Is everything really the nurses fault?

PAERRN20 · Feb 18, 2010

Yes I think everything and anything is ALWAYS the nurse's fault!

(Not really but sometimes it seems that way)

I wouldn't have gotten too concerned over a sodium of 149. Yes it is elevated but not that high. The cardiologist easily could have written orders for this. This is a general problem that any physician should be able to handle. I wouldn't beat yourself up over this too much. Sounds like no harm was done to the patient. I hope you documented that the cardiologist was aware of the Na just in case.

jerrylundergard · Feb 18, 2010

Yes I think everything and anything is ALWAYS the nurse's fault!
(Not really but sometimes it seems that way)
I wouldn't have gotten too concerned over a sodium of 149. Yes it is elevated but not that high. The cardiologist easily could have written orders for this. This is a general problem that any physician should be able to handle. I wouldn't beat yourself up over this too much. Sounds like no harm was done to the patient. I hope you documented that the cardiologist was aware of the Na just in case.

Thats the crazy part, the cardiologist told me about the lab value and then told me it was my duty to notify the attending to have the attending rectify the sodium. All this instead of the cardiologist just writing some kind of order to deal with it.

So there was no need to document that the cardiologist was aware cause he was the one complaining to everyone that he told me yesterday and that I didnt have the attending do something!

When the charge nurse called me this morning she said she didnt see anything in my nursing notes about documenting my call to the attending. I did forget to include a nurse note about the fone call. However, I told her I did call the attending and passed on the info to the night nurse but recieved no call back from attending. This, even though the attending came in and didnt write any orders concerning sodium yesterday and would of presumably looked at lab values. He did order further labs for the following day! I guess I have to document better.

midinphx, BSN · Feb 18, 2010

The documentation was the first thing I thought of when I read your OP. I have learned that when I have a conversation with a doctor, I will document what info I gave him/her and what response I got. Even if it seems minor. I write everything I told him/her. I used to think our doc's really backed us up, but that has changed alot in the last year. One nurse was brought before the BON for practicing medicine when she wrote an order the doc gave her as a verbal then denied having given the order. The nurse's documentation saved her.

But on this instance of yours, I would blow it off as a learning experience. Relax.

oramar · Feb 18, 2010

It is inconceivable to me that a Cardiologist would not treat the lab value???? I never had the experience of one of them passing it off to the attending. Is this something new?

fungez · Feb 18, 2010

You didn't do anything wrong. The doc was just a jerk. He needed someone to kick around for no reason, and you were handy. Just document any time a physician is paged so you can tell your charge to quit humoring this idiot.

Q: What's black, 18 inches long, and hangs in front of an a$$hole?

A: A stethoscope on a cardiologist.

rn4life2009 · Feb 18, 2010

I probably would have kept nodding while thinking what a jerk he was. Then depending on the day and if I could have gotten away with it said in the time it took you to scream at me you could have written a order. Or written out the order while he was talking and said would you like to sign this. There all done. LOL More than likely there is some p*ssing match going on with between him and the attending(s) territory wars. I had a cardio doc get in this kind of match with another cardio's pa and it wasnt pretty. I would probably of gone to the charge nurse and told her of situation with the doc and then document charge nurse notified attending paged no return call at this time passed in report and so on so if something ever went down you are covered.

cherrybreeze, ADN, RN · Feb 18, 2010

thats the crazy part, the cardiologist told me about the lab value and then told me it was my duty to notify the attending to have the attending rectify the sodium. all this instead of the cardiologist just writing some kind of order to deal with it.
so there was no need to document that the cardiologist was aware cause he was the one complaining to everyone that he told me yesterday and that i didnt have the attending do something!
when the charge nurse called me this morning she said she didnt see anything in my nursing notes about documenting my call to the attending. i did forget to include a nurse note about the fone call. however, i told her i did call the attending and passed on the info to the night nurse but recieved no call back from attending. this, even though the attending came in and didnt write any orders concerning sodium yesterday and would of presumably looked at lab values. he did order further labs for the following day! i guess i have to document better.

i am going to disagree with this! you still, imo, should have documented the conversation with the cardiologist. just because he was complaining doesn't mean there was a record of his complaining, or that he noted the lab, and didn't take it upon himself to correct it. if the attending were to approach the cardiologist and ask why he didn't write orders addressing the sodium, the cardiologist could very well turn around and say he didn't know. you just never know what they're going to do, so it needs to be documented, just like your call to the attending. since the lab wasn't considered a critical value, my note would have read something like, attending md (using names, of course) paged per request of cardiologist re: sodium level, no return call received. cardiologist aware of sodium of 149, no orders received. next shift made aware of attempt to inform attending md, etc etc. along those lines. covers all of the events in a quick, concise manner and more importantly, covers you, since it was obviously a sticking point with this orifice of a cardiologist.

i hate when physicians blame the nurse for what other doctors do or don't do. if they have a problem with how someone else manages (or doesn't manage) a patient, they can easily pick up a dang phone and call them themselves, and have a discussion! argh...big babies, they are!

Ruby Vee, BSN · Feb 18, 2010

yes, everything really is the nurse's fault -- there's a whole thread about that. how could you have missed it? really, you should be more up-to-date and astute in your allnurses.com reading.

ok, i'm joking. really, though, everything is the nurse's fault. or so "they" would have you believe. dietary sent up the wrong tray, it's the nurse's fault. unit secretary didn't answer the phone until it had run 6 times, tell the nurse. the patient wants a drink of water and the tech is standing right outside the room, you should still walk all the way down the hall to where the nurse is doing a sterile dressing change to complain that the patient hasn't gotten her drink of water that she requested four minutes ago.

and if the cardiologist doesn't like the orders the pulmonologist wrote, it's the nurse's fault. after all, you should have told the pulmonologist what the cardiologist wanted. if the id fellow doesn't like the orders written by the endocrinologist, that's the nurse's fault and if the renal consult hasn't rounded by the time the attending comes in, blame the nurse.

tell them to work it out like adults, and document, document document. then sit back and laugh because if you work in a teaching hospital, it's the resident's fault.

montinurse, BSN · Feb 19, 2010

This kind of behavior from the docs is what scared me right out of the hospital! I've learned to deal with everything being my fault, at work and at home. LOL

sistasoul · Feb 19, 2010

I love this forum and I learn so much here. I have less than a year experience on a med surge floor and I have always wondered and worried about abnormal lab values. I work the 3 to 11 shift. When I come on duty the hospitalists have until 7 pm to do their rounds with their patients. By the time I get my info and report it is close to 4 pm. By this time most of the patients have been rounded on. If I see an abnormal value I would hope the MD has already reviewed it and taken appropriate action if needed. If it is a low H+H, abnormal Potassium or INR I will usually look in the chart to see if the Dr is aware of values or not. If there isn't anything in the chart I call the MD to make him/her aware of the value. I never have the time to do this but because I know the Docs are human and may miss something I try to make the time.

My question is this. If the MDs do not address the labs when they round and If I am so busy that I cannot double check to make sure said MD seen the lab is it the nurse's fault? Or is it the Doc's ultimate responsibility to look at labs when they round. Of course if there is a critical we let the Md know right away. I ask because some of the nurses I work with have told me they don't look at labs until later in their shifts if at all.

PostOpPrincess, BSN, RN · Feb 19, 2010

This wasn't about you. This was about him. If he was so concerned, why didn't he order something?

Because like you said, an Na of 149 "ain't no big deal."

You were his target.

Bottom line.