Doctor vs Nurse

Nurses Safety

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I work in a nsg skilled facility and rehab at the same time. Our medical director always orders continue to monitor when I report something to him. One time I reported an extremely high blood glucose level of our hospice pt.he just told me what should he do since she's hospice! As much as I want to talk back on him that we should still treat the resident even if they are hospice I only suggested to increase her insulin. And as soon as I got the order I hung up on him.

Yesterday, I learned from my co-workers that he was infuriated that I logged a pt condition and stating the pt med that might have had a side effect.

I also wrote down that a couple of pt was having early s/sx of flu.

Oh yeah, one of our resident also has an incredibly audible wheezing inspiratory and expiratory but he doesnt want the resident be on a hospital so he ordered a stat cxr. The patient has an atelectasis. He ordered an antibiotic med. My gut feeling is telling me to send that resident into the hospital but I cannot make him give me an approval to send her out.

How can I speak with my DON about this matter?

The pt with atelectasis is not responsing with the neb treatment and she was supposed to be discharged on the next day but she started wheezing.

To describe this fully: His inital order was just robitussin. I lied to him that the pt is having difficulty of breathing even though the resident says that everything if fine cause my gut feeling is telling me that it isnt just a regular wheezing since the resident has inspiratory and expiratory wheezing.and so he ordered a stat chest xray and antibiotic. Then the xray revealed that the pt has atelectasis. Case rested with that one cause the doctor does not seem to care to treat if the pt is being discharged or hospice or no code.

And yes, I basically describe every pt sibjective and objective symptoms with nsg observations. I dont medically diagnose.

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As for the diabetic hospice resident, the pt is fine, eating well and fighting for her life. But the md simply stated 'she is hospice what do you want me to do? She is dying'

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I wouldn't lie and say the resident reports SOB when they denied it. I guess I'd have to hear the resident's wheezes. If you say they were serious sounding I'll take your word for it. I've told the doctor before that a resident "just doesn't look/acting right" when all the concrete objective data seems harmless. Good doctors will heed the intuition of nurses they trust. But I wouldn't "make up" symptoms in order to get the doc to send a resident out. You're playing with fire there....

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Specializes in LTC and School Health.

I was okay with this thread( assuming the OP is a new nurse that just needs to learn) until the OP admitted that they lied about their assessment.

Lying is NEVER okay. It seems like you have good intentions however you are going about it the wrong way. If you ever have a gut feeling that something is not right, go to another nurse or your supervisor. As nurses it is out of our scope to diagnosis and medically treat patients.

I assume you lied on your documentation as well, which is falsifying records. This can cause you to get in big trouble.

Please take heart to what we are saying. I hope one day you will see what we see and take accountability.

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Specializes in LTC and School Health.
As for the diabetic hospice resident, the pt is fine, eating well and fighting for her life. But the md simply stated 'she is hospice what do you want me to do? She is dying'

If the doctor doesn't want to treat hypo/hyperglycemia then he/she needs to D/C the finger sticks. There is no point in checking BGL if its' not going to be treated. Most of the hospice patients I've had were only comfort care. So we didn't do vitals, labs, FS, etc.

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Specializes in being a Credible Source.
I lied to him that the pt is having difficulty of breathing even though the resident says that everything if fine
Yikes, you're heading down a slippery slope with a set of freshly waxed and edged skis.

And yes, I basically describe every pt sibjective and objective symptoms with nsg observations. I dont medically diagnose.
... but you do lie as you see fit...

We're not talking short skis, either, we're talking 205s or better...

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Specializes in Emergency, Telemetry, Transplant.
To describe this fully: His inital order was just robitussin. I lied to him that the pt is having difficulty of breathing even though the resident says that everything if fine cause my gut feeling is telling me that it isnt just a regular wheezing since the resident has inspiratory and expiratory wheezing.and so he ordered a stat chest xray and antibiotic. Then the xray revealed that the pt has atelectasis. Case rested with that one cause the doctor does not seem to care to treat if the pt is being discharged or hospice or no code.

I know others have already talked about this, but I have to mention it too...you are really getting into very murky waters (legally speaking). Not to mention, the doctor might begin to ask himself, why is it that when anne919 calls me, it always seems the resident is in a dire situation....much more so than when I get calls from other nurses? (P.S. what is the difference between regular wheezing and the sounds that this residents lungs were making?)

Overall, it seems like you are being a bit standoffish over the entire thing. I understand that the doctor may be too, but that does not mean that you can't take the higher road in the whole thing. Starting a thread titled "doctor vs nurse" like it is some sort of a death match is not the higher road. Lying to the doctor is not the higher road. When you call him, present him with the facts. If he does not do why you think he should, document it. Document the call, document what you told him, document what interventions he ordered (even if it is no intervention). If you think he is not doing what is right, show your NM your documentation and hope that she is able to correct it.

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Specializes in Psychiatry.

Dear Anne,

It is my fervent hope that you'd see my comment as constructive criticism rather than malicious in nature.

