Is everything really the nurses fault?

[jerrylundergard]

I get a new batch of patients yesterday, 6 on a very busy tele/medsurg floor. One of my train wreck total care patients with a trach has sodium of 149. The cardiologist comes in at 0930 and calls me to the nurses desk to get nasty with me about why the patients sodium is 149 and why isnt it being treated by the primary. I tell him I hadnt noticed the lab value yet. I didnt tell him we just got a totally new med system that same day (pyxis with omnicell). We dont always go over labs in report but even if we did it wasnt in critical range (we get calls from lab if its critical and in that case we have to notify corresponding dr). So hes telling me about my incompetence and im thinking to my self, why dont drs take care of labs? Why doesnt this cardiologist just order something to lower the sodium? So anyhow, I make my call to the primary who of course doesnt call back. Im not really too worried about it cause its just 4 points over and several drs came in that day to see the pt. So im thinking all the drs ever do is come in and look at labs and order labs and whatever so I figured it was the way they wanted it. I told the oncoming night nurse of the sodium level and that the cardiologist was ****** at me cause I hadnt noticed it in the morning. Anyhow, today I get a call from the charge nurse cause the cardiologist is really ****** at me cause noone ordered anything. I told the charge nurse everything Im telling you and that was about the end of it. No actions against me that I know of. But my question is, with all these drs seeing the pt is it really my fault they didnt order anything to treat the sodium? Are things like this always are fault? It is annoying!

[t2000JC]

If the cardiologist wouldn't order why couldn't he call the attending if he wanted something done so badly. Collaborative Care!

When I worked on the floor I would keep an eye out for the labs and let the MD know just because they may not recall as they have a lot of patients to round on--as a new RN I was lucky enough to have supportive RNs around me to ask for second opinions---however I think the MDs hold ultimate responsibility.

[FowLaf24/7]

I can see the cardiologist point. Labs and calling the physician for orders is the responsibility of the nurse. I do believe the physicians have no idea what the nurses deal with on a day-to-day basis, nor do the nurses really know what the physicians deal with, except sitting down and chatting with the charts piled up at their desk...LOL:lol2:

[regularRN]

My response is to be as polite as possible and smile. It really bothers them that their pomposity is having no impact. :)

[BULLYDAWGRN, RN]

hell yes if they can't blame bush then its the nurses fault..

[sparketteinok]

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

A: A stethoscope on a cardiologist. "

Or a surgeon!! especially a vascular surgeon!

[wooh, BSN, RN]

My response is to be as polite as possible and smile. It really bothers them that their pomposity is having no impact. :)

I've got a couple docs that I get along with even though nobody else can stand them because the first time they pulled garbage like this on me I just held my ground and remained totally unimpressed by their tantrums.

I'd have to know more to know if I'd worry about a 149 sodium. But really, if he was THAT concerned about it, he needed to talk to the attending himself and/or order something himself. I've reached the point where I will absolutely NOT run between the docs. If they want another one to do something, then they need to talk to each other. I'm a nurse, not a string with a couple cans one each end.

[al2phoenix]

No, it's not always the nurses' fault. Nurses and doctors have their own jurisdiction. Doctors do the diagnosis, and the orders. Nurses do the assists, the carrying out of orders, and the taking care of patient. If a doctor fails to made an order, it's his fault, however, for the sake of the patient, a well-informed nurse may remind the doctor. It's all about helping each other really. This is how both professions team up. Now, if the error was made under your jurisdiction (ie. the patient falls from bed) then it's your fault. But, in this case, it was the doctor's fault since he failed to provide an order, which was supposed to be his/her task.

[morte, LPN, LVN]

yup, as prior post has said a turf war.....best thing is to absent yourself from these as much as possible, also mentioned in another prior post.....as soon as you engaged him he had you.....if the attending already rounded on his patients he had, presumablly seen the lab, felt it was not a big issue and, it appears, ordered labs for the next day....so he was watching the issue....good luck

[Triage24]

I agree with cherrybreeze. I would have documented it pretty like that. I would kinda of on purpose wrote my note so that it left no doubt the cardiologist knew and took no action on the Na+ level. That I paged the attending and got no response. That I notified the charge nurse of the situation and continued to monitor the patient. :)

[tencat]

I would have been pretty snarky and said something like, "Wow, I didn't know your fingers were broken so badly that you couldn't write any orders or dial a phone to call the attending yourself...." Really it is his/her issue, and he/she needs to deal with it if it's not acceptable because they are the ones who can write orders, not the nurse......and I probably would have mentioned that to the cardiologist as well......AND I would have documented like crazy....I'm NOT taking responsibility for something I have no control over. I don't care who thinks I should. Another reason NOT to work in the hospital setting.

[DeeAngel]

Another reason why working night shift rules

[Triage24]

So what would happen one of these days if every nurse and I mean everyone of us just stopped taking it. Intresting thought. Have a nice day.