new here but would like a response--long

Nurses Safety

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hi all, been reading posts here for a few years. laughed, cried and got angry with all of you for a while. never joined till now.

i may be moving a little fast here, but something happened to me at work this weeked and i know you all will help me get over this. so hello, and heres my story: 83 yo pt admitted from assisted living, weakness, dehydration, not tol po etc. long medical hx including metastatic bone ca. rapid decline in condition, dtr/poa at bedside whole time. dtr made him a dnr and expressed wishes to do comfort care only. i suggested hospice and told her a little about what it is and she said she would like to meet with a hospice rn. called md (who im not that familiar with, been at this facility for a long while but hes not a doc we work with frequently) got a consult for hospice and asked for some pain meds as the pt was c/o pain nothing on board, just tylenol. i have not mentioned the pt condition at this point but lets say hes fever 104,cooling blanket, nrb mask sating 80's but still somewhat awake enough to c/o pain. md told me not till i see pt 1st. ok, fine i think. md rounds, im in another room (oh yeah, let me mention that im also orienting a new grad all at the same time) and he calls me out to say that the pt had a bm and can i clean it. dose not want to discuss pt condition or plan of care with me i say ok and procede to clean pt up. when done, pt still c/o pain and dtr requests pain meds for pt. quick review of chart shows no orders still!!!! we just put pt on hospice! he d/c'd all meds ivf and tx modalities but gave no pain meds. i call him back and he give morphine 1mg q 4h prn. dtr expressed concern about the q 4 h part. "why cant he have it every hr if need be?' give the dose and tell dtr see if this works and if not will call md again and get increases as time goes on and symptoms worsen. just as i finish, house supervisor is waiting to talk to me (orientee at my side whole time) super tells me that md contacted her and told her i came across as too aggresive with my requests for pain meds and can she reassign the pt. md told super he thinks we (me and him) dont see eye to eye on poc and that if i give more meds at this time he will die of overdose. WHAT????:angryfire i talked to my charge rn (who took over the care) and the super at length as to what my side of story was. orientee witnessed everything i said /did and was able to vouch for me. i feel insulted and like i did something wrong. i took what the pt reported and what the dtr requested and told the md and he says I am too aggressive? i was only addressing the concerns of my pt and the pt family. i feel awful. turns out the super said that what the family said to md was diffrent that what they told me. but....as pt condition changes, requests change. when reporting this to the md what dose this have to do with me? i feel like so low and kinda like i did something wrong and i was being punished. please let me know what you think on this situation and help me stop thinking about it. thank you for listening.

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some times you don't see eye to eye with a patient or their family or with a md...

maybe the family told him something, maybe the patient denied pain when he was inthere maybe he had a fight with so that am a lot of varibles

chaulk it up to experience there are so many pts and mds that this is not going to harm you

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Specializes in cardiac/critical care/ informatics.

well what upsets me about this whole situation is why didn't the super or your charge nurse defend you. In fourteen years I have never had heard of a physcian asking for a different nurse take care of a patient. I think the Doctor is a jerk and for you not to take it personally.

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Specializes in Oncology, Neuro-orthopaedic, Medical, Su.

MD let Pride get in the way of compassion, sad but I've seen it a lot. If it were him you would have had a PCA up in no time and running at maximum rate.

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Specializes in med/surg.
MD let Pride get in the way of compassion, sad but I've seen it a lot. If it were him you would have had a PCA up in no time and running at maximum rate.

I 2nd this - seems the MD was the one with the problem, not you. As has been said chalk it up to experience. Also you could reflect on it... ask yourself if there is anything you could or would do differently if it happened again. That way you can take something positive from this for yourself - either a "no way I was completely right" or a "maybe I could have said ........in a different way" ,whichever it will still be something for you.

Oh & go buy a voodoo doll to stick a couple of pins in!! :lol2: (don't take offence - only a joke - honest ;) )

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thanks for the support. i did actually ask the super and my charge if the defended me and they said that if they were to come in contact with the md again they would reinforce that the root of the problem must my some form of miscommunication betwn family, nursing and md. yes that response was not the one i was looking for. the hospice rn who came and saw the pt and the family was very supportive of me. it helped, but not much. another thing my charge said is the day before i refrenced the rns and mds who are being charged for "murdering pts" in the hurricane katrina with mso4 and versed, she said that may be the md was paranoid. but ill be honest, reassigning me hurt my feelings. felt like this md couldnt trust what i was saying. keep the resposes comming, id really like to know what you guys think. thanks again :)

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Welcome to allnurses.com! I moved your post to a more suitable Forum.

I am glad you are looking out for your patients. Some MD's just don't have a clue.....

Suebird :p

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Well, I think you were totally correct to go to bat for your patient and try to get some pain meds on board, quickly.

The doc sounds like a jerk. I've found more than a few docs don't seem to have the compassion for elderly patients, for whatever reason. Did he expect the patient to have to wait till Hospice got doctor's orders for pain meds? And to think that was even a halfway adequate dose? Maybe he'd had a fight with the wife earlier or something!?

Do think your CN and supervisor should have been a lot more supportive to you than they were. Does doc really expect every nurse he doesn't agree with will be re-assigned?

The only thing I can think of (and I really don't mean this as a criticism of you) but perhaps he thought you came across as too aggressive, and he's of the school who expects nurses to flutter their eyelashes and giggle as they ask him. 'Pretty please' do you think maybe the patient should have some pain medication, doctor-god?

Just be glad you don't have to deal with him often. You did good - doc was wrong.

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Specializes in RN, Cardiac Step Down/Tele Unit.

I am proud of you for advocating for your patient. Pain control is the patient's RIGHT and is required by law (JCAHO)! Someone should remind the doc of this! Congrats on being a great nurse, and please do not let this event effect you too much. It sounds like you know in your heart that you did the right thing, and it hurts when others "throw you under the bus", but ultimately you have to be accountable to your patient and yourself.

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Specializes in OR< ER< ICU< Home Health.

You became a nurse because you cared......Continue that....You sound like a great nurse.

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Specializes in LTC, assisted living, med-surg, psych.

I wonder what "too aggressive" means when it comes to being a patient advocate and refusing to just let it go when someone under your care is in pain? Did you stalk the doctor down the hall and out to the parking lot? Smack him upside the head? Make threatening phone calls to his house at three in the morning? No, of course not..........therefore, you were not 'too aggressive', IMHO. Maybe you spoke to the MD in a less-than-respectful tone of voice, maybe you didn't bow and scrape---that's no excuse for his allowing his patient to go without adequate pain relief.

I'm all about diplomacy when asking an MD for something on behalf of a patient; generally, you catch more flies with honey than with vinegar, and I usually get what I want. But when diplomacy fails---and a patient suffers as a result---I have absolutely no problem with going around the physician, over him, behind him, or THROUGH him if need be.

Ya done good.:kiss

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You absolutely did the right thing. One measly milligram of morphine to challenge this amount of pain is like trying to put a bandaid on a sucking chest wound. The doctor is obviously not thinking clearly.

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