new here but would like a response--long

[medsurgfunrn]

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.

[JoeyDog]

I am proud of your for advocating for your patient!!!! Just be greatful that you don't have to deal with that doc very often. What a jerk wad!!!!

Ya know something that has always struck me as odd is that to get into med school you have to do a ton of volunteer work and what not to show that you care about people, have a desire to serve the community, and so on. IMO a lot of docs (not all) seem to be really lacking that "I care" quality. I guess it got replaced with the "bow in my prescence" quality after they graduated. Dunno just my opinion.

[barbyann]

OMG...MD is a jerk! I was in a similar situation one time. I was sooooo frustrated by MD's lack of response/compassion. Hospice referral had been made but they had not seen pt yet. I went out on a limb and called the Hospice On-call (weekend morning). I asked her what my next move should be. She was a breath of fresh air. She told me that this was exactly what Hospice was in place for and she came to the hospital within the half-hour. She called MD and had a morphine drip started within the hour. God Bless Hospice! They are my heroes. You did everything right for your pt., I guess it all comes down to you win some, you lose some. If you are in the same position again dont be gun shy......you got it right!

[momdebo, BSN, RN]

Your actions were right on, you were being the patient advocate, something to think about and it's a thing I've noticed, the docs we don't deal with that often seem to be difficult to work with, I wonder in those cases, why don't we see them that often, we have a couple and they are a real pain, they often seem very defensive, uncooperative etc. The other thing to think about is how often do patients ever say the same thing to the doctor that they tell the nurse, this has happened to me about a bazillion times, ex: I was just in the room and patient denies pain or states they have severe pain, doc walks in and they say the exact opposite, best defense against this kind of thing is document,document,document, exactly what that patient says and demonstrates. and as for management, I've only had one manager that backed the nurses and she was not well liked by doctors, other management, etc. If you know in your heart you did your job, let the rest of it be the doctors problem.

[DR2004RN]

Dear, you have my support. You did just what you should have for this patient. He was telling you he was in pain, and it was your responsibility to advocate for him. I know I would want someone to advocate that much for me if I was the one in that bed. If that time ever comes, I want someone just as compassionate and hardworking as you are to take care of me. Try not to let the fact that the patient was reassigned hurt your feelings too much, you did what any compassionate nurse would have done. He was only reassigned because the doc has a stick up his you-know-what. You did exactly what you should have done. Continue to take care of all of your patients that way. You sound like a GREAT nurse. Take care, keep us posted.

[DonnaRN66]

I can't stand supervisors who always take the doctors side without listening to the nurse