Felt stupid for calling Doc..

[tampaflrn6]

i received a transfer patient from another unit. the primary md got changed. i sent the first cardiac enzymes to the lab and they came back elevated. i called the primary md about continueing with tube feedings b/c the patient had a peg tube and there were no transfer orders for tube feedings. i also told the primary doctor that the cardiac enzymes were elevated. he asked me if he had an mi. i said i don't know, but they were elevated. (i can't medically diagnose, i am a nurse not a doc.) i read the labs to him. he got ****** and wanted me to get someone who knew. i got the charge nurse to explain it to him that it could of been an mi starting or mi going away. after the conversation i felt stupid for telling the cardiac enzymes. should i have mentioned it to him? after this, i found out that cardiology were consulted too, which was not mentioned to me by the previous nurse who gave me report when he got transfered. maybe i should of researched who was consulting? what do you think

[cardiacRN2006, ADN, RN]

When he said "get me someone who knows" I would have said "that's why I'm calling you"

He's the Dr, not you. If he can't figure out if the pt is having a MI, then maybe HE should be calling someone else-like the previous Dr assigned to the pt.

[hikernurse]

You made the right call--ethically and legally. If I were a doctor, I'd have definitely wanted to know those lab results.

I don't know what more he expected you to have told him .

Don't sweat it :).

[MMARN, BSN, RN]

When he said "get me someone who knows" I would have said "that's why I'm calling you"

He's the Dr, not you. If he can't figure out if the pt is having a MI, then maybe HE should be calling someone else-like the previous Dr assigned to the pt.

That's the same thing I was thinking. It's definitely the doctor's job to diagnose, not yours. I would have felt the same way, though. :chuckle

[firecoins]

The MD is the guy who is suppossed to know.

[Spatialized]

Don't feel stupid, you did the right thing by mentioning the elevated cardiac enzymes. He was just being a jerk. You could have said, "It's not in my scope of practice to diagnose if the patient is having a MI" but that probably would have made him madder.

Tom

[Morettia2, BSN, RN]

NEVER feel stupid for doing your job. YOu reported CRITICAL lab results to the MD. One hint in the furure, never doubt your self for reporting Critical Lab Results to an MD, even if the CK is 267 report it no matter what, the heart's a muscle and it's making enzymes for a reason, I know from experience..I would have said to that MD, do you want to me to do a STAT EKG., repeat STAT labs, call the resident, that's if you have a resident covering your service, do you wnat me to call a RRT or a code? I would make sure I asked the pt. if the pt. exp. any c/p or discomfort or a heaviness in the chest or a "heartburn" sensation, or a headache, or just not feeling like themself and don;t really know what's wrong. If the CK that I was reporting to the MD was 3x's the normal value and the trop was elevated and the MD was still asking me if the pt had an MI after reporting those labs and if I had said to the MD the CK was in the 1000's range, and trop was elevated. I would have taken it upon my self to call a code with out hesitation (at my hosp. we have code STEMI even if it's a NSTEMI). If the MD dosen't know if the pt. had an MI by just the labs reported, then..ahhhumm..that's all I am going to say. I would repeat STAT labs, STAT EKG with the MD's orders and call for Help no matter how stupid the MD made you feel, YOU as the RN are calling them, the MD, to report lab results about THEIR pt. that you as the RN know are IMPORTANT that's your job as the RN(i know from experience and have been laughed at for doing said things, but in the long run it's the pt's life and your license on the line, and that gut feeling you have as an RN is 99% of the time always right). Pt could have had a STEMI at one point that a STAT EKG would have shown a ST elevation, or pt. could have had a NSTEMI, in which case a STAT EKG may or may not show show a ST elevation and you have to go on labs results. Also important is what's the pt's PMH, previous cardiac conditions, med's given recently, most recent VS for the pt. cause the MD always asks when you call. My first week off orientation 7 months ago I had a pt. that just came from the cath lab, I drew the blood for labs at 8:30pm, and did a 12 lead EKG. EKG fine.The primary MD was in the room with me while I was doing the pt's admission and complete head to toe assessment. Pt. was fine. MD left the pt's room at 9:45pm. At 10pm pt began to have c/o CP, SOB, and a bursing sensation in the chest. The labs were not posted on the computer yet, I called the lab for the CK and trop. results, not ready yet, ok..I called the primary MD at 10:10pm to report s/s, the MD had just left the pt's bedside 25min ago, I figured since the primary MD was JUST at the HOSPITAL 25 min. ago that it would be appropriate to call him. The MD ripped into me, asked why I did't call a RRT, or call the house MD or tele resident. I explained that the House MD dosen;t cover him, the tele resident dosen;t cover him and I didn;t have the labs results b/c the lab was still processing them. The VS are stable, the EKG is Normal Sinus with no ST elevation. The MD hung up on me, I called a RRT just to get a MD to eval. the pt. Thank god the labs were WNL, no CK or trop. elevation. The next day I get to work, the same MD comes over and patts me on the back ans says great job with that pt. with a smile on his face. My Nurse manager pulls me aside and tells me that, that MD had went to the head of the Hosp. that morning and ******* and moand about how I called him. The MD wanted my license pulled, ect..I was devistated I was a brand new RN just off orientation for about 2 days and thought I was doing the RIGHT thing by calling the MD 25 min. after he saw the pt. ..the head of the Hosp. said to the MD, "YOu are the PRIMARY MD assigned to that pt. and according to the documentation by the RN and YOUR OWN MD notes, the RN was 100% correct by informing you about the pt". My Director and Manager backed me on this. This why I say NEVER doubt your self EVER, even when you feel like...should I tell the MD about XYZ..tell them, anyway. You can document you told the MD, and always call another MD even if it's a resident, to eval. the pt. I had a MD say to me one day, "Can you get me the REAL NURSE" I said to her, " I am the REAL NURSE, you see that RN in BIG BLACK LETTERS that hangs from my badge, that stands for REAL NURSE", she never gave be crap again. I wanted to say, "are you the maybe Doctor (MD), maybe I will come see the pt, maybe I will do this.." Hope I gave you some insight...keep up the great work!! YOu are a GREAT NURSE

[tampaflrn6]

That Doc was a jerk. I'm glad you still have your license.

[yellow finch, BSN, RN]

Holy cow. What kind of question is "did he have an MI?"????? That's not your decision. You did your part and he was just trying to be a jerk.

Don't feel like you did anything wrong. Just go on with your shifts and know that you followed protocol. I don't know any hospital that would change their policies to allow nurses to make medical diagnoses.

Jeesh.

Hang in there. Don't let this creep destroy your confidence.

[seabiscuitRN]

Do what's best for the patient. If a doctor or a coworker or whoever doesn't like it, that's not the point. You look out for the best interests of your patient and go home feeling good about the job you've done... Even if you think you sounded stupid on the phone :-)P

[Suninmyheart]

Definitely don't sweat it. I had a doc ask me the other day, in a crabby tone, why I didn't change the IV fluid order? I said "because I am not an MD".