Kind of a rant, sorry!

[MECO28, BSN, RN]

I work on a short stay unit so the bulk of our patients are coming to recover from minor surgical, GI and interventional radiology procedures and then we send them on their merry way once they are walking, talking, peeing and not crying in pain.

One of the frustrating things about working on this unit is that the attending doctors who do the procedures are often unwilling to deal with situations that arise that aren't directly related to the procedure they have performed and they often refuse to consult with the hospitalist teams.

For instance: yesterday I had a patient who had a minor interventional radiology procedure. I called the MD because the patient's BP was in the 90s to 200s systolic and the patient c/o headache, dizziness, etc. He adamantly declined to treat it and told me to "keep an eye on it; it's just pain-related". I kept an eye on it for the next 4 hours and it got progressively worse. Even though the pt's pain improved, the BP did not and the headache and dizziness grew more acute.

I called the MD again and got the on-call who tore me several new ones for bothering them with this again. His exact words "Why are you calling about this again?She is on two anti-hypertensives already; what are you asking- for us to give her more and have her bottom out?" My reply (as my face is growing tomato-red and I am struggling to maintain compsure) was "I'm calling because this is a reportable symptom and is cause for concern. I am doing my job and keeping you updated on the patient's condition." He was rude and told me not to call again and to make a note for others not to call about it.

As I was angrily writing a note quoting the exact words of the MD he sheepishly called back twice both times asking me what we would normally give in this situation. I told him I do not feel comfortable advising about cardiac meds and told him I would be happy to find out who the hospitalist on duty is. He finally agreed, thankfully and I gave report to the next nurse, amended my note, and went home to a much-needed beer.

Any of you have similar issues when dealing with specialists?

[NevadaFighter, BSN, RN]

My "like" was in reference to the beer. Don't let it get you down. You totally did the right thing and were a complete patient advocate. We need more nurses like you in the world :)

[NurseOnAMotorcycle, ASN, RN]

Yes, it happens. Sometimes they are hoping that if they ignore a problem long enough it'll resolve itself. I like how he ordered you not to call about it anymore. If I saw a patient was symptomatic like you did, I'd go right ahead and call anyway and ask who they'd like me to call instead.

Sometimes if we can't get a good answer, we do what we can as nurses within our scope of practice and call the person covering for them on the next shift with "Who would you like me to call for consult?" in a very firm way.

[anotherone, BSN, RN]

yeah sometimes but since i work in an acute care teaching hospitals some of them will quickly turf the pt over to medicine while others are reluctant to and the whole thing becomes a disaster

[KelRN215, BSN, RN]

Yes, have had similar issues... especially with surgeons. I remember one surgical resident who tried to tell our charge nurse that he didn't want a certain nurse assigned to one of his patients because she called too often. The charge nurse told him that nursing assignments were her prerogative.

[iluvivt, BSN, RN]

You can always go up the chain of command and have the hospitalist called in or send them to the ED for evaluation. If they need to be admitted they will get assigned the hospitalist. This happens all the time in our outpatient settings and we get the patient furthere evaluated and usually admitted.

Of course you did the right thing. You are an employee of the hospital and facility where you work not of the Licensed Practitioner (LP) that you are calling for orders. You have protocols in place that you need to follow and if he or she does not get with the program they should be written up and taken care of by the administration. We report non-compliant LPs all the time and they staighten up or get the boot. There was one really nasty MD/LP and he would not stop yelling at the nurses. He is now working only at SNFs. The idiot could not correct his abusive behavior and they gave him the boot and it is about time that nurses have the power to get rid of people like this.

[dah doh, BSN, RN]

To OP: You were being proactive for the patient! A bp that high can cause big problems for the patient. If the surgeon or procedure doctor doesn't want to manage it, document that. Ask which doctor they are consulting for management of it. To KelRN215: we get a lot of transfers into our unit in because the doctor doesn't want to get called all night by certain nurses or floor units so we get the patient because "we can manage the patient better" (eyes rolling around). Geez...I hate that! Such a waste of time and effort because we transfer those patients out the next day all so the doctor can sleep better that night!

[BostonFNP, APRN]

Was the BP 190 to 200 systolic or as written 90 to 200?

I would be hesitant to aggressively treat if the systolic was in the 90s at times. If it was 190-200, some hydral would be ordered up quick :)

[KelRN215, BSN, RN]

Yes, it happens. Sometimes they are hoping that if they ignore a problem long enough it'll resolve itself. I like how he ordered you not to call about it anymore. If I saw a patient was symptomatic like you did, I'd go right ahead and call anyway and ask who they'd like me to call instead.

Sometimes if we can't get a good answer, we do what we can as nurses within our scope of practice and call the person covering for them on the next shift with "Who would you like me to call for consult?" in a very firm way.

I've seen this too... when I worked inpatient, I worked neurosurgery. We had many patients with ICP monitors and always called for ICPs > 20. If it was 20, they'd say "let's wait until it's 25." If it was 25, they'd say "call if it gets to 30." If it got to 30 they'd say "it's ok unless it stays there for 5 minutes." If it stayed there for 5 minutes, the patient's HR was 50, RR was 10 and BP was 150/60 and they were unarousable and we were running to the OR hoping that the on-call team made it in on time, then it was ok to call in the Residents' minds. Nothing's an issue until it's a surgical emergency in their minds...

Our joke on the unit was that everytime you called the Neurosurgery resident because of bradycardia (on patients who were at risk for increased ICP), the response would be "the patient is an athlete." The patient could be a 2 month old or a wheelchair bound quadriplegic 25 year old and still, "they're athletic, it's not increased ICP." Then when they actually did the LP, tapped the shunt or brought the patient to the OR, the ICP would be so high they couldn't even measure it... but that's not why the patient was bradycardic.

[Student Mom to Three]

I work in a free standing ASC. I consult anesthesia for any patient problems that aren't directly related to the surgery itself.

[MECO28, BSN, RN]

oops, typo...190s-200s. :)

[tokmom, BSN, RN]

Yeah I have had to deal with this type of behavior in the past. I call them 'WNL' doctors. It doesn't mean 'within normal limits.' It means 'we never look.' If they don't hear or see it, then it doesn't exist. I don't let that behavior slide. They can chew me out all they want. I don't care. I'm going to advocate for the pt and cover my butt, sorry!!