I got written up by a surgeon for contacting the primary medical practice instead of the surgical practice. The pt is okay, no bad outcome. I talked to my charge nurse and another more senior nurse who takes charge several nights a week to get their input on which to call; both suggested I call the primary.
I'm new, only licensed 6 mos. This is my first time getting written up, and I'm dwelling on it heavily. I even had a dream in which the surgeon asked me, "Why did you call Dr. X instead of me??" I need to let this go!
This happens, right? We pick ourselves up and learn from it and go on, right?
I'd like someone to tell me that getting written up is just part of the job and that I shouldn't let it eat at me.
you will probably get written up over petty stuff many times in your career. Don't take it to heart unless it involves the direct care of a patient. Some people just like the power of a pen.
Because I'm interested in what's going on in all aspect of healthcare - not only to understand what my colleagues are dealing with, but also the topics and issues that are important to them. This is why I visit various forums - to learn and understand, and sometimes to give my input.
You are correct in that I'm not a nurse or a nursing student. However, I do believe I'm not violating any TOS agreement. But if this board wishes to make this site exclusive for nurses, nursing students, and pre-nursing students ... then I'll abide by its decision and leave (it is your board, I'm just a visitor). But I still stand by my advice - retaliating is never an option and is "childish". It just exacerbates any animosity and can potentially turn a small fire into a conflagration.
Forgive me, but you don't know enough to have an opinion here. Are you perhaps, an MD student? You have the arrogance down pat.
But if a doc wants to make an issue of the decisions I make in order to AVOID waking him/her up, then that doc cannot expect the luxury of sleep when those very decisions were designed to protect that sleep. A doc simply can't have it both ways.
It is an issue of respect. If a doc doesn't respect my judgment, that is fine. But it's not simply payback to then defer all those judgments to him/her.
A doc simply can't have it both ways.
And as far as a pt maybe suffering because a doc thinks the nurses are crying 'wolf' . . . If the doc doesn't trust us to watch the sheep, then I will call for every rustle of the leaves. But if he doesn't answer promptly to investigate, well he is a link in a chain of command. And I don't have any problem immediately calling his chief of staff to handle things for him, if necessary.
~faith,
Timothy.
EXACTLY! In the case of a floor nurse who is responsible for 6-8 or more patients, if appropriate nursing judgement is not going to be recognized this could easily translate into calls every 10 minutes.
Yes, true, and the pt was admitted by the surgeon, so that's probably where I went wrong. However, that surgeon was not on call that night, nor was the pt's primary. I had the choice of talking to two different doctors who had not seen the pt as far as I could tell from progress notes and from orders. Plus, the primary practice had been writing orders/notes on the pt, as the surgeon had. Anyway, probably best to call the surgeon. Anyway. Live and learn. Thank goodness the pt is okay, and I did call someone. So it goes.
I am a new grad as well, and from someone who has been there... move on it happens. In this situation I would have called the *on call* surgeon Not the primary or the "orignal" surgeon, Thats why they have on call rotations. To allow everyone to have their sleepFULL nights. :zzzzz
Generally, on our unit if threr is uncontrolled n/v in fresh post op bowel, Doc wants an NGT now. Out of curiosity is that what the primary ordered?
EXACTLY! In the case of a floor nurse who is responsible for 6-8 or more patients, if appropriate nursing judgement is not going to be recognized this could easily translate into calls every 10 minutes.
Please tell me... where would WE ever find time to phone the Doc every 10 minutes? But if the Doc has not written PRN orders, :angryfire Thus in my opinion not respecting nursing judgement, then yes I would call them for everything, including plain Tylenol for a headache. If the PRN orders are adequate and the patient is stable I never have to call them.:) And they get to sleep.
Please tell me... where would WE ever find time to phone the Doc every 10 minutes? But if the Doc has not written PRN orders, :angryfire Thus in my opinion not respecting nursing judgement, then yes I would call them for everything, including plain Tylenol for a headache. If the PRN orders are adequate and the patient is stable I never have to call them.:) And they get to sleep.
My post, and others, referred to situations where nursing judgement does not seem to be respected.
I'm fortunate in this respect that my current work environment in the ER - I'm working side by side with the MDs. If a patient's PCP needs to be contacted, our ER docs do that after they have sufficient info from labs, test results, etc.
For you nurses on various inpatient units -- here's wishing you stable patients and PRN orders a-plenty.
