Dr makes me feel so incompetent?

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Davey Do

10,476 Posts

Specializes in Psych (25 years), Medical (15 years).
Usually when something like this happens, I reflect on my actions, look up information, and think about what I would next time (sometimes I talk to a trusted RN coworker). After that I just move on. Doctors get snarky for a range of reasons. I don't let their attitudes affect how I think about myself.

Very succinctly and well said, umbdude!

To put a technique into practice provides opportunity for possible improvement!

LovingLife123

1,592 Posts

Eh, I had a doc get crappy with me for calling him over an ABG the other day. My pt had scheduled ABGs. If it was a normal one I would not have called, but my pt was getting acidic and needed a change in vent settings. I had to listen to why this was so stupid. I was like, well it's ordered so I did it. The results were way different from 6 hours ago. I need you to treat it.

Honestly, I think physicians think we like making extra work for ourselves. I know I don't. But I'm a patient advocate. If you don't like it, take it up with your fellow colleagues is my opinion. I doing what's safest for my pt.

I would like to check WNL on all my boxes and not do labs or tests and not have to assess my pt extra and leave on time every shift. That's what I would love. Stable, normal patients. Unfortunately they are in the icu because they are abnormal and sick.

Specializes in PCCN.

I've had some w/d pts in the past, and they like to give clonidine for anxiety as opposed to a benzo which they refuse to write for. Just like they give gabapentin for pain now (roll-eyes)

We assume it's a b/p med. maybe that's why the doc gave a smart ass answer (why, did I write parameters ?)

I'll tell you one thing though about clonidine, they shouldn't be suddenly cut off of it if they have been on it for a long time-the rebound hypertension is a bear!

Specializes in PCCN.

Also, did I read that right that the oncall doc charges 150 bucks just to take the call for their pt?????is this the norm ???

SmilingBluEyes

20,964 Posts

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Clonidine for withdrawals or Klonopin? Cause it would seem to me a person would have anxiety and withdrawal symptoms and need KLONOPIN for those symptoms more. I am just confused here.

Davey Do

10,476 Posts

Specializes in Psych (25 years), Medical (15 years).
Clonidine for withdrawals or Klonopin?

Both are used for alcohol withdrawal.

However the better choice of a benzo for alcohol withdrawal is oxepam (Serax) because it's chiefly metabolized through the kidneys. The other benzos are chiefly metabolized, like alcohol, through the liver.

Orion81RN

962 Posts

You did exactly what we are trained to do, and your thinking isn't incompetent. It's safe. The Dr was probably just pissed because you're making them actually do their job. If the pressure was low and you gave the drug and they had a brain injury or some untoward outcome because of poor perfusion to the brain, you'd be liable, and the lawyers would be asking you 5 yrs later why you didn't check and document a BP. Having done a deposition, I can tell you the lawyers will pick apart your charting looking for whatever they can to demonstrate inadequate care and failure to go up the chain of command. You did the right thing. Screw that Dr. - they'll be the one hung out to dry if you've dotted your I's and crossed your T's in your charting. Keep up the good work. Check BP's and blood sugars before giving meds, ask for parameters to be added if none exist in the BP med orders. If a drug is ordered PRN for an off-label diagnosis, like withdrawal and clonidine, but it would be inappropriate because the pressure is low, call and ask for something else, or ask for a parameter to be added for BP. I've had to do this before for clonidine and withdrawal but the person's BP was too low to comfortably give it. It's critical thinking and it sounds like you're using yours. It's why robots don't do this job. There needs to be a brain working and making critical decisions of appropriateness. Just cuz something is ordered doesn't mean it will be appropriate all the time. Use the on-call. It's what they're paid for. If they don't want to answer the phone, they shouldn't agree to take the on-call shift.

I'm standing and clapping in my head.

Orion81RN

962 Posts

Clonidine for withdrawals or Klonopin? Cause it would seem to me a person would have anxiety and withdrawal symptoms and need KLONOPIN for those symptoms more. I am just confused here.

It's definitely clonidine as OP stated 0.1 mg. Both clonidine and Klonopin are often used together for alcohol withdrawal. For opiod withdrawal it is a good option being that it acts to suppress the activity of the sympathetic nervous system, which does help anxiety. It is a great benefit in that it isn't a controlled substance, as it's being given to people with addictions issues as is.

I'm curious to know if this patient's elevated BP is due to withdrawals or pre-existing HTN.

Since this med is for his withdrawals, I'm guessing the doctor was annoyed that his BP was a big focus. Doctors just won't ever understand our liability as nurses. They don't seem to want to relinquish certain aspects of control, yet many of them get in a hissy fit when we are legally required to call them.

What does that doctor think the nurses are there for? Babysitting? Hmmm let's see...why would we need a nurse in the rehab setting. Could it possibly be to monitor their withdrawals by using our nursing knowledge which includes knowing when to take a v/s and when to update the doc???

OP, I want to say NEVER let anyone make you feel incompetent. But, I have my own issues with feeling the same, so...

Bumex, DNP, NP

1 Article; 384 Posts

Specializes in Assistant Professor, Nephrology, Internal Medicine.

Just for some clarity, OP, we all felt 'stupid' as new nurses.

allnurses Guide

hppygr8ful, ASN, RN, EMT-I

4 Articles; 5,049 Posts

Specializes in Psych, Addictions, SOL (Student of Life).

You did nothing wrong so relax but I would like to go out on an existential limb for a minute and tell you that a Doctor, co-worker etc... cannot make you feel anything including incompetent. You lack experience and so fear you may be incompetent. You feelings of competency will increase with your experience and in time the feeling of incompetence will go away. You are the master of what you feel. So master your feelings.

Hppy

Specializes in Med Surg.
This exactly what makes me hate nursing. I'm so tired of feeling so incompetent.

I thought I was being an advocate for my patient.

But guess not.

There are many ways to advocate for your patient.

In this case, consulting with more experienced nurses would have helped you a great deal. Because they might have said, "If the patient is asymptomatic, don't call the MD - because what do you want them to do about it? - You should continue to monitor the patient."

Had you done this, the patient's BP would have normalized under your careful guidance and the MD would not be annoyed at you.

I think it was a mistake to call the MD in this situation. Sure the MD could and should have been nicer, but that's the way it goes.

I would also advise you lose the "poor me" attitude.

Good luck!

JKL33

6,777 Posts

You did the right thing.

Is it possible the doc was genuinely trying to get info? For example: is it possible "why did you recheck the bp?" Meant "Is there anything else I need to know about this pt? Did you recheck because the pt had new symptoms? Or are you calling because of parameters only?

Was there something I'm missing (eg tone) that made you feel belittled?

It's natural to be insecure when we're new. And when we're insecure we tend to imagine that people are pointing out flaws when they might just be trying to get information.

My advice is to keep doing everything you're doing clinically and to cut yourself and the doc a break. If a doc says something that you perceive to be rude, try saying "I don't understand your question." Give doc a chance to state it a different way before you allow yourself to feel belittled.

I like this reply a lot.

Frankly I didn't think there was enough info in the OP to understand the finer points of what happened. So, who knows. If I had to guess based only what is in the OP, I would think it was a clarifying question; there is a bit to be clarified from this presentation, such as the OP rationale for concern.

There is a lot of unnecessary perpetuating of discord in some of these replies.

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