frustrating doctor

Virgo_RN, BSN, RN · Aug 30, 2009

I would think that if she didn't have any pain at the time of the catheter removal, the chances of her having pain related to the removal of the catheter later on would be very small.

Straydandelion · Aug 30, 2009

I doubt she was in pain if not showing any HOWEVER I hope she has something ordered for pain if needed, as a prn..this would help the family member be relieved she would be well taken care of if the event arises.

al7139, ASN, RN · Aug 30, 2009

HI, sounds like 4 issues here:

1. The family is assuming there is pain with the procedure and asks that you give tylenol prn. Fine, but if it is not needed, don't give it just to humor the patient.

2. You checked the MAR and there was NO order for tylenol for pain and called the doc for one. Yes, you were right to call, but do not assume every doc is going to order what you want or be nice. I hate to say it (because it will probably open up a whole can of worms), but get a thicker skin. Your doc may have had a bad day, or just be a jerk. Either way, just document and move on. Don't take it personally. You asked for orders, he or she did not give you any. I learned very quickly how to approach the MD's I work with. Each one is unique, and has a different way of doing things. as long as I document, I am OK.

3. BUT it sounds like the bigger issue is that a nurse on a previous shift gave a med (Tylenol) to this patient without an order for a headache. This is a major boo-boo if they really did that for one reason that brings me to

4. Unless there is an order for a med, it should NEVER be given. Either the previous nurse lied to the family or she gave a med that was not ordered for that patient...either way a CRITICAL med error (it sounds silly with an OTC like Tylenol) any nurse who gives an unauthorized med or lies could lose their lisence to practice.

Don't let it happen to you.

Amy

Virgo_RN, BSN, RN · Aug 30, 2009

HI, sounds like 4 issues here:
4. Unless there is an order for a med, it should NEVER be given. Either the previous nurse lied to the family or she gave a med that was not ordered for that patient...either way a CRITICAL med error (it sounds silly with an OTC like Tylenol) any nurse who gives an unauthorized med or lies could lose their lisence to practice.
Don't let it happen to you.
Amy

Or, the previous nurse took a telephone order and forgot to write it in the chart.

lwalk1963 · Aug 30, 2009

HI, sounds like 4 issues here:
1. The family is assuming there is pain with the procedure and asks that you give tylenol prn. Fine, but if it is not needed, don't give it just to humor the patient.
2. You checked the MAR and there was NO order for tylenol for pain and called the doc for one. Yes, you were right to call, but do not assume every doc is going to order what you want or be nice. I hate to say it (because it will probably open up a whole can of worms), but get a thicker skin. Your doc may have had a bad day, or just be a jerk. Either way, just document and move on. Don't take it personally. You asked for orders, he or she did not give you any. I learned very quickly how to approach the MD's I work with. Each one is unique, and has a different way of doing things. as long as I document, I am OK.
3. BUT it sounds like the bigger issue is that a nurse on a previous shift gave a med (Tylenol) to this patient without an order for a headache. This is a major boo-boo if they really did that for one reason that brings me to
4. Unless there is an order for a med, it should NEVER be given. Either the previous nurse lied to the family or she gave a med that was not ordered for that patient...either way a CRITICAL med error (it sounds silly with an OTC like Tylenol) any nurse who gives an unauthorized med or lies could lose their lisence to practice.
Don't let it happen to you.
Amy

The family could of lied also!! Families often lie to get what "they want". Who are we to say if the patient hurts or not? The patient should always be assessed!!!

lwalk1963 · Aug 30, 2009

I took care of a alert and confused, non-verbal, CVA pt recently who was a DNR on HD and she was in for sepsis, needed to have her Tesio removed. One of the surgeons removed it in her room. Pt's family member had been notified that the procedure had been done, and family member asked me over the phone if I would give the pt some Tylenol if she needed it for pain, because previous shift RN had given her some for a headache. Pt had no c/o pain at the time of the removal. I checked out the MAR and found she didn't have an order for the Tylenol, so I told family I would call for one and if she had any pain later, we would give it to her.
Called MD who usually barks the order into the phone and hangs up on me. This time ha told me, "the procedure that pt had done was not a painful procedure, she doesn't need any Tylenol." and then hangs up on me:banghead:
"Since I have never had a Tesio removed, I would like to know if it is painful or not.....Thanks,
Rebecca

" Always assess the patient. What might be painful for one is not for the other.

tencat · Aug 30, 2009

It's Tylenol, for heaven's sake. What harm is there in getting an order for Tylenol???? It's too bad your facility doesn't have standing orders for such things. It is perfectly reasonable to request Tylenol for possible pain control. It's not like the family was asking for morphine. And it's perfectly reasonable to fulfill the request from the family members to have it available just in case. In fact, I think it's UN-reasonable for the doctor to dismiss the request, unless of course the patient has severe liver issues or other medical reason NOT to have Tylenol.

Just re-read the post. She's non-verbal???? Good heavens, of COURSE there should be an order for some pain medication just in case. If she can't tell you, it's better to err on the side of caution and give her something if the family or you think that there's a possibility she's in pain. Tylenol is benign enough, and if it works, great.

tlburnsrnbsn · Aug 30, 2009

You did nothing wrong in being an advocate for your patient. I agree with the other nurse, do not take it personal and move on. Feel good that you did what you could to be an advocate for your patient. yeah, too bad there is not a standing order for this MD on your floor for tylenol, etc.

PostOpPrincess, BSN, RN · Aug 30, 2009

For a doctor to have issues with just giving Tylenol--that's so annoying.

Since I work with many post-op patients, I wouldn't assume ANYTHING done wouldn't involve pain.

Anytime you intervene on someone's physical body, there is bound to be some sort of inflammatory response at the interventional site--whether it is a little or a lot...that would be hard to assume...It irks me greatly when surgeons say that to me, and I respond (tactfully) that "it's the patient's body, how would they know?" After their initial surprise at my assertion, they don't argue and often order something. That assertiveness comes with time and experience. You will learn.

Whenever I don't get what I need from one doc, I go to another...try that next time? As for the doc, never mind him. He's not important. You did right for your patient and that is what counts.