Dr makes me feel so incompetent?

  1. I was giving a patient 0.1 mg of clonidine. I checked his bp prior and it was 154/101 rechecked it after clonidine it was 178/112. I called the MD. She didn't call back until later, he had no other s&s of stroke of anything abnormal. So about time she called it was 135/89.
    Her : why are you checking his bp?
    Me: He has an order for clonidine
    Her:So why are you checking it? does it have parameters?

    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.
  2. Visit mzsuccess profile page

    About mzsuccess

    Joined: Oct '12; Posts: 355; Likes: 140

    47 Comments

  3. by   Penelope_Pitstop
    You did nothing incorrectly. While the argument may be that people don't check their blood pressures prior to every routine dose of anti-hypertensive at home, the fact remains that in an acute care setting, nothing is "routine."

    Had the reverse been true, and you hadn't checked the BP but the person's pressure later tanked, you'd have an unstable patient and the opposite question from the doc - "why DIDN'T you check his pressure?"

    I always checked BP prior to anti-hypertensive meds when I worked in the hospital.

    Oh, and that physician is not your supervisor nor does she sign your paycheck, so don't worry about her opinion. Document the conversation and continue assessing your patients thoroughly.
  4. by   mzsuccess
    Quote from Penelope_Pitstop
    You did nothing incorrectly. While the argument may be that people don't check their blood pressures prior to every routine dose of anti-hypertensive at home, the fact remains that in an acute care setting, nothing is "routine."

    Had the reverse been true, and you hadn't checked the BP but the person's pressure later tanked, you'd have an unstable patient and the opposite question from the doc - "why DIDN'T you check his pressure?"

    I always checked BP prior to anti-hypertensive meds when I worked in the hospital.

    Oh, and that physician is not your supervisor nor does she sign your paycheck, so don't worry about her opinion. Document the conversation and continue assessing your patients thoroughly.
    I just feel so stupid as a new nurse. You think you're doing the right thing and then get belittle. I'm working in an drug addiction place and its just so tough. Because the other nurses don't seem to care. They tell me not to call on call but when I'm stuck I need to speak to someone. I know he has HTN but still in school we were always taught to check their bp. Plus I just started and she communicates with my boss so I'd hate for her to tell him something to the fact that I'm incompetent and the oncall phone charges $150. Sorry just had to vent
  5. by   Sour Lemon
    Quote from mzsuccess
    I was giving a patient 0.1 mg of clonidine. I checked his bp prior and it was 154/101 rechecked it after clonidine it was 178/112. I called the MD. She didn't call back until later, he had no other s&s of stroke of anything abnormal. So about time she called it was 135/89.
    Her : why are you checking his bp?
    Me: He has an order for clonidine
    Her:So why are you checking it? does it have parameters?

    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.
    It's fairly uncommon to recheck blood pressure after scheduled medication, at least from what I've seen. Was the clonidine a PRN? If it was and it was ineffective, that might have been a good reason to call. I would have given it time to peak first, though.
    In any case, I wouldn't say you're incompetent. You might be a little more cautious than most, but it's better to err on the side of caution if you're going to err. I would have been tempted to tell her I checked it because there was nothing good on TV.
  6. by   mzsuccess
    Yes it was prn but for withdrawals. But I gave it for his bp as well because it was no other orders .
  7. by   mzsuccess
    Quote from Sour Lemon
    It's fairly uncommon to recheck blood pressure after scheduled medication, at least from what I've seen. Was the clonidine a PRN? If it was and it was ineffective, that might have been a good reason to call. I would have given it time to peak first, though.
    In any case, I wouldn't say you're incompetent. You might be a little more cautious than most, but it's better to err on the side of caution if you're going to err. I would have been tempted to tell her I checked it because there was nothing good on TV.
    So I made a big deal out of nothing? I'm sure I sounded like the new idiot nurse.
  8. by   PaxDeo
    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.
    Last edit by PaxDeo on Jul 7
  9. by   Horseshoe
    If you give a PRN drug for hypertension, it would be negligent of you to not follow up and take the patient's blood pressure to assess the effectiveness of your intervention. This is standard practice. If you gave a PRN med for pain, you'd follow up to see if the patient's pain had decreased; if you gave a PRN for anxiety, you'd follow up on that.
  10. by   Crush
    I routinely float to a substance abuse unit and we always check the BP before giving clonidine whether there are parameters or not. Sometimes if there is a concern or the BP was unusually high, yes, we may do a recheck of the vitals after an hour than call the MD as needed. You did right. You are not an idiot new nurse. Always better safe than sorry, always. This is your license that you worked hard for and this is your patient that you are protecting and advocating for. As someone else mentioned patient's may not always check their BP at home before their antihypertensives but in the facility, they are under our care. Your thought process is not incompetent.
  11. by   JBudd
    If it was ordered for withdrawal, not just HTN, of course you would notify the MD about it. You didn't say how long you waited to take the 2nd reading. If after the peak time it was still high, definitely the phone call.

