The Doctor oncall told me not to call him - page 2

I want to know if anyone can help me handle this situation. I work in a small 3 bed ICU where I am the ONLY nurse. I recently had two critically ill patients. One had been on the floor (I had worked... Read More

  1. by   Brownms46
    I had a neurosurgeon scream at me in the chilling voice I have ever heard in my life. He admitted a GSW to the head to the ICU and I was assigned this pt. The little boy was on a vent, and had an NS IV at KVO. His head was wrapped in an ace, and brain matter was coming from his nose. The Neuro has sent verbal orders via the transferring ER nurse, to not call him! Of course this There were NO orders at all...NONE except. His B/P started to fall...and you guess it...I called him!! I have never heard anyone scream in such a manner and the way he did except on some fright nite show! I hung up on him, and called the supervisor. This was back in 1997 and I don't remember what else happened. I just remember hearing the way he screamed...telling me HE's DEEEEAAAAAADDDD! Don't YOU get it??? He's DEAAAAAAD! Then why was he placed in an ICU bed on a vent with no figging orders at all???
    The little boy was supposedly 14 yrs old and had a license, but he looked like he was about 8 or 9! He father was killed at the scene by a transient. His sister was found in shock by neighbors.
  2. by   catrn10
    I really, really appreciate all the support and advise I'm getting on this. This is a really small hospital, only 6 beds in ER, and 17 on the floor if you don't stack them 2 to a room.There is a Director over the hospital, a nurse director under him who hasn't done patient care in 10 or more years, then a manager over the floor and unit. Sometimes I have 3 patients by myself. As for calling a code, I leave the door to the unit open, it's next to the Nursing station, and I scream. I keep the supervisor for the shift appraised of my patient's condition, and usually, they are real close by. Lots of times the hospitals only Respiratory Therapist hangs out with me between treatments.I have been an ICU Nurse for over 9 years, most of it in level 1 trauma centers, and never have I seen the like of this. I am an agency nurse, most of us who work there are, they can't afford to keep regular staff on. Most of us have worked there for years. I have talked to my agency about this, and will further. The problem with them is that the manager is not even a medical person, much less a nurse, so she doesn't always understand what I'm talking about. I never call a Doctor unless there is a need to. And I don't intend to stop calling now. Work is hard to find as this is a rural area and choices are limited. I can't afford to go to the city and work for less than half of what I do now. I am so glad to have found this site and be validated by my peers. Thank you so much. You have no idea what it means to me.
  3. by   fab4fan
    You need to think about the real possibility that you may end up in a situation that puts you in jeopardy of losing your license.
    Then you wouldn't be able to work as a nurse, period. Having to scream for help?????

    Very scary.
  4. by   catrn10
    I really wish it was better, and I do worry about my license. Right now, I'm stuck there. No where else to work without driving an hour and a half. I'm hoping to change this situation. SOON.
  5. by   LasVegasRN
    Agree with everyone above. The only other thing I can offer is to anticipate the patient's potential needs with the diagnosis you have and what you have assessed. Then you can request standing orders based on what you know and go from there. You can try and make it as appealing to the physician as possible to show that you are trying, in good faith, to keep calls to a minimum. Just some examples (anyone else feel free to chip in) for a GI bleed:
    - orders for q 4-6 hour CBC's (or most often if necessary)
    - orders for when to transfuse (based on levels of H & H)
    - orders for fluid boluses or Dopamine for titration if BP or mean arterial pressure drops a certain level
    These are just a few off the top of my head. Just try to anticipate EVERYTHING and ANYTHING. You could also try to sit down with this physician and come up with standing orders that both of you would be comfortable with.

    If you approach it with acknowleging that calling him seven times in one night is a lot (in his mind, anyway), and offer a happy medium where both of you feel you have some control and autonomy that don't put either one of your licenses in jeopardy, it may help this and future situations greatly.
  6. by   SCB
    Did the patient live? If not I would see a lawyer, and the family of the patient. All be da-- if I would this jerk get away with this. That could be you, me, or a loved one in that sick bed. I would most definitaly not let this one die down. This MD is dangerous.
  7. by   sanakruz
    My question, too. What was the outcome?
  8. by   Stargazer
    I agree with Vegas's comprehensive standing orders suggestion--but the fact is, hemodynamically unstable patients cannot and should not be managed over the phone. As comfortable as I am with critical patients, with my assessment skills, with hemodynamic management, and with being autonomous--I would not be comfortable (from a legal standpoint, anyway) initiating high-dose pressors or giving large boluses on a patient whose change in status had not been assessed by the doc, UNLESS I knew for sure that the doc was on his/her way.

    And I am with Dr. Kate that it is complete and utter crap that the ER attending isn't even able to insert a central line. What CAN he do, then?
  9. by   ?burntout

    I would have written "do not call me again" as an order too...then I would have written in the patient's nurses notes EXACTLY what he said......CYA!!!

    Oh, the doctor is sleep deprived-bless his itty, bitty heart....NOT He is the one with MD after his name, not you!!!
    Last edit by ?burntout on Jan 8, '03
  10. by   night owl
    What kind of a doctor would even have the gaul to say, "Don't call me?????" Must be some kind of quack. He is the doc on call and is getting a pretty penny to be on call. I'd call him for a freakin' hangnail just for spite. I'd even ask him what kind of a doctor is he just to get him going. A patient is deteriorating and he doesn't want to be called because he's sleep deprived? Ya want my opinion, he's a sic pup and doesn't need to be working there or anywhere near a hospital and I'd let him know it's going to be his license, not mine, then I'd call the supervisor and then the chief of staff!
    LoL Night Owl you sound like me , I would be calling that Dr until his butt showed up just to rip my phone out of the wall so I would shut up. They get paid to do what they do.... atleast they are compensated we are not, we are not paid to write their orders, make their decisons, or covered by them when they"say " Yeah I will cover ya if you write what you want and I will sign them in the am. Thats the biggest line of BS I have heard they come in , and forget your name and then say I didnt authorize those orders. Which is true , and you would be out of a lic and so deep in shyte. You cover your azz, and make him do his job.
  12. by   mageean
    Doctors like this guy are a menace. Like you he has a "duty of care" to his patients and should be held to account. I would look forward to him being on-call again and make sure he had another sleepless night just like me.
  13. by   oramar
    Does anyone else have issues with a supervisor that takes an order from a physician like that? Shouldn't the supervisor have protested? Easy enough for supervisor to bow to the physicians wishes then not be the one whose butt is in the sling. Even the bad supervisors I have had would not have stood for that.