did the Dr. have a right to scold this nurse?

[Lurker011]

first let me say that i have no nursing experience..i do computer work for the huge local teaching hospital. 2 days ago i was told that i could become a "code" recorder. a "code" was announced yesturday for the Cardiac ICU and i had to be there to record the events. when the whole team showed up,the patient was awake,alert and breathing fine. it ended up being a false alarm. what happened was the new nurse just started her shift and she noticed on the monitor that this pt. had a severe bradycardic heart rate of 20 BPM. nurse said that she shaked the pts. shoulder and got no response,so she panicked and pushed the code button. as it turned out,this pt. is a very heavy sleeper and her baseline HR is very very low during sleep. after this false alarm was over,i noticed the team leader dr. talking with the nurse face to face and the nurse was wiping a tear from her eye. i'm guessing that the dr. was scolding her. i am a sensitive person and i felt very sorry for the nurse..i would have hated being scolded. would any of you call a "code" for a pt. with a HR of 20? and was the Dr. right in scolding this nurse??

[GreyGull]

Maybe they're confusing computer "code" with the type of codes medical personnel deal with. "You can write code? You're hired!"

Since this was a teaching hospital there might be several ways to "record a code". We record the actual code in action to be played back. There are also electronic markers on a computer screen that has all the monitored data sent to it and it takes is someone to press a button on cue. The OP might have been near the monitors where the ECG was printing. We've also had our Computer Technicians standby to limp our equipment along until a better solution is found or the equipment is replaced. They are more than capable of "recording" or ensuring the equipment continues to gather information and sometimes they are the Masters at doing this by knowing the equipment better.

Without knowing what actually was said between the MD and RN, it is hard to judge. Since the OP did not actually hear harsh words it could have been anything from comfort to questioning the events and an RN who was shaken by the event for some reason.

But, had it been a loud verbal attack to where bystanders noticed, then yes that would be very inappropriate regardless of the title of the person doing or rec'g the verbal attack or "scolding". No such exchange should take place in a patient care area or in view of others.

[cometnurse]

It is better to call a code in a situation that you are unsure about than not to and have the patient deteriorate before your eyes. One should never have to apologize for trying to be a safe nurse.

Where I work, we have the RRT (rapid response team) to call if it is not a true "code blue". We call them when the patients condition is deteriorating but not at the point of needing CPR, etc yet. The critical care team can come and intervene and possibly prevent any further problems. My hospital encourages us to use this service even if we are unsure of the situation as it is a safety measure to provide the best care possible.

Nurses should never be scolded for doing their job to the best of their ability:)

[netglow, ASN, RN]

At what I know to be crappy hospitals, it is common to threaten punishment for RR or code calling.

Recently a friend of mine had consulted her charge re a "situation". Her charge threatened her not to call a RR even tho she could not get a timely call back from the MD. She almost listened, had hesitated to do what her gut told her only because she was a new nurse and her charge had threatened her at the nurses station. She fumed for a while feeling embarrassed. Then she checked the pt again and got PO'd and picked up that phone and called an RR. Screw that charge. The patient was sent to ICU. Days later her NM told her she needed to write a statement about the events, that they thought the family might sue. Good thing she documented...

Summary: 'EF those who want to see if they can get you to go against your better judgement and kill someone, all the while knowing that they can blame you for it too should they have been in error...

[misswhitney]

At what I know to be crappy hospitals, it is common to threaten punishment for RR or code calling.

Recently a friend of mine had consulted her charge re a "situation". Her charge threatened her not to call a RR even tho she could not get a timely call back from the MD. She almost listened, had hesitated to do what her gut told her only because she was a new nurse and her charge had threatened her at the nurses station. She fumed for a while feeling embarrassed. Then she checked the pt again and got PO'd and picked up that phone and called an RR. Screw that charge. The patient was sent to ICU. Days later her NM told her she needed to write a statement about the events, that they thought the family might sue. Good thing she documented...

Summary: 'EF those who want to see if they can get you to go against your better judgement and kill someone, all the while knowing that they can blame you for it too should they have been in error...

I'm a charge nurse and would never, ever question my nurse if she felt the need to call Rapid Response. Our Rapid team is AWESOME and since they have cell phones, they can give us support over the phone and almost every single time they come to see a patient if we are worried about them. I recently called Rapid because I did not feel right about a patient and the very next morning (IDK what the night nurse was doing, but when I came the room at 0715 her respirations were over 30) the patient was sent to the ICU and intubated. Nurses should never feel bad about asking for support and I don't think I have ever heard of a physician who scolded a nurse for creating a false alarm. Better safe than sorry in the medical field.

[Horseshoe, BSN, RN]

I have called codes twice when pt's were still AAO - the first was starting to gurgle from acute fluid overload, and the doc tried to tell me I over reacted. Then the pt became unresponsive and gray.....Thank heavens the code team had already arrived. Everyone except the initial doc commented on my 'lucky' call. Lucky, my foot. Excellent nursing judgement, I say.

