Contested a Doctor's Order Psych ?

Patient assessment should be as comprehensive and pertinent as possible before asking for a medical intervention.

Taking the patient's pulse: It will be tachycardic due to pain.

Patient's pallor: Pale, sweating, feeling cold extremities.

Assessing how the patient is able to move? Try to observe when unnoticed. A patient in any kind of abdominal pain will be unable to be relaxed or stand and move easily.

I would do as many of these observations as able before making a referral to a Medic. I believe the Pulse is probably the best indication of what might actually be going on.

I had endometriosis for a long tine. I managed my pain with ibuprofen 800mg together with naproxen. It was effective for me. 
 

I think at this point it is not important to question whether you did the “right” thing  but rather focus on the outcome which was less than satisfactory for everyone involved and find out why something as simple as getting a patient’s pain properly evaluated and treated in a inpatient hospital setting got so convoluted. Clearly there was a deficiency here in some area, and most likely in more than one area. So the only question that needs to be asked is what needs to  be done so this doesn’t happen again. Is there a clearly written policy outlining the procedure  to request a medical consult? Have the nurses received the proper training regarding the process? Do the nurses and doctors do regular case meetings to facilitate communication and to coordinate care? I've been a nurse 35 years, sometimes things go wrong and the professional thing to do Is to determine why and implement a plan to correct it.  Determining right or wrong is irrelevant bc provider focused and not patient focused. You can use this experience as a way to make positive changes in patient care. 

In my opinion it is almost never wrong to advocate for the patient. Disagreeing with physicians I would argue can be a key component of effective nursing. RN's can be one of the "checks and balances" in the system and an adversarial (but hopefully respectful and polite) exchange of ideas may lead to better patient outcomes. When I used to sometimes get "written up" for calling MD's late at night over a patient issue I literally considered it a "badge of honor" an intrinsic part of my sacred responsibilities as a patient advocate sometimes of last resort.

1 hour ago, myoglobin said:

Disagreeing with physicians I would argue can be a key component of effective nursing. RN's can be one of the "checks and balances" in the system and an adversarial (but hopefully respectful and polite) exchange of ideas may lead to better patient outcomes. 

Argument for the sake of argument and calling it 'advocating for the patient' is not in my book of nursing. Look, we all want what's best for the patient including physicians. An adversarial interaction is by definition "involving or characterized by conflict or opposition". Maybe a discussion of your concerns may lead to a better outcome.

1 hour ago, myoglobin said:

When I used to sometimes get "written up" for calling MD's late at night over a patient issue I literally considered it a "badge of honor" an intrinsic part of my sacred responsibilities as a patient advocate sometimes of last resort.

When I was a new grad working on a surgical floor, patients came in the night before surgery. I worked evenings. Before going home at after midnight, I reviewed the data for the patients having surgery the next morning and started their 'pre-op checkoff list' -----a remnant of the ice age! One patient's CXR showed active TB. I got masks for outside the room - and all rooms were private.  I told the noc nurse and called the OR to cancel the surgery. I didn't see any reason to call the surgeon before early morning. Wouldn't you know the noc nurse called him in the middle of the night for in her opinion an 'immediately needed' order. 

I have noticed that there are some nurses who end up in conflict with physicians time after time. 

I have avoided saying this but I do think it needs to be said. The OP called 'advocating for the patient' getting her own way, not what was really best for the patient. A one time order for an opiate is never going to catch up her pain and 'calling' it a med for breakthrough pain is a misnomer.

The lesson to learn is: if you already know what you want, call the provider that will just say yes to your suggested intervention. 

As a midwife, hysterectomies are rarely "recommended" for endometriosis anymore. In fact, it's a lazy providers way of dismissing the patient.  A hysterectomy doesn't necessarily solve the problem as endometriosis is an inflammatory condition that can impact other organs than just the uterus.  The pain can be so bad I have seen patients vomit.  The treatment is to shut the cycles down.  Stop the cycling = stopping the pain.  

The problem is there wasn't an appropriate discipline available to help this woman nor was an ovarian cyst (that can lead to ovarian torsion) ruled out.  

Had this been a man with a swollen member or scrotum, a urologist would have been consulted, but this is another example of providers dismissing a gynecological complaint because it was a female.  

More times than I can count I have had psych doctors tell me they would rather the medical doctor handle severe pai.The charge or supervisor should have assisted more with this situation. 

That’s right  

20 hours ago, londonflo said:

Argument for the sake of argument and calling it 'advocating for the patient' is not in my book of nursing. Look, we all want what's best for the patient including physicians. An adversarial interaction is by definition "involving or characterized by conflict or opposition". Maybe a discussion of your concerns may lead to a better outcome.

When I was a new grad working on a surgical floor, patients came in the night before surgery. I worked evenings. Before going home at after midnight, I reviewed the data for the patients having surgery the next morning and started their 'pre-op checkoff list' -----a remnant of the ice age! One patient's CXR showed active TB. I got masks for outside the room - and all rooms were private.  I told the noc nurse and called the OR to cancel the surgery. I didn't see any reason to call the surgeon before early morning. Wouldn't you know the noc nurse called him in the middle of the night for in her opinion an 'immediately needed' order. 

I have noticed that there are some nurses who end up in conflict with physicians time after time. 

I have avoided saying this but I do think it needs to be said. The OP called 'advocating for the patient' getting her own way, not what was really best for the patient. A one time order for an opiate is never going to catch up her pain and 'calling' it a med for breakthrough pain is a misnomer.

While I don't believe that "arguing" is ever ideal. I do want to emphasize that I believe a key roll and function of nurses is to act as advocates and I would indeed submit guardians of patients welfare. Nurses are at the nexus of patient care and are perhaps even better suited to guard the interests of patients than doctors or any other health professional.  It is not only our right, but indeed our duty to act in this manner. I wish to contrast this with the attitude that I sometimes see in physicians that RN's are there to "implement MD orders".  Indeed such advocacy can and should include sometimes include questioning the medical decisions of MD's (although that doesn't mean we have the right or ability to implement our own medical orders without getting an appropriate order from a licensed clinician).  I want to make it clear that my approach on this can be either seen as very necessary or quite radical.

On 10/21/2020 at 2:46 AM, Davey Do said:

At Wrongway Regional Medical Center, the psychiatrists dealt with the psych issues and the hospitalists dealt with the medical issues.

Kept everything simple.

Our psych doctors deal with the mental health stuff, if the patient has physical health issues we send them out to the main hospital

Once was case managing a palliative patient who also had a major mental illness. Was told that my purview did not include dealing with physical health issues. ?

8 hours ago, Tenebrae said:

Our psych doctors deal with the mental health stuff, if the patient has physical health issues we send them out to the main hospital

Once was case managing a palliative patient who also had a major mental illness. Was told that my purview did not include dealing with physical health issues. ?

That's the thing as an RN your purview includes virtually all issues with the patient from their safety, health, emotional, psychological and even spiritual well being.  You are the central nexus of their care the one person who has the most intimate power, responsibility, and manifest duty to guide and guard virtually every aspect of their care to the best of your ability. That is why RN's should be empowered to constantly question, advocate and pursue these duties.