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?
I'm with ya. What was the admitting Dx? Lots of great advice on this one. But myself, I'm wondering the same, why am I waking this person? I'm guessing it's protocol, or admission orders.
I don't understand why you're asking this question at all. It didn't happen to you.
You only have the word of someone else to go on. How do you know what the doc said? Maybe the nurse was upset at the outcome and relayed what the doc said wrong. Maybe the doc was a worse jerk than what you were told. How would you know unless you were privy to their conversation?
It sounds like you're trying to stir up trouble.
In the future, commiserate with the nurse and say "I'm sorry you were treated like that." You can offer suggestions on how to report the doc in question. Otherwise, it's really none of your business.
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".
Systolic of 170 in a non-critical patient is not a reason to call at 0200, sorry. Everywhere I've worked, hydralazine and labetalol were not pushed until the SBP was at least 180, and often the parameter was over 190.
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".
Patients are typically not symptomatic at 170 because it is not a hypertensive crisis.
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 think you're confusing the acute setting with long-term issues.
I'm a little surprised at some of the responses this post received. It's interesting.
My unit has a specific policy on vital signs. With a few exceptions, most patients are q4hr. 19:00, 23:00, 03:00. I don't necessary agree with it- usually the 03:00 can be skipped. Rest and sleep are vitally important to healing. I've had some random wonky 03:00 vitals though that have surprised me and required treatment.
Sometimes you can't win for loosing. You don't call the doctor and get chewed out when the attending rounds. You wake up the doctor and he's outraged for his sleep being interrupted.
The point is, if it's an important change then we are obligated to call.
My unit has had a few notoriously grumpy doctors get upset over abnormal 03:00 vitals that they feel should not have been taken. When we explain its policy to take them at that time, and we are required to notify of abnormal values, they usually calm down. I suppose I could print our policy for them.
OP, what response did you want? Blind outrage void of any thoughtful discussion?
I don't think anyone here would agree that the doc was appropriate to yell and hang up on the nurse. Nobody is justifying that as being the nurses fault.
BUT people ARE suggesting ways to make communication more effective in the future. Nothing wrong with that.
People are discussing differences in practice at their varying institutions. Nothing wrong with that either.
Specializes in Cath/EP lab, CCU, Cardiac stepdown.
I'm a little surprised at some of the responses this post received. It's interesting.
My unit has a specific policy on vital signs. With a few exceptions, most patients are q4hr. 19:00, 23:00, 03:00. I don't necessary agree with it- usually the 03:00 can be skipped. Rest and sleep are vitally important to healing. I've had some random wonky 03:00 vitals though that have surprised me and required treatment.
Sometimes you can't win for loosing. You don't call the doctor and get chewed out when the attending rounds. You wake up the doctor and he's outraged for his sleep being interrupted.
The point is, if it's an important change then we are obligated to call.
My unit has had a few notoriously grumpy doctors get upset over abnormal 03:00 vitals that they feel should not have been taken. When we explain its policy to take them at that time, and we are required to notify of abnormal values, they usually calm down. I suppose I could print our policy for them.
I agree with this. My policy is also q4h and we skip the 0300 one unless they're unstable, seems off, or wakes up to use the bathroom. Normally tho if it's an elevated bp and its their baseline or they run it on occasion we just put a note to the doctor to read in the morning. If it's new then we recheck their bp again. If it's still high then we will notify the doc, of course if it's a cardiologist that's the attending we see if anyone else has any issues and lump everything to that one call so they don't get bombarded with calls all night long.
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".
I work nights. I am still a new nurse, but I wouldn't have called a doc at 0200 for that BP unless that was protocol for your facility. Most of the facilities call guidelines have been 180 systolic or higher. I probably would have rechecked it in 15 minutes though because it would be concerning to me and documented that I was rechecking. That's one of those numbers that always makes me think, ugh, do I want to call the doc or not. I usually though recheck bp in the other arm and recheck in 15 minutes. I also might raise the HOB a little, see if they are having any pain, or anything else that might be part of the problem. I would notify the doc in the am, but I don't know it's not a number I would typically wake someone up at 2am for. Most of my work has been LTC so I feel unqualified to comment, but I guess I'm surprised that nobody rechecked the BP before waking up the doc. I guess to me this is a reason to notify the doc, but not necessarily at 2 in the morning. I like reading the posts on here because it really does help me with my thinking things through on how to handle situations like this.
Systolic of 170 in a non-critical patient is not a reason to call at 0200, sorry. Everywhere I've worked, hydralazine and labetalol were not pushed until the SBP was at least 180, and often the parameter was over 190.
To be fair it does vary quite a bit from one setting to another. In ICU we often prefer extra BP to too little BP, so we often don't bat an eye at 170's, but even that's not always true, I'm certainly not going to let a fresh heart sit in the 170's all night and not do anything about it.
The OP only referred to the type of floor as "tele", which if that means a true cardiac tele floor then in my experience the Docs want to be called for 170's if they haven't already left orders to treat it, and I've worked with many cardiologists who as a flat rule want inpatients under 140 torr.
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I'm with ya. What was the admitting Dx? Lots of great advice on this one. But myself, I'm wondering the same, why am I waking this person? I'm guessing it's protocol, or admission orders.