Walkie/talkie patient with a cervical neck fusion on his second day post op. Continues to have sore throat and hasn't eaten much in the last day.
Patient: I'm having really bad heartburn, could you get me some tums?
Me: I'll check your chart to see if you have something that could help like Mylanta...No, I'm sorry the doctor didn't prescribe anything. Have you tried eating soda crackers, drinking water, going for a walk...etc.
Patient: Can't you call the doctor, you guys do that kind of thing all the time.
Me: You want me to call the neurosurgeon for some tums?
Patient: Well, yeah
Me: I'm sorry sir, I can't wake up the neurosurgeon for tums.
Patient: Well, don't you have some in your purse that you can slip me??
Me: Um, no
What are some things patients have asked you guys to call the MD for?
Specializes in Care Coordination, MDS, med-surg, Peds.
I understand the temptation to do this, BUT remember, the Doctor MAY NOT sign that order! If he doesn't then you have presecribed medication without a license, and poof! There goes your Nursing license. I do agree that there will be some Docs that you KNOW will allow some things to be written, but if you don't KNOW that, don't DO IT! It ain't worth losing your license. Either call the Dr and get theorder, or give the pt any non-medication you can after through assessment tomake sure it is heartburn and not an MI.
Three things as nurses we have to learn to accept....1) you are going to get yelled at by a doctor. Most times, it's not warranted, but it's what they like to do.2) Drs get paid for being on- call. Utilize them. Even if you may get occasionally yelled at.3) most important- CYA, CYA, CYA. That way, even if you get yelled at, it's ok because you covered your a$$.:)
Wow...I guess I am spoiled by working in a teaching facility,but you're telling me if I told you I had a splitting headache at 3am, you'd tell me, sorry nothing you can do about it? You better believe I'd be talking to someone higher up on that count. I'm sorry, that is ridiculous to not call a doc, it is their patient!
And to address the writing a telephone order without making a call...that is just asking to get fired. You won't call a doc, but you will risk your license to write an illegal order. Makes perfect sense.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I really don't understand why you didn't call? Your patient has unmet needs that could be met simply. The surgeon chose not to write PRNs for very common, normal and expected problems overnight. I assume that means he is lonely and wishes to speak to a nurse at 3:30AM.
This is a case of a physician not doing their job. Wake them up a few times and maybe they will learn to write appropriate post op orders.
If you are worried about being yelled at by a doctor, well you need to put your adult pants on and deal with it. I am never yelled at by physicians, at least not for more than very briefly. I don't tolerate being yelled at by anyone and any physician who yells at me will regret it.
Yeah sorry, but that definitely warrants a call to the doctor. Their fault to not prescribe something in the first place. Both hospitals I've worked at automatically put every patient on GI prophylaxis. The patient (or their insurance company) is paying for them to be cared for, so you need to do that.
All our patients are on some sort of GI prophylaxis be it zantac, prilosec, or prevacid. I would have called for them. I am so glad that I work at a teaching facility. The other places I worked had a MD for medical management we could have called instead of calling the neurosurgeon.
It isn't fair to the pt that they had heartburn and it was 3am and you didn't want to call the neurosurgeon.
I was in the middle of a cardiac cath - yes, it was being done to me - when I started to reflux. I was so scared that I would aspirate. They brought my head up about 10 degrees and got me some Mylanta to drink. In the middle of the cath procedure!
There was a post-procedure order for more meds, thank heavens! BTW, got 2 stents!
You should have called the doc - reflux/heartburn is very painful, and makes sleep difficult. Aspiration is always a risk. Been there, done that.
"Nurse up" here, and pray you don't ever have heartburn in the middle of the night. Encourage the docs and your facility to have some standing orders for these everyday type issues.
I've had patients know that we are wondering that and start reporting heart attack sx because from previous admissions they know the Rapid Response nurse will give them a GI cocktail.
Specializes in psych, addictions, hospice, education.
Where I've worked, nurses could give a few OTC meds as a "Nursing measure." This included tylenol, mylanta, ibuprofen. A doctor's order wasn't required.
sorry that the neurosurgeon did not think ahead and address this for you. you, then, were put in a difficult situation-wake him up, or have the pt suffer. neither is fun or good for either one (or you). i was taught in nursing school, that it is standard care to provide gi prophylaxis in surgical cases and especially if a patient has anything involving the neurological system d/t the stress response and danger of stress ulcers. i have, however, seen this standard routinely ignored and find that i routinely ask when my hospitalists round if they will add something, unless the surgeon rounds first :)
here's hoping that this will prod the day shifters to address this for you folks on night shift when you share what happened in report. may your next shift go better.:hug:
silverbat
617 Posts
I understand the temptation to do this, BUT remember, the Doctor MAY NOT sign that order! If he doesn't then you have presecribed medication without a license, and poof! There goes your Nursing license. I do agree that there will be some Docs that you KNOW will allow some things to be written, but if you don't KNOW that, don't DO IT! It ain't worth losing your license. Either call the Dr and get theorder, or give the pt any non-medication you can after through assessment tomake sure it is heartburn and not an MI.