Can a doctor write you up or fire you??

I don't think they can personally write you up (unless you are employed by the doctor in question). However, they can cause enough heat with your supervisor that you end up written up anyway.

I was written up once because our medical director complained to my DON that I called him too much.

No. The doctor isn't your boss. Also, get used to doctors getting their panties in a twist when you call them. It's par for the course. They seem to get so annoyed by doing their job sometimes....

In my experience, you have to REALLY bug the doc for him/her to take 5 precious minutes to write you up .

The conversation was a little prolonged. The doc really doesn't have to explain the rational to you. The following would suffice:

"Hi, Dr. X. This is Epona, Mr. Smith's nurse. His electrolyte level is xxx. I would like to verify your order to hang xxx." (Text paging works even better)

Then, you DOCUMENT that the physician was notified about levels and give the drug as ordered.

I work in the OR, where we don't have med reconciliation, so I am constantly telling the doc "the patient is allergic to that!" to which they generally respond, "yeah, ok" as they push it. It's his/her license, not yours. Notify and document.

nooo they can get mad at you or annoyed.. but who cares .. you are there for the patient not them.. i've been screamed at and hung up on... they don't bother me.. don;t let them get to you !!

Docs can write you up, but no, a doc can not fire you. If you work in a hospital setting, you are NOT an employee of the doc, you are an employee of the hospital. Docs get PRIVILEGES to work there. They are not administration.

Epona,

Being new is never fun. We have all been there. Unfortunately, when you are new it takes some time to get used to the doctors, routines and orders. As the other posters stated, yeah it seemed like the conversation was a bit prolonged and some docs, just have no tolerance. (I know its not right but, unfortunately this seems to be the way of the world) Some doctors are nice and will be more than happy to explain things to you. As posted the correct way to go about the situation (which its hard to say exactly without knowing the specific med and level was) however you should have called said that this was the patients level and you are verifying that medication. Now if you feel that you have serious problems with the order being given, it would be wise to talk that over with your preceptors, or other nurses on the floor. Then after you have made a decision, document, document, document.

Also, unless the doctor is who you are working for (for example in the office) they most likley can not fire you. As long as you did not cause any adverse problem with the patient you should be in good shape.

Advice, its a rough world out there. The first few months are hard. Good luck, and keep your head up and take good care of those patients!

A doctor can go to your supervisor at complain about something-but it's your supervisor who decides whether to write you up..my boss at work has our backs about stuff like that. 9 times out of 10, it's just the doc being a putz. And they cannot fire you.

A more important question is "was there something wrong with your critical thinking skills that would indicate to the doctor that you were an unsafe or unskilled partner in patient care" I can't answer this- But I can imagine particulars that could apply to the situation that you described that would be cause for concern. .. Has the patient been getting this med on a regular basis and that is what is keeping his levels in the normal range- why would you hold it - did you want then to become abnormal?, Is there something about the patient that would indicate a need for "high normal" levels of a particular electrolyte, or increased loss ot this electrolyte?- for instance a patient with a hx of ectopy or post-op CABG would want to keep the potassium level high normal- to avoid cardiac irritability, a renal failure patient you would want to be very careful with potassium supplimentation for fear of hyperkalemia, a patient receiving aggressive lasix dieuresis for CHF would need potassium replacement. There are MANY MANY other examples specific to different conditions and patient populations. This type of critical thinking is part of your nursing judgement and your preceptor is not doing thier job if they are not helping you through this process. If a doctor had to re-order and re-affirm every med every time it was due they would have no time to see thier other patients. Yep,- that would annoy me if I were a doc. Your best bet now- when there is a stress free minute in the next week or two and this doc is on the unit, apologize for pestering him unnecessarily (even if you don't feel it was- he did). Ask him to clairify why he was miffed- explaining you are a new nurse to the floor but really want to learn to work together to provide the best patient care. Even the testiest docs like mentoring if it means fewer calls that they consider unnecessary.

You did the right thing. Your nurse manager will back you up if the doc comes to have a word. I review clinical issues with my coworkers and mentors all the time. That is how you learn.

As your coworker I would give you kudos for taking the time to reverify something. (You paid attention to the safeguards of BCMA.)

I was given a verbal order for IM olanzapine the other day by one of our psychiatrists. I verbally verified the order with the doc before the behavior team went out to intervene.

Remember it is your license that the IV med was administered under. You are the last line of defense for the patient. Reverifying the med with the doc protects you because it makes it clear that you double checked. (along with documentation.)

You did the right thing. It is always better to question before acting if you are unsure. Don't let the doctor intimidate you into not doing the same exact thing in the future as well. She could have been having a rough day as we all do. Move on and I have no doubt she will as well. Not a biggie.

The only time a doctor can fire you is when you work directly for them i.e. a doctor's office. Our doctors can't write us up. If they have an issue they bring it to our CN to deal with it. I can't think of one time this has happened since I've been there. I work with really great staff on all sides so I'm lucky.

well.... I work in a right to fire state, that being said... a few years ago, the docs could push management to fire nurses... not so much now. Every state is different.

You were very general in your post, as we should be with that hippa crap, but if you had a normal potassium of 3.5 in a cardiac patient... You'd have to give it as they generally like to sit higher and not throw ectopy and irritate the heart, same as mag. A resperatory patient needs a high phos.

So while I can't comment on your particular situation as there are too many variables,

learn the culture of your unit. many unfortunately still are in the dark ages where the primary docs call the shots, but I promise you there are many places where that order would be clarified and need to say....

If so and so is 5 or less replace with ........ prn and recheck one hour after replacement and call MD for instructions. or check K every 9 hours, if less than 4.5 give 20 meq IV times one and recheck and call MD.

From what you posted you sure as heck aren't going to get written up or fired, but you can insure you're not left with vague orders such as that.