I'll just sit over here and eat bon-bons.

[canoehead, BSN, RN]

I work in a small ER, after midnight it's just me, the secretary and the doc. At 1am we had a MVA rollover with two victims, the doc and I went over #1, then she went out to write orders for the secretary while I started the IV etc. Victim #2 rolled in 5 min after #1, and as I emerged from #1 room we got a walk in triage call. Doc was in room #2 so I figured I'd let her finish up while I took care of the triage. The triage was just a request for meds (why do people wait til 2am?) so I was less than 5 minutes. When I walked back to the main ER patient #2 was gone. The secretary said the doc sent him to xray before he was registered, before consent had been signed, and obviously before I had a chance to triage, or even get initial vital signs. She was frustrated, I was livid.

Doc said that since I was in triage she figured she'd just go ahead with sending him to Xray. She confirmed that he had no acute injuries, denied pain, no particular reason he had to go so fast...she just decided to send him, and said he gave verbal consent, so paperwork wasn't a priority. Keep in mind we had patient #1 who had all his initial stuff completed, was GCS 14, and could have gone right off without upsetting the apple cart.

I felt like she was very disrespectful to the people she was working with, and the contribution we make to patient care. It's not like the guy was sick, or unstable when she sent him, but we are supposed to be a team. If my work isn't needed I'll be happy to sit down with my feet up.

Am I overreacting? Should this be written up as an incident?

[momdebo, BSN, RN]

That does make it hard when your in an environment where teamwork is essential, ICU, ER etc. It's very important that everyone follow protocol, that way the right hand always knows what the left hand is doing. Maybe she was just trying to lighten your load a bit? Maybe you could just let her know it's more helpful if she just sticks to the program.

[DutchgirlRN, ASN, RN]

Am I overreacting? Should this be written up as an incident?

I can see why you are upset but I don't see an incident report. Legally it's not a big deal. I would let it go unless it continues to happen.

[welnet66]

She sent the patient to x-ray before you saw him because she feels your assessment would be irrelevant anyway.

[canoehead, BSN, RN]

Yes, brefni, and it sounds like the nurses replying agree with her.

[DutchgirlRN, ASN, RN]

I don't agree that your assessment would have been irrelavant. Not in the least. I see why you were upset. I have been totally just as frustrated over such issues but in the end had to just let it go. I do understand how you feel. (If we could be in charge we could set them all straight permanently!)

[canoehead, BSN, RN]

OK, I get it now. Thanks for replying.

This doc pulls this stuff all the time, and there is no need to go on a power trip when the department is crazy, it just bungs everyone all up. I've let it go (and my coworkers have) so many times that I feel like a pitching machine (and just as mindless).

I need to let some time pass, perhaps.

[TrudyRN]

She sent the patient to x-ray before you saw him because she feels your assessment would be irrelevant anyway.

How do you know that?

[TrudyRN]

So, Canoehead, what did you do about it? Or what do you plan to do about it?

[healer1]

I would tell the doc "you triaged the patient. Fill out the paperwork". they want to do the job, they can do the paperwork.

[swartzrn]

I have had that type of scenario happen to me in 2 different environments. The first ER I worked was a small 7 bed ER and at night it was an LPN, a doc and me. Oftentimes, if 2 or more higher acuity patients came in and the doc could so something he/she would go ahead and do it. I never felt like he or she was disrespecting me. It would at times aggravate me b/c I was responsible as well for that patient's care and so forth and not having time to at least do an RN assessment would bother me--if the paperwork were not done, it REALLY would've bothered me. There's really no record that the patient is even there if he's not signed in. I wondered sometimes if the doctors even realize that there is a proper way to do things? Knowing the doctor's though, I felt like they were honestly trying to help BUT with that said, they would always come and say "hey, I sent the patient on to XR (or whatever) because blah, blah, blah." They would also give me a brief run down of the patient's status, etc. Because of that I never felt like the doctor was trying to by-pass me as the charge nurse. Even though I am in a larger ER now, we have docs and providers who'll get a patient in via ambulace with an ortho type injury or the such and will go ahead and send them over. Our patients are already entered into a database (military hospital) for the most part so order entry is possible without have the patient signed in. But--the provider will get the military ID and have the clerk signing in the patient in the process even if he sends the patient over to XR. He at least documents something in the meantime. It's nothing to have several injuries come in at once depending on what kind of training is going on that day. If we are short staffed and an RN hasn't had physically time to get over to the bed, the provider will get things going.

With all of that said, it sounds like that provider of yours did jump the gun though and in actuality patient #1 should've gone to xr first.