Absolutely! Some of the doctors especially the new young doctors think they are hot shots with god complexes.
Just the other day we had a new patient come to the floor after spending a couple of days in the ICU for a skull fracture and swelling on her brain due skateboarding without a helmet on. Luckily she didn't need surgery, decadron brought the swelling down on it's own. So she was stable enough to come to the Neurology/Neurosurgery floor. But we had to get her orders changed, in the ICU she had a PCA of dilaudid, was given ativan 1mg IVP for agitation and to prevent seizures, 4mgs IVP of decadron to prevent swelling, Ambien to help sleep and flexeril TID due to muscle spasms in her neck. When a patient comes to us from the NSICU or MICU they come down with the PCA and it's up to US to D/C it. Then we get the rest of the orders that the patient was getting changed/adjusted. But for some reason the ICU D/Cd the PCA themselves, which in my opinion was odd.
We have a BRAND new doctor on our floor that transferred from another hospital in Manhattan. He had just finished his residency and was now a new attending on our floor. He was young, cocky, full of himself(though that I will give to him..he is a very good looking guy). But I despised when we were both working at the same time. He just LOVED looking down on the nurses and especially the patient care associates, he treated them like they were his personal servants always asking them to go out and fetch him coffee(but NOT hospital coffee it had to be from starbucks) and order him lunch, meanwhile WE need the patient care associates to take care of the patients.
So I really had no choice but to go to this doctor get this patients orders put in ASAP, the rest of the stuff could wait a little while but she needed pain medication right away. So the doctor said HE would take a look at her chart and decide what she was to have. I pleaded with him that she needed pain medication, she was tacky and are BP was on the rise. Finally he gave in and put in the orders for 1mg of morphine IVP every 3 hours. REALLY? A skull fracture and brain swelling and this DR thought 1mg of morphine was going to control her pain? After being on a PCA of dilaudid .5mgs bolus every 6 minutes with a basal rate of .4mgs. So I just agreed to disagree and went and got the morphine for her, I pushed it and told her I would be back in 15 minutes to see if her pain was any better. I went out and called the Pain Service to come take a look at this patient. So I went back in my patients room after 20 minutes to see if her pain was better. I didn't even have to ask. The look on her face and tears running down on her face said it all. By that time the doctor put her new orders in and I was completely flabbergasted. He stopped the ativan all together, changed the ambien from 10mgs to 5mgs and the flexeril she had been getting and responded well to had been changed to skelaxin BID. The Decadron orders stayed the same 4mgs IVP and he also added toradol 15mgs every 6 hours(how big of him). As a nurse I am a big advocate of toradol, its a really good medication, but this patient needed a higher dose of narcotics. I went and got the toradol and skelaxin for my patient to maybe help take the edge off her pain until pain service came.
20 minutes later my favorite pain service doctor came up to access my patient so I knew she would be in good hands. First he looked at her chart orders and what she was getting in the ICU and what she was in for. So he went in and saw my patient and changed all of her orders.
Her new orders were: 6mgs of morphine IVP every 2 hours around the clock. .5mgs of ativan IVP PRN, Toradol 30mgs every 6 hours, Flexeril 10mgs TID, Ambien 10mgs at bedtime and 15mgs of Oxycodone PO PRN for BTP. The decadron stayed the same. MUCH better than DR "Sting's" orders. I talked to the pain service doctor and he said the plan was to keep these orders in for about two days and then to try to transfer all of her meds to PO and see how she does..if she does well then she would be discharged home on these medications. He said someone from pain service would be back later to see how she was handling the new orders and if for some reason the patient was still uncomfortable than to page him and he would come back up. He knew what she was getting in the ICU and after getting a decent dose of pain medication in the ICU there was no way in hell 1mg of morphine was going to be like water going into her IV(hence the reason I paged pain service)
After the order went through, I went in to talk to my patient, explained her new orders, gave her the 6mgs of morphine as well as the ativan. I also explained to her if she was having pain breaking through the morphine that she had an order for 15mgs of oxycodone but she had to ask for it. I asked her if she had any questions and she said no and she said that the new dosage of morphine plus the ativan made her feel a bit better, I explained it had been only a few minutes since I gave her the medications and she had to give it a little while to kick in. I also told her not to be afraid to ask for the oxycodone...but only if she REALLY felt like she needed it. I told her I was going to lunch for an hour and another nurse would be covering for me and if she needed anything to just ring the call bell.
So I went to lunch and came back and Dr "Stingy" was waiting at the nurses station for me. Oh boy he chewed me out as if I did something negligent and killed a patient. He said "HOW DARE I GO OVER HIS HEAD AND CALL PAIN MANAGEMENT WITHOUT ASKING HIM FIRST!" Actually we don't need an MD's permission to page pain service. "MY ORDERS WERE SUFFICIENT!" I respectfully disagreed and told him the patient was still in a lot of pain and going from that amount of medication in a PCA to 1mg of morphine was not going to cover her pain at all. "Oh so your a doctor now?" he asked me."You better keep narcan standing by because I guarantee this patient is going to need it!" I just walked away. He knew I was right and he was ticked off that pain service was called because once they get involved(they are part of the anesthesia team) no one can change their orders but them...and zofran and narcan are standing orders on any patients receiving decent amounts of opiates.
Perfect example of a brand new doctor thinking he is a hot shot, being sadistic(in my opinion) with his orders, let alone chewing me out at the nurses station in front of my colleagues, patients and their families. I have a steel spine so I wasn't embarrassed at all, which made this doctor even madder. What kind of a doctor gets off on embarrassing and belittling nurses?