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Doctor's lying about telephone order

Nurses   (8,107 Views 43 Comments)
by Irabee Irabee (New Member) New Member

668 Visitors; 11 Posts

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I an very upset, mad, devastated, anxious and depressed. I received a TORB from a doctor for 10 mg or medication to be given once. 4 days later patient developed EPS (which is kind of strange because EPS would develop on second day not after 4 days.) I am suspecting that the patient was getting a "nursing dose" of the medication because no orders were documented 4 days after the shot he received from me. Any way.... the patient had EPS, mom got upset and started complaining. The doctor told the administration that I must be written up because he only ordered 5 mg. I would admit there is a small chance that I misheard the order ( it was busy on the unit that day) BUT he also told them that I suggested to give higher dose and asked him 3 times : " Are you sure you want to give such a small dose?" Later he told another nurse that I kept insisting on giving patient higher dose and , according to him" I gave higher dose despite his order of 5 mg. I do not recall him giving order for 5 mg and I know for SURE I never questioned his order, never insisted of higher dose. Such conversation NEVER happened between us. It was short and sweet: "Pt such as such does this and this. What can we get? Thank you, Bye! He is demanding to write me up. The management stated that they believe me but I am bitter about fact that the doctor can just throw you under the bus and there is NOTHING you can do. I called him and he got all defensive claiming I questioned the dose 3 times which is a big fat lie. he told me that ' everybody in the world can confirm I was insisting higher dose. I asked : "Who are those " everybody"? He said its his wife. Yaah... very unbiased witness....Uninterested party..... I never questioned his order. I was told not to confront the doctor and basically it was all swiped under the rug which is ok with me but I am fearful for my future. We are not allowed to record phone conversations with doctors and its is unrealistic to always have another nurse to witness the phone conversation especially when we have emergency situations requiring immediate call. In fact, we have another doctor, who is known for refusing her orders with multiple nurses....and no disciplinary actions are taken against her. Basically a doctor can very confidently give any order and than " hang it "on the nurse. How do I protect myself from this ever happening again??? This case really gives me depression ,anxiety and feeling of hopelessness.

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1,133 Likes; 7 Followers; 21,301 Visitors; 2,696 Posts

Sounds like he "doth protest too much!" So does your management plan to write you up, or is this bothering you more for the fact that he is running around lying about it to everyone?

That place sounds kinda dysfunctional with all that going on...not the least of which is "nursing doses" - - people surely are insane if they are doing that these days, and besides, if it was a one-time order, any subsequent administration of the same is way more than what a "nursing dose" ever was anyway, as I understand the concept. Nursing doses are illegal...just to throw that in there.

its is unrealistic to always have another nurse to witness the phone conversation especially when we have emergency situations requiring immediate call

I hear you, but that can't be the case any more. Unless your emergencies involve pending arrest then I guess it can wait until someone can witness anything this jerk says. And that's true for ALL telephone orders, whether you trust the ordering provider or not. I don't like feeling like I have no compassion, but the stakes are high as you've found out. So I guess we must all play by the rules all the time. I learned this lesson early on, the same way you're learning it...I had an MD deny having given me a verbal order after the patient had an adverse effect due to the order. It got ugly, and I won. "Fool me once...."

Sorry this is happening to you. What to do about it really depends on whether your management plans to let it blow over or not.

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232 Likes; 3 Followers; 95,229 Visitors; 36,400 Posts

Reading this caused me to wonder if I had read something (or somethings) like this a long time ago, would I have made the decision to forego nursing school? It certainly gives me reason to pause to think about my career choice now.

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blondy2061h has 9 years experience as a MSN, RN and works as a Nurse, duh!.

3 Likes; 37,035 Visitors; 4,094 Posts

Why is your facility using telephone orders on a routine basis in 2017? Do your providers not have remote EMR access?

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668 Visitors; 11 Posts

Yes, We are still paper based and 99% of orders on pm and night shift are given over the phone. The administration agreed not to write me up but I was also strongly suggested not to confront the doctor. They never wanted a write up at the first pace but the doctor was insisting on write up. What bothers me is that just because somebody has an MD title can LIE, throw a nurse under the bus, demand her to be written up for false reason and get away with all that. The administration is on my side because logically whatever he says does NOT make any sense. According to him, I was arguing over the phone that the dose is too small and made a conscious chose to go against the order. This is INSANE!!! Why on earth would I do that ? I never discussed the appropriateness of the dose with him. By the way the patient developed EPS almost 4 days later after the dose.... I gave him a shot on Thursday and he developed EPS on Monday... I do believe he was given a nursing dose of the medication on over the weekend... But that is another story..... It really pisses s...t out of me everytime I recall him stating irritably: " Well... You asked me three times "Dr., are you sure you want to give such a small dose?". I NEVER questioned his order. He said that " everybody" in the world can witness that I said that. And this everybody is his wife.... What upsets me the most that disciplinary actions are NOT applicable to you if you happened to med school.

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668 Visitors; 11 Posts

Please choose a facility with electronic records

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712 Visitors; 45 Posts

DOC

U

MENT

:):D

Sorry thought it would make a trend in a new type of acronym... (DOC- U - "MEANT" - :D)

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668 Visitors; 11 Posts

Document what? I wrote the order down.. What else could I have I documented? Pt. was transferred to another unit and 4 days later developed EPS. It is very unlikely to develop EPS 4 days after a single dose. EPS usually occurs either with scheduled anti-psychotic (given daily) or soon after the administration of STAT order not 4 days later. I can't document because the patient is no longer under my care.

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668 Visitors; 11 Posts

Thank you for support. "Ugly" is a perfect definition for this story. I am infuriated that MDs can feel safe to put blame on nurse if an "oopsy" happens. What is worst case scenario for them? NOTHING!!! Nurse won't get in trouble! That is their worst possible consequences!

But what hurts me even more.... He told one of the nurses that I kept insisting on higher dose. Later he changed his mind and took his words back. The nurse told this to me but refused to confess " because she doesn't want to get involved". The other nurse, who also heard the conversation also stated " Sorry .... but not gonna get involved...". Sad.....

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1 Like; 13,823 Visitors; 815 Posts

Does your facility tape phone calls? I would check into that. Ours does (facility phones) and it has saved a couple of people who insisted that the recordings be heard.

Surely this physician has access to a fax machine...I would personally insist on a faxed copy of order before implementing anything this doc orders by phone from now on.

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Ruby Vee has 40 years experience as a BSN.

941 Likes; 11 Followers; 64 Articles; 168,842 Visitors; 13,727 Posts

Document what? I wrote the order down.. What else could I have I documented? Pt. was transferred to another unit and 4 days later developed EPS. It is very unlikely to develop EPS 4 days after a single dose. EPS usually occurs either with scheduled anti-psychotic (given daily) or soon after the administration of STAT order not 4 days later. I can't document because the patient is no longer under my care.

I'm sure you wrote the phone order with date and time. Did your nursing note also include the phone call to the physician and the order received? If this is true, I don't see how the physician can throw you under the bus. You documented; he probably did not.

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1,460 Visitors; 52 Posts

I would talk to my coworkers and try to get couple of them and go upto the management and tell them that the doctors need to put their own orders or the management needs to start taping their phone calls. Just because the MD is claiming doesn't mean that nurses have to be thrown under the bus. Its the nurses who literally care for the pt. , these so called MDs are there to take the credit for the good thing and chuck the bad on to nurses.

PS: not all the doctors are the same.

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