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

Nurses   (2,574 Views 13 Comments)
by DMRubes DMRubes (New Member) New Member

523 Visitors; 2 Posts

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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.

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hypocaffeinemia is a BSN, RN and specializes in Critical Care.

14,477 Visitors; 1,381 Posts

Depends on the severity of the issue, acuity of the patient, and etc.

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528 Visitors; 4 Posts

Does your institution have a rapid response team??? Many do, having them see the patient and then advocating as a second pair of eyes helps. If not, another seasoned nurse or supervisor. Also are there other doctors on the case?? Sometimes updating another physician on the case may produce results. Depending on the severity moving things up the change of command will help or the physician over your unit.

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523 Visitors; 2 Posts

What if the only options are report to next shift so they can observe patient, leave note for DNS, or call doctor again and explain concern and ask for orders on how to handle the problem and then notify your supervisor?

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57,428 Visitors; 10,263 Posts

A very detailed nursing note saying, "VS at xxxx. Pt c/o of xxxx. Dr. x informed at 0900. He stated that 'blah blah blah.' "

Report off and alert the DNS.

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MERRYWIDOW46 has 33 years experience and specializes in ER, OR, PACU, TELE, CATH LAB, OPEN HEART.

4,498 Visitors; 311 Posts

Document what you did in progress notes, pass information to next shift, notify charge nurse/supervisor. Monitor patient, if deteriorates call rapid response.

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53,574 Visitors; 11,191 Posts

What if the only options are report to next shift so they can observe patient, leave note for DNS, or call doctor again and explain concern and ask for orders on how to handle the problem and then notify your supervisor?

there is no med'l director?

depending on acuity/urgency, i would likely call dns at home (if time is critical), then tell dr. you are sending pt out.

if pt's condition only needs to be monitored, then pass it on for next shift.

either way, make sure your nsg notes tell entire story.

leslie

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929 Visitors; 9 Posts

i learned my lessons throughout the years of my nursing experiences. documentation saves you in a lot of trouble! keep another documentation for yourself alone to remind you of things exactly how they happened the ones that u cnt put on the chart. also, if in a critical situation use ur judgement very well. today, i transferred a patient right before the attending physician called back. otherwise if i waited for her or someone else my patient died already. always pray! God will empower you of seeing, feeling and recognizing things others normally don't do. Goodluck!

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OutlawNurse86 specializes in Formerly Med/Surg now LTAC/critical care.

4,728 Visitors; 148 Posts

I once had a pt who's BP spiked all of a sudden. After running near textbook, it just spiked to 198/102, she had a headache, and was anxious about it. I called the Doc on call for the primary (at 0200) to report this and see if we could restart her prn clonidine (it was dc'ed 3 days prior because she hadn't needed it and was due to be discharged soon). The operator connects me to the Doc at his house: 1st, the old ***** hangs up on me halfway through my explanation (old as dirt doc with a history of doing such). He then calls me back and before I can explain he says "Don't worry about it, just let it go". After just staring at the phone for a few seconds (and cussing that Doc in my mind) I asked the operator to page the consult :idea:.

"Good morning Mr Nephrologist.... I can't reach the primary can you help me out here....":cool:

Got her BP down, headache and anxiety resolved, and I felt good too.

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systoly has 23 years experience and specializes in LTC, Memory loss, PDN.

12,082 Visitors; 1,756 Posts

Why not call the doctor again and explain you're really concerned and if he still is not, ask him to explain his position. I've called doctors back a second and third time, have been yelled at and reported to the DON when I told a doc that I am not so bored that I have to keep calling him to fill my time. What's worse, someone having a hissy or delaying care?

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53,574 Visitors; 11,191 Posts

Why not call the doctor again and explain you're really concerned and if he still is not, ask him to explain his position. I've called doctors back a second and third time, have been yelled at and reported to the DON when I told a doc that I am not so bored that I have to keep calling him to fill my time. What's worse, someone having a hissy or delaying care?

we had a palliative care pt (still being aggressively treated) that i had major concerns about, and the dr. blew me off.

i called again, and again, still nno's.

pt went bad, family sued for "delay of care"/negligence.

thank God for my notes, and my big mouth, that complained to anyone who would listen.

seriously, the notes saved me.

leslie

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Kristyn, RN specializes in Med-Surg with tele.

1,532 Visitors; 23 Posts

If you think the doctor needs to come see the pt or isn't giving you orders to fix the problem, just keep calling. Of course document document document, but nurses' notes don't save the pt's life.

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