Hello! I am a new RN. I had an order to hang a bag of XXX today. Before I hung it, it said to check the patients levels. I did. They were in normal range. I talked with my preceptor about it and she asked me what did she think I should do. I said I would not hang it. She said call the doc. to verify the order. I did.
Doc. started out the conversation with "Are you new?" I said yes. The doc. proceeded to tell me what the normal range for the mineral was. I said 'Yes. I know this. I am very familiar with this drug. I am fine and know it well." I asked her if the patient had a history of this element being low, etc. She explained why she wanted to keep him on it. I said "Ok. I understand. I was just double checking as the pat's range was normal. I said "thank you." And with that the doc. slammed the phone down and hung up on me. Cut off. That was it.
I guess the doc. DID NOT like me calling and questioning the order. BUT the range was normal and I did not want to hang the med. and harm the pat. My system lite up in BOLD letters when I scanned the med. and said to CHECK THE LEVELS BEFORE GIVING. AND... they were normal. So I did what I thought was right.
My family is scared the doc. will go to my boss and have me written up or fired. Can docs. do this?? Oh my. I am sure I will not be on their favorite list from here on out....
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.
When a doctor tells you "stop calling me about this patient," (and you will hear that at some point), state "Let me repeat this order I'm writing on the chart... Stop calling me about this patient. Do I have that correct doctor?"
I wish I could take credit for that brilliant statement, but a seasoned co-worker taught me that. I've only had to use it once, but it worked brilliantly.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I've never seen a doc write up a nurse, because as someone else mentioned, we just aren't important enough in most of their minds to justify the time it would take to do it. Though I know there are exceptions to the rule, usually the goal is to rattle you enough that you will begin to hesitate before calling them again.
Sometimes they will demand that your manager write you up. This is hopefully where you have a manager who has your back and refuses to do it because you didn't violate any policies or make an error.
Sounds like this doctor was more civil than most, actually. It gets much easier when you get to know each doc's unique personality, but most, see their time in very small increments and are supremely p'o-ed at those they view as wasting it. If they know you could have your question answered in some way other than calling them, they resent it. They may think you should have used your critical thinking about what an abnormal lab means on their particular patient, rather than calling on every result with an alert of some kind.
Congratulations! You've just lost your virginity. Prepare for a life of being screamed at, insulted and degraded on a regular basis. And that's just by your coworkers.
The first time is the worst, then it gets a lot easier. After awhile youll be able to listen to a prolonged cussing out without blinking an eye. In fact, you'll put that time to good use. Like going over your grocery list, or trying to remember when your last oil change was.
I'll bet they didn't prepare you for that in nursing school, did they. They sure didn't in my program. No one ever bothered to inform me that asking a reasonable question is a guarenteed way of getting your head bitting off.
On a more serious note, I can assure you nothing will come of this. Trust me, the doc just blew off a little steam and has since mentally moved on. I worked with a doc for over a decade, both in the hospital and in his clinic, and he never remembered my name. He called me Jolene. Do I look like a Jolene?
hello! i am a new rn. i had an order to hang a bag of xxx today. before i hung it, it said to check the patients levels. i did. they were in normal range. i talked with my preceptor about it and she asked me what did she think i should do. i said i would not hang it. she said call the doc. to verify the order. i did.
doc. started out the conversation with "are you new?" i said yes. the doc. proceeded to tell me what the normal range for the mineral was. i said 'yes. i know this. i am very familiar with this drug. i am fine and know it well." i asked her if the patient had a history of this element being low, etc. she explained why she wanted to keep him on it. i said "ok. i understand. i was just double checking as the pat's range was normal. i said "thank you." and with that the doc. slammed the phone down and hung up on me. cut off. that was it.
i guess the doc. did not like me calling and questioning the order. but the range was normal and i did not want to hang the med. and harm the pat. my system lite up in bold letters when i scanned the med. and said to check the levels before giving. and... they were normal. so i did what i thought was right.
my family is scared the doc. will go to my boss and have me written up or fired. can docs. do this?? oh my. i am sure i will not be on their favorite list from here on out....
