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.
Did the nurse reassess? What was his bp last night at the same time. Is this the first time he got that sbp? Any s\s such as head ache? Neck pain? Decrease in urime output? Was the cuff too small?
I have broken many doctors over the years of their rudeness by calling them for every fart sideways being the good nurse until they get the hint. The lesson a nurse can be ur best friend or worst enemy so play nice doc!
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.
EXACTLY. Most of the hospitals I worked in (and that's been more than several, since I did travel nursing) had a standing order sheet that the doctors used, or the doctors themselves had standing order sheets. You went by those. It was generally a standing order that you called about a tele patient with a systolic BP >160, especially if it was inconsistent with previous readings, had been checked in both arms, and the patient maybe had been admitted with something where this would be alarming (or maybe the doc had forgotten to write orders for one of his/her meds, which sometimes happened). As for why the B/P at 0200.....the patient was on tele, and maybe had meds due then rather than at midnight. Or had been admitted at 2200. There are any number of reasons. Don't jump on the nurse.
Specializes in ER - trauma/cardiac/burns. IV start spec.
Rude doctors are everywhere. Each one is different and each situation is different. I have never worked anywhere other than in an ED and never with a hospitalist only residents and admitting doctors. I have had my fair share of rude private practice doctors and while being nice have "pinned their ears back" so to speak including the most feared cardio/thoracic surgeon in my area. He had a patient being transferred from another hospital. The transferring hospital called him at about 9PM but the patient did not arrive until 2:30AM. When I called for orders he went off I just waited until he finished and asked nicely if he wanted our ER physician to see the patient and write orders or give me the orders. Apparently that caught him off guard because he just rattled off orders which I read back to him he then said thank you and hung up.
Some doctors just have that "attitude" so you find ways to mitigate their rudeness. I had a resident one night accept a snake bite victim from a smaller hospital without contacting his attending. He never notified the Night Supervisor that a transfer was on its way, never notified the ER and did not let us know that the patient was unstable for transport as he had already crashed 2 times. We got the call from the ambulance with report and advised us that the patient had not had but 1 vial of anti-venom at the smaller hospital. We called the resident to let him know the patient was here. When the resident showed up he was almost screaming at all of us about the patient. Seems that he called the Nearest level one trauma hospital (2 hours away) and they would not send anti-venom without a NURSES say so especially when he was demanding it be airlifted in. While he was doing that I had called our local zoo that happens to keep one of the largest stocks of anti-venom in South Central Alabama and the manager was bringing us his entire selection as we still did not know what snake was involved. I happened to be charge that night and took the phone and asked the state troopers to ferry the anti-venom down before 6AM. The resident went off and I cut him off reminding him that his best resource in the ER were the nurses and we could make his ER rotation easy or we could make it a living hell. The supervisor was around the corner laughing about the entire affair. The patient arrived, crashed but survived and that resident never shouted at another nurse in the ER.
Document what happened and notify the charge nurse or nurse manager, that is all you can do. My name is not one I selected. It is the name given to me by all the new graduate residents as they came through our program. They learned to be neither rude nor keep patients in the ER when they had a room ready upstairs. Sometimes it is all in the training as they move out into practice.
Wake me up at 0300 and my blood pressure is likely to be abnormally high! Why should this surprise anyone, and why do vitals at 0300? Does it really provide any useful data that can't be obtained 3 or four hours later? Obviously the ICU would be an exception, but in routine acute care! The reason that vitals are "routinely" done every 4 hours is because of the lawyers, not because there is any real evidence to suggest that it is necessary or helpful. I for one reject senseless application of "nursing" tasks that are based on sacred cows and not real scholarly research!
Specializes in Cath/EP lab, CCU, Cardiac stepdown.
Wake me up at 0300 and my blood pressure is likely to be abnormally high! Why should this surprise anyone, and why do vitals at 0300? Does it really provide any useful data that can't be obtained 3 or four hours later? Obviously the ICU would be an exception, but in routine acute care! The reason that vitals are "routinely" done every 4 hours is because of the lawyers, not because there is any real evidence to suggest that it is necessary or helpful. I for one reject senseless application of "nursing" tasks that are based on sacred cows and not real scholarly research!
Well in a telemetry, progressive care, intermediate care, step down care, or whatever, the patients can go south suddenly. Early identification is important in just about anything.
By subjecting patients to unnecessary sleep interactions are we helping or are we increasing the incidence of problems? Give me a source that shows that doing vitals every 4 hours is GOOD for patients! Also, patient's in telemetry are monitored around the clock. If anything goes wrong with the vitals, it is most likely going to be picked up by the person monitoring the telemetry, not the nurse in the room. I'll look into this, but I'm pretty sure there is ample evidence to show that sleep disruption is bad for patients and effects the outcome. If you can find anything to the contrary, post it here. Let's start a real evidence based discusssion.
Specializes in Cath/EP lab, CCU, Cardiac stepdown.
By subjecting patients to unnecessary sleep interactions are we helping or are we increasing the incidence of problems? Give me a source that shows that doing vitals every 4 hours is GOOD for patients! Also, patient's in telemetry are monitored around the clock. If anything goes wrong with the vitals, it is most likely going to be picked up by the person monitoring the telemetry, not the nurse in the room. I'll look into this, but I'm pretty sure there is ample evidence to show that sleep disruption is bad for patients and effects the outcome. If you can find anything to the contrary, post it here. Let's start a real evidence based discusssion.
Telemetry only shows their heart rate and rhythm. That is only one part of the picture. Not to mention I've caught someone having a stroke during my late night/early am vitals before.
Wake me up at 0300 and my blood pressure is likely to be abnormally high! Why should this surprise anyone, and why do vitals at 0300? Does it really provide any useful data that can't be obtained 3 or four hours later? Obviously the ICU would be an exception, but in routine acute care! The reason that vitals are "routinely" done every 4 hours is because of the lawyers, not because there is any real evidence to suggest that it is necessary or helpful. I for one reject senseless application of "nursing" tasks that are based on sacred cows and not real scholarly research!
Alas, I am not qualified to decide which tasks are senseless and should be rejected. Here at my hospital, my job is to do as I'm told and not think too much or I'll hurt myself.
Wake me up at 0300 and my blood pressure is likely to be abnormally high! Why should this surprise anyone, and why do vitals at 0300? Does it really provide any useful data that can't be obtained 3 or four hours later? Obviously the ICU would be an exception, but in routine acute care! The reason that vitals are "routinely" done every 4 hours is because of the lawyers, not because there is any real evidence to suggest that it is necessary or helpful. I for one reject senseless application of "nursing" tasks that are based on sacred cows and not real scholarly research!
Yeah... No.
Vitals are done Q4 based on EBP to keep people from crashing, so we can catch the early signs.
And for people with normal circadian rhythms, BPs are usually lowest between 2-4 in the AM.
So, you probably shouldn't "scream" when you're wrong. Louder isn't necessarily better.
I don't doubt that you can catch problems, but that can happen any hour of the day. There's nothing magic about 0300. Besides, as I challenged, where's the evidence based research? Anecdotal evidence is just that, anecdotal. The telemetry unit I worked on also had BP designed to go off automatically, we didn't even need to step in the room, unless the cuff had been removed. I would also question what symptoms of a stroke did you see and how did taking a blood pressure lead you to that determination? And again, give me some sources! Even if you catch one stroke in your lifetime, does that justify the damage done to dozens of other patients through disrupting their sleep?
thevez17
24 Posts
Did the nurse reassess? What was his bp last night at the same time. Is this the first time he got that sbp? Any s\s such as head ache? Neck pain? Decrease in urime output? Was the cuff too small?