The second was a first-time dialysis patient who started to cough immediately as we started the treatment. I knew he was about to go into anaphylaxis, stopped the treatment, got the doc who was available. She didn't want me to call the code. We called anesthesia 'just in case'. Then the pt went into full-blown anaphylaxis, and we called the code. Again, everyone except the nephrologist was impressed with my nursing judgement.

Both patients survived because a nurse made a call.

Keep making those calls. The life you save may be the doc's.

Some nurses seem to have almost a sixth sense about patients who are about to go down the tubes. Those are the ones you want on your unit. Better to intervene BEFORE they code and get them up to the ICU than REACT to a patient after they are down.

I've worked with some nurses like you who correctly gauge the subtle and not so subtle changes appropriately and you can bet your sweet bippy that I believed them when they predicted an adverse event. Better safe than sorry.

[mmtrnstudent, BSN]

better to be safe than sorry!! she did what she thought was best. Doctors are not always right.

[beckster_01, BSN, RN]

I would have called a rapid response while I sternal rubbed the patient/checked for a pulse/got VS. The people on the RRT are the same people that would respond to a code, you just don't get the ridiculous influx of med students etc. that come when a code is called overhead :-p Nothing worse than having so many students/first year residents in a room observing their first code that there is no room for the nurses that know what they are doing I love having a RRT available. It is comforting to know you have excellent resources to assess the patient and react before things go sour

[cherrybreeze, ADN, RN]

When we have codes, the nursing supervisor is the one that records the events. Having non-medical personnel do this seems odd to me, but I guess that's beside the point.

You have no idea what that doctor was saying to this nurse. Her tears may have been due to embarrassment of having so many people show up for a "code" that wasn't, and/or from most likely upsetting the patient, as well (think of how you'd feel as a patient, if the whole code team suddenly showed up and swarmed you!). Also, using my definition of "scolding," there isn't ANY situation that it would be warranted for a doc to "scold" a nurse. Children are scolded. If the doc disagreed with the nurse's call, they can discuss it. A scolding isn't appropriate then, or ever.

As far as if the code should have been called at all, well, I wasn't there. It's easy in retrospect to say that no, it wasn't necessary, but at that moment in time it's totally different. I'd rather err on the side of caution than waste precious minutes waiting for a bad situation to become much worse. You don't have to wait until resps or pulse are totally gone before you call. If the patient's HR actually was 20, and they were not arousable, I can see calling it. I do wonder what else the nurse did (what was the blood pressure?), but either way, a pulse of 20 is critical. Having that be a "norm" for the patient is very odd, indeed, and it would NOT be your first assumption. You also don't really sit back and thumb through the chart after a finding like that; you act.

[Pepper The Cat, BSN, RN]

Add me to the people who say the doctor may not have been "scolding" the nurse.

I remember one of my first codes very well. Pt did not survive.

Pt had cancer - I can't remember where - and I had been trying to get him to take something for pain all day but he wouldn't. He finally took something, then 1 hour later coded and died. I was a wreck.

Next day, pt's doctor (who was not present at time of death) asked me what happened - I got all teary and said "I gave him morphine and then he died" - because I was convinced that I had caused his death. He talked to me, explaining that nothing I did caused his death, etc etc. I was very teary during the conversation - but he helped me a lot.

As for someone "scolding" someone for calling a code - I've never seen this. It usually the theory that it is better to call a code and not need it, that the other way round.

[Altra, BSN, RN]

Yet another ask-a-nurse-line question from this non-nurse poster.

I will not comment on what he *thinks* *might* have transpired between an RN and an MD.

[anotherone, BSN, RN]

At what I know to be crappy hospitals, it is common to threaten punishment for RR or code calling.

Recently a friend of mine had consulted her charge re a "situation". Her charge threatened her not to call a RR even tho she could not get a timely call back from the MD. She almost listened, had hesitated to do what her gut told her only because she was a new nurse and her charge had threatened her at the nurses station. She fumed for a while feeling embarrassed. Then she checked the pt again and got PO'd and picked up that phone and called an RR. Screw that charge. The patient was sent to ICU. Days later her NM told her she needed to write a statement about the events, that they thought the family might sue. Good thing she documented...

Summary: 'EF those who want to see if they can get you to go against your better judgement and kill someone, all the while knowing that they can blame you for it too should they have been in error...

One time ( don't want too many specifics in order to keep my irl identity someone unknown), I had a patient go bad, FAST. .well the pt kept going downhill, i knew pt should go to an icu. the patient began to become very unstable and none of the drs were responding to pages (they were aware of the situatin as i had been talking with them about it earlier that shift.it is a major hospital, i am sure they were busy, not ignoring my paging so i thought might as well call a rrt).The nursing supervisor became aware of the situation and said not to call a rapid response. Well I did it any way. The primary team and the rrt team came up, the patient ended up being transfered and the mds I had been in contact with told me it was a good call to just utilize the rrt. i would be thrown under the bus had i not done so. i dont regret it in the slightest. The nursing supervisor didn't even assess the pt but thought she could give advice on what to do......... i ignored it.... in the end there was a avery good pt outcome

[Lurker011]

altra,don't get so defensive..i may not be a nurse,but i do work at a hospital and at times i am interested in nurses imput on some cases.