Dr. complaint

Depends on what it was.

I have had two instances where a physician complained about me and both times I was NOT at fault. I had a resident throw me under the bus, thank God I documented the heck out of everything. And the other was a consult that I placed that is within my scope and the surgeon didn't like it. In both instances, my charge nurse, manager and a specialty nurse all "educated" the attending physicians about each situation and of I did not get an apology, but you earn a bit of respect back when they find out they were incorrect in their assumption.

Other nurses have been called out, rightly so, for things. It just depends on what the situation was.

That depends; what happens could be anything from an eye roll from your manager to termination and possible loss of license. Unfortunately, the devil is in the details and you have provided none (not that I'm encouraging you to go into specifics on a public internet forum). If the doctor complained about the tone of voice you used while speaking to him/her or that it took you too many rings to answer the phone, the consequences could be minimal to none. If the doctor complained that s/he saw you shooting up in the bathroom, the consequences could be severe.

yes, I think they would tend to frown on shooting up in the bathroom

Along with what the others have said, I'll add that even minor complaints can get you fired if they're frequent and/or from multiple people.

Hi,

thanks for the responses; I appreciate it. To shed light on the incident in question, here are the details.

I work in a long term care facility. I had a woman who has advanced Alzheimers that I sent to the ER for a query bowel obstruction. It is the ER doctor who filed a complaint; in fact he was FURIOUS that I sent her! My reasoning for sending her was:

- No one had witnessed her having a bowel movement in 11 days.

- Her abd was distended, and she was guarding it. She hit me when I tried to touch it.

- I couldn't hear bowel sounds in the LUQ.

- She has been given suppositories 2 days in a row with no result except a hard marble sized poop. When I came on my night shift the following night no one had yet to give her an enema. We normally give supps/enemas around 6:00 in the morning but she had woke up around 2am screaming. After almost 2 hrs of screaming I figured she was probably uncomfortable d/t constipation and decided to give her the enema at 4am thinking it would give relief. I did not get much of a result so I was concerned.

- I tried paging her doctor twice (before and after enema) but he never answered.

- For the last 3 days she had straining on the toilet complaining of pressure.

- She was screaming in pain and I had nothing left to give her. I just felt like I had no other option but to send her.

Please be honest. Was I wrong in sending her, as the doctor furiously suggested?

I would have sent her. I guess the ED doc did not think that was not an exciting enough case for him/her. They can be quite dangerous. I worked LTC for a while. An impaction in my state is a sentinel event. Nothing worse for nurse or pt than a disimpaction. 11 days? Someone at the facility should be getting in trouble for THAT one.

Hi,

thanks for the responses; I appreciate it. To shed light on the incident in question, here are the details.

I work in a long term care facility. I had a woman who has advanced Alzheimers that I sent to the ER for a query bowel obstruction. It is the ER doctor who filed a complaint; in fact he was FURIOUS that I sent her! My reasoning for sending her was:

- No one had witnessed her having a bowel movement in 11 days.

- Her abd was distended, and she was guarding it. She hit me when I tried to touch it.

- I couldn't hear bowel sounds in the LUQ.

- She has been given suppositories 2 days in a row with no result except a hard marble sized poop. When I came on my night shift the following night no one had yet to give her an enema. We normally give supps/enemas around 6:00 in the morning but she had woke up around 2am screaming. After almost 2 hrs of screaming I figured she was probably uncomfortable d/t constipation and decided to give her the enema at 4am thinking it would give relief. I did not get much of a result so I was concerned.

- I tried paging her doctor twice (before and after enema) but he never answered.

- For the last 3 days she had straining on the toilet complaining of pressure.

- She was screaming in pain and I had nothing left to give her. I just felt like I had no other option but to send her.

Please be honest. Was I wrong in sending her, as the doctor furiously suggested?

That sounds reasonable to me, but I have never worked in SNF and I'm not sure what's "typical" (if there is such a thing). The only good reason I could think of to slow down a bit would be if the facility MD would be waking (and returning calls) or rounding soon. If either of those were the case, I might have tried to hold out a little longer since the situation had been ongoing and not just occurred ...assuming the patient was stable, or course.

Added: Just saw the "screaming in pain" part. I wouldn't have waited if that were the case.

I would have sent her as well. I assume all of this was documented? Even so I don't see how an outside doctor can get you fired, despite how angry they might have sounded. You did the right thing.

I probably would have asked for double dose of Miralax, 200 colace, 2 senna tabs, and another enema before sending ... but you weren't wrong.

Usually when the ER docs I work with get upset that a patient was sent in from an LTC it's because the patient had clear directives that they were not to be sent to the hospital. We also have a couple of nursing homes in the area that refuse to have any sort of bowel care protocol, so they end up coming to the ER for basic bowel care. Otherwise I think what you did was appropriate, whether an ED doc gets upset without reason isn't really your concern, your concern is your patients, not the Doc.

Hi,

thanks for the responses; I appreciate it. To shed light on the incident in question, here are the details.

I work in a long term care facility. I had a woman who has advanced Alzheimers that I sent to the ER for a query bowel obstruction. It is the ER doctor who filed a complaint; in fact he was FURIOUS that I sent her! My reasoning for sending her was:

- No one had witnessed her having a bowel movement in 11 days.

- Her abd was distended, and she was guarding it. She hit me when I tried to touch it.

- I couldn't hear bowel sounds in the LUQ.

- She has been given suppositories 2 days in a row with no result except a hard marble sized poop. When I came on my night shift the following night no one had yet to give her an enema. We normally give supps/enemas around 6:00 in the morning but she had woke up around 2am screaming. After almost 2 hrs of screaming I figured she was probably uncomfortable d/t constipation and decided to give her the enema at 4am thinking it would give relief. I did not get much of a result so I was concerned.

- I tried paging her doctor twice (before and after enema) but he never answered.

- For the last 3 days she had straining on the toilet complaining of pressure.

- She was screaming in pain and I had nothing left to give her. I just felt like I had no other option but to send her.

Please be honest. Was I wrong in sending her, as the doctor furiously suggested?

No - you were not wrong.

It points to the fact that the resident has some bowel problems, which is common. A regiment that helps before it gets to this point would be favorable including dulcolax supp and enema if po are out of the question. Having said that, sometimes it fails.

ED MDs can be vocal about residents who come with this kind of problem - too bad - but he/she needs to get their act together. People show up for blisters ...

Don't worry - you have outlined the reasons for sending her very clearly - just because the other person is a physician does not mean he/she is right!