congratulations on experiencing your first damned if you do and damned if you don't nursing moment. firstly, i think you're really reading too much into this. any doctor that would have really wanted to be totally dismissive and hang up the phone on you wouldn't have waited for your "...ok. i understand. i was just double checking as the pat's range was normal, ...thank you." i think that maybe the phone's handset hit the cradle a little too hard on her end and you interpreted that as evidence of the doctor's displeasure. i've done that myself to doctors (where the phone had slipped from my hand and came down hard on the cradle) and i've often wondered if they thought i had rudely hung up the phone on them, lol...
that said, in regards to your question of whether a doctor may invoke disciplinary actions on nurses; the quick answer is that no one can discipline you unless they're your boss or the state organ that provides your license. in terms of "write ups" though, any person can document your actions as they perceived it, and file a complaint with either your employer or your state. whether your employer or state ultimately uses those statements and takes action against you though, is quite another story. new nurses often fail to realize that within the hospital system, doctors are really just another employee in another department. they have no say over nursing other than from the aspect of adherence to medical orders of patients under their care, and even that is with strict caveats regarding state laws, hospital policy (and or regulations), and patient safety as per a nurse's own clinical judgment.
i remember once having to tell an intern who wanted me to insert an iv into a patient that she couldn't get (admitted on another floor that i wasn't even assigned to); that she had no such authority, after she had insisted that she was ordering me to do so. the intern unfortunately did this in front of a nursing station full of other nurses and doctors. she stood there slack jawed, and her face was beet red before she turned on her heels and retreated off the unit in humiliation. one of the things that you have to realize is that doctors are technically no where in your chain of command, and have literally no real power (other than the perceived political) to invoke disciplinary actions on nurses. of course, if you happen to work for a medical office and the chief md there is your boss, then that's a different story.
i hope you'll have a long and satisfying career (why does this icon still smoke when i've quit more than 20 years ago?)
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
unlike what you see on tv, the nurses in the hospital do not work for the doctors. therefore the doctors cannot discipline or fire you, change your schedule, take away your vacation or reduce your raise. they can, however "write you up." you'd have to really annoy someone to make them take the time and effort to do that, though!
Specializes in Hospice, corrections, psychiatry, rehab, LTC.
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....
This is all too true. Several years ago I worked on a mental health unit. We once got a patient who a cardiologist we had never worked with before agreed to serve as medical consultant for. The patient started having transient states of altered consciousness, and his psychiatrist ordered several lab tests. We called the cardiologist when we got the results because of some abnormal values. We called several times because he never returned our calls. When he finally called the unit (almost three hours after our original call), he told the LPN who answered the phone that we should stop calling him, and that the next time "the patient had better be lying dead on the floor." I had her hand me the phone. I promptly informed him that we would not be calling unless we had a valid reason, and unless he gave me orders immediately he might get his wish, because his patient had a blood ammonia level that was not compatible with life. He was a lot more courteous after that.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Hello! I am a new RN. I had an order to hang a bag of XXX today. Before I hung it, it said to check the patients levels. I did. They were in normal range. I talked with my preceptor about it and she asked me what did she think I should do. I said I would not hang it. She said call the doc. to verify the order. I did.
Doc. started out the conversation with "Are you new?" I said yes. The doc. proceeded to tell me what the normal range for the mineral was. I said 'Yes. I know this. I am very familiar with this drug. I am fine and know it well." I asked her if the patient had a history of this element being low, etc. She explained why she wanted to keep him on it. I said "Ok. I understand. I was just double checking as the pat's range was normal. I said "thank you." And with that the doc. slammed the phone down and hung up on me. Cut off. That was it.
I guess the doc. DID NOT like me calling and questioning the order. BUT the range was normal and I did not want to hang the med. and harm the pat. My system lite up in BOLD letters when I scanned the med. and said to CHECK THE LEVELS BEFORE GIVING. AND... they were normal. So I did what I thought was right.
My family is scared the doc. will go to my boss and have me written up or fired. Can docs. do this?? Oh my. I am sure I will not be on their favorite list from here on out....
