I have had this happen a few times, most often due to pain meds. Pts pain out of control and I've called a couple of times for orders and they have said " she can have this and/or that and nothing else. Don't call me back."
I do write the order. Something as "MD notified of pain 8/10. MS 2-4mg every 2-4 hours prn pain. Do not call back regarding pain control issues. MD will see in am."
I simply would ask the doctor, "Sir/Ma'am, would you like me to write an order stating not to call you back?" Of course, this would be done in a syrupy sweet tone.
to you experience nurses who document the doctors lovely attitude..heres a question...if a case ever went to court, wouldnt they also review the nurses notes as well? i can just imagine a jury or worse the family hearing, "doctor order dont bother me about this unless they code"..omg...
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i have had this happen a few times, most often due to pain meds. pts pain out of control and i've called a couple of times for orders and they have said " she can have this and/or that and nothing else. don't call me back."
i do write the order. something as "md notified of pain 8/10. ms 2-4mg every 2-4 hours prn pain. do not call back regarding pain control issues. md will see in am."
is that appropriate?
probably more appropriate than some of the "verbal orders" i've written when the md has sufficiently enraged me. i have actually put verbal orders in the chart (back when we could take verbal orders) such as:
"don't call back unless patient is actively coding".
"yes i do want blood gases drawn every hour, and i don't care that the patient is a dnr."
"don't bother me with this jackass anymore."
so your order was far more professional and appropriate!
Good answers and they are all over the place. I can count on one hand the times this has happened, and I've actually initiated the order before. It was a patient that wouldn't be happy with her pain meds until sedated, and I told the doctor just that. My words were along the lines of "Doctor X, you are going to have to give me what you are going to give me and tell me that is all she is going to get." This was a patient that was demanding A LOT of pain meds.
What made me wonder about it was I did write the order about a week ago because I didn't think the MD was taking the pts pain seriously. I called twice, and without getting too specific the pain relieving measures for someone complaining of an 8/10 pain was ridiculous. The next day he addressed the order in the progress notes by saying she was fine earlier and the nurse had called twice regarding pain. He signed it off. So far nothing else has been said.
Oh, and I do understand the difference between comments and orders. Once there was an ortho surgeon, friendly doc, when asked about a constipation issue with the patient..."Ask the medical doc. If it doesn't have to do with his foot I don't want any part of it. He's an *******. Give Milk of Mag, Miralax, a Gallon of Golightly for all I care..."
Specializes in geri,acute,subacute,correctional,pysch,.
I have written a "do not notify" order before. I clarified what the MD was telling me and asked if he wanted that written as a order. He said "that's what I just said", so I wrote it. I also documented a complete rundown of the conversation in my nursing notes.
Specializes in Cardiac care/Ortho/LTC/Education/Psych.
I had a case when my patient was asking for extra pain medication and doc refused and told me to not call him back . So I said " listen to me sir, at this moment they are on my tail and going after me to give them medication that you do not want to prescribe , we both know what is the deal here, so I will ensure that tomorrow when you come they will ride on your tail as much as they are doing on my now!" . He stopped , was quiet for a minute and said " Ok, so what do you want" .. Oh, Vicodin 2 pills q 4hr PO prn for pain greather then 5, thank you " . Got it!! It was a joke for a while on my floor .
My experiance is that when you tell a Doc that you are going to chart that he said "don't call back" they generally back up and re-evaluate that particular order. I had a urologist who I called at 2230 about an I&O issue on a CBI patient. His response was "Idon't give a damn, there is no way to keep accurate I&O on a patient with CBI and if you had called me after midnight I would chew youur ass out!" I calmly said "Actually Dr _____ you kind of are, but I am just going to chart that I notified you and your response was Idon't give a damn." You could actually hear him start back pedaling when he realized that would place the burden on him and not on me. He then decided to give me a more appropriate order in a more polite tone.
I would repeat the order back to the physician and if he stands by his comment/order not to call back, I would document it in my nurses notes. Then if the situation calls for it I WOULD call him back regardless of his order. My patients come first. If I get no call back I will give it a reasonable ammount of time and then call the medical director and in the morning document this in my nurses notes and report it to the DON. If he answers the phone and refuses to discuss the situation I would follow the same procedure.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I had a patient who kept fainting. The doctor ordered an EKG and a potassium level. I called with the results (EKG normal, K low). He ordered a K supplement for the morning and told me not to call him unless the patient hung herself. I charted that. As luck would have it, that doctor was one of the few who read nursing notes. He was livid....
I<3H2O, BSN, RN
300 Posts
I simply would ask the doctor, "Sir/Ma'am, would you like me to write an order stating not to call you back?" Of course, this would be done in a syrupy sweet tone.