Doctor vs Nurse

SionainnRN · Dec 30, 2012

As much as I want to call 911, my hands are tied with sending the resident out cause we do have a policy that the md should give an order first before sending the patient out. hence the md ordered cxr. I know it is unethical and unlawful.
As a novice nurse i carried out the md's order. hoping the resident will be fine. Until now I am monitoring the resident. Maybe the md will actually visit the resident when he goes to the facility for which he do not do.

Why in the world would you call 911 for wheezes??? As another ED RN that is an extreme reaction. Your patient has wheezes and poss pneumonia on an CXR, and guess what? The MD started abx and breathing treatments and O2. What in the world do you think we could do that isn't being done? The only reason to call 911 in this case is if the pt couldn't maintain their O2 sats and was going into resp distress. Otherwise give the abx some time to start working, geez.

And this is in NO WAY unethical or unlawful. It seems to me you have your panties in a bunch about the doctor and are trying to find anything you can to make them look bad.

anne919 · Dec 30, 2012

Initially he did not order abt neither cxr. His only order was monitor the pt. He would not o rder anthing besides monitor.

SionainnRN · Dec 30, 2012

Initially he did not order abt neither cxr. His only order was monitor the pt. He would not o rder anthing besides monitor.

But he DID order a chest xray and antibiotics. I don't know about anyone else but not only am I having a hard time following your posts, but to me it's just coming off like you have it out for this doc. You work in tertiary care, the md is ordering appropriate care, you are trying to make him/her out to be unethical and not only that, you are not a doctor yet you continue to diagnose pts and LIE about your assessments. I get that it's hard not to be defensive, but you really need to look at your actions here.

anne919 · Dec 30, 2012

Maybe it is just really hard to explain the scenarios. He only order to monitor the patient in most of the cases not just this one.

To make the story short to fully describe this is that most of the old nurses in the facility are the ones who orders their lab without the md order. I know that is malpractice.

I dont medically diagnose my patient. Nurses do have nursing diagnosis based on signs and symptoms.

Maybe the thread had become so inconsistent with the time frame im so sorry.

First off, the patient had audible wheeze. Auscultated the pt learned that the resident has inspiratory and expiratory wheezing. Use of acessory muscle but denies everything. States that wheezing is nothing. Patient daughter asked for re-assessment from md because the resident is to be discharged for the next day.

I called the md. Described how the resident was. His order was just keep on monitoring the patient. He hanged up on the phone cause he is with another patient. Gave the md some time to call back for clarification. Told him again that the resident exhibits inspiratory and expiratory wheezing and the daughter thinks its best to send out the resident. Then now the md ordered cxr abt

SionainnRN · Dec 30, 2012

Maybe it is just really hard to explain the scenarios. He only order to monitor the patient in most of the cases not just this one.
To make the story short to fully describe this is that most of the old nurses in the facility are the ones who orders their lab without the md order. I know that is malpractice.

Okay what are you talking about?? You are all over the place with your stories and there is no consistency in your stories. Now you are talking about the other nurses? From what I can piece together from your stories it sounds like you have problems with everyone one you work with, so it maybe in your best interest to find another job. Especially since you've made one of the docs so mad he will no longer be responding to your calls.

Kooky Korky, BSN, RN · Dec 30, 2012

I think Anne needs a different job because she is on bad terms already with this doctor, who might decide to take action against her.

If it is a hopsice pt and the doc wants to monitor her, then do that. Just call him back if her condition changes.

Anne, you write in a terribly confusing and incomplete way. Any reply to you has resulted in you adding more information that you really should have included at first - like the patient being the mother of your nurse coworker! And you really should stop posting stuff like that on this or any other public website. I think now you have given enough information that your coworker(s) could tell who you are talking about. That would constitute a HIPAA violation!

Please stop arguing with the doctor, please stop posting publicly. You say you are a new nurse. Slow down a little, consult with the Charge nurse, take an attitude of being a learner when you speak with the doctor.