    If you figured the increased BP was part of withdrawal (and it often is, more so than "stroke sxs"), then it is appropriate to give, but no call needed, just good documentation that it was effective.

    Honestly, I wouldn't likely have called right away. BUT, you are new, you are covering your bases, and when a doc gets snippy all you have to say is "I'm just be careful and double checking with you". Does that doc seriously get paid $150 just for answering the phone. JEEMANEEZ!
  12. by   Ddestiny
    There are ***hole doctors just like there are ***hole lawyers, cops, accountants, etc.
    Some of those doctors show their ***hole-ness when nurses call them because they don't like dealing with that aspect of their job. Apparently.
    In the beginning we nurses tend to internalize it as a problem with US, when really it is a symptom of the physician's attitude. Over time, as you realize this, it helps you to be less worried about the attitude you receive when you call. Some ***hole types like to feed on the nervousness/feeling of incompetence that is natural when you're new to your field. It doesn't help that nursing school builds up calls to the doctor like some kind of conversation with God (eyeball roll). The best advice you can get -- and it will be hard to hear right now -- is to let that crap roll off your back.

    After you spend some time with physicians that are actually invested in making their hospital/unit succeed, you'll see the difference in how they talk to you. These physicians want to teach the nurses with which they work and will give insight for how to handle similar situations in the future rather than just berating you. After you experience that, you'll no longer give credence to the ***hole physicians' nastiness.

    Part of being a new nurse is making more phone calls than is probably necessary. From what you say, this phone call was appropriate. Not all calls are. I was precepting a new RN a couple weeks ago and he had to call a physician 5 times in one day. The initial couple of calls were updates and to get further orders (this is an ICU so things change quickly) but several of the calls were to clarify information that he didn't know to ask for initially ("So, that order for weight-based IV heparin...we have 3 weight-based protocols, which one did you want?" kind of stuff). He felt silly having to do this but it's just part of learning. The physician was kind about it because he knows he will be working side-by-side with this nurse as long as he is in our unit and it doesn't make sense to strain relationships over a few extra phone calls.

    The first year after nursing school is hard. Accept that it's hard, lean into the discomfort, and don't let anyone make you feel inferior for asking questions and advocating for your patients. Its the new RNs that don't ask questions and/or that are apathetic that really are scary.
  13. by   caffeinatednurse
    Was it a scheduled dose or a PRN dose?

    I understand checking the BP prior to a scheduled dose, but we don't commonly recheck the BP a certain time after the dose. What usually happens on my unit is: I check the BP @2100, I give the pt their scheduled dose of BP medicine. Then I recheck their VS @2330 because their Q4HR VS are due. The only time I would recheck their BP earlier than that is if it was unusually high.

    If it's a PRN dose, what are the parameters? Our providers typically write out parameters such as, "give PRN dose of clonidine 0.1mg for systolic >170 or diastolic >100. Hold for diastolic <70." So then the nurse knows at one point they can administer this medication, and if their BP happens to be 182/65, to call the MD for an alternative order. MOST of our providers would laugh if we rechecked the BP after an hour and called them back - most BP meds don't work that quickly, unless we're pushing them through an IV.

    I'm not trying to make excuses for this provider. I'm sure they were quite snippy with you, and many times, providers do this for no reason at all. But they also receive a lot of phone calls when they're on-call, and I find it helpful to think about this before I pick up the phone and call them. When in doubt, I run it by my CN and pick her brain. A simple, "would you do this?" can save you and the doctor a lot of time.
    Last edit by caffeinatednurse on Jul 8
  14. by   Kallie3006
    Quote from Ddestiny

    The first year after nursing school is hard. Accept that it's hard, lean into the discomfort, and don't let anyone make you feel inferior for asking questions and advocating for your patients. Its the new RNs that don't ask questions and/or that are apathetic that really are scary.
    This right here.....AMEN!!!

    OP, at the end of the day it is your license you are working on and you will be the only one willing to go through h*ll and back to defend it.

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