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 am not stammering out a response was adequate. In defense of the doctor, she needed her facts in a row, direct communication is what is desired and needed especially when you wake a doctor in the night hours. I agree that she needed to report these changes in patient status, did she address pain issues, anxiety or other factors that can affect status. Could she have employed a rapid response to assist her before calling, have a good SBAR for communication reporting what, why (situation, background and assessment) and directly asking what she wants the physician to do (response) that she feels would best take care of the patient before additional problems accelerate.
I personally would not call a pressure of 170 - nursing judgement, but anyway.... When a doc asks me "what do you want me to do" or something like that. I let them know I am transferring liabilty for this from me to you - it's up to you to decide what you would like to do. That usually wakes them up to listen. On the side of the doctor, some nurse will call about anything all night long and many people don't deal well with sleep deprivation. They drive docs like slaves sometimes. I can't imagine working a 17 day stretch and having to take call. I remember one doctor who was away from home so much his wife sent him a video of his kids. Try to remember while you are home sleeping from your nightshift, that doc that was awakened is now at work and you probably aren't the only one who woke him up. Not excusing their behavior, but saying who of us might behave better under their difficult circumstances.
Hmm. I know you're not so happy with the discussion you've created but it's an interesting one! A few things have jumped out at me.
- In my experience, as many others have said, a systolic BP is generally treated if it's >180 as a threshold-type parameter. That being said, there are some patient populations where a systolic BP of 170 would be concerning (i.e. the freshly head-injured trauma patient on telemetry). Therefore, it might necessary and totally appropriate to make the 0200 call to the MD asking for orders. Without knowing the background of the incident, it's hard to say, though.
- You seem frustrated that other posters are asking questions about your story- i.e. what happened to make your colleague concerned? What else was going on? This response is actually a helpful one, especially if you are a new grad! It can shape your critical thinking skills. These questions aren't excusing the seemingly rude and unprofessional behaviour of the MD. We are just trying to understand the scenario a bit better so that we can provide you with thoughtful feedback.
- You mentioned that the nurse was concerned about the patient. This is a justifiable time to do a set of VS, no MD order needed. It is also perfectly reasonable to tell the angry MD this is why the VS were taken. It can be frustrating to have to justify this, but a good MD will appreciate a diligent and proactive nurse. It really beats the 0500 code blue call! If this is an issue that comes up frequently on your unit, or with one particular doctor, I would consider brining it to my nurse manager's attention. Have a few specific examples ready. It is highly detrimental to patient safety to have this kind of culture.
I think the thing to keep in mind, which is why I post on this board, is for the variety of experiences, opinions, and points of view. People challenge one-another and aren't all in blind agreement- this is a good thing! It has definitely helped me to expand my perspective and consider issues differently. If you make a post here, anticipate that you might elicit a contrarian point of view. And this isn't a bad thing! You'll either solidify your original position or see things differently.
I understand your consternation. You are asking a question about a problem that plagues the industry-MD to RN hostility- and instead of support you are getting... more hostility. Unfortunately lateral violence is a problem in nursing, as well.
To address your actual question of how to react should you be on the receiving end of such a rude reaction from an MD: DOCUMENT. Use times, names, and direct quotes. Mention that you were hung up on. Mention that you were following unit policy or physician orders, etc. Mention that charge RN was notified. And should anyone, physician or RN, speak to you that way again, keep calm, retain your dignity, and remind them that you expect to be treated in a civil manner. This crap wouldn't fly in a regular office environment. It shouldn't in healthcare, either.
Aw. Girl. Don't worry about it. Document the whole thing. Reported SBP of 170, physician respond "What are you doing taking BP at 0200 am? No orders received. Bwahahaha. Let him eat the whole thing. What a stupid guy. If they do not want to be waken up, order prn meds for all kinds of reason/situation. Sorry you feel bad but I just shrug off docs with bad attitude. I'm doing my job. Do not shoot the messenger.
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.
So... is the BP taken @ 0200 because the nurse is late? Or the CNA didn't report the BP in a timely manner? I've worked nights forever and q4 vitals are 20-24-04...everywhere I've worked.
If the doc knows the general schedule of the floor, then he probably wonders why he is being awakened at 0200, not to mention the patient!