As your peer, I want to point out at least 2 items that I take exception to: You wrote

(1) stating the pt med that might have had a side effect.

(2) I also wrote down that a couple of pt was having early s/sx of flu.

1: As a nurse, I would refrain myself from speculating. Nursing documentation need to be purely objective. In a court of law, "gut feeling" and "hunch" do not have a leg to stand on.

2: I am trying hard to think where exactly you wrote down that a couple of patients were having early signs/symptoms of flu but the answer has been elusive insofar. Please tell me that you did not document that in any patient's chart.

As a friend, I can only tell you that you will need to be very careful with what you document and whom you question. A vindictive MD can haul you all the way to the portals of the Nursing Board edifice.

Again, please understand that I am not perfect, and I am not trying to judge you but just alerting you of the pitfalls and landmines that you seem to be jaywalking through.

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Specializes in OR, Nursing Professional Development.

Between the hanging up on the doctor (your first post) and the admission of lying to the doctor, I seriously think you need better manners and better ethics. Hanging up on the doctor because you've bullied him into giving you what you want isn't right. Lying to the doctor to get you what you want is even more wrong, and very well could result in disciplinary action by your workplace and by the board of nursing. Quite honestly, I think you just might need that to make you wake up and act as an ethical nurse. What you've admitted to are definitely not the actions of an ethical nurse.

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You cannot initiate oxygen without an order unless you have a standing order protocol in your unit with specific criteria for doing it, signed by your medical director or control.

You cannot chart, "Signs and symptoms of flu." You can chart, "Temp of 101.2degF; aches in neck, shoulders, and back; sore throat; rhinorrhea."

You cannot determine what treatment, besides CPR, is or is not appropriate for a hospice patient; if the physician isn't willing to order more insulin, for example, you cannot slam down the phone on him.

You are wrong that atelectasis (not "an atelectasis") requires hospitalization. Had that CXR showed a roaring pneumonia, different deal. That's why the physician orders the CXR, and makes the determination.

If you think there is a possible side effect of a medication and for some reason you think the physician is unaware of this (a generally unreasonable assumption, and one that is bound to be taken poorly), ask if he could explain to you for your own learning. This is NOT "playing the doctor-nurse game," it's seeking to expand your own understanding and learn something of which you might not be aware. Don't use the log book to lecture him.

And the lying? Dear, you need to take a very big step backwards here, because the ice you have put yourself on is very, very thin.

In short, you have overstepped your bounds and scope of practice on more than one occasion. You have ****ed off the physician doing it, and as a result he may not, in fact, respond to you when he ought to. This burnt bridge will endanger patients if he has to waste time trying to find another nurse to discuss the situation with. And you have endangered your license by falsifying information. You'd better pray you have not mouthed off about any of this to patients or family members, because that is the lawsuit just waiting to happen. It doesn't take much water for the seeds of doubt to grow into nice big flowering hunches, as I read in a book recently; that's what sends families to attorney offices and supervisors to report to BONs.

You ought to have called your supervisor or a more experienced RN for backup before you acted. I can't tell how long you have been a nurse, and what kind of experience cred you have; an experienced physician usually can tell the difference. It doesn't sound like much, though, by your description. I agree that you'd better be looking for a new job, because you might not have this one much longer without a major attitude and performance adjustment. Perhaps it would be better for everyone if you left ... but don't do this sort of thing again wherever you go unless and until you have a great deal more experience and much firmer grasp of nursing ethics.

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Specializes in Emergency, Telemetry, Transplant.
You are wrong that atelectasis (not "an atelectasis") requires hospitalization. Had that CXR showed a roaring pneumonia, different deal. That's why the physician orders the CXR, and makes the determination.

I almost did not post what is to follow, for the sake of not wanting to 'pile on' to someone who came here for help; however, I think it does serve a point.

Atelectasis can be a chronic condition. If it is chronic for this resident, my guess is they are not treating the atelectasis. The resident's wheezing does not indicate that they have atelectasis and if the wheezing does not go away it does indicate anything (either improvement or worsening) about the state of the atelectasis. The nebulizer treatments will not clear up the atelectasis if the person does not start more deep breathing exercises.

One guess that I have is that the resident is wheezing d/t bronchitis, which would not show up on a chest X-ray If that is the case, the breathing treatments are meant to open up the airways, improve air flow, and reduce/eliminate the wheezing.

Since the bronchitis itself is likely viral, antibiotics would not help. However, if the atelectasis is acute, then pneumonia could develop, hence the order for antibiotics. Point is, there is a whole lot more that just wheezing, atelectasis on the chest X-ray...send them out.

Do I know for a fact that he has bronchitis? No. Do I know for a fact its viral? No. Do I know more than your doctor? Definitely not. And I don't think it is helping your case to act like you do.

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Specializes in Emergency, Telemetry, Transplant.
Case rested with that one cause the doctor does not seem to care to treat if the pt is being discharged or hospice or no code.

What does this mean? Please, please, please don't tell me that this means you think you won. Guess what? You didn't and you can't.

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