MD notify question to all experienced nurses

[Kennynguyenlvn]

good morning nurses..

first off, i'm pretty new to the nursing world (LVN) and came across this problem over the night shift. i'm working at a rehab/post acute facility and i'm new to this facility. I came over from a psych facility. The AM shift nurse endorse the resident had a low grade fever and was able to lower the temp with acetaminophen. **(On the side note, she didn't chart anything about the incident other than endorsing it to me). With the same resident, i check her temp few hours later and found out temp of 100.1 and on the chart stated to notify MD if over 100.4 so i didn't notify the MD and administer acetaminophen 650mg PRN with a ice pack over the head and was able to bring down the temp to 99.1. During endorsement to AM shift, one of the older nurses, more experienced nurse, chewed me out because i didn't notify the MD of the C.O.C. and i can lose my license because of it. What i did was wrong? Any advice would much appreciated to prevent future mistakes. thank you nurses.

[RedHeadedBrat]

Goodmorning. Im new as well, but from what Ive learned. You prob gonna get chewed out from certain experienced nurses for anything you do. The whole "darn if u do and darn if u dont thing". Dont let that bother you. Seems you followed the Drs order, but I would always chart anything out of ordinary with pt and fever is out of ordinary. I also if Im talk something like that in shift change report and see the previous shift didnt chart it, I chart what I was told in shift change by previous nurse. I dont make many friends this way butt my orifice is covered. ?Be sure you charted. The older nurse prob thought you were being lazy and the fever was actually higher and were just lying, so she was gonna end up checking it on her shift and it be over 100.4 and she would have to call MD. It happens. Often.

[RedHeadedBrat]

If u had of called Dr for 100.1 fever in middle of night he would of prob chewed you out. He has standing orders for reason. Food for thought. Im learning getting chewed out is inevitable. ?

[Kennynguyenlvn]

9 minutes ago, RedHeadedBrat said:

Goodmorning. Im new as well, but from what Ive learned. You prob gonna get chewed out from certain experienced nurses for anything you do. The whole "darn if u do and darn if u dont thing". Dont let that bother you. Seems you followed the Drs order, but I would always chart anything out of ordinary with pt and fever is out of ordinary. I also if Im talk something like that in shift change report and see the previous shift didnt chart it, I chart what I was told in shift change by previous nurse. I dont make many friends this way butt my orifice is covered. ?Be sure you charted. The older nurse prob thought you were being lazy and the fever was actually higher and were just lying, so she was gonna end up checking it on her shift and it be over 100.4 and she would have to call MD. It happens. Often. 

that's exactly what came through my mind. Our facility Doctor is an ER doctor and pretty busy and i wouldn't want to notify him every little C.O.C and take the heat for it. We are nurses, we know a thing or two on how to deal with these stuff. If we can solve the problem in house, it would be okay, right? But then again, i guess the older nurse just want to help me protecting my license. once again, thank you for the comments. cheers.

[MissDiagnosis, LPN]

At my facility we have been told specifically not to call the MD late at night or before 7 am unless it’s a life or death situation-per the MD. If I were to call him for a low grade fever and woke him up, he’d go straight to scorched earth and heads would roll.

In situations like yours, I just make sure I chart it, put in a nurses note and update family members when it is necessary. I update the MD during normal business hours if it needs to be addressed and is non-emergent. I do let upper management know of any change in condition just to cover my butt though.

Like the previous posted said, *some* seasoned nurses just make it harder than heck to please them.

[KatieMI, BSN, MSN, RN]

Ok, here is that very "doctor" (well, NP, but that's me who would be called):

1). You have The Holy Order of Parameters which say "above 100.4". It is written so with purpose to give you clear direction what to do. So you did just what was ordered and it was a good job. If parameter says "call when above 100.4", then do not call till it is 100.5. Plain and simple.

2). Otherwise, you may want to call when there is the fever of not quite those 100.5 AND something else. You do your assessments. IF you find something CLEARY unusual IN ADDITION TO that 100.4 fever, then PLEASE CALL. Dirty smelling urine. 6 liquid BMs that day. Patient being sleepy, not drinking, refusing whatever he/she usually enjoys. Do not treat your numbers, treat the patient.

If all business goes as usual except that "fever" of 100.4, then PLEASE DO NOT CALL.

3). I do not know how your doctor goes about it, but if I hear about however old and experienced nurse abusing and threatening (yes, those are the words) someone with license loss for "not updating provider" about everything and anything, I bring things to screeching stop then and there. I did not forget, and did not forgive a monster in scrubs who used to call the State because she saw a piece of package of coumadin pill falling down on floor, and behave accordingly toward those who threaten and abuse others.