I've been beating myself up over this for days and I just want to get someone else's perspective. I apologize in advance for the wordiness
I work in a chronic, non acute setting where the patient's come in for treatment 3x/week, the patient's don't see a doctor or NP everyday but at least 1x/week.
I was assigned a notoriously difficult patient this week. Threatens to sue on a weekly basis, doesn't trust anyone's RN judgement, has "allergic" reactions to almost everything, and is generally a crab apple.
She has a standing order for a large dose of benadryl IVP 75mg per treatment. She complains of the medical tape itching her and our general patient population get's very dry and rough itchy skin as a manifestation of their illness.
During treatment she started crying and wailing and begging for more benadryl. I told her I can't give her anymore, because I only have an order for 75mg. Which is already a high dose. I called the on call physician because the patient was in hysterics to see if they would authorize any more. In retrospect I think the patient was just putting on a show in an attempt to get more drugs.
The physician wasn't rude or condescending but he basically said he would NEVER give any more then 75mg for something as non life threatening as itching. He was surprised that I would even call to ask.
Now i'm a new nurse about a year, I didn't expect him to authorize more but legally I thought I had to call to at least ask the doctor. I'm a nurse, I can't decide what's enough medication for a patient, don't I need a MD or NP to actually say no before I tell the patient no. I called the doctor because if the patient actually does decide to follow up on her weekly threats to sue the clinic, I thought it would be better to have it documented that the patient had a complaint, I performed an intervention by calling the doctor, and the doctor said no. If I hadn't called the doctor and she sued, the doctor could have said well nobody told me the patient was experiencing pain.
Was I wrong to call the doctor? I'm second guessing my decision. I try at all times to cover my bases with as much documentation as possible but now does the doctor think I'm an idiot?
Don't be embarrassed. It's best to ask & err on the side of caution than not to ask and pretend to know it all. None of us are perfect and know everything. If you have a question, call and ask. It will get better over time but it's the random questions and occurrences that make us more knowledgeable. Always call if you have doubt.
No you were not wrong to call the doctor. Classic case of CYA. The patient can't come back and rightfully complain that you did nothing to address their concerns and the doctor saying no takes the blame off you.
It’s all how you frame it. Try this way. “Hi Dr X this is RobertJo RN. I’m calling at the request of Mr Crabapple I’m at a bit of a loss for options on this situation and was wondering if you could help?”
basically. This guy is demanding I call, I have no suggestions, please help!
Was I wrong to call the doctor? I'm second guessing my decision. I try at all times to cover my bases with as much documentation as possible but now does the doctor think I'm an idiot?
It sounds like a ridiculous scenario and your emotional investment is way more than it should have been. You need to be matter of fact in these scenarios. Remain professional. Assess the patient. Call the doc. Relay answer to patient. See if there is anything else you can do to make the patient more comfortable. Finish the infusion and get them out of there. The end.
Sometimes when I approach the physician I'll say something like, "I've made her aware that it's unlikely we will be giving even more benadryl; I just wanted to check if there is anything else you'd like me to try."
There's nothing wrong about that; if the physician has a poor reaction (which has been extremely rare in my experiences)....So what. NMP.
We’ve all been there! The good thing is the doctor didn’t make a big deal about it. Some can be so rude and make you feel like a idiot.
In future if your unsure always talk to your more senior nurses or charge nurse before calling the doctor. Provides a good learning opportunity, you can document In your notes about you discussion so it’s not on you if something happens, and saves so much time and possible embarrassment.
Don’t worry about what the MD thinks of you, you did your job.
I once had a visit on a Saturday to a home health patient, I knew she was almost certainly healing normally but she had some concerns. I made a call to the MD’s answering service just to cover my own butt in the off chance that the patient complained or actually had a complication. I made it very clear DO NOT contact the Md, not an emergency, just leave him the message to receive during normal hours.
Well they called the Md and he yelled at me for 15 minutes about what an idiot I am that I don’t recognize the normal symptoms of healing from this procedure and “worried the patient unnecessarily”. Even though it was the patient who was worried, I was confident that her symptoms were normal, I reassured her, but left the message to let the doctor know that SHE may be concerned or calling him for follow up since she was anxious about her symptoms.
I would still make that call today even knowing that the egomaniac doctor would scream in my ear. Because if something actually did happen, or the patient complained that I dismissed her concerns, then it would actually be my error for NOT following up.
I don’t think it was stupid. I also don’t think that doctors realize that sometimes nurses make such phone calls just to be able to say they called the doctor. Sometimes I do it to humor the patient. Sometimes I do it just to say I tried!
Don’t beat yourself up! That’s how we learn. Trust me I’m sure your going to ask more and more “stupid” questions while learning, and than will come the day when you school the doctor! That’s a great feeling! Hahah
Nurses are always in the middle. We always take the brunt of the physicians' wrath whenever a patient has a question we ourselves cannot legally answer, even if we already know what the answer will be. Among our thousands of other duties, it's also our job to relay those inane questions to the doc. I hate to say that, but it is. We are the go-between. I still have yet to understand just WHY we, as nurses, are forced to be in this position, but we are. I have called countless doctors asking questions such as yours, all along knowing what the answer would be, and I too felt really stupid. But sometimes we have no choice. If it makes it any better, I've found that "asking for an order clarification" helps a lot. Like, "My patient states she normally gets X amount of whatever medication; I'd like clarification on that order." I apologize if someone else already said the same thing here...I think we've all dealt with this.
If in doubt ask the MD. I’ve asked the MD questions I already knew the answer to 1) just to confirm, 2) every once in a blue moon MD will change their mind, and 3) to shut the pt up that I did, in fact, ask THE DOCTOR since I’m “just the nurse”. Never be afraid to ask.
NurseBlaq
1,756 Posts
Don't be embarrassed. It's best to ask & err on the side of caution than not to ask and pretend to know it all. None of us are perfect and know everything. If you have a question, call and ask. It will get better over time but it's the random questions and occurrences that make us more knowledgeable. Always call if you have doubt.