Physician Complaint

  1. Hello All
    ok so I recieved a pt who was hypotensive and a little tachy, I sat next to her on the bed assessing her and bolusing her until she was stable enough for me to leave the room.
    that time was about 35-40 min
    the physician walked into the nurses station just as I sat infront of the untouched chart and asked for the records, I gave the records and we proceeded to the room to see the pt.
    I did not know all of the hx or the labs of this pt because I had not cracked the chart open yet
    later as my pt was stable and I came to the desk to work on the chart my coworkers asked what was up with the doc because they came to the desk and said they didn't think their pt was managed correctly and what woule "they" do .. and that I (the nurse)should have been watching the pt more closely instead of sitting around talking, the physician also said a clear lie about an assessment.
    Had i seen the phys. I would have asked them to come to me directly if they feel their pt is not managed appropriatly and not to question my competence at the nurses station, however they went home
    The next day my manager and director called me into the office to tell me off the complaint and that the phys. went to the chief as well and we would do a timeline and chart review.
    I am told my superiors that I have their support, but I feel awful about it
    the main complaint is that I did not have the info to report (labs,records-history) and an order was not initiated that was ordered while the pt was in another dept 2hours prior to me... that is all true however I felt ( and still feel) that the pt needed me in with her not as the desk doing the chart.
    I feel like the phys. should have come to me directly
    not spoke with my colleagues in a defamation tone
    and I feel like they are trying to get me into trouble intentionly
    This is a phys. that is notorius for being very rude with new nurses/students/residents and so I really wasn't all that bothered at first but then when I heard all the effort and energy she is putting into it I feel betrayed... and to say I didn't watch her close is frustrating because the phys. wasn't even there and I was on the bed with the pt until just before the phys. arrived.
    so no I didn't have the info from her chart to tell the phys. and I did not know about orders in the chart because I never saw the chart!
    I also cant believe the phys is reporting a different assessment then what we both saw (at the same time)
    anyway I am told there won't be disciplinary action, but I have never had my competency questioned and an official review with all my superiors and chief phys. of my chart and actions..
    any advice?
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    About HelloAgain

    Joined: Dec '06; Posts: 11


  3. by   augigi
    It's hard for anyone to give you advice who wasn't there at the time to know the patient and situation etc. However, just make sure you document things correctly and watch your back - it's great that your bosses are supporting you. If there is nothing to be found from the chart review, you'll be fine
  4. by   Lacie
    Just make sure you are documenting in your chart and cya. If management is backing you then I wouldnt worry too much about it. When I first became an RN and was in my orientation in a CCU one of the task was to spend one week doing nothing but giving the unit meds. While making med rounds I was in a pt. room when the MD came in and he started bouncing all these questions on me regarding the pt who was on a vent and in full blown DIC. She was also very alert. I had to push lasix and had checked the chart to ensure labs were ok regarding lytes etc. Otherwise I only had a general knowledge of this patient as it was a 19-bed unit. When I responded that I would be happy to get the pt primary care nurse as she could provide him with more update information on the patient this MD went off on me right in front of the pt. "What are you doing pushing meds on my pt when you dont know sh** about them". Needless to say I went right ahead and finished pushing my meds (I was pushing them when he came in) and did what I was doing, never responded to him during his tantrum, finished assured the pt I would get her primary care nurse to come in as it was obvious in her face he put her in a panic!! I went out got the primary and explained the situation then waited outside the pt door. When the MD came out I stopped him right there and told him "If you ever have a question regarding my nursing actions then feel free to ask and ask appropriately. Most definitely never approach me in that manner in front of a patient again!" If you have any further questions I will be more than happy to get my NCM and we can meet as soon as you like in her office to discuss any questions you have regarding the practice of med orientation on this unit PRIVATELY." Needless to say he apologized called me MS,. then never raised his voice at me again after that. My understanding he had a habit of hitting up new grads this way but I wasnt one to run with my tail between my legs in fear.
  5. by   gitterbug
    Recheck your notes, go over your actions in your own mind, make sure you have a clear explanation of exactly what you did, how you did it, and approximately how long you were working with the patient. If the untouched order was not related to transfer, if you truly feel it was a doable order prior to transfer then file a complaint against the other unit, and please do make it clear that you feel the physician should be written up for his treatment of you. I think you will be fine, do not expect the doctor to be too forgiving if he is shown to be at fault for his conduct, and do not put too muh trust in your fellow nurses. Seems like when trouble happens, the s$&% hits the fan in many unexpected ways. Good luck.
  6. by   Poochee
    I had something happen to me like that, charting is key. I knew after my shift NOC, poop would hit the fan. I got off at midnight, and left the job at 4:30am. I probably finished up my regular charting at 1am, but i charted 3 hours, 6 pages, legal pad, on this pt. Needless to say, she ran out the facility and jumped on the city bus (lol) that morning, but because of my in-depth charting, time-line, intereventional charting, they never said a word to me, but, sorry you had to go through that. I find, that if a job is above my stress level, in terms of staffing shortage, nurse to patient ratio, people just plain after you, bad attitudes, too many lazy folks, non-team player attitudes, I'm out. My nursing is priviledge and a excellence. I have told NM, I will not work with others, because of liability, and if nothing was done, adios.
    I have been thrown a party at every job I have left, cakes, balloons, plants. I treat others like I want to be treated, patient, staff, etc. :spin:
  7. by   P_RN
    What is the policy on orders written before transfer? Our policy: definite transfer orders are done by the transferred TO unit.