This was and is a learning experience for you. The bad news is that the nurse/MD industry is so full of opinions and what one should and should not do, to call or not call and who to call???? This won't be the last time this happens and I would not let it get you down.
I am a newer nurse of only 2 years and I called the wrong oncall MD today because the charge told me the wrong name of the covering MD. In my situation I hunted down the right MD after waiting 2 hours for a return call from him.
One thing that I do is in any situation I call the main MD and then I state the issue with a standard answer every time of "I am passing this information so that you are aware of this patients current plan of care". Then, I always ask "is there another MD on this case that you would like for me to share this information with?" Then document it regardless of his answer. Some of the MD's I work with know my standard answers now and are even somewhat respectful of the fact that I make an effort to keep them in the loop.
If another MD is upset that he/she was not called then you have verbal affirmation from the main MD that it was not necessary. If that consulting MD is still not happy, you can provide the office number of the primary MD and they can talk directly to each other. I have done this several times in the past when MD's do not "agree" and it has nothing to do with nursing care but we get the short end of the stick on all of it. Nurses are here to perform patient care- not be involved in the love triangle or pissing match of MD's.
Hang in there and don't worry! I always try to remember that I did not just magically POP out of my nursing professor's uterus and know EVERYTHING about EVERYTHING .....even though that is what is generally expected these days! Smile :p
My post, and others, referred to situations where nursing judgement does not seem to be respected.
I'm fortunate in this respect that my current work environment in the ER - I'm working side by side with the MDs. If a patient's PCP needs to be contacted, our ER docs do that after they have sufficient info from labs, test results, etc.
For you nurses on various inpatient units -- here's wishing you stable patients and PRN orders a-plenty.
Yay to that. I have been very fortunate thus far, only getting yelled at by one doc for calling him for an insulin order. He said thats not my paitent why are you calling me- um because you were consulted re. The patients diabetes and wrote the order to call if blood glucose is greater than.... And we do get lots of cover orders for things like po tylenol, gravol, ativan ect. I guess some docs need to learn that the hospital never sleeps, even when they do.
Oh, and as to the PRN orders, oh, yeah, he had a PRN for nausea--Zofran 4 mg IV Q 12 (yes as in twelve) hours. Written by the anesthesiologist as part of the epidural orders 3 days prior! Yep, we sure are staying on top of the nausea here! The PMD only ordered more Zofran. By the time I got there the next night, the pt had a central line c TPN & NGT to LIS.
Thing is, the surgeon had seen the pt at shift change that night, so he basically had the same baseline I did. When the pt vomited early the next morning, nothing else had changed in the assessment.
Oh well, oh well, I'm feeling better, not beating myself up so much. Can't, too much work to do.
And we are all being respectful and polite to each other, RIGHT? Good, I thought so. Peace to you all. Cheers to standing orders!
WOW, I am really amazed at the behaviors I have read here. Why not go to the doc that complained and say I was unsure of whom to call and in the future I will know. If its surgery related or is a expected result of surgery N/V, pain, increased temp etc. call the surgeon. If its BP or other complaint call the attending.
Those of you that chose to give vindictivenss as advice. Bad advice. You want respect for the job you do, so do the docs. Remember the direct approach is always more effective than revenge.
Forgive me, but you don't know enough to have an opinion here. Are you perhaps, an MD student? You have the arrogance down pat.
first off - id like to say this persons advice was accurate and should be respected - it was an opinion and another view that i personally feel was accurate - i have even said "dont use revenge " or " lets teach them a lesson" to many of my nursing and cna staff. it gets you nowhewre but deeper into the problem sometimes even causeing even more grief. just because someone is not in the nursing field does not mean they dont have valid opinions. it isnt like this person was stating anything about how to do a procedure like starting an iv or the like - he was voicing on a more management issue which i will remoind folks EVERY profession has. i am not to proud tyo talk to people that have the managment abilities and ask what woulod they have done.............. further more - i dont know where you work but i know many docs and have known very few who are arogant. its unfortunate that you feel they are that way an generalize so. seems to me arrogance means they feel " i am better than you" and that the one who is arrogant here wasnt the original poster of the advice.
:p
purplemania, BSN, RN
2,617 Posts
you will probably get written up over petty stuff many times in your career. Don't take it to heart unless it involves the direct care of a patient. Some people just like the power of a pen.