Docs with too much pride...

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I just wanted to share my recent experience with you guys and I welcome comments, criticism or feedback. Ok so I work in a small, rural critical acces hospital emergency room. My background includes general medical floor, orthopedics and 2 years in a much larger super fast paced ED. Most of the docs where I work now are either residents or family medicine physicians. None are board certified for emergency medicine.

So anyway I was working one night and received a 92 y/o female c/o chest pain. I also noticed, once she was on the monitor that her heart rhythm was A-Fib with RVR (ventricular rate of 103, not horrible but still). I called the physician to let him know we had patient and gave him a little info as to what was going on with her. After he assessed her and walked out of the room I asked job if I needed to give her cardizem to which he responded "why would you do that?". I told him that she might need some because this is a new onset of afib and technically she had RVR and her vent was was in the 130-150s now. I was always taught that if the vent rate is over 100bpm and in afib it qualifies as RVR. He goes on to explain to me what afib is and insisted she didn't have RVR. I then asked him, politely, to explain why I'm wrong because I legit wanted to be corrected if I truly dont understand something. He mumbled under his breath and had no further comments. That ticked me off already but the best part was what he ordered next for this lady... Yep, you guessed it: cardizem 20mg IVP. This happened only 5 min after our debate.

So help me out here to understand what he was trying to say! Am I even correct? Should I have questioned him like I did? How would you handle this situation? Thanks so much!

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Specializes in PCT, RN.

I feel like part of a nurse's job is to be the doctor's back up.

Doctor's are people too, which means they also make mistakes and the nurse is the next line of defense in ensuring that everything is caught in case a doctor misses something.

I don't feel that you were in the wrong in bringing this up; it sounds like he agreed with you (just not in so many words :sarcastic:).

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Specializes in Complex pedi to LTC/SA & now a manager.

You don't sound confrontational only asking for a correction of what you thought you knew about aFib/RVR.

IMHO don't worry about it and move on...he may not have known what to say when you asked for clarification and realized his error. I'm going to guess he may have focused on her age not the new onset aFib/RVR

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I was a monitor tech for many years, and we were always taught that Afib with RVR is a rate of at least 140. So if she had a consistent rate greater than this then you are absolutely correct...RVR it is. And on the floor I worked on Cardizem was not given unless the HR remained above 120 for at least 20 minutes and to titrate to keep HR below 100. Just as long as the BP is good, I don't see why the doc thought your request for Cardizem was off.

I don't think it's ever wrong to question a Dr. Maybe there was something that you missed that he could have taught you. Or maybe he didn't completely understand what you were trying to tell him. If you need something clarified or are just plain curious about something just ask. I would have asked for clarification...but that's just because I'm nosey and always looking for an opportunity to learn. And I especially would like to know if I am wrong. But of course, there is a polite way to ask for clarification too. Just as long as you weren't rude, confrontational, or overstepped any boundaries you're good.

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Specializes in Family Nurse Practitioner.

As a NP I have no problem when nurses question my rationale and most times I will automatically give it because it not only lets them know why I'm making that choice and I enjoy teaching but it can also, especially in the middle of the night when I have been woken up for the call, be helpful for me to verbalize it and re-consider what I'm proposing.

In the few, thankfully rare, cases where they are politely trying to get my attention to something that I was clearly missing I'm humble and truly thankful. My nurses are my eyes, ears and many times my brain so I don't ever make light of what they say even if I decide to take another path.

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Thank you all for your kind replies! It just makes me feel better to hear all of your opinions! I actually really love this particular doc; we have a good rapport. It definitely could have been a misunderstand because he really likes to teach. I always try to "question" my docs without trying to be rude or in an attempt to be nasty or condescending. I really learn a lot from my docs as I ask tons of questions so if I was incorrect I truly appreciate when they take the time to explain the rationale behind it. Again, thanks so much for your comments! It's nice to get feedback from all different nursing backgrounds!

Lauren

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

This thread has been moved to the Nurse Colleague / Patient Relations forum since the topic pertains to interactions with doctors.

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I work in a CVICU, and I agree with the other posters who said that cardizem might not have been necessary. If her pressure was stable, we might have tried a few doses of IV lopressor to see how she responded and then started her on a PO beta blocker. Or we might have just started a PO medication.

Either way, it's your job to ask the doc questions. He might not have realized this was new for that patient, and I think that's probably the bit of info you said that made him change his mind.

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Sometimes, in the moment, when we're questioned, our reaction is to be defensive rather than open to the new idea. I think we've all been there. Then later, when I've gone away and thought about it a bit, I've realized the person was right. I've had similar experiences with docs. I'm hospice, not ER, but there have been times when I've been asking for specific meds because I can see what's coming down the pipe and the physician has declined (for whatever reason). Then a bit later changed their mind and ordered it anyway. I just thank them and move on. I got what I wanted.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

It doesn't sound as though this physician has too much pride -- you say you usually have a good rapport with him. You just got him at a bad moment. It happens. I'm sure there are times when someone has caught YOU at a bad moment as well. Someone caught me at a bad moment just last night . . . .

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I think you just caught him at the wrong moment. As long as things are back to normal, should be no problem.

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
My nurses are my eyes, ears and many times my brain so I don't ever make light of what they say even if I decide to take another path.

Thank you, Jules! I had the fortunate experience to have good MDs who operated like you!

Thank you for listening to us floor nurses!😊

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