nurses VS doctors

[iamann]

hello guys just wanted to vent out and hear your opinions as well.. so a doctor at work prescribed a med that what I think based on my judgement and what I have learned from school is not right for the patient.. so I called the doctor told that doctor the condition of the patient and asked if she would still want us to give the patient the medication.. she got all mad and started to use words like "who is the doctor here!?!" she imediatley called the admin whose buddy buddy with her told her I don't know what because the next thing I know that that mean lady who has nothing to do with nursing btw just showed up in the station all mad saying that the doctor called her and that we have no right to question any orders that the doctors make... No matter what it is.. I so not agree with that.. because I am a patient's advocate and I will do what is best for my patient.. the doctor never spoke with the head boss of the nurses she went and ranted on to that admin lady who keeps on poking her nose to places where it doesn't belong.. she doesn't know crap that's all I have to say..

[SNB1014, RN]

OP, im curious as to what the end result was after the admin spoke to you?

did you give a drug that you ultimately felt was harmful?

did your NM stand up for you?

was an alternate prescribed? etc

and yes, you clearly are still a bit upset over the whole altercation. i don't blame you. nonetheless, breathe in, breathe out. you will most likely be carrying out this particular dr's orders in the future and will most likely continue to "see the nosy admin lady" poking her head around your nurses station. you nee to maintain an effective professional relationship with these people.

[Pepper The Cat, BSN, RN]

Additional thoughts - it also helps to know the doctor you are calling. We have one doctor that does not like nurses asking for specific orders unless you can really back them up. Example - I called him once at 6:00 am for xray orders due to a pt's fall. he asked "why do you think we need to xray" I replied " she was walking on her own before all, now cannot. Leg is shortened, externally rotated and pt is c/o pain". He gave me the xray order (pt's hip was fractured).

I have found with him that I really need to support my request before he will agree. Other doctors I could call and just say "Mrs X fell - can I get an order to xray hip" and then will agree because they know and trust me.

Other doctors like me to present the facts and then let them make the decision - "Hi Dr D - Pt X fell. She can't walk now. Her hip is externally rotated and shortened". And then wait for orders.

In each case I was advocating for my pt, I just know how to approach the MD in a way that gets me the order I need.

[Isabelle49]

Not sure about other state's laws, but in Louisiana blame is placed on the hand that delivers the drug. The doctor can order anything at any dose for any patient, if the nurse gives it and the patient is harmed, guess whose fault it is? Yes, the nurse. I wouldn't hesitate to question an order if I felt uncomfortable with it. And, I am certainly not going to strictly go on what the Charge Nurse thinks, since she is a nurse. I'll talk to pharmacy and I will clarify with the MD, don't care how mad the MD might get. If the MD can't stand the heat they better get out of the kitchen!

[wooh, BSN, RN]

There's an art to getting what you want from the doctors. I know some that I get my best results by being a smart a$$, "Hey Doc, that order for teratogenic med was stupid, you trying to kill her baby? What do you want me to change it to?" Some, the complete opposite tact, "Good morning Dr. (usually newly minted female docs that feel self conscious trying to get respect from their colleagues and women nurses old enough to be their mother.) I don't know if you noticed that Ms. Patient is pregnant, but everything I'm reading is that teratogenic drug is bad for the baby. Did you want to change it to something else?" Some just being direct, "Teratogenic drug is bad for developing fetuses, did you mean to order it for Ms. patient? Since she's pregnant, want to order something else?"

[kool-aide, RN]

That's some sound advice from Canes and Pepper!

[rntj]

I will never hesitate to question a doctor's order if I feel it is inappropriate. Working at a teaching hospital this is especially important. I always make sure I am respectful and tactful but patient safety comes first, my license comes next, and doctors' don't even rate on my scale of importance

[xtxrn, ASN, RN]

First post and gone? I hope things went better on the next scheduled shift for the OP.....

[psu_213, BSN, RN]

First, it is regretful that this situation went down like it did...it does not reflect well on doctors, nurses and anyone else involved.

I must say, however, I find the title of the post totally inaccurate. The title makes it sounds like doctors and nurses are entreched on opposite sides of the nurse's station throwing stool specimens at each other. This was a situation the involved one doctor and one nurse. Are there some doctors who handle calls from nurses inappropriately? Yes. The vast majority of doctors, however, have the utmost respect for nurses, and it is very unfair to paint with such a wide brush. This was one doctor 'versus' one nurse.

P.S. I agree with previous posts, that questioning the order is appropriate, but correct wording when contacting the doctor is very important.

[Altra, BSN, RN]

If OP used similar verbiage to speak with the MD as she has here ... I'm not surprised that the exchange did not go well.

For the sake of her patients and her career, OP would do well to immediately seek out some help in understanding her organization's clinical and administrative structure, the chain of command, and to seek to interact with others in a more mature and professional manner than her recent encounter with "this mean lady."

Another lovely thread viewable by the general public ...

[diva rn, BSN, RN]

If OP used similar verbiage to speak with the MD as she has here ... I'm not surprised that the exchange did not go well.

For the sake of her patients and her career, OP would do well to immediately seek out some help in understanding her organization's clinical and administrative structure, the chain of command, and to seek to interact with others in a more mature and professional manner than her recent encounter with "this mean lady."

Another lovely thread viewable by the general public ...

Not to mention the "head boss of all the nurses"......

I have to say that reading this post made me cringe...and I agree with Altra, it looks just great to the general public:o

[linearthinker, DNP, RN]

Yes, I agree re: cringe worthy. Does no one use grammar, spelling and punctuation anymore?

In any event, I suspect the "consult" with the physician was executed just as unprofessionally, hence the reaction. Tact and diplomacy are valuable tools. As is an understanding of fetal development and specific drug risks. I'd like to know what the drug was and how far along the pregnant patient was. These details matter. If indeed the drug was contraindicated for the developmental stage of pregnancy, communicating that clearly, concisely and professionally will usually get the desired result.

I'm sorry the mean lady and the head boss of all the nurses got angry with you.

[Stephanita]

interesting - in my governing body, it IS the nurse's job to question ALL orders. If we give a medication, after the doctor prescribed it, and there is a huge adverse effect, the error falls on the nurse; not the doctor.