    Routine orders before transfer orders are done by the transfeer FROM unit. It only makes sense that a M/S floor may not be set up to do some things that are ordered.

    As far as Mr/Ms. Doctor.....some get off on powertrips. You were doing what you were supposed to do.

    One thing I might suggest is having your "brain" or other paperwork on a clipboard. Even if it isn't official charting it shows you were doing systematic care of your patient. It is especially useful as far as times are concerned.
  8. by   HelloAgain
    Thank You all for responding
    I now it is difficult without knowing the whold story
    The order in question was a DIC panel ordered at 830AM in the ER and I recieved the pt at 1030am, it should have been done at 830 however I do accept some accountability for that had I reviewed the chart/put it together I would have seen that it was not done and initiated it but again I never cracked the chart open until 45min after the pt was on my unit because i was sitting on the bed with her until her pressures and appearance looked better.
    I was asked what I might do differently and honestly I would do the same, hindsight is great so of course now i might ask someone to put my chart together or check her records and ER paperwork in case there was something missed in report, but really we never do that
    pt first chart later- i still stand by that
    I am not a new nurse I am an exp. RNC that has been there longer than this phys. I do agree this situation was not ideal I would have liked to go through her records to know more as well but the situation would not have been appropriate for me to review the chart 1st.
    also this MVA pt just exp a tremendous loss and I needed to be ginger with her I sat on the bed assessing/bolusing as well as discussing POC offering support to her and her husband and allowing her to express her emotions as needed. 40 min wasn't really that long for all of that, I felt like she was in need of immediate care/action however I did not feel she was in dire straits or I would have called the phys. and asked that they come immediatly but I knew they would be there soon
    my charting was all done after the fact-the whole chart
    I progressed a couple paraphraphs on the situation (1hour)
    I have gone over the situation and I would still be with the pt initially however this phys putting so much energy into reporting me (going to my director/chief of staff/and planning to discuss it at the phys mtg.), makes me feel guilty-know what I mean?
    also if the phys. really was interested in pt advocacy they should have come to me immediatly so we could be on the same page with her care, but because she waited it feels "slithery" like she is trying to get me in trouble
    I have never had a review of my chart like this - sigh-
    I have a feeling that even though it appears that I have the support of my coworkers and managment at this point, they will also want to pacify the phys and show that action was taken.
  9. by   TrudyRN
    You did nothing wrong. The doc, on the other hand, sounds like a powertripping mess. The ER screwed up and needs to be reprimanded. Do you not have a secretary who can help put charts together and who would, presumably, find missed orders, or does that cost too much money?

    I guess you could have kept the chart with you and somehow flipped through it in between bolusing but the physician's actions are a complete insult.

    I think you should not wait for someone else to write her up. You do the writeup yourself. Send it to your boss, her boss, and Admin. She needs to know that she is disrespectful and out of line. If you don't quite want to put it in writing, then tell her verbally that she is to stop slandering and defaming you and that she is to approach you personally and in a respectful, adult, courteous manner with any concerns she might have. Tell her she needs to find out why the ER didn't draw the lab and ask her how you are supposed to do the work of a clerk and a nurse and why she personally doesn't open the chart or look up the lab results if she needs them. Be nice when you talk to her and have a couple of witnesses. Keep a written record.
  10. by   HelloAgain
    Hello Trudy
    yes I could have brought the chart with me but still I don't know that I would be looking at it I was literally sitting with her on the bed.. one hand on her one hand on her IV bag making eye contact with her while she was sobbing about her loss.
    we do have a clerk but they just put the papers under the right tab and hand it to the nurse, I have already addressed this learning moment with that clerk
    yes I plan to discuss this with the phys. simply (non aggressive)
    Thank you
  11. by   miracle1986
    Short and sweet. Just as there are nurses with good bed-side manners, there are also doctors acting the same towards us. Some think they are gods walking the earth, while others ARE in fact angels on earth. I, personally, would have had a little note pad, scribbling notes, while assessing the patients condition and had them ready and presented them to the appropriate person when confronted. Remember nursing is also a verb. Don't take it too personal. It is going to get worse and sadly, the doctors feel they are always right.
  12. by   RYNOBLASTER30
    Forget about it. Come one, you did what was best for the patient at that particular time. It appears as if you acted appropriately. Screw the physician. I mean, these old cranky asses. Remember the ABC's. Looking at the chart and reviewing the orders come 2nd. Getting the DIC panel probably wouldn't have changed the emergency treatment of the patient. You did good, and keep up the good work. Remember, you are a nurse, you can go anywhere and be guaranteed a job. We all need to remember that when it comes to unsafe working conditions.