Grateful but discontent

jadelpn, LPN, EMT-B · Mar 22, 2014

This does sound very frustrating. The only thing you can make sure that you do, is cover yourself and document, as in most facilities, if you don't document, it was "not done". "Shift assessment completed, plan of care reviewed"."MD made aware of whatever lab result. No new orders". "Discussion with MD on plan of care, advised of no changes to plan at this time".

Be mindful of your charting policies, however, the best thing you can do for yourself is to be very thorough in your documentation.

BigBluemadness · Mar 22, 2014

Thanks for the reply! I do document all pages/comm. with docs. I actually had one doc ask me not to document "no response from doc". I always just documents verbal orders/ orders to be wrote/ no orders. But obviously someone document a little more accurately, and maybe unprofessionally.

Retired APRN, MSN, RN, APRN · Mar 22, 2014

There may be cases in which documenting "no response from doc" is important to the preservation of your license. There are ways to document that are tactful but honest and keep you covered. Depends on the situation.

jadelpn, LPN, EMT-B · Mar 22, 2014

I am not sure I would document "no response from doc" however, "no changes in plan of care" or "no new orders" is perhaps more appopriate.

If a doc says to you "don't document no response"....."Well then, ARE you going to respond?"

Here's the thing, if you are seeing that a patient is crumping, has drastic changes in condition, whatever it is that makes you think that a patient is not being adaquetely followed, family members notice too. As do other nurses, and other disciplines. If you do not document that the MD was notified, and the resulting intervention, or no intervention, it looks as if you either saw it and ignored it, or you did not see it at all.

And it is interesting how selective amnesia can come into play when MD's are confronted about being notified about anything.....

Oh, and to cover yourself, you may want to look into a get some malpractice insurance. Good thing to have.

Gabby-RN · Mar 22, 2014

I do not think it is appropriate to chart no response from doctor. It is appropriate to chart MD Smith notified at 1800 patients heart rate elevated to 120's, temp 101, BP 99/56, patient increasingly lethargic, skin pale, recent labs show increase in wbc from xx to xx on xx/xx/xx. Pt reports ____ symptoms. Per MD Smith, no new orders at this time. Care plan updated to reflect q2h vitals, neuro checks, i&o monitoring or whatever nursing interventions you wish to implement. Pt encouraged to cough, deep breathe, report xx symptoms, will continue to monitor.

Never be afraid to ask the doctor for their rationale. Most doctors will appreciate you wanting to learn. If you think someone is going septic say that if they disagree ask why (nicely of course). I'm concerned Mr Smith could be septic because I have observed the following, he has a fever, his blood pressure is lower than it normally is and his heart rate has been faster than normal. He did not have labs today but yesterdays labs showed that his wbc's were increasing. He also has been more lethargic than usual and respiratory reported to me that he has needed more frequent suctioning and was only able to wean from the vent for half the time he usually does. Would you like me to put in orders for a chest xray, labs, blood cultures, send out a urine sample? If the doctor says no ask what their reasoning is? "I'm glad you don't think the patient is septic, what do you think the cause is for these changes? The patients daughter will be in and always asks for an update. Maybe the doctor will still blow you off but maybe they wont. At the very least they will know you are on top of the patient and them lol.

I have found that sounding confident and having all the information available especially when calling the doctor on the phone helps. You are their eyes and ears. If they are confident you did a thorough assessment and are giving them the full picture they are more likely to give you verbal orders. If you call them with vague info that could be any number of things and would require them to come and do their own assessment the. They are less likely to give verbal/phone orders.

It sounds like you are a good nurse and trying to look out for your patients.

Retired APRN, MSN, RN, APRN · Mar 23, 2014

I definitely would not chart "per MD Smith, no new orders at this time" if she didn't respond. There is a huge difference between no response and "no new orders".

"No response", at least to my ears, means that Smith did not answer the page or call back or whatever the arrangement is. As I mentioned above, there are ways to chart "no response" more tactfully. One such way would be "Dr. Smith paged" or "phone message left for Dr. Smith" with no further comment.

uRNmyway, ASN, RN · Mar 23, 2014

Thanks for the reply! I do document all pages/comm. with docs. I actually had one doc ask me not to document "no response from doc". I always just documents verbal orders/ orders to be wrote/ no orders. But obviously someone document a little more accurately and maybe unprofessionally.[/quote']
I've been given grief for the whole 'No new orders' thing. So I'll document that I notified such-and-such, 'see orders'. Lol. Maybe a little passive-aggressive, but eh.

Gabby-RN · Mar 23, 2014

I definitely would not chart "per MD Smith no new orders at this time" if she didn't respond. There is a huge difference between no response and "no new orders". "No response", at least to my ears, means that Smith did not answer the page or call back or whatever the arrangement is. As I mentioned above, there are ways to chart "no response" more tactfully. One such way would be "Dr. Smith paged" or "phone message left for Dr. Smith" with no further comment.[/quote']
I wasn't reading it as the doc didn't return the page, sorry. In that case I would chat MD paged at xxtime regarding xx, awaiting callback at this time.