dishonest residents.. what can be done?

RNinSoCal · Sep 2, 2006

I have this happen many times, not only with residents but with all types of MDs. In my experience only the surgeons respond quickly. The first thing you have to do is document the exact times called and have your charge nurse as a witness after the first time. Most hospitals have a policy of who to contact in the "Chain of command". After paging an MD 3 times with no response in 2 hours I notified the RN supervisor. She tried herself twice over the next hour. Then we started up the chain of command and ended up calling the Chief of Staff to get pain med orders FINALLY!! My poor patient was in pain for hours before an order was given. The benefit of doing this was that the chief of staff confronted the other MD himself and the problem did not happen again. All residents have an MD that oversees their work. Perhaps your charge or supervisor could discuss the problem with the resident's supervising MD in a casual way. It is ridiculous for the Residents to claim that the nurses are not paging. And furthermore if their paging system really does not work then it needs to be fixed! Be calm and logical when you talk to your charge nurse, unit manager, or supervisor about this. It doesn't have to be a big confrontation on the side of the nurses UNLESS nothing improves. I hope my suggestions help.

Best of luck:nurse:

barbyann · Sep 2, 2006

I work nights and weekends and have these troubles also. I advise if you haven't received your call back after two calls, work your way up the chain, calling the attending if neccessary. And....call the operator and ask her to page Dr. soandso! The operator calls get logged automatically and can be used as proof positive. The computer print out will clearly show you were actively seeking help.

Of course, documentation is a given.

Many years ago I pushed a pt to the ED to be seen by an MD. I couldn't get one to come and the pt kept saying, but if I was home I would call 911 and go to the ED. Yeah, I got in big trouble.

Trauma Columnist · Sep 2, 2006

Many things can happen when you page people:

1. The pager system may malfunction.

2. You may be paging the wrong number.

3. The provider may not have their pager turned on or know how to activate it.

I worked at a teaching institution for 10 years and at other hospitals too. If you don't get an answer to your page, then you go up the chain - to the attending, the dept head, the medical director, etc.

I always document when paged, who answered, etc.. With the fatality, I would question whether attempting to contact the resident repeatedly was indicated. If the pt was going downhill quickly and the MD didn't answer, page the attending, inform the nursing supervisor of the issue and prepare to transfer the pt.

Its been my experience that residents don't ignore pages. However, many times it is equipment or human error when paging. Most residents in the hospitals where I have worked carry cell phones too that can be accessed by the operator.

I will say too that I am now on the other side of the pager. As an advanced practice RN, I carry a pager and cell phone. I do travel out of the area though and sometimes there are "dead zones" for my pager and/or cell phone. We have a clearly defined way of continuing up the chain if I do not answer immediately.

I would suggest that your hospital develop a clearly defined policy regarding pager and cell phone answering. Good luck.

KellieNurse06 · Sep 2, 2006

Not to be off subject....but in regards to residents...I actually witnessed one at a hospital yesterday (where my child is a patient) who was sitting in one of the empty patient rooms down the hall on the unit playing playstation. with the game cart they have for the patients........................how old are we????????? (he could of been a medical student though......but still...I wonder what the attending would think seeing that????))

BittyBabyGrower, MSN, RN · Sep 2, 2006

We page 3 times, then we overhead them (the operators keep a log of who they page). If still no answer we then find out who the chief is and page them and so on up the ladder. We also have to inform the charge nurse and the nursing supervisor and call the director if they do not respond after the above attempts. We have had this happen with peds surgeons A LOT in our hospital and when a preemie goes bad, they go belly up fast and you don't have time to waste.

Use your chain of command! And document every step of the way, we even document the pager number we use so they can't come back and say it wasn't their pager.

bagladyrn, RN · Sep 2, 2006

The hospital can/does receive an itemized bill showing every call going out from the hospital (have seen this used to "ding" staff for making personal calls) In a case where serious harm/fatality occurred and there was a question of responsibility I would demand, in writing, that the phone records for the time period in question be pulled and checked. There would be your proof of each time you paged.

babynurselsa, RN · Sep 2, 2006

I have also encountered residents who have slept through a number of pages. I will page their pager with them standing right there.

prmenrs, RN · Sep 2, 2006

Years ago, we had to call the room where they were sleeping. One guy was notorious for falling asleep in your ear. Like we needed to hear him snore! Or he would give orders in his sleep and then swear he never said THAT the next am! We always got a 2nd nurse on the phone w/him. Or he would "miss" when he hung up the phone. Had to send security to his room to get him up that time!

One doc got called @ 11:30 pm (right after report) for an order, he started yelling @ the nurse--she was so shocked she pulled the phone away and was looking @ it. A resident from another service was @ the desk saw her, took the phone, listened to the abuse, told him to get himself over there and write the requested order, and that the incident would be discussed w/the Chief. We all stood around and clapped!

That was in the days before pagers!

Bottom line: Chain of command! Everybody has a boss.