notified the hospitalist that on a tele floor VS are done Q4 (or whatever the interval) and that if he wasn't going to assess/treat the patient then I'd be waking up the attending. I cannot imagine any circumstance that a BP that far from baseline is acceptable and should go untreated.