Getting yelled at by a doctor for the first time....

[NewbieNurse93]

So, I've been a nurse for about 6 months now and have been off orientation since the end of October, so I'm still pretty new and still learning new things. Today, I had a doctor yell at me for the first time.

Long story short, the attending dr and the consulting dr both agreed to discharge my patient. However, none of them were able to write a pain script for discharge. When brought to the attention of the attending that rounded that day, he basically said, "oh, well, she'll just have to stay another night and then go home tomorrow. I'm home now and won't come in to write a script."

The patient was devastated and stated her frustration with this. She also lives hours away and told me about having to get her son back home so he can get back to school. As her advocate, I did my best to try to make her discharge happen, because I feel like staying another night for just a pain script is a pretty poor reason to have to stay. I had called a partner of the attending who was also rounding that day, but was not the "on-call" dr. I didn't think anything of this because this dr was rounding with the on-call dr that day, and made the mistake of thinking that he too was on-call for that group. He was more than happy to help discharge the patient. The patient was so happy and thankful that I was able to get her out that day and I felt good that I was able to help her and her son.

At at the end of my shift, I had received a call from the on-call dr who had called me just to yell at me over the phone about the patients discharge. He said things like "How DARE you go behind my back and call another dr!!!" and "you better NEVER let this happen again." I've never had anyone speak to me the way he did and I kind of froze on the phone. I apologized to him for any mistakes that I had made and he hung up on me.

Has as anyone else experienced this? How do you deal with this? I was feeling so good and finally starting to feel like I'm doing a good job at work, now I feel like a horrible nurse....

[MunoRN, RN]

You did nothing wrong, in places I've worked the MD who refused to fulfill their role as the covering provider would be removed as the patient's provider and reported for abandonment, if there was no other provider who could immediately take over then the patient would be discharged to the ED and assigned another primary provider.

[Crush]

You did just fine.

[Ambersmom, BSN, RN]

Doc was probably mad because his colleague probably called him on keeping a patient an extra night in hospital over a script.

One of the ways a mentor nurse told me years ago to handle these kinds of situations was to say, my job is to advocate for OUR patient, she did not want to spend another night (and lack of a pain script is not a medical reason to keep someone an extra day), and dr. x happened to be willing to write it.

Now, I would not have specifically paged a certain doctor, I would have called the answering service and whoever responded explained the situation. I think the only wrong here was paging the other doc directly-always go through proper channels. Hopefully this will be the last time this happens just remember doctors get diarrhea too.

[Ambersmom, BSN, RN]

Here in Florida, I believe most narcotic scripts need an actual signature on them and not a printed/stamped signature.

My state narcotic scripts can be sent from home to hospital but require a physical signature, and to complicate matters more narcotic prescriptions for patients in the bordering state where 50% of our patients come from cannot be signed by NP or PA, MD only. So in the case where we only have a NP to sign have to tell patient fill your prescription in this state before you go home.

[bugya90, ASN, BSN, LVN, RN]

Texas is also one of those states.

Not true. I am a clinic nurse in Texas currently. Narcotics can all be sent electronically (including Schedule II). There is secure app the provider must download on their phone and then when they put the Rx in the computer the app will generate a 4-6 digit code that they must type in to send it electronically. Typing in the code is basically the electronic version of signing it.

[AlwaysLearning247, BSN]

He was unprofessional and his ego sounds too big to deal with. A patient's discharge should not be held up over that, he should have gotten someone else to write the script for him. I would have told him the circumstances for the patient (driving hours, etc). I've had this happen before too but the doctor asked one of the other doctors to come to the floor to write the script, it was NBD. You don't have to take the abuse from him and if he tries to be like that again I would tell him he can't talk to you like that. Good luck, sorry that happened to you.

[OrganizedChaos, LVN]

Not true. I am a clinic nurse in Texas currently. Narcotics can all be sent electronically (including Schedule II). There is secure app the provider must download on their phone and then when they put the Rx in the computer the app will generate a 4-6 digit code that they must type in to send it electronically. Typing in the code is basically the electronic version of signing it.

I work in a hospital & every time someone is sent home with a narcotic they get a paper script.

[bugya90, ASN, BSN, LVN, RN]

I work in a hospital & every time someone is sent home with a narcotic they get a paper script.

Maybe your hospital just doesn't want to pay for the app service.

[Tenebrae, BSN, RN]

In Florida, narcotic scripts need an actual paper script -- they cannot be called in to the pharmacy, for example. The signature may be printed or stamped. At least, that has been my (rather limited) experience.

Non narc scripts are printed however narc scripts need to be written on a special three layer pad.

[DowntheRiver]

Interesting. In NYS paper scripts aren't used any more.

A lot of places do eScribe but certain medications, mostly narcotics, must be hand carried scripts. I was just given Soma for my back and I had to bring the actual signed Rx to the pharmacy. We have a HUGE narcotic problem in the surrounding areas so I understand why.

But, both my former employer (Urgent Cares) did not eScribe and all scripts were physical scripts so it isn't everywhere but most places.

[DowntheRiver]

My state narcotic scripts can be sent from home to hospital but require a physical signature, and to complicate matters more narcotic prescriptions for patients in the bordering state where 50% of our patients come from cannot be signed by NP or PA, MD only. So in the case where we only have a NP to sign have to tell patient fill your prescription in this state before you go home.

Well, that's insane. Silly policy, but I'm glad y'all are well informed to be able to tell your patients that.

[Axgrinder]

It's amazing how free MD's feel with their unvarnished opinions, screaming it from the rooftops, while we nurses are cowed enough to apologize to avoid a verbal brawl. I've noticed men (although not exempt from getting reamed) are on the receiving end far less than women. Hmmm ...

I've often wondered if manners are stripped away in medical school (How To Be An orifice 101). I guess you've never had to pleasure of witnessing a MD throw objects yet (charts, chairs, telephones, etc)?

I'm sorry this happened to you - it won't be the last time, sadly.