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.
Specializes in Cath/EP lab, CCU, Cardiac stepdown.
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.
Amen, my cv surgeon would rip me a new one if i didn't notify her
Specializes in Family Medicine, Tele/Cardiac, Camp.
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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? ...
In your post you ask 2 questions. At least a half a dozen people have answered them and some people also offered what they would have done differently in order to help you prevent a similar situation in the future.
I agree that many doctors can be absolute tools and he shouldn't have acted that way. But I don't understand why you're upset with the responses you've received. If you feel we're missing the point, maybe you can clarify so we can better advise you.
Specializes in Family Medicine, Tele/Cardiac, Camp.
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.
But the doctor was called, right? You mentioned that the nurse called him and documeted it. Unless I'm missing something. And what is the rock and hard place you're being put between? And many members answered your questions. Or were the questions meant to be rhetorical?
My head is hurting. I think this may be the reason why I don't frequent AN as often as I used to or would like to. A brand new nurse a few months off orientation asks a question and is not happy with the answers that nurses with years of experience have posted. I am also a new nurse so I know that feeling. However, the doctor didn't say it to you but to your coworker. So, it could have been misinterpreted along the way to your ears. Regardless, the phone should not have been hung up. In that case, document everything that was said including the name of the doctor.
I am wondering if the protocol on your unit was followed? Is it possible this patient (that wasn't even your patient) had a B/P medication that was due soon after that blood pressure was taken? Sometimes doctors leave nursing communication orders that state certain readings that should be reported. The sudden increase is a cause for concern. Just don't forget the patient's blood pressure was in the 130's while in the hospital. Maybe it has been in the same range, because of the current meds they are taking.
If you were ever in that situation, just make sure you document it to cover yourself. Good luck!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
I think your point is "this poor nurse was subjected to rudenss by that mean doctor, WAHHHHHHH!!!!"
I think the previous posters have pointed out to you that the nurse could have handled the call someone differently -- and perhaps gotten a different result.
Doctors are people, too. Just like you, they need to sleep and just like many of us, they're cranky when they're unecessarily woken at 2 am. If you must wake a hospitalist, have your ducks all in a row. Apologize for waking them (it's just being polite) and state your business as briefly, completely and succinctly as possible. Know what you're looking for in terms of a response. Do you want a 1 time hydralazine order? Just to be able to chart "provider notified?" Know in advance, and be able to suggest it if the provider is too sleepy to think of it himself.
Nursing -- healthcare -- is a team effort. Everyone has a bad moment or a bad day. Everyone is rude now and again. Be prepared to forgive and forget. And understand your part (or your colleague's part) in the interaction. That hospitalist was probably sleep deprived. Get over it.
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.
Well, "never understand" seems a bit harsh. Maybe if you explain it to me in really simple terms, I could grasp the complexities.
"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."
Stammering out a response isn't actually the best way to handle it. Giving a well reasoned response would be better. Even if it is to comply with an arbitrary policy, a decent response might be- " I called in compliance with hospital policy. I would be happy to change the parameters on this patient if you want to give me me an order"
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.
Don't base your actions on whether or not you will have to "answer to the charge". Base your actions on what is in the best interest of the patient.
Judging by your responses it seems you may not want advice- rather you are looking for support. If that's the case, I agree with you. Mean people suck, and nobody should be rude.
Specializes in Psych, LTC/SNF, Rehab, Corrections.
Some providers are just crazed. What are you gonna do?
Welcome to healthcare/nursing. We're all a little mad, here.
In this career field, it's kind of okay to treat others any kind of way because you're a provider or an RN or an LVN or a nurse with 1000 years of experience or sleepy or have been on the unit longer...or because they're a old nurse/new nurse/student nurse/new hire, etc....
It's not the fault of meanspirited/rude people. It's the fault of everyone else for not knowing how to 'tip-toe' around them.
The longer you're a nurse or a healthcare professional, the better able you are to just shrug things off. You'll find ways to cope, OP, and 2 to 5 years from now you'll be like everyone else in the thread.
"Yeah, the doc was rude but here's where things went wrong on YOUR end -"
"Let's see what YOU could've done to alleviate the situation."
