Nurse concern for patient, but doctor unconcerned and declines to see patient

[DMRubes]

Say you as a nurse are concerned with a patient and telephone the doctor to report it, but the doctor seems unconcerned and declines to see the patient. You still feel however that something more should be done. What to do next.... leave a note for DNS or report, drop it because it is now in the doctors hands, or report it to the next shift so they can watch the patient.

[RhiaRN75, RN]

If it's bad- I keep calling, and make it pretty clear I will continue to do so until the pt improves or the doc decides he's like some peace. I've rarely had to do this but I will if need be. I also force them to set parameters and write said parameters, or lack of, as an order. "Don't call me again unless the BP is really high." Ok- it's currently 220/110.... care to give me a specific number for that order?

Sometimes I think the docs forget MS can only do so much. One cardiologist- a really good doc but one who was sometimes oblivious to the limitations of MS- said "You MS nurses get so excited about a number over 200." I said yes, we do. I currently have eight pts, no tele, and a new-onset high BP unresponsive to meds, pain control, or over an hour of one on one care and I really need to see my other pts. He chuckled and admited that I might have a point- pt ended up in ICU w/ a drip. Every time I called about a BP again for him I'd tell him- well, this MS nurse is getting a little excited about so-and-so's BP.... or Dr. Cardio, I'm not excited about the BP yet, but I wanted to let you know about xyz. He was a cool doc.

The twits are a different matter. I just kept calling and documenting. My fave was always the 'intractable pain' admit w/ no pain med orders. "Sir, I just wanted to clarify the new admit orders. Oh, you didn't want to order pain meds? Ok, I just wanted to make sure at 2000 instead of calling at 0300." That almost always got a med order.

One thing I love about the ER- the doc is right there.