So... is the BP taken @ 0200 because the nurse is late? Or the CNA didn't report the BP in a timely manner? I've worked nights forever and q4 vitals are 20-24-04...everywhere I've worked.
If the doc knows the general schedule of the floor, then he probably wonders why he is being awakened at 0200, not to mention the patient!
That doesn't mean that's the case at every hospital. My first hospital the vitals vials were 10, 2 and 6.
It's a good idea to talk with the hospitalist before he goes to bed and find out what he wants to awakened for. Ask for parameters. This aside, the hospitalist in this case was a [fill in your favorite word], and nothing will change that. I've been tempted to say, "It's your job you moron! (and hang up on him!). I haven't done this, but ooh have I been tempted! Welcome to the world of nursing! By the way, I don't get too excited about one BP that's different. Trends are what matter. Repeat the BP in an hour and go from there.
Im with the doc on this one. I would be annoyed too. The blood pressure is elevated big deal. Were they symptomatic, ie, dyspenic, diaphoretic, chest pain. There was no reason to call.
Aside from the fact that the hospitalist in this case is a first class jerk, I've been thinking more about the practice of frequent vitals and all the other horrid things we do to people in the middle of the night. Here's an interesting question. I worked acute care for 15 years and have done vitals at all hours of the day and night. My question is this, is there any evidence that doing so makes any difference in the outcome for our patients? Is there any best practice, any, evidence based practice guidelines? If so, I've never seen them! SO . . . how about some nursing research into the subject? Any takers? Are we simply doing what the administration thinks will open up a bed sooner ($$) or do the things we do actually improve the lives of our patients?
Specializes in Family Medicine, Tele/Cardiac, Camp.
Not everyone has the experience of being yelled at or belittled in their childhood and so it can come as quite a shock when they start working and there is it. Sadly, there are rude people everywhere. It's just a fact of life that you need to learn with live with.
There can also be a pretty steep learning curve getting into nursing. It varies depending on so many factors, but I know you'll get the hang of it. Realizing that so many things beyond your control influence the way that people choose to act and react can be helpful. Chin up. You didn't do anything wrong and neither did your co-worker.
I remember calling a doc, when I was a new grad, once in the middle of the night for a post-op fever of 100.4. Boy did he tear me a new one. Apparently we weren't supposed to call unless it was over 101. No one told me that and I spent a couple of minutes crying in the breakroom until going to him and asking him to please explain when it would be appropriate to call so I can do right the next time.
I was so shocked that someone would outright scream at me for my doing what I truly thought was in the best interest of the patient. At that moment I definitely felt darned if I do, darned if I don't.
But some of us haven't had any similar experiences or just don't react the same so can't truly sympathize with what happened to you. For that, I can understand where you are coming from with not wanting to come back to AN but I assure you that not every member means to upset you and not every thread is useless. Most, I would venture to say, can be extremely helpful.
So, here is my take on it. I'm about to graduate with my DNP, so I understand where both you and the MD are coming from. MDs work 24 hour shifts. They get annoyed when someone calls at 2 am with one vital sign out of normal limits. He was rude, I will not defend that. But when you call a MD, you need to tell them everything and anticipate what they are going to ask you. You should repeat the bp every 30 minutes X 3. Ask the patient if he has any symptoms of high bp. Look back in the charting to see where he has been running. Then you call the MD. The most important point I have here, is that if you feel the MD isn't responding appropriately, you need to closely monitor that patient and escalate. Your priority is the patient even if the doctor doesn't give you orders. If the patient is in danger, you have to take action. You have to call a condition if all other avenues fail. If something happens to that patient, and you did not escalate appropriately, you are in danger of a lawsuit.
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rhellner57
40 Posts
I am not stammering out a response was adequate. In defense of the doctor, she needed her facts in a row, direct communication is what is desired and needed especially when you wake a doctor in the night hours. I agree that she needed to report these changes in patient status, did she address pain issues, anxiety or other factors that can affect status. Could she have employed a rapid response to assist her before calling, have a good SBAR for communication reporting what, why (situation, background and assessment) and directly asking what she wants the physician to do (response) that she feels would best take care of the patient before additional problems accelerate.