"No, you didn't actually do anything wrong but I just wanna clarify a few things because I've got a feeling that this could still be your fault."
On that note? (laugh)
A nurse can't get on the phone with any doc 'stammering' and 'hemming and hawing'. Certainly not at 2 in the morning. I don't care what the provider says. Every time, I call a provider, I'm mentally prepared for an avalanche of crazy to pour through the receiver of the phone. I seldom get it but I'm prepared.
"Why are you calling me at 0200 in the am?!"
Answer: "...because we're required to notify the provider when their pt's systolic > 170, jacka**...."
(don't say 'jacka**', though. >laugh
Provider 'tude happens and many times it wont be justified. We're placing calls for a purpose, though. Can't let a little attitude throw us off the objective.
"Reorient" the irritable/sleepy provider, "redirect" the conversation to the issue at hand, get what you need and be done with it. The provider would've settled down and felt like an a** in the morning for getting snappy with the nurse because he failed to recall his own damned protocol.
^BP? No PRN? Provider's getting a phone call. The end.
PRNs on deck? Administer. SBP goes down? Faux-crisis averted. Continue monitoring. I would notify the provider ... 'later'.
That's how I'd handle things. I work LTC/SNF/Rehab. In LTC/SNF, you don't wake anyone up to "notify".
You work tele, though. Wouldn't a provider in a tele specialty actually want to be notified? I don't get it. I've worked the clinic where such protocols were implemented and it would've been ridiculous for a provider to get all wound up over such a thing.
Specializes in Psych, Addictions, SOL (Student of Life).
HM.
Don't know If I would have woken at doc at 2 am for SBP if 170. But we have clear standing orders from our docs so we know what to do. With no standing order I would have called - but we have the nicest bunch of physicians. They never yell at us and always listen to our input. IF PT was asymptomatic - no headache/chest pain etc I would have waited 15 to 20 minutes and taken it again. A person's highest BP of the day can be immediately after waking. But if you have no SO you have to call. I have one patient who has nightmares and even though her BP are normal during the day they can be quite high during or after a nightmare.
We understand, we just have some other thoughts. These are highly problematic issues you are raising - the doctor's wrong and unacceptable response and behavior, and your feeling that you are being put down by your colleagues here. Stuff like the foregoing destroys a nurse's spirit and that should not be happening. I'm sorry, please hold on, don't throw in the towel yet.
An answer that has helped me more than once is along the lines of, "I'm just trying to keep you and me out of Court, Doc". Or, "Yeah, I know it's a bad time, but I followed your orders and here we are, so what do you want me to do about the BP?"
Chin up, friend, you can make it. Don't allow anyone anywhere to discourage you.
Vitals q 4 hours for a tele patient seems pretty standard.
However ... have you ever been abruptly awakened from a deep sleep? Did you momentarily have the heart-pounding, disoriented, WTH feeling? What do you think your BP was at that moment, vs. what it was 3 or 4 minutes later?
What multiple posters have questioned was how clinical judgement was applied in this situation. What do you normally do when you get an unexpected BP reading? Eyeball the patient to get a more complete picture, wait a minute and reassess, perhaps? Did the person obtaining the vitals perhaps apologize for waking the patient, let them get their wits about them for a minute or two, then retake the BP?
As this case has been presented here, the only facts are that a one-time SBP of > 170 was reported to a physician who felt that it did not warrant concern and expressed that gruffly. OK. Is this really the end of the world?
Two possible alternatives:
1. RN is sufficiently concerned about SBP > 170 for reasons not explained here, and takes appropriate next action. Whether that is calling the attending, taking the issue up the nursing management chain, or whatever.
2. RN responds to gruff hospitalist, "ok - as you know I have to document that I reported abnormal vitals (mutual chuckle/eyeroll) ... have a good night." Click. RN expends about 6 seconds thinking "geezz ... what a tool" ... and then moves on to the 1000 other important things that need attention and doesn't give it another thought.
RescueNinjaKy
593 Posts
Amen, my cv surgeon would rip me a new one if i didn't notify her