Oh Honey....some Doc's still get off on intimidating people especially when there are "new nurses" in the hospital. sick sadistic drive for power but mostly a large dose of insecurity or small body parts syndrome. Never forget.....you are responsible for what you do! "because the doctor ordered it" will not absolve you from a lawsuit or losing your license if "another reasonable nurse" would have done different. If I had a penny for everytime some hot shot MD demended "what is your name"......or would "have my job" I'd been richer than Warren Buffet!!!!!!!!!!!!! Trust me...You cannot be sued for calling the doctor but you can get sued if you did not!!!!!
To quote Laura Gasparis Fonfriolio (sp) at a critical care seminar back in the mid 80"s "When a doctor screams at me.....'where did you get your medical degree' I smile sweetly and state 'Harvard.....but I decided to further my career and better my education, so I went on to be a nurse'." I never laughed so hard and I have never forgetten what she said and yes.....I have quoted her on occasion.
Once there was a nephrologist whom i admired.......but he too one day became the "MD". a particular open heart patient was not doing well and was started on dialysis (CAVHD--gambro) and could not maintain the pressure inspite of some powerful inotropes........it was the fourth of july when he screamed "GET THOSE DRIPS OFF YOU ARE KILLING HER KIDNEYS......WHAT ARE YOU DOING..... YOU INCOMPETENT?' I let him rant for a few minutes and reminded him that if I did not recover a blood pressure that the patient was going to die and "trust me if she dies her kidney's will die with her!" :mad:and hung up the phone.........he showed up in person to care for the patient but to also apolpgize.....follow what is right and is in your gut......good job..... by the way you are hired by the hospital and so are they........so you are both employees.
I'm not saying this is DEFINITELY the type of thing you should do, because you *are* new and (not being mean, but) inexperienced. This suggestion is only for those that are super offensive, HOWEVER ... I have on MANY occasions written up an MD b/c they're rude, obnoxious, or exceptionally condescending. I've heard SOME people have gotten apologies for them being a jerk, so ... keep fighting the good battle!
Great job questioning things. Depending on what you were giving (kinda vague w/ the XXX), but if it was something simple like D5 0.9NS w/ 20KCl @ 50ml/hr, I'd hang it no problem UNLESS they were hyperkalemic. .... 20 of KCl is a drop in the bucket.... and 50ml/hr is going to take forever to infuse that 20mEq. ... I wouldn't have worried about it.
I do agree, though, that you need to just state the facts and let them answer. If they're aware of their e-lytes and being WNL, and continue to say, "Hang it" then by all means.
This is true in most cases, HOWEVER, if you have first year residents that are more than a little bit green, you may have a problem. Inexperience, inattention, non-sufficient sleep are also things to look out for.
Specializes in Peds, PACU, ICU, ER, OB, MED-Surg,.
A doc can ask that you be written up, but usually it is over a mistake. You made no mistake you only irritated him. Your question was valid and he could have written in his orders a parameter or statement saying give the medication even if lab is normal. We are not employed by the doctors if we are working in a hospital. They do have a say as they bring patients to the hospital but it is still the hospital's right to hire/fire.
My family is scared the doc. will go to my boss and have me written up or fired. Can docs. do this?? Oh my. I am sure I will not be on their favorite list from here on out....
Sounds like your family has you more worried than anything. I'd say the MD hanging up on you abrubtly means she didn't want anything more to do with you regarding the discussed subject rather than having some vendetta against you.
I am a new RN. I had an order to hang a bag of XXX today. Before I hung it, it said to check the patients levels. I did. They were in normal range. I talked with my preceptor about it and she asked me what did she think I should do. I said I would not hang it. She said call the doc. to verify the order. I did. 
Oh my. I am sure I will not be on their favorite list from here on out.... 
(why does this icon still smoke when i've quit more than 20 years ago?)
Trust me...You cannot be sued for calling the doctor but you can get sued if you did not!!!!! 
I never laughed so hard and I have never forgetten what she said and yes.....I have quoted her on occasion.
by the way you are hired by the hospital and so are they........so you are both employees.
Zookeeper3
1,361 Posts
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.