If the doctor is losing patients, that is not your problem. Good luck.

SionainnRN · Dec 30, 2012

I see nothing wrong with monitoring a pt if they aren't having any SOB, discomfort, or dropping of their O2 sats. You have no idea what he was in the middle of when you called. And as I said before he did order CXR and abx, it takes a couple of days for the abx to kick in.

I know it's hard not to be defensive, but it's hard getting a straight answer from you, I can only imagine how hard it is for the doctor to understand what you want also.

LadyFree28, BSN, LPN, RN · Dec 30, 2012

Anne,

Please take the advice of the many nurses in this thread.

I also suggest reading this book: Critical thinking and clinical Judgement: a Practical Approach by Rosalinda Alaro-LeFevre. This is a book I have had for about 8 years. One of my nursing instructors gave it to me during LPN school. I read it while I was a new grad, and I plan to read it again before I start my Clinical Nurse I job as a RN. This book touches on managing conflict constructively, developing empowered partnerships, giving and taking feedback, evaluating and correcting thinking, diagnosing actual and potential problems, all things that you need to polish up on. One of the most valuable assets of the healthcare team is the nurse-provider relationship. We all have personalities and way we react and handle our care of patients. You are a baby nurse and are going through a growing pain figuratively. You must develop your nursing skills in prioritizing based on your patients, for assessment accurately, as well as the clinical setting you are in. Now that you snowballed your post, now is the time to really think though the feedback and suggestions, because as long as you are nursing, you are going have to work with providers with many personalities under the sun. They trust us to uphold integrity in order to benefit the patient. If and/or when leave this position, when a doctor at your new position rubs you the wrong way, will you react the same way-lie, diagnose, etc-what levels of violations will you enact against YOUR license? The next situation you may have may require you to answer your BON. I hope you will be able to do your own "corrective action" measures before your current or next DON does it for you.

anne919 · Dec 30, 2012

Thanks for your help. Really apreciate it.

OnlybyHisgraceRN, ASN, RN · Dec 30, 2012

I agree with the other posters. Anne, there is no need to post any more information. This thread has run its' course. I hope you found some valuable information and advice from some of the nurses. Take care Anne, it'll get better with time and experience. LTC is not an easy place to work.

rockstar11 · Dec 30, 2012

A lot has been said on this thread... most of which I agree with. Anne, these posters are giving you great advice, and from one novice nurse to another..... LISTEN.

I will add that I, as a nursing assistant and nursing student, had a very negative view of the nurse/doctor relationship and power struggle. I have come to realize that there is no need for a power struggle, because we DO have one common goal as to care for the pt. However, we do have different scopes of practice, and the basics of that, you should know. If not, ask, quickly.

One thing that has helped me immensely in communicating with physicians and providers is the SBAR: Situation, background, assessment, and recommendation.

S: Hi, I'm nurse Anne, I have pt ___ with s/sx of ___

B: Pt was admitted for (insert dx___) six days ago. He has a history of ___ (keep it brief)

A: He has wheezes, both inspiratory and expiratory, which is/is not a change from the previous assessment. Also, the pt does not complain of SOB, but I am concerned about the new wheezes.

R: Would you like to order a CXR? Would you like me to initiate oxygen?

I would say that, even as a new nurse, the MD will usually follow my recommendation. Sometimes it helps to make a list of the recommendations before you call, so that you don't forget about what you think the patient needs. The physician/provider will ALWAYS say continue to monitor (that is our job...). If I don't feel comfortable with their recommendation, and depending on the emergent nature, I ask for them to come physically assess the pt. Always keep it professional and courteous, no yelling at each other, no hanging up the phone.

The SBAR has made my job, as a nurse, soo much easier to communicate with someone with a different power than I do.

Anna Flaxis, BSN, RN · Dec 30, 2012

OP, I see a lot of backpedaling here. Because you are all over the place, I don't know what I should believe. I agree with the others who are telling you that you are on thin ice. If you want to keep your job and your nursing license, you need to change your ways.